Spine Surgery and Related Research最新文献

Introduction: This study investigated brace treatment for patients with adolescent idiopathic scoliosis (AIS) to comprehensively evaluate the factors associated with curve progression, including the effects of in-brace correction rate (ICR) and objective brace compliance. Additionally, it aimed to establish a clinically useful optimal ICR threshold for effective curve progression control.

Methods: In this single-center retrospective analysis of prospectively collected data, 116 patients with AIS, with Cobb angles of 20°-40° and at least 1-year follow-up were included. Patients whose Cobb angles progressed by >5° were classified into the progressed group, whereas the others were categorized into the non-progressed group. Bracing time was objectively assessed using a thermometer.

Results: In this study, 19 (16.4%) patients were assigned to the progressed group. Open triradiate cartilage was significantly more frequent in the progressed group (22.2% vs. 2.6%, p=0.011) whereas no significant differences were observed in demographics or pre-brace Cobb angles. The progressed group demonstrated a lower ICR (26.8% vs. 39.5%, p=0.002) and shorter bracing time at 6 months (14.0 hours vs. 17.4 hours, p=0.042). Multivariate logistic regression analysis revealed that Sanders grade (1-4), ICR, and bracing time were independently associated with Cobb angle progression (odds ratios: 7.01, 0.95, and 0.89, respectively; all p<0.05). Based on receiver operating characteristic curve analysis, the ICR threshold of 38.3% was identified to achieve a clinically significant negative predictive value of 95%.

Conclusions: Under objective bracing time monitoring, skeletal maturity, ICR, and bracing time were crucial factors in preventing curve progression 1 year after brace initiation in patients with Cobb angles of 20°-40°. An ICR of 38.3% is recommended as the target when bracing adjustments are feasible.

Introduction: Surgical outcomes for adult patients with residual adolescent idiopathic scoliosis (AdIS) with a major thoracic curve are expected to be inferior to those of AIS but have not been well reported. This study aimed to evaluate surgical, radiographical, and clinical results in adult patients with AdIS and to characterize these patients by comparing their results with those of patients with adolescent idiopathic scoliosis (AIS).

Methods: Thirty-five patients with AdIS, who were diagnosed with AIS Lenke type 1 or 2 before the age of 19 years and underwent surgery after the age of 20 years, were included in the study. As a control group, 84 patients with AIS Lenke type 1 or 2 who underwent surgery before the age of 19 were included. Both groups were matched on the basis of the preoperative main thoracic (MT) and proximal thoracic (PT) Cobb angles, causing 30 patients to be selected in each group.

Results: The AdIS group exhibited a greater preoperative bending Cobb angle of the MT and PT curves (MT: 35.1° vs. 31.3°, PT: 17.8° vs. 13.8°) and a lower MT curve flexibility index than in the AIS group (36.6% vs. 42.2%). Postoperatively, the AdIS group had a higher number of fused intervertebral segments than did the AIS group (8.2 vs. 7.4), but the correction rate was comparable in the 2 groups. Moreover, the intraoperative time was longer and blood loss was larger in the AdIS group. In the Scoliosis Research Society (SRS)-22 score, self-image and mental health domains were significantly lower preoperatively in the AdIS group. Postoperative improvement of self-image domain was significantly greater in the AdIS group (Δ self-image: 1.6 vs. 0.9), and postoperative satisfaction was similar in the 2 groups.

Conclusions: Surgical invasiveness was increased in AdIS, and preoperative SRS-22 scores were lower in self-image and mental health domains than in AIS. However, postoperative SRS-22 scores were comparable, and postoperative self-image improvement was significantly greater in AdIS than in AIS.

Background: Cortical bone trajectory screw (CBTS) is reported to offer increased cortical bone purchase and improved outcomes as compared to the traditional pedicle screw (PS), particularly in osteoporotic patients. The systematic review aims to compare randomized controlled trials comparing CBTS with PS in single-level lumbar spine fusion surgery.

