David Eugenio Hinojosa-Gonzalez, Ricardo J Estrada-Mendizabal, Luis Carlos Bueno-Gutierrez, Andres Roblesgil-Medrano, Eduardo Tellez-Garcia, Cecilia Anabell Galindo-Garza, Juan Bernardo Villarreal-Espinosa, Jose Ramon Rodriguez-Barreda, Jose Miguel Ortiz-Perez, Jose A Figueroa-Sanchez
Background: Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities.
Methods: In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized.
Results: In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups.
Conclusions: This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.
{"title":"A Network Meta-Analysis on the Surgical Management of Thoracolumbar Burst Fractures: Anterior, Posterior, and Combined.","authors":"David Eugenio Hinojosa-Gonzalez, Ricardo J Estrada-Mendizabal, Luis Carlos Bueno-Gutierrez, Andres Roblesgil-Medrano, Eduardo Tellez-Garcia, Cecilia Anabell Galindo-Garza, Juan Bernardo Villarreal-Espinosa, Jose Ramon Rodriguez-Barreda, Jose Miguel Ortiz-Perez, Jose A Figueroa-Sanchez","doi":"10.22603/ssrr.2022-0196","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0196","url":null,"abstract":"<p><strong>Background: </strong>Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities.</p><p><strong>Methods: </strong>In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized.</p><p><strong>Results: </strong>In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups.</p><p><strong>Conclusions: </strong>This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/90/2432-261X-7-0211.PMC10257960.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
First, we would like to thank Drs. Tsukamoto, Morimoto, Yoshihara, and Mawatari for their pertinent questions regarding our publication. We appreciate that they found value in our work and took the time to read it in detail. This study was an additional investigation using data from a multicenter, prospective, randomized study reported by Ebata et al. in 2017. The authors performed CT imaging four times: immediately postoperative and at 2, 4, and 6 months after surgery. They took the negative impact of radiation very seriously and used a low-dose protocol. We devised CT photography for decreasing radiation exposure by 50% using dose-reduction technique and iterative reconstruction method for image reconstruction. Our investigation revealed that bone fusion decisions at 2 or 4 months postoperatively had little clinical significance due to the possibility of fake union. Based on the study results, we recommended against future investigations of bone fusion being performed at those potentially misleading time points. In contrast, CT imaging immediately after surgery may be useful since bone contact immediately after surgery greatly affects subsequent bone fusion. We agree that the relationship between intravertebral bone cysts and pseudarthrosis is important, and we believe that future studies should include vertebral cysts in their evaluation. The assessment of osteoporosis in fused vertebrae using the Hounsfield unit is another interesting method. As you pointed out, the effect of teriparatide use in patients with a history of bisphosphonates cannot be ignored. In our cohort, there was one patient in the teriparatide group who had been previously treated for osteoporosis. The patient was considered to have bony fusion at 2, 4, and 6 months postoperatively, and so no fake union occurred. We also agree that a history of bisphosphonate use should be investigated to evaluate the efficacy of teriparatide. Perhaps the strongest limitation of our study was the short final evaluation period of 6 months. We have defined fake union as any event in which a vertebral body judged to have fused is later determined as not fused at the final evaluation. Moving forward, we aim to extend our observation period on the rate of fake union from 6 months to 1 or 2 years postoperatively in order to confirm our results.
