Spine Surgery and Related Research最新文献

Introduction: Lumbar spondylolysis (LS) is a stress fracture of the pars interarticularis that can occur in adolescents. Both early- and progressive-stage LS can be successfully treated with conservative therapy consisting of activity modification and external bracing; however, conservative therapy is not suitable for athletes who hope for an early return to sports. We introduce a novel, minimally invasive surgical technique for the treatment of LS that enables an early return to sports and describe surgical results, including bone union rates, time of both bone unions, and return to sports.

Technical note: To facilitate an early return to sports in adolescent athletes with early-to-progressive-stage LS, we developed a percutaneous spondylolysis repair technique using cannulated compression headless screws with a cortical bone trajectory. Fourteen adolescent athletes underwent this technique; as a result, all athletes achieved bone union and returned to sports within 3 months.

Conclusions: This minimally invasive surgical technique for LS can achieve early bone union in adolescent athletes, thereby facilitating an early return to sports.

Introduction: Postoperative infection remains a significant concern and technical challenge for spine surgeons. Preoperative albumin level may predict risk of infection, but no definitive consensus regarding the optimal preoperative albumin level in anterior cervical discectomy and fusion (ACDF) has been reached. Therefore, this study aimed (1) to determine the impact of preoperative albumin on complications following ACDF and (2) to identify optimal albumin threshold that minimizes the likelihood of infection following ACDF.

Methods: A retrospective cohort analysis was performed using a national database. Patients with a preoperative measurement of albumin prior to ACDF were included, whereas patients undergoing multilevel ACDF were excluded. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven albumin strata that minimized the likelihood of infectious complications within 30 days of ACDF.

Results: A total of 30,896 ACDF patients were included in this study. Stratum-specific likelihood ratio analysis identified two albumin strata: 1-3 and 3+ g/dL prior to surgery. Relative to the 3+ g/dL cohort, the 1-3 g/dL cohort was more likely to experience 30-day infectious complications such as deep surgical site infection (SSI) (OR: 8.02, P<0.001) and SSI domain (OR: 4.85, P<0.001).

Conclusions: This study demonstrates a significant association between preoperative albumin level and infectious complications following ACDF. These results emphasize the importance of integrating nutritional management strategies into the broader context of surgical decision-making, thus contributing to enhanced patient outcomes and quality of care in spine surgery.

Introduction: Japan is experiencing a significant demographic shift characterized by a declining birthrate and an aging population. A previous report indicated a discrepancy between the trends in the number of spinal surgeries performed for minors and the overall population dynamics. Japan has the National Database of Health Insurance Claims and Specific Health Checkups (NDB), which contains 99.9% of public health insurance claims from hospitals and 97.9% from clinics. This study aimed to investigate the annual number of scoliosis surgeries performed on patients aged 19 years in Japan, evaluate trends in relation to the overall population dynamics, and examine potential factors contributing to the observed changes.

Methods: This retrospective study utilized NDB and census data. Scoliosis surgeries were identified using K-codes specific to the procedure. Population data were estimated using census and national birth records released by the Japan Cabinet Office. The number of surgeries per 100,000 minors was calculated, and trends were analyzed from 2014 to 2021.

Results: The number of scoliosis surgeries for patients under 19 years old increased from 1,282 in 2014 to 1,850 in 2021, despite a decrease in the number of patients under 19 years old. The rate of scoliosis surgeries per 100,000 minors increased from 5.6 in 2014 to 9.1 in 2021, whereas other spinal fusion procedures for minors did not show significant changes during the same period.

Conclusions: Despite a decline in the underage population, the number of scoliosis surgeries among minors has paradoxically increased in Japan. Improvements in screening tools and the April 2016 change in the law mandating a full motor examination, including scoliosis testing, may have affected this trend. Further follow-up studies are required.

Introduction: Despite an increase in the demand for surgical treatment of elderly patients with degenerative spinal disorders, little is known about mortality following spinal surgery in this population. This study aims to identify the incidence and causes of in-hospital mortality in elderly patients after elective spine surgery.

Methods: We extracted the data of patients aged ≥65 years who underwent elective spine surgery between December 12, 2016, and May 31, 2022, from our prospective multicenter cohort. The primary outcome was the in-hospital mortality rate. Univariate analysis was conducted to identify potential risk factors for postoperative mortality. The detailed clinical course of patients who died was retrospectively investigated using medical records.