Methods: A systematic search was conducted on PubMed (MEDLINE), Scopus, Embase, Web of Science, and Cochrane. Moreover, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), and China National Knowledge Infrastructure (CNKI) were also searched. Outcome measures included fusion rates, complication rates, perioperative parameters, pain scores, and functionality. (PROSPERO: CRD42024523809).

Results: Four manuscripts, reporting on three randomized controlled trials (RCTs) and 416 patients, were included in this review. The follow-up ranged from 24 to 26 months postoperatively. All patients underwent single-level fusion only. There was no significant difference in the fusion rates between CBTS and PS at one-year (risk ratio [RR] 1.05 [0.97, 1.13], p=0.24) or two-year (RR 1.02 [0.96, 1.08], p=0.47) follow-ups. The CBTS group had a lower risk of intraoperative complications (RR 0.44 [0.32, 0.60], p<0.001) but an equal risk of postoperative complications (RR 0.71 [0.42, 1.22], p=0.22). There was no difference in pain, functionality, disability, and quality-of-life scores. CBTS group had better outcomes in incision length (mean difference [MD] -25.44 [-40.76, -10.12], p=0.001), operative time (MD -20.71 [-32.91, -8.51], p=0.009), and blood loss (MD -60.23 [-106.74, -13.72], p=0.01), while there was no difference in length of stay (MD -0.49 [-1.01, 0.04], p=0.07).

Conclusions: Although slightly favoring CBTS, RCTs were limited in number and had a serious risk of bias. Future RCTs should use superiority trial designs, have minimal bias, and include implant details, incidence of adjacent segment disease, and quality-of-life metrics.

Introduction: The study investigated the complications of adult spinal deformity (ASD) surgery in Japan in 2022 using the Japanese Orthopedic Association National Registry/Japanese Society for Spine Surgery and Related Research Database (JOANR/JSSR-DB).

Methods: Among the 158,407 patients registered in JOANR/JSSR-DB, 4,822 patients aged ≥19 years (1,115 males [23.1%], 3,707 females [76.9%]) were included in this study. Diagnoses were scoliosis in 1,961 patients (40.7%), kyphosis in 1,613 patients (33.4%), and kyphoscoliosis in 1,248 patients (25.9%). Intra-operative and postoperative/systemic complications (within 30 days) were investigated.

Results: The age distribution was 468 (9.7%) aged 19-39, 855 (17.7%) aged 40-64, 1,779 (36.9%) aged 65-74, and 1,720 (35.7%) individuals aged ≥75 years, with 72.6% of the total population aged ≥65 years. The total complication rate was 11.8% (567 patients), with 6.2% in patients aged 19-39 years, 12.6% in patients aged 40-64 years, 11.6% in patients aged 65-74 years, and 13.0% in patients aged ≥75 years, whose rate was significantly higher (p<0.001). Intra-operative complications occurred in 215 patients (4.5%). Dural tear in 110 patients (2.3%), massive bleeding (>2,000 ml) in 54 (1.1%), implant-related complications in 14 (0.3%), and intra-operative nerve injury in 10 patients (0.2%). Postoperative complications occurred in 266 patients (5.5%). Lower extremity paralysis in 99 patients (2.0%), surgical site infection in 55 (1.1%), vertebral body or endplate injury in 25 (0.5%), epidural hematoma in 18 (0.4%), and weakness of the iliopsoas muscle due to lateral lumbar interbody fusion in 21 patients (0.4%). Systemic complications occurred in 162 patients (3.4%) with urinary tract infection in 29 (0.6%) and postoperative delirium in 26 (0.5%).

Conclusions: While the 11.8% total complication rate was lower than previous reports, rates were higher in patients aged ≥75, indicating the need for careful perioperative management in elderly patients.

Introduction: Some cases of postoperative correction loss have been observed in the reduction of vertebral slippage using a percutaneous pedicle screw system for lumbar degenerative spondylolisthesis. We aimed to identify the risk factors for correction loss after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine the effect of postoperative correction loss on postoperative clinical outcomes.