{"title":"Authors' Response to Letter to the Editor. Fake Union.","authors":"Hiroki Oba, Jun Takahashi, Tetsuro Ohba, Tomohiko Hasegawa, Shota Ikegami, Masashi Uehara, Yukihiro Matsuyama, Hirotaka Haro","doi":"10.22603/ssrr.2022-0214","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0214","url":null,"abstract":"First, we would like to thank Drs. Tsukamoto, Morimoto, Yoshihara, and Mawatari for their pertinent questions regarding our publication. We appreciate that they found value in our work and took the time to read it in detail. This study was an additional investigation using data from a multicenter, prospective, randomized study reported by Ebata et al. in 2017. The authors performed CT imaging four times: immediately postoperative and at 2, 4, and 6 months after surgery. They took the negative impact of radiation very seriously and used a low-dose protocol. We devised CT photography for decreasing radiation exposure by 50% using dose-reduction technique and iterative reconstruction method for image reconstruction. Our investigation revealed that bone fusion decisions at 2 or 4 months postoperatively had little clinical significance due to the possibility of fake union. Based on the study results, we recommended against future investigations of bone fusion being performed at those potentially misleading time points. In contrast, CT imaging immediately after surgery may be useful since bone contact immediately after surgery greatly affects subsequent bone fusion. We agree that the relationship between intravertebral bone cysts and pseudarthrosis is important, and we believe that future studies should include vertebral cysts in their evaluation. The assessment of osteoporosis in fused vertebrae using the Hounsfield unit is another interesting method. As you pointed out, the effect of teriparatide use in patients with a history of bisphosphonates cannot be ignored. In our cohort, there was one patient in the teriparatide group who had been previously treated for osteoporosis. The patient was considered to have bony fusion at 2, 4, and 6 months postoperatively, and so no fake union occurred. We also agree that a history of bisphosphonate use should be investigated to evaluate the efficacy of teriparatide. Perhaps the strongest limitation of our study was the short final evaluation period of 6 months. We have defined fake union as any event in which a vertebral body judged to have fused is later determined as not fused at the final evaluation. Moving forward, we aim to extend our observation period on the rate of fake union from 6 months to 1 or 2 years postoperatively in order to confirm our results.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/83/2432-261X-7-0295.PMC10257955.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Only a few reports have described the clinical features of recurrent spinal cord tumors. This study aimed to report the recurrence rates (RRs), radiographic imaging, and pathological features of various histopathological recurrent spinal cord tumors using a large sample size.
Methods: This study adopted the retrospective observational study design using a single-center study setting. We retrospectively reviewed 818 consecutive individuals operated for spinal cord and cauda equina tumors between 2009 and 2018 in a university hospital. We first determined the number of surgeries and then the histopathology, duration to reoperation, number of surgeries, location, degree of tumor resection, and tumor configuration of the recurrent cases.
Results: A total of 99 patients (46 men and 53 women) who underwent multiple surgeries were identified. The mean duration between the primary and second surgeries was 94.8 months. A total of 74 patients underwent surgery twice, 18 patients thrice, and 7 patients 4 or more times. The recurrence sites were broadly distributed over the spine, with mainly intramedullary (47.5%) and dumbbell-shaped (31.3%) tumors. The RRs for each histopathology were as follows: schwannoma, 6.8%; meningioma and ependymoma, 15.9%; hemangioblastoma, 15.8%; and astrocytoma, 38.9%. The RRs after total resection were significantly lower (4.4%) than that after partial resection. Neurofibromatosis-associated schwannomas had a higher RR than sporadic schwannomas (p<0.001, odds ratio [OR]=8.54, 95% confidence interval [95% CI]: 3.67-19.93). Among the meningiomas, the RR increased to 43.5% in ventral cases (p<0.001, OR=14.36, 95% CI: 3.66-55.29). Within the ependymomas, partial resection (p<0.001, OR=2.871, 95% CI: 1.37-6.03) was found to be significantly correlated with recurrence. Dumbbell-shaped schwannomas exhibited a higher RR than non-dumbbell-shaped ones. Furthermore, dumbbell-shaped tumors other than schwannoma had a higher RR than dumbbell-shaped schwannomas (p<0.001, OR=16.0, 95% CI: 5.518-46.191).
Conclusions: Aiming for total resection is essential to prevent recurrence. Dumbbell-shaped schwannomas and ventral meningiomas exhibited higher RR requiring revision surgery. As for dumbbell-shaped tumors, spinal surgeons should pay attention to the possibilities of non-schwannoma histopathologies.
