Spine Surgery and Related Research最新文献

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The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 2. Diagnosis and Evaluation. 腰椎管狭窄症临床实践指南要点，2021:2。诊断与评估。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0080

Miho Sekiguchi

•In the middle-aged and elderly, if pain and numbness are experienced from the buttocks to the lower limbs and the symptoms are exacerbated when walking and standing but alleviated when in the sitting and flexed positions, lumbar spinal stenosis (LSS) is very likely. Intermittent claudication is a characteristic symptom of LSS, but it is important to differentiate it from vascular intermittent claudication. •The “Diagnostic Support Tool for Lumbar Spinal Stenosis” is a convenient and useful tool for screening patients.

引用次数: 0

Impact of Brace-Related Stress on Brace Compliance in Adolescent Idiopathic Scoliosis: A Single-Center Comparative Study Using Objective Compliance Measurement and Brace-Related Stress. 支架相关压力对青少年特发性脊柱侧凸支架依从性的影响:一项使用客观依从性测量和支架相关压力的单中心比较研究。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0246

Tomoyuki Asada, Toshiaki Kotani, Tsuyoshi Sakuma, Yasushi Iijima, Keita Nakayama, Kazuhide Inage, Yasuhiro Shiga, Tsutomu Akazawa, Shohei Minami, Seiji Ohtori, Masao Koda, Masashi Yamazaki

Introduction: This study aimed to investigate the brace compliance and clinical background of patients with adolescent idiopathic scoliosis (AIS) who demonstrate different degrees of psychological brace-related stress.

Methods: Forty-five patients initiating brace treatment with a Cobb angle between 25° and 45° were included. Patients receiving brace treatment for AIS were administered a questionnaire for brace-related stress (i.e., the Japanese version of the Bad Sobernheim Stress Questionnaire-Brace [JBSSQ-brace]). Based on their scores, we allocated the patients into two stress groups: mild-stress (≥16 points) and below-moderate-stress (<16 points). We investigated the character of brace compliance and brace-related psychological stress in all patients and compared the demographics and brace compliance between both groups.

Results: Forty-one of 45 patients completed the study. The mean JBSSQ-brace scores were 18.7±5.1, 19.1±5.2, and 18.7±5.0 points at the 1-month, 4-month, and 1-year follow-ups, respectively. There was no significant change in JBSSQ-brace scores over one year after the brace prescription (P=0.332). There was no difference in-brace compliance between seasons during the first month of brace prescription (P=0.252). Both groups' overall brace compliance was comparable (below-moderate: 17.1±7.1 h/day vs. mild: 20.4±3.0 h/day; P=0.078). The mild-stress group showed better compliance than the below-moderate-stress group on weekdays (below-moderate: 17.0±6.9 h/day vs. mild: 20.5±2.8 h/day; P=0.048) and at nighttime (below-moderate: 82.3%±27.0%/nighttime vs. mild: 93.8%±12.4%/nighttime; P=0.008).

Conclusions: Overall, brace compliance was comparable among patients with different brace-related stress, but brace compliance during weekdays and nighttime was significantly better in the mild-stress group.

摘要:本研究旨在探讨具有不同程度托具相关心理压力的青少年特发性脊柱侧凸(AIS)患者的托具依从性及临床背景。方法:纳入45例Cobb角在25°~ 45°之间的患者。接受支架治疗的AIS患者接受支架相关压力问卷(即日本版Bad Sobernheim压力问卷-brace [JBSSQ-brace])。根据评分，我们将患者分为两个应激组:轻度应激组(≥16分)和中下应激组(结果:45例患者中有41例完成了研究。随访1个月、4个月和1年，JBSSQ-brace评分分别为18.7±5.1分、19.1±5.2分和18.7±5.0分。使用支具处方1年后，jbssq -支具评分无显著变化(P=0.332)。在支架处方的第一个月内，不同季节的支架依从性无差异(P=0.252)。两组整体支具依从性相当(中度以下:17.1±7.1 h/天vs轻度:20.4±3.0 h/天;P = 0.078)。在工作日，轻度应激组的依从性优于次中度应激组(次中度:17.0±6.9 h/d vs.轻度:20.5±2.8 h/d;P=0.048)和夜间(中度以下:82.3%±27.0%/夜vs轻度:93.8%±12.4%/夜;P = 0.008)。结论:总体而言，不同支具相关应激组患者的支具依从性具有可比性，但轻度应激组患者在工作日和夜间的支具依从性明显更好。

