Spine Surgery and Related Research最新文献

Background: Symptomatic lumbar foraminal stenosis (LFS) occurs when the neuroforamen narrows, compressing the exiting spinal nerve, leading to symptoms such as radicular pain, paresthesias, and potentially weakness. Although cross-sectional imaging studies are used for diagnostic purposes, there is no clear consensus as to which grading system best evaluates LFS, predisposing to inconsistencies in care. This systematic review aimed to evaluate and compare existing published grading systems for LFS to identify (1) systems most used within the literature and (2) the most effective and reliable method for classifying anatomic severity and clinical symptom correlation.

Methods: This study is a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing available literature on grading systems for LFS, level of evidence IV. A comprehensive search of PubMed, Embase, and Cochrane Trials was conducted from inception through July 2024. Eligible studies were evaluated for methods, bias, sample size, patient demographics, imaging modalities, and grading systems. Bias was assessed using the Methodological Index for Non-Randomized Studies. Data were synthesized narratively and descriptively.

Results: The review included 35 studies, most using magnetic resonance imaging (88.6%). Seven grading systems have been identified. The original Lee et al. grading system was the most frequently used LFS grading system (69%), followed by Wildermuth et al. (14.3%). Notably, artificial intelligence (AI) grading systems were included in two studies (5.7%). Findings regarding symptom correlation were mixed.

Conclusions: The Lee et al. grading system remains the most used grading system for LFS in the literature and is reliable. Several small studies found an association between the Lee et al. system and clinical symptoms/treatment outcomes; however, this was not universally found. Further investigation is needed to validate the newer grading. The introduction of AI may offer promise for refining the diagnostic and clinical utility of published LFS grading systems.

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.

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.

Lumbar disc herniation (LDH) is one of the main causes of low back pain, and far lateral lumbar disc herniation is a specific type of LDH. Owing to the limitation of the bony structure and surrounding ligaments in the foraminal area, the closer the protrusion inside and outside the foramen is to the exiting nerve root ganglia, the more severe the compression. Therefore, the clinical symptoms of this type of LDH are more pronounced, and timely diagnosis and treatment are required. Some patients can experience pain relief through conservative treatment, whereas others require surgical intervention. Spine surgeons can choose different surgical options according to the patient's condition and their own surgical habits, such as traditional surgery, microendoscopic discectomy, percutaneous endoscopic lumbar discectomy, and unilateral biportal endoscopy. There are different characteristics between traditional surgery and minimally invasive surgery, and there are also different characteristics between different minimally invasive surgeries. This article reviews the anatomical structure, clinical manifestations, and various treatment approaches.

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.