{"title":"Clinical Features of Recurrent Spinal Cord Tumors.","authors":"Osahiko Tsuji, Narihito Nagoshi, Satoshi Suzuki, Yohei Takahashi, Satoshi Nori, Mitsuru Yagi, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.22603/ssrr.2022-0136","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0136","url":null,"abstract":"<p><strong>Introduction: </strong>Only a few reports have described the clinical features of recurrent spinal cord tumors. This study aimed to report the recurrence rates (RRs), radiographic imaging, and pathological features of various histopathological recurrent spinal cord tumors using a large sample size.</p><p><strong>Methods: </strong>This study adopted the retrospective observational study design using a single-center study setting. We retrospectively reviewed 818 consecutive individuals operated for spinal cord and cauda equina tumors between 2009 and 2018 in a university hospital. We first determined the number of surgeries and then the histopathology, duration to reoperation, number of surgeries, location, degree of tumor resection, and tumor configuration of the recurrent cases.</p><p><strong>Results: </strong>A total of 99 patients (46 men and 53 women) who underwent multiple surgeries were identified. The mean duration between the primary and second surgeries was 94.8 months. A total of 74 patients underwent surgery twice, 18 patients thrice, and 7 patients 4 or more times. The recurrence sites were broadly distributed over the spine, with mainly intramedullary (47.5%) and dumbbell-shaped (31.3%) tumors. The RRs for each histopathology were as follows: schwannoma, 6.8%; meningioma and ependymoma, 15.9%; hemangioblastoma, 15.8%; and astrocytoma, 38.9%. The RRs after total resection were significantly lower (4.4%) than that after partial resection. Neurofibromatosis-associated schwannomas had a higher RR than sporadic schwannomas (p<0.001, odds ratio [OR]=8.54, 95% confidence interval [95% CI]: 3.67-19.93). Among the meningiomas, the RR increased to 43.5% in ventral cases (p<0.001, OR=14.36, 95% CI: 3.66-55.29). Within the ependymomas, partial resection (p<0.001, OR=2.871, 95% CI: 1.37-6.03) was found to be significantly correlated with recurrence. Dumbbell-shaped schwannomas exhibited a higher RR than non-dumbbell-shaped ones. Furthermore, dumbbell-shaped tumors other than schwannoma had a higher RR than dumbbell-shaped schwannomas (p<0.001, OR=16.0, 95% CI: 5.518-46.191).</p><p><strong>Conclusions: </strong>Aiming for total resection is essential to prevent recurrence. Dumbbell-shaped schwannomas and ventral meningiomas exhibited higher RR requiring revision surgery. As for dumbbell-shaped tumors, spinal surgeons should pay attention to the possibilities of non-schwannoma histopathologies.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/99/2432-261X-7-0225.PMC10257957.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor-related spinal instability.
Methods: We retrospectively identified 428 patients who had been diagnosed with spinal metastases from February 2009 to May 2017. Those with an opioid prescription during the first 1 month after the diagnosis were included in this study. Patients given opioids were divided into two groups: the opioid requirement group [≥5 mg oral morphine equivalent (OME)/day] and the nonopioid group (<5 mg OME/day). Spinal instability due to metastases was evaluated using the Spinal Instability Neoplastic Score (SINS). Cox proportional hazards analysis was performed to evaluate the relationship between opioid use and overall survival.
Results: The most frequent primary cancer site was the lung, in 159 patients (37%), followed by the breast in 75 (18%) and the prostate in 46 (11%). Multivariate analyses showed that patients who required ≥5 mg OME/day were approximately twofold more likely to die after a spinal metastases diagnosis than those who required <5 mg OME/day (hazard ratio 2.13; 95% confidence interval 1.69-2.67; p<0.001). The SINS was significantly higher in the opioid requirement group than those in the nonopioid group (p<0.001).
Conclusions: For patients with spinal metastases, opioid requirement was associated with shorter survival, independently of known prognostic factors. The patients were also more likely to have tumor-related spinal instability than those in the nonopioid group.