Methods: In this retrospective study, a total of 111 patients (mean age 69.5 years, 37 men and 74 women) who underwent single-level MIS-TLIF with slippage reduction for lumbar degenerative spondylolisthesis and were followed up for >1 year were included in the study. The correction loss group (group L) included those with a correction loss of ≥3 mm between immediately after surgery and 1 year after surgery, and the correction maintenance group (group M) included those with a correction loss <3 mm. Demographic data, preoperative and postoperative radiographic measurements, and clinical outcomes were collected, and the risk factors in group L and clinical outcomes in the two groups were analyzed statistically.

Results: Groups L and M comprised 19 and 92 cases, respectively. High pelvic incidence-lumbar lordosis (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.07-1.25, p<0.001), high slip vertebra slope (OR: 1.22, 95% CI: 1.07-1.39, p<0.001), and ≥10° segmental angulation (OR: 15.00, 95% CI: 3.04-73.95, p=0.0022) were risk factors for correction loss; however, low bone density was not. The Oswestry Disability Index and Visual Analog Scale scores for low back pain, leg pain, and leg numbness were not significantly different between both groups; however, the bone union rate at 6 months postoperatively was significantly lower in group L (p=0.0020).

Conclusions: Postoperative correction loss was influenced by preoperative sagittal alignment and instability rather than bone density. Patients with correction loss tend to have prolonged bone union and should be closely monitored.

Introduction: The pathogenesis of dropped head syndrome (DHS) involves factors like fat infiltration of the cervical extensor muscle, cervical degeneration, and sarcopenia, which are typically assessed using conventional imaging. Previous studies have demonstrated cervical and thoracic anterior tilt deterioration during gait in patients with DHS. However, the relationship between dynamic spinal balance and conventional imaging findings has not been investigated. The purpose of this study was to investigate the walking posture of patients with DHS using 3D gait motion analysis and to analyze the relationship between dynamic posture and conventional imaging factors, leading to the investigation of the pathophysiology of cervical imbalance during gait in patients with DHS.

Methods: Twenty-two patients with DHS were included. Global and cervical static alignments were assessed using whole spine radiography. 3D gait motion analysis was performed, and dynamic kinematic variables were segmented into the cervical and thoracic regions. The paraspinal muscle activity was assessed using wireless surface electromyography. The cervical deep extensor muscle (C-DEM) condition was assessed using magnetic resonance imaging. Correlations of changes in dynamic kinematic variables with paraspinal muscle activity and C-DEM condition were determined.

Results: A significant change in the anterior cervical and thoracic spine tilt was observed during gait. These changes were inversely correlated with thoracic paraspinal muscle activity. The change in the cervical anterior tilt was significantly correlated with the fat-free C-DEM at C3/C4 and C4/C5 and the fat infiltration rate of the C-DEM at C5/C6 and C7/T1.

Conclusions: The thoracic paraspinal muscle activity failed to respond to the deterioration of the thoracic anterior tilt, indicating a notable contribution to postural endurance during gait and to DHS pathogenesis. Evaluating the condition of the C-DEM could be an alternative for evaluating dynamic postural endurance and is clinically important when considering patient complaints regarding difficulties in daily activities.

Introduction: Cervical compressive myelopathy is a leading cause of spinal cord dysfunction in middle-aged and older adults. Although the pathological classification of cervical myelopathy is well established, the quantitative analysis of its imaging features remains underexplored. This study quantitatively evaluated the imaging characteristics of unilateral motor deficit cervical compressive myelopathy.

Methods: This retrospective observational study included patients who underwent surgery for cervical compressive myelopathy between 2009 and 2023. Pre-operative cervical magnetic resonance imaging (MRI) and postmyelographic computed tomography (CTM) axial images were assessed for spinal cord rotation, deformity, available space, and signal changes. Patients were classified into unilateral motor deficit (Group U) and symmetric transverse (Group ST) types, and were analyzed for specific imaging parameters.