Results: A total of 10,976 eligible patients (5,976 males and 5,000 females), with a mean age of 75.5 years, were identified. There were eight in-hospital deaths (0.07%). Univariate analyses showed that the eight patients were significantly older (82.1 years vs. 75.5 years, P=0.008), were more frequently hemodialysis-dependent (50.0% vs. 2.9%, P<0.001), and had a higher proportion of cases with cervical surgery (62.5% vs. 17.0%, P<0.001) and preoperative American Society of Anesthesiologists Physical Status ≥3 (87.5% vs. 14.6%, P<0.001). Death occurred at a median of 24.5 days postoperatively. The causes of in-hospital death were as follows: gastrointestinal diseases in five cases (ischemic colitis in three cases, panperitonitis in one, and intestinal perforation in one), sepsis due to unknown causes in two, and lethal arrhythmia in one. The initial symptoms preceding the lethal clinical course were mainly common gastrointestinal symptoms, such as abdominal pain, anorexia, diarrhea, and vomiting.

Conclusions: The main cause of in-hospital mortality was gastrointestinal disease. Surgeons should be aware that common gastrointestinal symptoms can be the initial symptoms of a subsequent lethal clinical course in elderly patients.

Introduction: Thoracic ossification of the ligamentum flavum (T-OLF), which leads to neurological impairment, is a rare pathologic entity. Open posterior laminectomy is the gold standard treatment for T-OLF. However, the high rates of postoperative complications and perioperative morbidity have raised many concerns among surgeons. This study presented a series of patients with symptomatic single-level T-OLF who underwent posterior decompression using biportal endoscopic spinal surgery (BESS). The objective of this study was to demonstrate our procedure using BESS for T-OLF resection and to evaluate its safety and efficacy.

Methods: We retrospectively reviewed patients who previously underwent thoracic posterior decompression with BESS between February 2021 and March 2023. Neurological status was assessed using the revised Japanese Orthopedic Association (JOA) score for thoracic myelopathy before surgery and at the final follow-up, along with the recovery rate (RR) at the final follow-up. The radiological outcome was evaluated by measuring the cross-sectional area (CSA) of the spinal canal from the T2 axial images at the most stenotic level, before and after surgery.

Results: Twenty patients (8 male and 12 female; aged between 38 and 79 years) were enrolled in this study. The mean operation time was 89.7±21.8 min. The average JOA score was 5.6±1.1 before surgery and 9.1±1.0 at the final follow-up. The average RR at the final follow-up was 65.6%. Outcomes were classified as excellent in six patients (30.0%), good in nine patients (45.0%), and moderate in five patients (25.0%), with no cases categorized as fair or worsened (0%). The mean preoperative and postoperative CSA were 0.92±0.14 cm² and 1.38±0.22 cm², respectively.

Conclusions: BESS is a safe, effective, and minimally invasive alternative to conventional open surgery for single-level T-OLF.

Introduction: To compare the clinical outcomes between a full-endoscopic transforaminal approach lumbar interbody fusion (TF-LIF) using the percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) system and a minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: A total of 102 patients (80 females, 22 males; mean age: 70.0 years) with degenerative lumbar spine disorders who underwent PETLIF and were followed up for 2 years were assigned to the PETLIF group. Based on age, sex, and operated lumbar levels in the PETLIF group, 100 patients (71 women and 29 men; mean age: 68.9 years) who underwent MIS-TLIF were randomly selected and included in the MIS-TLIF group. This retrospective investigation included surgical data, radiographic assessment, and clinical outcomes.

Results: The fusion rate was 95.1% and 96.0% in the PETLIF and MIS-TLIF groups, respectively (P=0.38). The decrease in hemoglobin levels from before surgery to 1 day after surgery was significantly lower in the PETLIF group than in the MIS-TLIF group (P<0.01). Five patients had detectable transient neurologic disorders after PETLIF that were resolved within 3 months. The increase in the local lordosis angle from before surgery to the final follow-up was significantly higher in the MIS-TLIF group than in the PETLIF group (P<0.01). Clinical scores were comparable between the two groups.

Conclusions: Compared with MIS-TLIF, PETLIF showed excellent bone fusion rate and clinical outcomes. It was minimally invasive, resulting in less blood loss. However, exiting nerve root injury was a PETLIF-specific complication, and proper preventive management, including techniques to enlarge the Kambin's triangle, is required.

Introduction: To estimate natural standing sagittal alignment in patients with adult spinal deformity (ASD), we previously reported the normative values of anatomical pelvic parameters in a healthy population, based on the anterior pelvic plane (APP), and observed the relationships between anatomical and positional pelvic parameters in the standing position. As the second step, we aim to investigate the relationships between anatomical pelvic parameters and standing spinal sagittal alignment in a healthy population.

Methods: We analyzed biplanar, slot-scanning, full-body stereo radiography of 140 healthy Japanese volunteers (mean age, 39.5 years; 59.3% women). The APP was defined by bilateral anterior superior iliac spines and anterior surface of the pubis symphysis. Anatomical sacral slope (aSS) and anatomical pelvic tilt (aPT) were calculated as angles of the SS and PT regarding the APP.