{"title":"Association between Opioid Requirement and Overall Survival in Patients with Spinal Metastases.","authors":"Sho Dohzono, Ryuichi Sasaoka, Kiyohito Takamatsu, Hiroaki Nakamura","doi":"10.22603/ssrr.2021-0169","DOIUrl":"https://doi.org/10.22603/ssrr.2021-0169","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor-related spinal instability.</p><p><strong>Methods: </strong>We retrospectively identified 428 patients who had been diagnosed with spinal metastases from February 2009 to May 2017. Those with an opioid prescription during the first 1 month after the diagnosis were included in this study. Patients given opioids were divided into two groups: the opioid requirement group [≥5 mg oral morphine equivalent (OME)/day] and the nonopioid group (<5 mg OME/day). Spinal instability due to metastases was evaluated using the Spinal Instability Neoplastic Score (SINS). Cox proportional hazards analysis was performed to evaluate the relationship between opioid use and overall survival.</p><p><strong>Results: </strong>The most frequent primary cancer site was the lung, in 159 patients (37%), followed by the breast in 75 (18%) and the prostate in 46 (11%). Multivariate analyses showed that patients who required ≥5 mg OME/day were approximately twofold more likely to die after a spinal metastases diagnosis than those who required <5 mg OME/day (hazard ratio 2.13; 95% confidence interval 1.69-2.67; p<0.001). The SINS was significantly higher in the opioid requirement group than those in the nonopioid group (p<0.001).</p><p><strong>Conclusions: </strong>For patients with spinal metastases, opioid requirement was associated with shorter survival, independently of known prognostic factors. The patients were also more likely to have tumor-related spinal instability than those in the nonopioid group.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/a7/2432-261X-7-0235.PMC10257962.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9999180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Musculoskeletal neck pain is the fourth common cause of disability worldwide. Scapula dysfunction can subsequently lead to neck pain. Previous literature could not establish the effectiveness of scapular stabilization exercises on neck pain due to the different definitions used for exercise in different studies. There is a need for quality evidence examining the effectiveness of scapular interventions on pain and disability in patients with neck pain.
Data sources: PubMed, EMBASE, Scopus, Cochrane, OVID, and PEDro were searched from 1 April 2011 to 31 March 2022.
Methods: We included randomized controlled trials that focused on scapular interventions and other active strategies in the management of neck pain. The following outcomes were assessed: pain, disability, and quality of life. PEDro scale was used to assess the risk of bias and the data pooled was analyzed using standardized mean difference.
Results: The 5 trials included in the review assessed (116 participants) the effects of scapular interventions in patients with chronic nonspecific neck pain. Risk of bias for one study was low and that for the others was moderate. The meta-analysis showed that there was a significant difference between the combined effect of neck and scapula interventions and only neck interventions group (Standardized mean difference -1.51, 95% CI [-2.79, -0.23], z=2.32, p=0.02). On assessing the effect of scapula interventions on disability, the results revealed that there was no significant (p=0.40) impact.
Conclusion: Moderate quality evidence was found for the combined effect of scapular and neck interventions in reducing pain in patients with neck pain. However, it was not effective in improving the disability.
{"title":"Effects of Scapular Interventions on Pain and Disability in Subjects with Neck Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Nithin Prakash, Karvannan Harikesavan, Joshua Cleland","doi":"10.22603/ssrr.2022-0237","DOIUrl":"10.22603/ssrr.2022-0237","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal neck pain is the fourth common cause of disability worldwide. Scapula dysfunction can subsequently lead to neck pain. Previous literature could not establish the effectiveness of scapular stabilization exercises on neck pain due to the different definitions used for exercise in different studies. There is a need for quality evidence examining the effectiveness of scapular interventions on pain and disability in patients with neck pain.</p><p><strong>Data sources: </strong>PubMed, EMBASE, Scopus, Cochrane, OVID, and PEDro were searched from 1 April 2011 to 31 March 2022.</p><p><strong>Methods: </strong>We included randomized controlled trials that focused on scapular interventions and other active strategies in the management of neck pain. The following outcomes were assessed: pain, disability, and quality of life. PEDro scale was used to assess the risk of bias and the data pooled was analyzed using standardized mean difference.</p><p><strong>Results: </strong>The 5 trials included in the review assessed (116 participants) the effects of scapular interventions in patients with chronic nonspecific neck pain. Risk of bias for one study was low and that for the others was moderate. The meta-analysis showed that there was a significant difference between the combined effect of neck and scapula interventions and only neck interventions group (Standardized mean difference -1.51, 95% CI [-2.79, -0.23], z=2.32, p=0.02). On assessing the effect of scapula interventions on disability, the results revealed that there was no significant (p=0.40) impact.</p><p><strong>Conclusion: </strong>Moderate quality evidence was found for the combined effect of scapular and neck interventions in reducing pain in patients with neck pain. However, it was not effective in improving the disability.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68229949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The number of patients on antithrombotic drugs for coronary heart disease or cerebrovascular disease has been increasing with the aging of society. We occasionally need to decide whether to continue or discontinue antithrombotic drugs before spine surgery. The purpose of this study is to understand the current perioperative management of antithrombotic drugs before elective spine surgery in Japan.
