Spine Surgery and Related Research最新文献

Introduction: The Japanese Scoliosis Society conducted a survey on the complications of pediatric spinal deformity surgeries in 2012, 2014, and 2017. However, a registry-based survey was necessary to systematically and comprehensively identify complications, and a web-based registry system was established. This study aimed to investigate the frequency of pediatric spinal deformity surgeries and perioperative complications in Japan in 2022, using a web-based registry.

Methods: Of the 158,263 cases collected from 1,032 institutions, 1,945 (485 boys and 1,460 girls) were included in the study. The diagnoses were idiopathic scoliosis (64.9%), congenital scoliosis (10.1%), neuromuscular scoliosis (7.4%), congenital kyphoscoliosis (1.1%), and others (16.5%). The intraoperative, postoperative (within 30 days), and systemic (within 30 days postoperatively) complications were investigated.

Results: The overall complication rate was 6.0% (intraoperative, 2.5%; postoperative, 2.4%; and systemic, 2.0%). The complication rates by diagnosis were highest in congenital kyphosis (25.0%), followed by congenital kyphoscoliosis (18.2%) and neuromuscular scoliosis (13.3%), whereas idiopathic scoliosis (10-18 years old) had a complication rate of 3.7%. The most common intraoperative complications were massive bleeding (>2,000 mL) in 0.9%, dural tears in 0.7%, and nerve injury in 0.2% of the patients. The most frequent postoperative complications were neurologic deficits (0.8%), surgical site infections (0.8%), and implant failure (0.5%). The most frequent postoperative systemic complications were respiratory (0.6%) and urinary (0.4%).

Conclusions: This nationwide web-based registry study provides a highly comprehensive report on pediatric scoliosis surgery in Japan in 2022. The complication rates were notably high for congenital kyphosis, congenital kyphoscoliosis, and neuromuscular scoliosis. These findings may help improve patient and family understanding of the risks associated with various spinal deformities and support shared decision-making in pediatric surgical care.

Introduction: Double crush syndrome (DCS) refers to compressive neuropathy at multiple sites along a peripheral nerve (PN), yet its relevance in the lower extremity remains poorly defined. This study aimed to (1) determine the prevalence of PN lesions in patients undergoing surgery for lumbosacral radiculopathy (LR), (2) identify commonly affected nerves, (3) assess associated risk factors, and (4) evaluate the DCS hypothesis by comparing the incidence of PN lesions in patients undergoing surgery for LR versus matched controls.

Methods: A retrospective cohort study was conducted using the PearlDiver database (2010-2022) to identify adult patients who underwent lumbar decompression and/or fusion for LR. PN lesions diagnosed within two years before or after surgery were categorized by nerve. Univariate logistic regression was used to identify risk factors. A matched control cohort without LR was created using propensity score matching to evaluate the DCS hypothesis.

Results: Of 650,562 patients undergoing surgery for LR, 32,909 (5.1%) were diagnosed with a PN lesion, with 60.6% occurring before and 38.4% after surgery. The most commonly affected nerves were the sciatic (31.7%), plantar (16.1%), and peroneal (11.2%). Risk factors for PN lesions included female gender (odds ratio [OR]: 1.22), age 50-59 years (OR: 1.23) and 60-69 years (OR: 1.17), and higher comorbidity burden with Elixhauser Comorbidity Index ≥5 (OR: 1.50). Comorbid conditions associated with increased risk included complex regional pain syndrome (OR: 3.33), fibromyalgia (OR: 1.73), and osteoarthritis (OR: 1.61). Compared to matched controls, patients with LR were significantly more likely to develop a PN lesion (OR: 3.10).

Conclusions: PN lesions affect over 5% of patients undergoing surgery for LR and are significantly more common than in controls, supporting the DCS hypothesis in the lower extremity. Clinicians should maintain a broad differential diagnosis when evaluating radicular symptoms, especially in patients with high comorbidity burden or recurrent postoperative pain.

