Spine Surgery and Related Research最新文献

Background: The study of physiotherapeutic scoliosis-specific exercise (PSSE) for adolescent idiopathic scoliosis (AIS) is rapidly progressing. However, there are limited reports on the medium- to long-term effects of PSSE on scoliosis.

Methods: A systematic review and meta-analysis feasibility study were conducted according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In our exhaustive search, we employed nine search formulas and four search databases according to a preregistered protocol. Identification, screening, eligibility, inclusion, and meta-analysis were performed through repeated meetings involving all coauthors. Each process was conducted by three or more authors.

Results: A total of 1,518 studies were identified in the initial search. After manually reviewing abstracts and full texts, 11 studies were chosen for evaluation and reporting. The overall risk-of-bias was high in approximately half of the studies and moderate in the other half, with none found to have a low risk-of-bias. Only two randomized controlled trials (RCTs) specifically evaluated the therapeutic effect of PSSE on over a 1-year clinical course and the preventive ability of PSSE on surgery. One RCT reported that Cobb angle was substantially smaller in the PSSE group than in the control group at the final follow up, whereas the other found no significant difference between the groups. The methods of exercise intervention, control group selection, and timing of outcome assessments were not standardized in the selected studies. Thus, conducting a meta-analysis of the literature was deemed unfeasible at this time.

Conclusions: The certainty of the evidence that PSSE reduces the progression of Cobb angle in patients with AIS in the short and long term was extremely low. Accordingly, healthcare providers should carefully examine the current evidence when explaining and applying PSSE in such patients. High-quality studies addressing the long-term changes in Cobb angle and Cobb angle at bone maturity as primary outcomes are warranted.

Level of evidence: Level 1.

Introduction: Multimodal intraoperative neurophysiological monitoring (IONM)-such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve-is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm.

Methods: We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm.

Results: All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type.

Conclusions: Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes.

Study design: Single-institution retrospective study.

Objective: To assess the impact of growing rods (GRs) on postoperative cervical sagittal alignment in patients with early-onset scoliosis (EOS).

Summary of background data: Cervical sagittal malalignment is associated with neck and cervical spine dysfunction. The impact of surgery for adolescent idiopathic scoliosis on postoperative changes in cervical spine alignment has been reported by studies. Nevertheless, research on sagittal and spinopelvic parameters in patients with EOS is limited.

Methods: In this study, 28 patients who underwent GR and were followed up until final fusion or bone maturity were included. Standing whole-spine radiographs obtained before GR, after the initial GR surgery, and at the final follow-up were utilized to measure the radiographic parameters. Patients with one or more of the previously reported poor prognostic factors were included in the cervical malalignment (CM) group (n=13), and those with none of the factors were included in the non-CM group (n=15) at the final follow-up, which was followed by correlation analysis and multivariate logistic regression analysis.

Results: No significant change in sagittal alignment between preoperative and final follow-up measurements was found. Pearson correlation analysis revealed a significant positive correlation between the change in the C2-7 angle and T1 slope (T1S) or thoracic kyphosis and a negative correlation between the change in the C2-7 angle and T1S minus C2-7 angle (T1S-CL). The percentage of patients in the CM group increased from 25% preoperatively to 46% at the final follow-up but without significant change. The CM group had significantly smaller preoperative C2-7 angles and lumbar lordosis (LL) and larger T1S-CL and pelvic incidence minus LL (PI-LL) values than the non-CM group.

Conclusion: Smaller preoperative C2-7 angles and larger T1S-CL values were identified as risk factors for CM. Postoperative CM is more likely to occur in patients with reduced compensatory function to maintain preoperative cervical kyphosis.

Introduction: The objective of this study is to investigate the poor recordability characteristics of intraoperative neurophysiological monitoring (IONM) for metastatic spinal tumors, focusing on tumor status or preoperative muscle weakness.

Methods: A total of 132 patients (age 65.3±11.8 years; 82 men) with or without preoperative lower extremity muscle weakness were included in this study. The patients' background characteristics, the presence and degree of pre- and postoperative muscle weakness, and the IONM outcome, including the availability of transcranial motor evoked potential (Tc-MEP) recording and the occurrence of Tc-MEP alarms, were investigated. The data between the groups with and without preoperative muscle weakness were compared. Logistic regression analysis was performed to identify the risk factors for unrecordable Tc-MEP.

Results: Sixty-seven patients with muscle weakness had significantly more unrecordable Tc-MEP (19% vs. 5%, p=0.009) than the 65 patients without muscle weakness. The highest percentage of recordable Tc-MEP in the group with muscle weakness was noted in the plantar muscle (72%). Multivariate analysis identified manual muscle test (MMT) score of ≤3 (odds ratio [OR] 4.529) and ventral spinal cord compression by metastatic tumor (OR 3.924) as independent significant factors for unrecordable Tc-MEP.

Conclusions: IONM for metastatic spinal cord tumors with muscle weakness had a high rate of unrecordable Tc-MEP. Additionally, Tc-MEP may not be detectable in cases of ventral spinal cord compression by a tumor; therefore, preoperative imaging should be thoroughly evaluated.

Introduction: Cervical myelopathy diagnosis is based on specific symptoms, physical signs, and imaging findings. However, information on the accuracy and reliability of physical signs, particularly the Wartenberg reflex and the finger escape sign (FES), is lacking. Therefore, this study aimed to assess the validity and reliability of the Hoffmann and Trömner signs, FES, Wartenberg reflex, and combination of any one positive of these four physical signs.