Methods: In 2021, members of the Japanese Society for Spine Surgery and Related Research (JSSR) were asked to complete a web-based questionnaire survey that included items concerning the respondents' surgical experience, their policy regarding discontinuation or continuation of antithrombotic drugs, their reasons for decisions concerning the management of antithrombotic drugs, and their experience of perioperative complications related to the continuation or discontinuation of these drugs.
Results: A total of 1,181 spine surgeons returned completed questionnaires, giving a response rate of 32.0%. JSSR board-certified spine surgeons comprised 75.1% of the respondents. Depending on the management policy regarding antithrombotic drugs for each comorbidity, approximately 73% of respondents discontinued these drugs before elective spine surgery, and about 80% also discontinued anticoagulants. Only 4%-5% of respondents reported continuing antiplatelet drugs, and 2.5% reported continuing anticoagulants. Among the respondents who discontinued antiplatelet drugs, 20.4% reported having encountered cerebral infarction and 3.7% reported encountering myocardial infarction; among those who discontinued anticoagulants, 13.6% reported encountering cerebral embolism and 5.4% reported encountering pulmonary embolism. However, among the respondents who continued antiplatelet drugs and those who continued anticoagulants, 26.3% and 27.2%, respectively, encountered an unexpected increase in intraoperative bleeding, and 10.3% and 8.7%, respectively, encountered postoperative spinal epidural hematoma requiring emergency surgery.
Conclusions: Our findings indicate that, in principle, >70% of JSSR members discontinue antithrombotic drugs before elective spine surgery. However, those with a discontinuation policy have encountered thrombotic complications, while those with a continuation policy have encountered hemorrhagic complications.
{"title":"Management of Antithrombotic Drugs before Elective Spine Surgery: A Nationwide Web-Based Questionnaire Survey in Japan.","authors":"Fumitake Tezuka, Toshinori Sakai, Shiro Imagama, Hiroshi Takahashi, Masashi Takaso, Toshimi Aizawa, Koji Otani, Shinya Okuda, Satoshi Kato, Tokumi Kanemura, Yoshiharu Kawaguchi, Hiroaki Konishi, Kota Suda, Hidetomi Terai, Kazuo Nakanishi, Kotaro Nishida, Masaaki Machino, Naohisa Miyakoshi, Hideki Murakami, Yu Yamato, Yasutsugu Yukawa","doi":"10.22603/ssrr.2023-0015","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0015","url":null,"abstract":"<p><strong>Introduction: </strong>The number of patients on antithrombotic drugs for coronary heart disease or cerebrovascular disease has been increasing with the aging of society. We occasionally need to decide whether to continue or discontinue antithrombotic drugs before spine surgery. The purpose of this study is to understand the current perioperative management of antithrombotic drugs before elective spine surgery in Japan.</p><p><strong>Methods: </strong>In 2021, members of the Japanese Society for Spine Surgery and Related Research (JSSR) were asked to complete a web-based questionnaire survey that included items concerning the respondents' surgical experience, their policy regarding discontinuation or continuation of antithrombotic drugs, their reasons for decisions concerning the management of antithrombotic drugs, and their experience of perioperative complications related to the continuation or discontinuation of these drugs.