Introduction: Although percutaneous kyphoplasty (PKP) is widely recognized as an effective treatment for osteoporotic vertebral compression fractures (VCFs), there is growing concern about the risk of subsequent VCF after the procedure. Prior studies suggest that the timing between primary VCF and PKP may affect future VCF, but there are limited data evaluating this timing, and no studies use data-driven methods to derive precise thresholds. Therefore, the aim of this study was to determine (1) the optimal time interval that minimizes the risk of 2-year subsequent VCF and (2) the impact of this interval on 90-day medical complications after PKP.

Methods: A retrospective cohort analysis in patients who underwent PKP for primary thoracic VCF from 2010 to 2022 was identified using a national administrative claims database. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven timing strata between primary thoracic VCF and PKP that minimized the likelihood of subsequent VCF within 2 years of the index PKP procedure. To control for confounders, multivariable regression analysis was conducted to confirm the identified data-driven association with 2-year VCF rates and compare the likelihood of various 90-day medical complications.

Results: In total, 16,197 patients who underwent PKP after primary VCF were included in this study. SSLR analysis identified two timing thresholds: 0 weeks (same day cohort) and 1 to 30 weeks (Delayed cohort). The same day cohort was significantly less likely to experience 2-year subsequent VCF than was the Delayed cohort (odds ratios: 0.52; 95% confidence interval: 0.47-0.56; p<0.001).

Discussion: Early PKP significantly reduces the risk of 2-year subsequent VCFs compared with delayed intervention by nearly 50%. During this preoperative period, patient optimization should be prioritized to enhance management outcomes, allowing a careful balance between timely intervention and comprehensive patient evaluation.

Introduction: Some adult patients with spinal deformities show a sloping spine, not kyphosis, with severe global malalignment and deterioration of patient-reported outcome measures (PROMs). The purpose of this study was to elucidate sloping-type deformities on the basis of radiographic parameters and PROMs.

Methods: This study included participants from a health screening program with sagittal vertical axis (SVA) >40 mm. The sloping-type deformity (S group) was defined as the deformity in which all posterior vertebral walls were positioned anteriorly to the vertical line extending from the posterior end of the sacrum on standing whole-spine lateral radiographs. SVA, thoracic kyphosis (TK), lumbar lordosis (LL), L4-S angle, pelvic incidence (PI), and pelvic tilt (PT) were measured. PROMs were evaluated using the Oswestry Disability Index (ODI).

Results: A total of 348 participants (142 men and 206 women; average age 75.8 years) were included in the study, and 50 participants (14.4%) were classified into the S group. The mean age and measured variables of the S and non-sloping-type (non-S) group were 76.1, 72.6 years; SVA 111, 79 mm; TK 24, 35°; L4-S 15, 30°; PI 58, 49°; PT 27, 21°; PI-LL 28, 14°; and ODI 22, 15%, respectively. There were 30 participants (60%) with evident lumbar anterolisthesis in the S group and 76 (25.5%) in the non-S group (p<0.001). The S group had larger SVA, PI, PT, and PI-LL (all p<0.001) and lower TK and L4-S angle (both p<0.001) than did the non-S group. The S group showed an inferior ODI to that of the non-S group (p=0.012).

Conclusions: The sloping-type deformity showed a significantly higher PI, and worse spinopelvic alignment and PROMs. The significant factors contributing to the incidence of sloping-type deformities were higher PI, prevalence of lumbar anteriolisthesis, and lower TK and L4-S angle.

Introduction: Double-door laminoplasty is a common surgical approach; however, implant displacement and hinge fractures can cause lamina closure, leading to unfavorable outcomes. A novel clip-type implant has been introduced to improve rigid fixation safely; however, its biomechanical stability, compared with that of hydroxyapatite (HA) spacers, has not yet been evaluated. Therefore, the aim of this study was to compare the mechanical stability of polyetheretherketone clip implants versus that of HA spacers in freshly frozen cadaveric cervical spines.

