Spine Surgery and Related Research最新文献

Introduction: The geriatric nutritional risk index (GNRI) has emerged as a useful predictor of surgical risk and postoperative outcomes. This study aimed to explore the utility of GNRI as a semiquantitative tool for predicting systemic and local complications after multilevel thoracolumbar fusion surgery in older patients and to evaluate the broader implications of nutritional status on postoperative recovery and independence.

Methods: This multicenter study included 249 patients aged 65 years or older who underwent thoracolumbar fusion of at least four vertebrae. The nutrition-related risk grades were defined by the GNRI values, and the patients were divided into four groups: risk absent (GNRI >98), low risk (GNRI 92 to ≤98), moderate risk (GNRI 82 to <92), and major risk (GNRI <82). The occurrence of systemic complications, surgical site infection (SSI), length of stay in the hospital, place of discharge, and occurrence of proximal junctional kyphosis or failure (PJK/PJF) within 2 years after surgery were examined.

Results: The risk-absent group consisted of 165 patients, the low-risk group of 40, the moderate-risk group of 36, and the major-risk group of eight. The incidence of any systemic complications (p=0.016), PJK/PJF (p<0.001), and hospital stay (p=0.028) significantly increased with worsening GNRI. Furthermore, the number of patients who were discharged home significantly decreased as GNRI worsened (p<0.001). SSI occurred most frequently in the risk-absent group (4.2%).

Conclusions: The GNRI serves as a semiquantitative assessment tool that enables the identification of high-risk patients who may benefit from preoperative nutritional interventions.

Introduction: We evaluated the effect of 3 high-angle cages on spinal alignment and clinical outcomes following posterior lumbar interbody fusion (PLIF).

Methods: A retrospective analysis was performed on 104 patients who underwent PLIF at the L4/5 level between January 2021 and August 2023. Patients were divided into 3 groups: 12° (L), 16° (M), and 22° (H) cage groups. Lumbar spine radiographs were taken preoperatively and one year postoperatively to assess slip rate (% slip), segmental lumbar lordosis (SLL), segmental intervertebral angle (SIA), lumbar lordosis (LL), pelvic incidence-LL, sagittal vertical axis (SVA), Japanese Orthopedic Association score, and lower back pain visual analog scale score. Bone union and cage subsidence rates were evaluated using computed tomography 6 months postoperatively. Statistical analyses were performed using either the Wilcoxon signed rank test, Kruskal-Wallis test, or z-test.

Results: Intragroup analysis showed significant improvements in local alignment, with notable SVA improvement in the H group. Intergroup comparisons revealed no significant differences in preoperative evaluation items. Postoperatively, the H group showed significantly greater improvements in SLL and SIA than the L group. Although no significant difference was observed in bone union, the cage subsidence rate was significantly higher in the H group than in other groups.

Conclusions: PLIF using high-angle cages (≥12°) significantly improved local alignment in all groups. The 22° cage showed greater improvements in SLL and SIA but a higher incidence of cage subsidence. No significant clinical differences were observed between groups. LL in the lower lumbar spine can be achieved relatively easily using a cage with a larger angle in PLIF. However, although a cage with a larger angle may be advantageous for lordosis formation, postoperative clinical outcomes do not differ; therefore, cage selection should consider the surgeon's skill and patient factors, such as the degree of preoperative lumbar disc degeneration, instability, and alignment.

Introduction: Diffuse idiopathic skeletal hyperostosis (DISH)-related fractures have a high frequency of delayed diagnosis and paralysis even if caused by low-energy trauma, which makes diagnosing vertebral fractures (VFs) with DISH challenging. This study compared the clinical and radiologic features of VFs with DISH.

Methods: This study included 252 patients (70 men and 182 women; mean age±standard deviation, 81.0±8.6 years) with VFs in this study. Patients were divided into two groups depending on DISH (group D) or not (group N). We measured the sex, age, body mass index, hemoglobin A1c, and bone mineral density. This study also measured the spinopelvic sagittal alignments, local angular motion, inflection point, number of VFs, intervertebral disk (IVD) injury, and signal changes on magnetic resonance image (MRI).

Results: The presence of DISH in VFs was identified in 104 patients (41.3%) (49/70 [70.0%] in men vs. 55/182 [30.2%] in women). Group D was related to male sex, older age, larger thoracic kyphosis, VF at lower lumbar lesion, number of VFs, IVD injury, inflection point at lower lumbar, local angular motion, diffuse low signals on T1 MRI, and high or diffuse low signals on T2 MRI on univariant analysis. Multiple logistic regression analysis showed that the predictive factors for DISH were male sex, angular motion, VF at lower lumbar lesion, IVD injury, inflection point at lower lumbar, and diffuse low signals on T1 MRI.

Conclusions: DISH was related to IVD injury, angular motion, and diffuse low signals on T1 MRI. In addition, VFs with DISH were more frequently found in men at the lower lumbar lesion than in women at thoracolumbar. When physicians detect these factors, attention should be given to VFs with DISH, and whole-spine computed tomography should be considered not to overlook the presence of DISH.

