Spine Surgery and Related Research最新文献

Introduction: Cervical pedicle screw (CPS) placement is crucial for posterior cervical fusion surgery due to its strong fixation ability. However, CPS insertion is associated with risks, including screw perforation, which can lead to complications such as vertebral artery injury and neurological deficits. Although previous studies have explored some morphological factors affecting CPS placement, comprehensive data on specific parameters contributing to perforation remains limited. This study aimed to investigate cervical vertebrae features associated with CPS perforation and established threshold values for improved preoperative planning.

Methods: A retrospective analysis of 36 patients who underwent posterior cervical fusion surgery with CPS placement was conducted using preoperative computed tomography (CT)-based navigation. Cases with CPS insertion at C1 or C2 were excluded. The key morphological parameters-optimal screw trajectory angle, pedicle diameter, and distance from the entry point to the pedicle isthmus (DEP)-were measured on preoperative CT images. CPS placement accuracy was assessed postoperatively using Neo's classification. The receiver operating characteristic (ROC) curve analysis determined the cutoff values for predicting CPS perforation.

Results: Among the 102 CPSs placed from C3 to C7, the overall perforation rate was 25.5%. C3 had the highest perforation rate (45.5%), whereas C7 had the lowest (3.1%). The vertebrae with CPS perforation exhibited a significantly larger optimal screw trajectory angle (45.5° vs. 38.0°, p<0.001), smaller pedicle diameter (4.2 mm vs. 5.2 mm, p<0.001), and longer DEP (13.2 mm vs. 11.9 mm, p=0.002). The ROC analysis identified the following cutoff values: 44.0° for the optimal angle, 4.35 mm for the pedicle diameter, and 12.7 mm for the DEP. These morphological parameters strongly predicted the risk of CPS perforation.

Conclusions: Establishing key morphological thresholds enhances preoperative planning for CPS placement, improves accuracy and patient safety, and minimizes complications.

Introduction: Endoscopic Spine Surgery (ESS) has begun to gain traction as an alternative to traditional microscopic spine surgery, particularly for lumbar decompression. However, one of the challenges associated with this approach is the steep learning curve. A recent advancement in this field aims to flatten the learning curve by incorporating navigation into ESS. This technology provides valuable information on the extent of decompression, confirms the working level, and reduces radiation exposure.

Technical note: We aimed to describe our experience using electromagnetic navigation in biportal endoscopic spine surgery (BESS). The surgical technique is initiated by positioning the patient prone on a radiolucent table. The navigation field generator is positioned over the caudal end of the patient. The navigation system is set up with patient mappers at the desired working levels. The patient tracker is implanted. The final fluoroscopy images are captured in anteroposterior and lateral views. Subsequently, standard incisions are made, and endoscopic decompression is performed. When required, various instruments can be used to confirm the level, angulation, and extent of decompression.

Conclusions: Our experience showed that this approach reduced the need for intraoperative imaging and provided an accurate alternative to repeated intraoperative imaging. However, it does involve a significantly long setup. Further trials of larger scale are required to determine its efficacy.

Introduction: Spinal alignment in women with osteoporosis tends to deteriorate with advancing age, and this misalignment may serve as an indicator of future fall-related fractures. Vertebral fractures, which commonly occur in patients with osteoporosis, have distinct characteristics compared with other fall-related fractures and should therefore be separately evaluated. This study aimed to investigate the association between future fall-related fractures and sagittal spinal alignment, excluding vertebral fractures.

Methods: A total of 333 women with osteoporosis were recruited and followed up between November 2013 and July 2024. At baseline, information on medication status and bone mineral density in the lumbar spine and femoral neck was obtained from the patients' medical record. Furthermore, the locomotive syndrome (LOCOMO) stage was assessed via risk tests, and sagittal alignment parameters, including sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic incidence (PI), and lumbar lordosis (LL), were evaluated. In addition, Cox proportional hazards regression analysis was conducted to determine the risk of fall-related fractures based on all variables.

Results: The mean follow-up period was 5.4 years. The final sample for assessing fall-related fracture incidence consisted of 214 participants. Fall-related fractures occurred in 31 of the 333 participants (9.3%). Cox proportional hazards regression analysis, adjusted for all variables, revealed that SVA (hazard ratio [HR]=1.011, 95% confidence interval [CI] 1.003-1.02), LL (HR=1.039, 95% CI 1.007-1.072), LOCOMO stage (HR=1.801, 95% CI 1.127-2.879), and presence of parathyroid hormone (HR=0.165, 95% CI 0.031-0.891) are independent risk factors for future fall-related fractures.