Results: The APP was tilted anteriorly in the sagittal plane by an average of 0.7°. Anatomical pelvic parameters significantly correlated with standing sagittal parameters, except for cervical lordosis and T4-12 thoracic kyphosis (TK) (p<0.05). L4-S1 lumbar lordosis (LL) significantly correlated with aPT and aSS, but not with pelvic incidence (PI). In addition, T1-12 TK significantly correlated with aSS. Multiple linear regression analysis for lumbar alignment produced the following equations: L1-S1 LL (°)=0.588×aSS+30.522, L4-S1 LL (°)=0.165×aSS-0.248×aPT+32.825, lordosis distribution index (%)=-0.662×PI+102.8.

Conclusions: Novel relationships in a healthy population were identified between the anatomical characteristics of the pelvis and standing sagittal parameters not represented by PI. This novel measurement concept based on the APP may estimate natural standing sagittal alignments and proportions using anatomical pelvic parameters in ASD.

Introduction: Acute celiac artery compression syndrome occurs after corrective surgery for adult spinal deformity. It occurs due to ischemic abdominal organ necrosis, caused by compression of the celiac artery (CA) and superior mesenteric artery by the median arcuate ligament. There are no studies measuring the extent of CA or superior mesenteric artery stenosis. Therefore, this study aimed to investigate stenotic changes in the CA after adult spinal deformity surgery.

Methods: We obtained contrast-enhanced computed tomography scans for 21 pre-and postoperative patients with adult spinal deformity. Three-dimensional reconstruction computed tomography measured the degree of stenosis in the CA trunks. Stenosis was considered worse if it progressed from being less than 35% before surgery to over 50% afterward. This study investigated the relationship between worsening CA stenosis and the median arcuate ligament crossing the proximal portion of the celiac axis (median arcuate ligament overlap) or the distance between the median arcuate ligament and the anterior edge of the vertebra (DMV). Change in spinal parameters was defined as differences between pre- and postoperative values.

Results: The average stenosis degree in the CA was 9.4%±11.4% pre-operatively, which increased to 25.1%±21.8% post-operatively (P=0.002). In contrast, the stenosis degree in the superior mesenteric artery was 5.6%±7.1% before and 7.9%±10.2% after surgery (P=0.177). CA stenosis worsened in four patients (19.0%), which was significantly associated with preoperative median arcuate ligament overlap (P=0.012) and ΔDMV (P<0.001).

Conclusions: Nineteen percent of patients undergoing adult spinal deformity correction surgery experienced worsened CA stenosis. Risk factors were preoperative median arcuate ligament overlap and DMV shortening during adult spinal deformity correction surgery. Moreover, patients with preoperative CA stenosis and median arcuate ligament overlap were at risk for acute celiac artery compression syndrome following adult spinal deformity surgery.

Introduction: Chemonucleolysis with condoliase (chondroitin sulfate ABC endolyase) has been widely employed to treat patients with lumbar disc herniation (LDH) in Japan. Although it is an effective and relatively safe treatment for radicular neuropathy in patients with LDH, there have been no reports that investigate how severe low back pain (LBP) changes after condoliase injection. In this multicenter study, the effectiveness of condoliase injection for reducing severe LBP in patients with LDH was evaluated.

Methods: This retrospective study involved patients treated with intradiscal condoliase injection for LDH at nine participating centers. Patients were diagnosed with subligamentous-type herniation based on pretreatment MRI. Patients with severe LBP (defined as a preinjection numeric rating scale [NRS] for LBP greater than or equal to that for leg pain) were categorized into the LBP group. Demographic data, adverse events, treatment costs, and the NRS for LBP and lower extremity pain were analyzed. A 50% response was defined as ≥50% improvement in the NRS at 1 year postinjection. On the basis of the Pfirman classification, the LBP group was divided into less-degenerative (Grades II and III) and degenerative (Grades IV and V) subgroups.

Results: Seventy-nine patients were classified into the LBP group. Of these patients, 61 (77.2%) showed a >50% reduction in LBP, and another 61 (77.2%) demonstrated a >50% reduction in lower extremity pain. Improvement of lower limb pain was considerably better in the less-degenerative group than in the degenerative group, whereas that of low back pain was similar between the two subgroups. Medical costs, which include remuneration for injection, drug fees, inpatient costs, and other expenses, were similar between the LBP group and all cases.

Conclusions: This retrospective multicenter study revealed that patients with LDH with severe LBP frequently experienced improvement in radicular pain and LBP, which is similar to LDH cases without severe LBP.