Methods: We reviewed the Hoffmann and Trömner signs, FES, and Wartenberg reflex from the medical records of patients with cervical cord compression who underwent surgery. We included those who underwent lumbar spine surgery as controls, except those with upper extremity symptoms or a history of cerebrospinal disease. Subsequently, we calculated the sensitivity and specificity of cervical cord compression. The primary and secondary observers performed two and one trial, respectively, to measure the intra- and interobserver reliabilities.

Results: This study included 46 cases and 42 controls. The diagnostic sensitivities for the Hoffmann sign, Trömner sign, Wartenberg reflex, FES, and combination of any one positive were 46%, 72%, 63%, 22%, and 83%, respectively; the diagnostic specificities were 98%, 79%, 95%, 98%, and 79%, respectively; the intraobserver kappa value (κ) was 0.80, 0.82, 0.86, 0.66, and 0.95, respectively; and the interobserver κ was 0.84, 0.51, 0.51, -0.02, and 0.60, respectively. Notably, all κ values, except the interobserver κ for the FES, were obtained with P<0.01.

Conclusions: Each physical sign had high specificity but low sensitivity in predicting cervical cord compression. Therefore, they may be useful for definitive diagnosis but not for screening tests. The combination of the four physical signs exhibited improved sensitivity and may be useful for screening tests. However, the results of these physical signs should be carefully interpreted owing to the low level of interobserver reliability.

Introduction: Condoliase-based chemonucleolysis and microendoscopic discectomy (MED) are considered to be minimally invasive treatments for lumbar disc herniation (LDH). The aim of this study was to compare the clinical outcomes of both treatments, specifically focusing on whether the outcomes vary by age group.

Methods: Patients with LDH who received intradiscal condoliase injections (condoliase group) or underwent MED (MED group) with 1-year follow-up were enrolled in this study. A numerical rating scale (NRS) was developed for leg and back pains. Using magnetic resonance imaging, changes in disc height and degeneration were evaluated. The data were assessed at baseline and at 3-month and 1-year follow-ups. The therapy was considered effective in patients whose NRS for leg pain improved by ≥50% at 1 year from baseline and for whom surgery was not required. Comparative analyses were conducted between the condoliase and MED groups and among the <20, 20-39, 40-59, and ≥60 year age groups.

Results: In this study, a total of 345 patients (condoliase group, n=233; MED group, n=112) were enrolled. Subsequent surgery was required in 23 patients (9.9%) in the condoliase group because of the ineffectiveness of the condoliase therapy. Because of herniation recurrence, reoperation was required in five patients (4.5%) in the MED group. The efficacy rates were respectively 74.4% and 74.6% in the condoliase and MED groups, and no intergroup or age-group differences were found. The condoliase group had a significantly higher decrease in disc height when compared with the MED group (9.0% vs. 4.4%, p<0.05). Compared with the older age group, the younger age group had a greater decrease in disc height and disc degeneration; however, their recovery was better than that of the older age group. Among the age groups, the herniation reduction rate did not significantly vary.

Conclusions: Condoliase and MED had equivalent 1-year outcomes, with no differences observed in efficacy across age groups. For informed decision-making, the advantages and disadvantages of each treatment must be understood.

Clay shoveler's fracture is a stable spinous process fracture commonly occurring at the seventh cervical vertebrae. The name originated in Australia during the 1930s, after many reports of similar injuries among clay workers who suffered fractures due to a sudden flexion force on their neck and back muscles, hence the name "clay shoveler's fracture." This fracture may occur as a consequence of a direct blow/trauma, a contraction of the shoulder muscles, and sudden extreme movements of the neck influenced by additional factors presented throughout the article. Clay shoveler's fracture mechanisms vary among different age groups; Schmitt's disease is the juvenile version. Although this fracture was initially associated with clay shoveling, it occurs in modern-day sports and activities such as paddling, weightlifting, volleyball, Wii gaming, and many more. A rare occurrence, clay shoveler's fracture is frequently misdiagnosed. Hence, many characteristics were pinpointed to help distinguish it from other differential diagnostics. What does a clay shoveler's fracture patient feel? What are the best tools for the physical exam and imaging? These questions will be answered and developed in this article to reach the right diagnosis and correct treatment for the patient.

There have been increasing reports on prediction models in spine surgery. Interest in prognostic tools or risk calculators can facilitate shared decision-making about treatment between patients and clinicians. In recent years, there has been a steady increase in the number of models developed using varying methods. External validation is an essential component of prediction model testing to ensure the appropriate use of these models in populations outside of the developing center. This narrative review aimed to provide an overview of the literature describing the development and validation of prediction models in the field of spine surgery.

Study design: Literature Review.

Objectives: To conduct a comprehensive literature review about the risk factors and preoperative considerations that are related to postoperative venous thromboembolisms (VTEs) in patients who undergo spinal fusion.

Results: Postoperative VTEs are associated with higher costs and longer hospital stays for patients, in comparison to those who did not develop VTEs. Spinal level and multilevel fusion are risk factors for postoperative VTE. The effect of the surgical approach on VTE risk is unclear. Elevated BMI and age, kidney dysfunction, previous VTE, and primary hypercoagulability are preoperative risk factors for developing VTE. Intraoperative and postoperative risk factors for VTE include prolonged procedure time, discharge to inpatient facilities, and length of hospital stay. The effects of hypertension (HTN), sex, and dural tears on VTE risk in spinal fusion patients are uncertain. Chemoprophylaxis reduced the incidence of VTE. Tranexamic acid was not associated with an increase in VTE postoperatively. The American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator served as a poor predictor of VTE incidence in spinal fusion. Preoperative D-dimer levels may help as a predictive tool.

Conclusions: To elucidate the effects of surgical approach, revision surgery, HTN, and dural tears on postoperative VTE risk, further research is warranted. To help identify high-risk patients, a risk calculator sensitive to VTE must be developed.