Introduction: Low bone mineral density (BMD), a history of vertebral fractures (VFs), and steroid use are established risk factors for VFs. Additionally, age, nutritional status, muscle mass, and spinal sagittal alignment have been linked to osteoporosis and fractures. This study aims to investigate the risk factors contributing to new occurrences of VFs.

Methods: We included 597 patients with osteoporosis who visited our outpatient department and were available for follow-up 1 year after the visit. The following data were collected: age at examination, presence of secondary osteoporosis, body mass index, lumbar spine BMD, femoral neck BMD, number of VFs, grip strength, trunk muscle mass, controlling nutritional status (CONUT) score, sagittal vertical axis (SVA), pelvic tilt, pelvic incidence-lumbar lordosis, thoracic kyphosis on whole-spine standing radiography, and osteoporosis treatment status at baseline. Patients who had new VFs confirmed on whole-spine standing radiography at the 1-year follow-up visit were included in the group with new VF occurrence. We performed between-group comparisons of each parameter. Additionally, to identify risk factors for new VFs, we conducted a multivariate analysis using the presence of new VFs as the dependent variable.

Results: A total of 60 new VFs occurred during the 1-year period, representing 10.1% of the study population. When comparing the new VF incidence group with the non-incidence group, the CONUT score and SVA were significantly higher in the new VF incidence group. There were no significant differences between the 2 groups for the other variables. Multiple logistic regression analysis indicated that both a high CONUT score and SVA were independent risk factors for the occurrence of new VFs.

Conclusions: The 1-year incidence of new VFs was 10.1% among patients with osteoporosis, despite appropriate osteoporosis treatment. These patients also exhibited malnutrition and spinal sagittal malalignment at baseline. Our findings suggest that malnutrition and spinal sagittal malalignment may be independent risk factors for the occurrence of new VFs.

Introduction: Delayed diagnosis and therapy initiation for pyogenic spondylitis can have severe and fatal consequences. Early diagnosis and intervention are crucial in the treatment of pyogenic spondylitis. This multicenter cross-sectional study with prospective case series aimed to identify factors influencing the time from symptom onset to the diagnosis of pyogenic spondylitis.

Methods: Patients hospitalized with pyogenic spondylitis between 2019 and 2023 were included. Patients were classified into 2 groups: the delayed diagnosis group (>30 days from the onset of initial symptoms to the diagnosis of pyogenic spondylitis) and the early diagnosis group (within 29 days). Risk factors for delayed diagnosis were analyzed.

Results: A total of 74 patients (42 men and 32 women; mean age: 70.2 years) from 5 institutions were included. Univariate analysis of risk factors for delayed diagnosis revealed that the significant risk factors included advanced age (p=0.03), low white blood cell count (p<0.01), low C-reactive protein level (p<0.05), and semi-rigid spinal level, based on the spinal instability neoplastic score classification (p=0.05). Multivariate analysis for delayed diagnosis showed that the location at the semi-rigid spinal level was a significant risk factor (p=0.02). The vertebral bone destruction rate and abscess cavity index in the delayed diagnosis group were significantly higher than those in the early diagnosis group (p<0.01 and p<0.01, respectively).

Conclusions: Significant risk factors for delayed diagnosis of pyogenic spondylodiscitis include infection at the semi-rigid thoracic spinal level. Early diagnosis of spondylodiscitis is crucial because delayed diagnosis can lead to progressive bone destruction and the formation of large abscesses. Increased awareness of thoracic spinal infections, which can easily delay diagnosis, could help in the early diagnosis and treatment of pyogenic spondylodiscitis.

Introduction: This study aimed to compare the outcomes in patients who received non-steroidal anti-inflammatory drugs (NSAIDs) ≤90 days or 90 days-1 year after posterior cervical fusion (PCF) with those in patients who did not receive NSAIDs after surgery.

Methods: Using the MarketScan^Ⓡ Research Databases, we analyzed adults (18-90 years) who underwent PCF and adjusted for confounders with inverse probability of treatment weighting (IPTW) to compare outcomes in those receiving NSAIDs ≤90 days or 90 days-1 year after surgery and those not receiving NSAIDs within a year. In one analysis, we included single- and multi-level PCF, and in a sub-group analysis, we focused on single-level PCF. Outcomes included 30-day readmissions, pseudoarthrosis, hardware failure, and wound complications.

Results: After IPTW, NSAID use ≤90 days of single- and multi-level PCF was not associated with increased readmissions, pseudoarthrosis, or wound complications. However, NSAID use 90 days-1 year increased the odds of pseudoarthrosis and hardware failure (odds ratio 1.157, 95% confidence interval 1.075-1.245, p<0.001). In single-level PCF, NSAIDs use ≤90 days or 90 days-1 year of surgery was not associated with increased odds of complications. No difference was observed in postoperative complications between patients who took COX-2 selective inhibitors and those who took non-selective NSAIDs.

Conclusions: NSAID use ≤90 days of surgery does not increase the risk of adverse outcomes for either single- or multi-level PCF, suggesting it may be a viable option for pain management. Postoperative NSAID use 90 days-1 year does not seem to increase complications in single-level PCF. However, caution is advised for multi-level fusions or cases with complex clinical factors, in which NSAID use from 90 days-1-year postoperatively may increase the risk of pseudoarthrosis and hardware failure.