Conclusions: Awareness of fall-related fracture risks can be increased by monitoring the SVA, LL, and LOCOMO stage as well as administering parathyroid hormone medications. While the deterioration of sagittal spinal alignment is a well-known factor in vertebral fractures, this study suggests that future fall-related fractures, excluding vertebral fractures, are influenced by sagittal spinal alignment.

Introduction: Cage subsidence (CS) after posterior or transforaminal lumbar interbody fusion (PLIF or TLIF) is challenging; however, its impact on health-related quality of life (HRQOL) remains unclear. This study aimed to explore the impact of CS occurrence on HRQOL and identify the risk factors in patients following PLIF or TLIF.

Methods: A total of 138 patients (mean age, 67 years; follow-up period, 12 months) who underwent single-level PLIF or TLIF were retrospectively analyzed. CS was defined as >1 mm sinking of the intervertebral cage evaluated via computed tomography. The patients were divided into the CS and nonsubsidence (NS) groups. HRQOL was assessed using the Oswestry Disability Index (ODI) scores.

Results: Among the 138 patients, 30 (22%) developed CS following PLIF or TLIF. All cases with TLIF surgery (n=25) involved the use of one cage. A significant difference was observed in the use of two cages between the CS and NS groups (20.0% vs. 48.1%; P=0.006). The CS group had lower occupancy rate of autograft soon after the operation than the NS groups (P=0.002), and the occupancy rate of autograft tended to decrease in the CS group compared with the NS group over time. The ODI scores improved in both groups postoperatively; however, the NS group exhibited greater improvements in ODI scores from 4 months postoperatively. The CS group had a significantly lower proportion of patients with intervertebral osseous union at 6 and 12 months postoperatively compared with the NS group (P=0.003 and P<0.001, respectively).

Conclusions: The use of two intervertebral cages may enhance initial stability and reduce CS risk after PLIF. Initial intervertebral stability was crucial to preventing CS occurrence, as evidenced by the high occupancy rates of autograft in patients without CS. Surgical factors, including surgical strategy and intraoperative techniques, should be considered to prevent CS occurrence and to improve surgical outcomes and patient satisfaction.

Introduction: Adult spinal deformity (ASD) is prevalent among older adults, considerably affecting their quality of life. Although surgical interventions are effective, they have high complication rates and medical costs. Furthermore, there is a lack of evidence supporting the effectiveness of nonsurgical treatments (e.g., physical therapy) in patients with ASD. This study aimed to investigate the impact of "Koshimagari exercise," a specific home-based exercise regimen designed for patients with ASD, and to evaluate its effects on clinical outcomes in older adults.

Methods: A total of 144 participants aged 50-80 years with chronic low back pain (LBP) due to spinal deformities were included in this multicenter prospective study. Qualified physiotherapists conducted intervention sessions at the hospital once a week, and self-exercise was performed at home three times a week. After 3 months, the frequency of self-exercise at home increased to four times a week. Clinical evaluations were conducted using the Oswestry Disability Index (ODI), five-level classification system of EuroQol-5 Dimensions (EQ-5D), Japanese edition of Scoliosis Research Society-22r (SRS-22r), and visual analog scale (VAS) for LBP at baseline and 3, 6, and 12 months. Radiographic evaluations were performed in standing and supine positions.

Results: Of 130 participants who provided written informed consent, 98 completed the 6-month follow-up and were included in the analysis. Significant improvements observed in ODI, EQ-5D, and VAS scores were observed at 3 months, with SRS-22r scores improving throughout the study period. Radiographically, there were significant differences in the sagittal vertical axis and pelvic tilt at 12 months. Sufficient compliance with the self-exercise program was reported by 96%, 86%, and 73% of participants at 3, 6, and 12 months, respectively.

Conclusions: The "Koshimagari Exercise" program led to significant short-term improvements in health-related quality of life and pain among elderly patients with ASD. This home-based self-exercise program is an excellent nonsurgical treatment option for patients with ASD.

Introduction: Surgical interventions for cervical spine and spinal cord diseases may lead to life-threatening postoperative airway obstruction, requiring urgent airway management. This study aimed to assess the feasibility and effectiveness of our respiratory management protocol for patients undergoing anterior cervical approaches, posterior occipitocervical fusion, and intramedullary tumor resection.