</p><p><strong>Results: </strong>A total of 1,181 spine surgeons returned completed questionnaires, giving a response rate of 32.0%. JSSR board-certified spine surgeons comprised 75.1% of the respondents. Depending on the management policy regarding antithrombotic drugs for each comorbidity, approximately 73% of respondents discontinued these drugs before elective spine surgery, and about 80% also discontinued anticoagulants. Only 4%-5% of respondents reported continuing antiplatelet drugs, and 2.5% reported continuing anticoagulants. Among the respondents who discontinued antiplatelet drugs, 20.4% reported having encountered cerebral infarction and 3.7% reported encountering myocardial infarction; among those who discontinued anticoagulants, 13.6% reported encountering cerebral embolism and 5.4% reported encountering pulmonary embolism. However, among the respondents who continued antiplatelet drugs and those who continued anticoagulants, 26.3% and 27.2%, respectively, encountered an unexpected increase in intraoperative bleeding, and 10.3% and 8.7%, respectively, encountered postoperative spinal epidural hematoma requiring emergency surgery.</p><p><strong>Conclusions: </strong>Our findings indicate that, in principle, >70% of JSSR members discontinue antithrombotic drugs before elective spine surgery. However, those with a discontinuation policy have encountered thrombotic complications, while those with a continuation policy have encountered hemorrhagic complications.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/71/2432-261X-7-0428.PMC10569803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Few articles have investigated patient satisfaction with laminoplasty in patients with cervical spondylotic myelopathy (CSM) alone, excluding other diseases, such as ossification of the posterior longitudinal ligament. In this study, we aimed to investigate patient satisfaction after double-door laminoplasty for CSM and determine the preoperative and postoperative factors that affect patient satisfaction.
Methods: We retrospectively reviewed cases of laminoplasty for CSM. We measured sagittal imaging parameters (cervical lordosis [CL], C2-C7 cervical sagittal vertical axis [cSVA], and T1 slope [T1S]), Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes (PROs) such as the neck disability index (NDI) and visual analog scale (VAS) preoperatively, 3 months postoperatively, and 1 year postoperatively. In addition, a multiple regression analysis was performed to investigate factors affecting patient satisfaction.
Results: Ninety patients were included in the analysis. After surgery, CL decreased significantly (p<0.01), whereas cSVA increased significantly (p<0.01). No significant differences were observed in the preoperative and postoperative T1S values (p=0.61). The JOA, NDI, and VAS scores significantly improved postoperatively (p<0.01). The median patient satisfaction was 85 (range, 12-100) at 1 year postoperatively and 80 (range, 25-100) at 3 months postoperatively. In the multiple regression analysis, lower-extremity sensory disorder in the JOA score at 1 year postoperatively (p<0.01) and VAS scores for neck pain preoperatively and 1 year postoperatively (p=0.01 and p<0.01, respectively) were determined as factors affecting patient satisfaction.
Conclusions: Cervical laminoplasty is a useful and satisfactory surgical procedure to restore patient function. However, patients with severe preoperative and postoperative neck pain and those with severe postoperative sensory disorders of the lower extremities may be less satisfied with the procedure. It is important to keep these things in mind when treating patients.