Introduction: Total disc replacement (TDR) using Mobi-C^Ⓡ and Prestige LP^Ⓡ was approved in Japan in 2017. To ensure effective surgical outcomes with TDR, the Japanese TDR guideline was established before its clinical use, and a registry system was developed to monitor the safety of early cases in Japan. This study assessed complications associated with TDR during the early post-approval period using this nationwide registry to evaluate the short-term safety of single-level TDR.

Methods: Data from the nationwide registry covering postoperative 2-year surveillance were analyzed for single-level TDR performed during the post-marketing surveillance period in Japan. The database included patient characteristics, surgical details, complications, and reoperations. Complication and reoperation rates were analyzed for the perioperative period during hospitalization and the postoperative period after discharge.

Results: In total, 332 patients were enrolled in this study, and 271 patients completed the 2-year follow-up (81.6%). Mobi-C^Ⓡ and Prestige LP^Ⓡ were used in 158 and 113 patients, respectively. Perioperative complications included hematoma (n=3) and airway obstruction (n=1). Three (1.1%) patients with hematoma underwent reoperation in the perioperative period during hospitalization. Overall, 20 (7.4%) patients experienced complications after discharge up to 2 years postoperatively, including recurrences of neurological symptoms (n=9), implant migration (n=2), implant subsidence (n=7), and others (n=3). Two (0.7%) patients who experienced a recurrence of neurological symptoms underwent additional posterior foraminotomy within 2 years postoperatively. One (0.4%) patient underwent implant removal and conversion to fusion due to implant subsidence.

Conclusions: The overall complication and reoperation rates of TDR were relatively low: 1.5% and 1.1% in the perioperative period during hospitalization and 7.4% and 1.1% within the 2-year postoperative period after discharge, respectively. TDR achieved favorable outcomes with acceptable complication rates when performed under appropriate surgical indications.

Introduction: To predict the onset of dysphagia in hospitalized patients with osteoporotic vertebral fractures (OVF) early after admission and to investigate cutoff values for risk factors.

Methods: The subjects were 341 hospitalized patients with OVF. We excluded 30 cases as the required data could not be measured, and 25 cases with conditions that could contribute to dysphagia, such as neurological or respiratory comorbidities. Gender, age, number and level of OVF, collapse rate (CR) of OVF, thoracolumbar kyphosis angle (KA), bone mineral density (BMD), systemic skeletal muscle mass index (SMI), and body mass index (BMI) were examined by dividing the patients into those with dysphagia (the P group) and others (the N group).

Results: There were 26 cases in the P group and 260 cases in the N group, with no significant difference in the male-female ratio, number, and level of OVF. The mean values of CR (%), KA in the P group/the N group were 40.0/36.1, 16.7/17.8, and the mean values of age, BMD (%), SMI (kg/m²), and BMI (kg/m²) in the P group/the N group were 86.4/82.3, 64.5/71.6, 4.43/5.58, 20.0/22.1 in men, 85.7/83.4, 55.1/63.8, 4.43/4.99, 19.4/21.6 in women, with significant differences in SMI in men and women and BMD in women. Analysis of SMI and BMD in women using a multivariate logistic model with dysphagia as the dependent variable showed that low SMI was an independent risk factor. The cutoff value, sensitivity, specificity, and area under the receiver operating characteristic curve for SMI were calculated. For men, the values were 4.610 kg/m², 0.867, 0.750, and 0.829, respectively, and for women, 4.410 kg/m², 0.790, 0.571, and 0.687, respectively.

Conclusions: A correlation was found between dysphagia and SMI in patients with OVF. For patients with SMI below the cutoff value, early swallowing evaluation and training intervention are considered important.

Introduction: Accurate pedicle screw placement is critical in spinal fusion surgery to prevent complications such as neurological and vascular injuries. While conventional intraoperative computed tomography (iCT) navigation systems enhance placement accuracy and reduce radiation exposure compared to fluoroscopic guidance, they can encounter line-of-sight issues that disrupt surgical workflows. The NextAR iCT navigation system aims to overcome these challenges by integrating an infrared camera directly onto surgical instruments, streamlining navigation and improving procedural efficiency.

Methods: This retrospective study evaluated the accuracy and safety of pedicle screw insertion using the NextAR navigation system in lumbar spinal fusion for degenerative diseases. We analyzed 307 screws using a CT-based grading system.

Results: Among the 307 screws inserted, only 8 (2.6%) exhibited minor deviations (grade 1 or 2), with no severe perforations (grade 3 or 4). There were no neurological or vascular complications related to screw placement. The NextAR system enabled precise pedicle screw insertion without the need for fluoroscopic guidance, eliminating radiation exposure for the surgical team.

Conclusions: The NextAR navigation system demonstrated high accuracy and safety in pedicle screw placement for lumbar degenerative diseases. By addressing line-of-sight issues inherent in traditional navigation systems and eliminating intraoperative radiation exposure, it offers significant procedural advantages. Further randomized controlled trials are needed to compare its effectiveness with other advanced navigation systems.