Methods: This single-center retrospective study consisted of 497 patients who underwent cervical surgeries, including anterior fusion, posterior occipitocervical fusion, combined anterior and posterior fusions, and intramedullary tumor resection between January 2006 and June 2022. Our institution implemented a specific postoperative airway management protocol from September 2014 onward. The protocol involved continued intubation for at least the first postoperative night, followed by a spontaneous breathing trial with a cuff leak test and extubation one or more days after surgery. We compared the outcomes between the pre-protocol period (non-protocol group, n=234) and the protocol period (protocol group, n=263).

Results: There were no significant between-group differences regarding demographic, clinical, or surgical details. In the non-protocol group, four subjects required reintubation because of postoperative airway complications (anterior fusion: 1 patient, posterior occipitocervical fusion: 1 patient, and intramedullary tumor resection: 2 patients). After the airway protocol implementation, the reintubation rate dropped to zero (P=0.048).

Conclusions: Our airway management protocol substantially reduced the need for reintubation. These findings emphasize the importance of postoperative respiratory management after cervical spine surgeries and underscore the need for appropriate measures to prevent complications.

Background: Spinal fusion is a common form of orthopedic surgery, the most common of which involves pedicle screw placement (PSP). Despite well-documented benefits, pedicle screws are associated with several intraoperative complications. This area of surgery has subsequently been recipient to many surgical developments. Currently, augmented reality surgical navigation (ARSN) is at the forefront of surgical interest. This systematic review evaluates whether, when compared to freehand, fluoroscopic, and intraoperative image-guided navigation, ARSN results in superior screw accuracy and operative outcomes for patients undergoing PSP surgery.

Methods: Data collection was performed on PubMed, Ovid MEDLINE, the Cochrane Library, Embase, and the Web of Science between January 7, 2023, and January 8, 2024. PRISMA guidelines were followed and the level of evidence was graded per the Centre for Evidence-Based Medicine's recommendations. Risk of bias was assessed per the ROBINS-I tool and the Cochrane guide for assessing study quality. A modified version of the Newcastle-Ottawa Scale was used to determine the certainty of the body of evidence.

Results: A total of 521 papers were obtained from all bibliographical databases, 31 of which were included in the final review. ARSN resulted in a significantly greater number of screws placed as Gertzbein and Robbins grade 1 or 2 (93.33% vs 85.86%, p<0.000), significantly reduced intraoperative blood loss (470.32 vs 802.44 ml, p=0.050), comparative operative duration (281.6 vs 255.5 min, p=0.819), comparative time to place a screw (2.71 vs 3.1 min, p=0.703), and a nonsignificant reduction in hospital stay (5.4 vs 7.5 days, p=0.097). Maximum follow-up was more than 14 days.

Conclusions: ARSN results in a significantly greater number of screws placed at Gertzbein-Robertson grade 1 or 2 than non-ARSN surgery. Therefore, ARSN can be considered as a safe and efficacious technical innovation within PSP surgery.

Introduction: Proper cervical sagittal alignment is essential for maintaining overall spinal stability and function. A crucial measure of this alignment is the T1 slope, which is an important indicator. However, lateral cervical spine radiographs often fail to clearly show the T1 slope owing to several factors, such as shoulder anatomy or variations in body shape. In this study, we aimed to evaluate the differences in cervical alignment between individuals with visible and invisible T1 slopes.

Methods: This study was a retrospective cohort analysis involving 60 patients diagnosed with cervical spine conditions and evaluated via radiographic imaging. The patients were categorized into two groups based on whether the T1 slope was clearly visible or not. Key radiographic measurements, such as the C2-C7 sagittal vertical axis (SVA) and C2-C7 Cobb angles in the neutral, flexion, and extension postures, were recorded and statistically analyzed.

Results: Significant differences were observed in the C2-C7 SVA between the groups, particularly among men. Men in the invisible T1 slope group had an average SVA of 28.9 mm, whereas those in the visible group had a mean SVA of 16.0 mm (P<0.05). Although no notable differences were observed in the Cobb angles for the neutral and flexion positions, a substantial reduction in the extension Cobb angle was noted in the invisible than in the visible group (24.4° vs. 37.6°, P<0.05).

Conclusions: Male patients with obscured T1 slopes exhibited unique radiographic features, including higher C2-C7 SVA and diminished extension capacity. This suggests that the visibility of the T1 slope plays a pivotal role in the evaluation of cervical alignment. Furthermore, the exclusion of patients with an invisible T1 slope from research studies could lead to biased results.