{"title":"Preoperative and Postoperative Factors Affecting Patient Satisfaction with Double-Door Laminoplasty for Cervical Spondylotic Myelopathy.","authors":"Takaki Yoshiyama, Shunsuke Fujibayashi, Bungo Otsuki, Takayoshi Shimizu, Koichi Murata, Shuichi Matsuda","doi":"10.22603/ssrr.2023-0022","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0022","url":null,"abstract":"<p><strong>Introduction: </strong>Few articles have investigated patient satisfaction with laminoplasty in patients with cervical spondylotic myelopathy (CSM) alone, excluding other diseases, such as ossification of the posterior longitudinal ligament. In this study, we aimed to investigate patient satisfaction after double-door laminoplasty for CSM and determine the preoperative and postoperative factors that affect patient satisfaction.</p><p><strong>Methods: </strong>We retrospectively reviewed cases of laminoplasty for CSM. We measured sagittal imaging parameters (cervical lordosis [CL], C2-C7 cervical sagittal vertical axis [cSVA], and T1 slope [T1S]), Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes (PROs) such as the neck disability index (NDI) and visual analog scale (VAS) preoperatively, 3 months postoperatively, and 1 year postoperatively. In addition, a multiple regression analysis was performed to investigate factors affecting patient satisfaction.</p><p><strong>Results: </strong>Ninety patients were included in the analysis. After surgery, CL decreased significantly (p<0.01), whereas cSVA increased significantly (p<0.01). No significant differences were observed in the preoperative and postoperative T1S values (p=0.61). The JOA, NDI, and VAS scores significantly improved postoperatively (p<0.01). The median patient satisfaction was 85 (range, 12-100) at 1 year postoperatively and 80 (range, 25-100) at 3 months postoperatively. In the multiple regression analysis, lower-extremity sensory disorder in the JOA score at 1 year postoperatively (p<0.01) and VAS scores for neck pain preoperatively and 1 year postoperatively (p=0.01 and p<0.01, respectively) were determined as factors affecting patient satisfaction.</p><p><strong>Conclusions: </strong>Cervical laminoplasty is a useful and satisfactory surgical procedure to restore patient function. However, patients with severe preoperative and postoperative neck pain and those with severe postoperative sensory disorders of the lower extremities may be less satisfied with the procedure. It is important to keep these things in mind when treating patients.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/fe/2432-261X-7-0421.PMC10569807.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thoracic Spondylitis Associated with Sepsis and Neurological Deficit Caused by <i>Edwardsiella tarda</i>: A Case Report.","authors":"Koki Tsuchiya, Ichiro Okano, Youhei Miyamoto, Hiroshi Maruyama, Yoshihisa Komuro, Yoshifumi Kudo, Tomoaki Toyone, Katsunori Inagaki","doi":"10.22603/ssrr.2023-0017","DOIUrl":"10.22603/ssrr.2023-0017","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68230458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diffuse idiopathic skeletal hyperostosis (DISH) reportedly increases the risk of fracture due to low-energy trauma. Countries with an increasing aging population have an increased incidence of cervical trauma in elderly patients, mostly occurring in the setting of low-energy trauma. We report a rare case of cervical fracture with DISH and subsequent respiratory insufficiency managed by emergency anterior cervical surgery. An 87-year-old man was brought in by an ambulance and transferred to our hospital 4 h after a fall on the floor. He lost consciousness for 2 h following the fall and woke up with muscle weakness. His past medical and surgical histories included hypertension, atrial arrhythmia, and cerebellar infarction with residual mild paralysis in his right upper and lower limbs. The patient was taking oral rivaroxaban. Plain radiography and computed tomography (CT) revealed ossification of the posterior longitudinal ligament at C3-5, fusion due to the ossification of the anterior longitudinal ligament (OALL) at C5-7, fusion due to DISH at C5-7 and T2-12 (Fig. 1), and a fracture involving the OALL at the C6/7 intervertebral disc level. Magnetic resonance imaging (MRI) slices showed a large retropharyngeal hematoma extending to the mediastinum. Moreover, cervical spinal canal stenosis and myelomalacia at the C3/4 and C4/5 levels were observed, which showed the spinal cord injury (Fig. 2). At that point, muscle strength was fully recovered, although he reported severe paresthesia in both hands. Dyspnea and respiratory insufficiency occurred 6 h after the presentation. Tracheal intubation was performed, and the patient was ventilated. Arterial active bleeding was still observed after 10 coiling attempts by transcatheter angiography (Fig. 3). Therefore, we decided to perform emergency anterior cervical surgery (Fig. 4). A large hematoma extending from the retropharyngeal re-