Results: The final analysis included 119 of the 812 identified patients. Group U patients were younger (59.1±13.8 years) and had higher Japanese Orthopaedic Association scores (10.6±2.7) compared with Group ST patients (71.1±11.0 years, 8.4±2.3). Group U showed significant morphological differences, including a reduced anterior-subarachnoid space and increased spinal cord rotation on the affected side. Group U exhibited significant differences in the median fissure rotation angle (7.4°±6.7°) and anterior-aspect rotation angle ratio (1.26±0.31) compared with Group ST (4.14°±3.87°, 1.10±0.14). Receiver operating characteristic curve analysis identified specific cutoff values for distinguishing Group U (2.80° for median fissure rotation angle and 1.116 for anterior-aspect rotation angle ratio). The MRI-based detection sensitivity was lower in Group U (27.6%) compared with in Group ST (68.9%).

Conclusions: Unilateral motor deficits are associated with distinctive spinal cord rotational deformities, including a greater median fissure rotation angle and anterior-aspect rotation angle ratio. CTM is better than MRI for detecting unilateral motor deficits. Future research to improve treatment outcomes should focus on spinal cord circulation assessment using advanced imaging techniques.

Background: Degenerative scoliosis is a progressive side-to-side deformity of the spine that is common in mature individuals, characterized by a Cobb angle of >10°. Current treatment options vary and can be categorized as conservative or non-conservative (surgery), with the primary goal of pain reduction. However, there is conflicting evidence regarding which treatment option is most effective. The aim of this study was to determine the effectiveness of braces in this group of subjects.

Methods: A systematic search was conducted in databases including PubMed, Web of Science, Scopus, and Embase for the period between 1950 and 2024. Keywords used were: (degenerative scoliosis OR adult scoliosis) AND (conservative treatment OR brace OR orthosis). The quality of the selected studies was evaluated using the Downs and Black tool.

Results: Of 500 papers identified in the search, a total of 11 studies were chosen for final analysis. Most of the selected studies focused on the effects of various types of braces on pain intensity, quality of life, and functional performance in subjects with degenerative scoliosis.

Conclusions: Based on the available literature and the lack of strong studies on the effectiveness of braces, it cannot be definitively concluded that the use of braces reduces the severity of scoliosis curves in adults with degenerative scoliosis. However, braces may have an impact on quality of life and pain severity in this group of subjects.

Introduction: Impaired standing alignment and postural instability diminish health-related quality of life (HRQOL). Reduced trunk muscle mass is correlated with worsened spinal alignment and HRQOL in patients with spinal disease. However, the interplay among standing balance, whole-body alignment, muscle mass, and HRQOL remains unclear. This study aimed to elucidate this relationship.

Methods: This study evaluated the influence of whole-body alignment, standing balance, skeletal muscle mass (SMM), aging, and sex on HRQOL in healthy volunteers (HV; men/women: 37/63, median age: 45), patients with lumbar degeneration (LD; men/women: 100/100, median age: 65), and patients with spinal deformity (SD; men/women: 16/84, median age: 71). HRQOL was assessed using the Scoliosis Research Society-22 (SRS-22r). Whole-body alignment and standing balance were measured using EOS Imaging combined with simultaneous force plate measurements. SMM was measured using a medical body composition analyzer. Based on univariate analysis and multicollinearity, 10 selected parameters were used in multivariate logistic regression analysis to identify factors affecting SRS-22r.

Results: The SRS-22r score was significantly higher in the HV group than in the LD and SD groups; however, there were no significant differences between men and women. The whole-body alignment and standing balance were better in the HV group, followed by the LD and SD groups. The total-body SMM (SMM.total) of men was significantly lower in the LD and SD groups than in the HV group. In females, the SMM.total was significantly lower in the SD group than in the HV and LD groups. However, trunk SMM did not significantly differ among the three groups. Based on the multivariate analyses, diagnosis, body mass index (BMI), SMM.total, lumbar lordosis (LL), and T1 pelvic angle (TPA) were correlated with the SRS-22r score.

Conclusions: HRQOL was negatively affected by spinal disease, as well as by higher BMI, lower SMM.total, and sagittal malalignment (smaller LL and greater TPA).