Methods: Seven freshly frozen cervical spines were used in this study. Double-door laminoplasty was performed at the C3-C6 cervical vertebral level. Clip-type implants and HA spacers were alternately placed on each specimen. Strain gauges were used to measure lamina displacement and reaction force at 0-mm to 2.5-mm lateral displacement. The reaction forces between the clip implant and HA spacer groups were compared.

Results: Polyetheretherketone clip-type implants had significantly higher reaction force values than HA spacers at all displacement levels (p<0.001). Clip-type implants exhibited a 1.5- to 1.7-times higher reaction force than that of spacers at the middle of the lamina and a 1.9- to 2.0-times higher reaction force than that of spacers at the tip of the lamina.

Conclusions: Novel clip-type implants provide greater stability than HA spacers. To the best of our knowledge, this study is the first to demonstrate the superior biomechanical stability of clip implants.

Introduction: Pedicle screw placement can be technically challenging in anatomically narrow pedicles, such as those in the thoracic spine or in older patients. Although smaller screws preserve cortical integrity, they may compromise fixation strength. Conversely, oversized pedicle screws that breach the pedicle cortex may enhance anchorage but raise concerns about potential neurovascular injury.

Methods: We performed a cadaveric biomechanical study using 36 thoracic and lumbar vertebrae harvested from five older donors. Each vertebra received an oversized screw that intentionally breached the pedicle cortex on one side and a smaller intracortical screw on the contralateral side. Four vertebrae were excluded owing to fracture during testing, leaving 32 vertebrae for analysis. After cyclic loading, pullout strength was measured. Subgroup and multivariate analyses were conducted based on pedicle diameter, vertebral level, and insertion side.

Results: Oversized screws indicated superior pullout strength in 20 of the 32 analyzed vertebrae. When the breach percentage exceeded 40%, oversized screws generally outperformed intracortical screws. Subgroup analysis revealed a significant advantage of oversized screws in narrow pedicles (<5 mm), where they increased pullout strength. In contrast, a decrease in strength was observed in wide pedicles (≥5 mm). Multivariate analysis identified pedicle diameter as the only independent predictor of strength improvement.

Conclusions: Oversized screws provide stronger fixation than do intracortical screws, particularly in anatomically narrow pedicles where cortical contact is limited. These findings suggest a potential biomechanical advantage of oversized screws in selected patients. However, careful consideration of anatomical risk and patient-specific factors is essential to minimize neurological complications.

Introduction: Intradiscal therapy with condoliase is becoming one of the minimally invasive treatment options for lumbar disc herniation (LDH). However, evidence regarding its efficacy in elderly populations remains scarce. The purpose of this study is to reveal the efficacy of condoliase treatment for LDH in patients over the age of 70 years.

Methods: The patients with LDH who received condoliase treatment in our institution with a follow-up period of 1 year were enrolled in this study. The patients were divided into two groups according to age: group E (>70 years) and group C (20-70 years). To assess clinical outcomes, visual analog scale (VAS) scores for leg and back pain and the Oswestry Disability Index (ODI) were obtained. Disc height and degeneration were evaluated using magnetic resonance imaging. Treatment was considered effective if the VAS scores for leg pain improved by ≥50% at 1 year and surgery was avoided.

Results: A total of 121 patients were enrolled in the study. The therapy was effective in 12 of 17 patients (70.6%) in group E and 79 of 104 patients (76.0%) in group C. The deterioration rate of Pfirrmann grade was significantly higher in group C than in group E (53.9% vs. 7.1%). Improvements in VAS scores and ODIs were comparable between the two groups. There were no significant differences in disc height reduction or herniation reduction rates between the groups. Despite disc degeneration, herniation reduction was observed, accompanied by a decrease in disc height.