{"title":"Cervical Fracture with Diffuse Idiopathic Skeletal Hyperostosis and Respiratory Insufficiency: A Case Report.","authors":"Kengo Fujii, Toru Funayama, Kaishi Ogawa, Sayori Li, Masashi Yamazaki","doi":"10.22603/ssrr.2022-0231","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0231","url":null,"abstract":"Diffuse idiopathic skeletal hyperostosis (DISH) reportedly increases the risk of fracture due to low-energy trauma. Countries with an increasing aging population have an increased incidence of cervical trauma in elderly patients, mostly occurring in the setting of low-energy trauma. We report a rare case of cervical fracture with DISH and subsequent respiratory insufficiency managed by emergency anterior cervical surgery. An 87-year-old man was brought in by an ambulance and transferred to our hospital 4 h after a fall on the floor. He lost consciousness for 2 h following the fall and woke up with muscle weakness. His past medical and surgical histories included hypertension, atrial arrhythmia, and cerebellar infarction with residual mild paralysis in his right upper and lower limbs. The patient was taking oral rivaroxaban. Plain radiography and computed tomography (CT) revealed ossification of the posterior longitudinal ligament at C3-5, fusion due to the ossification of the anterior longitudinal ligament (OALL) at C5-7, fusion due to DISH at C5-7 and T2-12 (Fig. 1), and a fracture involving the OALL at the C6/7 intervertebral disc level. Magnetic resonance imaging (MRI) slices showed a large retropharyngeal hematoma extending to the mediastinum. Moreover, cervical spinal canal stenosis and myelomalacia at the C3/4 and C4/5 levels were observed, which showed the spinal cord injury (Fig. 2). At that point, muscle strength was fully recovered, although he reported severe paresthesia in both hands. Dyspnea and respiratory insufficiency occurred 6 h after the presentation. Tracheal intubation was performed, and the patient was ventilated. Arterial active bleeding was still observed after 10 coiling attempts by transcatheter angiography (Fig. 3). Therefore, we decided to perform emergency anterior cervical surgery (Fig. 4). A large hematoma extending from the retropharyngeal re-","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/6a/2432-261X-7-0468.PMC10569800.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical laminoplasty (CLP) is an established procedure; however, postoperative concerns such as axial pain, C5 palsy, restriction of neck motion, and loss of lordotic curvature are commonly noted. Moreover, axial pain after laminoplasty is common. However, the cause of this complication has not been fully elucidated. Several studies have suggested the origins of these complications as cervical muscles, and the preservation of paravertebral muscles and early activation of the range of motion have been recommended. Although these countermeasures improved the rate and severity of axial pain, some unexplained axial pain after CLP persists. Specifically, it is difficult to explain the laterality of the severity of the postoperative axial pain because double-door laminoplasty is a completely symmetrical procedure. This case study suggests that the C4 nerve root may contribute to postoperative axial pain. A 48-year-old woman presented with numbness in her
{"title":"Postoperative C4 Radiculopathy May Result in Axial Pain after Cervical Laminoplasty.","authors":"Kaho Yasuda, Yoshitada Usami, Sachio Hayama, Yoshiharu Nakaya, Takashi Fujishiro, Masashi Neo","doi":"10.22603/ssrr.2023-0018","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0018","url":null,"abstract":"Cervical laminoplasty (CLP) is an established procedure; however, postoperative concerns such as axial pain, C5 palsy, restriction of neck motion, and loss of lordotic curvature are commonly noted. Moreover, axial pain after laminoplasty is common. However, the cause of this complication has not been fully elucidated. Several studies have suggested the origins of these complications as cervical muscles, and the preservation of paravertebral muscles and early activation of the range of motion have been recommended. Although these countermeasures improved the rate and severity of axial pain, some unexplained axial pain after CLP persists. Specifically, it is difficult to explain the laterality of the severity of the postoperative axial pain because double-door laminoplasty is a completely symmetrical procedure. This case study suggests that the C4 nerve root may contribute to postoperative axial pain. A 48-year-old woman presented with numbness in her","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/37/2432-261X-7-0461.PMC10569804.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}