Conclusions: Chemonucleolysis with condoliase is effective in treating LDH in patients over 70 years of age, affording outcomes comparable to those in younger patients. Despite disc degeneration, herniation reduction was observed accompanied by a decrease in disc height. Condoliase offers a less invasive alternative for treating elderly patients with multiple comorbidities. Careful patient selection is critical for ensuring optimal clinical results.

Introduction: Brace treatment is an essential nonoperative strategy to prevent curve progression in adolescent idiopathic scoliosis (AIS), yet it can cause substantial psychological stress. However, few studies have investigated factors associated with brace-related psychological stress. This study aimed to evaluate the association between pre-bracing health-related quality of life (HRQOL) and brace-related psychological stress during treatment.

Methods: This study retrospectively analyzed female patients with AIS aged 10-15 years who initiated brace treatment at a single center. Inclusion criteria were a baseline Cobb angle of 20-40°, initiation of full-time bracing, and completion of standardized questionnaires. Baseline assessments included demographic and radiographic data, as well as patient-reported outcomes: the Scoliosis Research Society-22r and the Scoliosis Japanese Questionnaire-27 (SJ-27). Brace-related psychological stress was assessed at multiple time points during the first year using the Japanese version of the Bad Sobernheim Stress Questionnaire-Brace (JBSSQ-brace). A linear mixed-effects model was used to identify baseline factors associated with higher stress levels over time.

Results: A total of 151 patients (mean age 12.4±1.1 years) were included. At one month, 32.5% of patients reported moderate to severe stress (JBSSQ-brace ≤16), and 11.8% of the total cohort experienced worsening stress during the first six months. In multivariable analysis, a higher baseline SJ-27 score was significantly associated with increased brace-related psychological stress over time (β=-0.15±0.04, p<0.001). Other factors, including age, skeletal maturity, pre-bracing Cobb angle, and in-brace correction rate, were not significant.

Conclusions: Lower pre-bracing HRQOL, as measured by the SJ-27, was independently associated with increased psychological stress during brace treatment. Early psychological screening using AIS-specific HRQOL tools may help identify high-risk patients and provide timely support to improve compliance and treatment outcomes.

Introduction: Ultrasound-guided cervical nerve root block (US-CNRB) is increasingly recognized as a safer alternative to fluoroscopy-guided procedures for treating cervical radiculopathy, owing to its ability to visualize neural and vascular structures in real time and to avoid exposure to radiation and contrast media. However, its clinical adoption remains limited due to concerns regarding inadvertent vascular puncture and misidentification of cervical levels. This study focuses on anatomical anomalies at the C6 and C7 levels, which are critical to the accuracy and safety of US-CNRB, and investigates the prevalence of morphological variations using cervical computed tomography (CT).

Methods: This retrospective observational study included patients who underwent cervical CT between April 2018 and March 2020. Patients with tumors, rheumatoid arthritis, infectious spondylitis, destructive spondyloarthropathy, or a history of cervical spine surgery were excluded. Axial and sagittal CT images were analyzed to assess two specific anatomical variants: absence of the anterior tubercle at C6 and presence of the anterior tubercle at C7. Two board-certified orthopedic spine surgeons independently assessed the images. Descriptive statistics and Cohen's kappa coefficient were used for analysis, with a p<0.05 considered statistically significant.

Results: We included 671 patients (359 females, 312 males; mean age: 62.1 years). Anatomical variants were observed in 1.34% (9/671) of cases: absence of the anterior tubercle at the C6 vertebra in 0.45% and presence of the anterior tubercle at C7 in 0.89%. No patient had both anomalies. Interobserver agreement was high, with disagreement in only one case. The Cohen's kappa coefficient for interobserver reliability was 0.97.

Conclusions: Although rare, anatomical anomalies at C6 and C7 can obscure critical landmarks during US-CNRB, increasing the risk of level misidentification and procedural errors. Recognizing these variants through preprocedural imaging is essential to improve the safety and precision of cervical spine interventions.