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引用次数: 0

The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 5. Postoperative Prognosis. 腰椎管狭窄症临床实践指南要点，2021:5。术后的预后。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0082

Miho Sekiguchi

Preoperative numbness at rest (OR 85.6) was associated with residual leg pain/numbness, and preoperative numbness at rest (OR 4.5) and foot drop (OR 11.6, 95% CI 2.5-59.1) were associated with residual gait disturbance. The degree of symptoms after surgery was stronger in the DM group than in the non-DM group. It is necessary to explain that leg numbness and pain tend to remain when performing surgery on LSS patients with DM. The mechanism of leg cramps is complex and remains inconclusive. Therefore, it cannot be confirmed whether leg cramps are a symptom of LSS or a comorbidity. Poor Prognostic Factors for Surgical Outcomes of LSS

引用次数: 0

Thoracic Dislocation Fracture Complicated by a Serious Electric Shock Injury: A Case Report. 胸脱位骨折并发严重电击伤1例。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2023-0007

Ryosuke Hirota, Atsushi Teramoto, Mitsumasa Chiba, Masahiro Onuma, Hidetomo Narimatsu, Takatoshi Yotsuyanagi, Toshihiko Yamashita

The patient, a 14-year-old boy, was injured after he collided with a high-voltage power line, which led to his loss of consciousness and caused him to fall from a 20-meterhigh steel tower. After being taken to a nearby hospital, he was flown by helicopter to our hospital for multidisciplinary treatment, where he was administered light sedation for pain relief. His initial measurements were 112/68-mmHg blood pressure, 118-beats/min heartbeat, respiratory rate of 15 breaths/ min, SpO2 of 100%, and body temperature of 38.0°C. His posterior neck, chest, and back were all severely burned (Fig. 1), and he had lost all motor and sensory function caudally from the Th10 level. He was diagnosed with an electric shock injury, a Th 10/11 dislocation fracture (AO type classification; type C), and a complete thoracic spinal cord injury. Concomitant injuries included Th 7.8.9.12 fractures, right hemothorax, left hemothorax, and multiple rib fractures (Fig. 2A-D). MRI revealed a complete spinal cord tear at the Th10/11 level (Fig. 2E). The paraspinal muscles showed high signals on MRI T2 weighted imaging, respectively (Fig. 2F-G). After confirming partial dislocation repair by manual traction under fluoroscopic guidance, we performed percutaneous posterior stabilization (Th5-L2) with percutaneous pedicle screws (PPS) without bone fusion. Relatively good realignment was achieved by intraoperative compression of the injured area in the supine position (Fig. 3A-D). On day 20 after injury, Th7-12 anterior intervertebral body fusion was performed via the extraperitoneal approach to reconstruct the anterior column (Fig. 3E-H). Debridement of burned skin was performed on the 5th, and skin grafting on the back was performed on the 35th day after the injury, respectively. The grafted skin survived well, and the wound healed completely on day 47 (Fig. 4). Rehabilitation, including wheelchair mobility training, could be started after two-stage spine surgery. On the 70th day after the injury, the wound was well-healed, and the patient was transferred to a nearby hospital. Electric shock injuries may be accompanied by deep tissue injury to the nerves, blood vessels, muscles, and bones. To our knowledge, this is the first report of severe electroshock injury combined with spinal cord injury. Recently, the concept of spine damage control has been reported in the field of spine trauma injuries, often accompanied by complications caused by high-energy trauma, such as iliac and pelvic ring fractures. Early stabilization of the spinal column promotes hemodynamic stability, respiratory failure, and systemic management and prevents complications. Initial stabilization with PPS and two-stage anterior strut reconstruction may be helpful in cases of high spinal instability and soft tissue damage. In this case, early surgery allowed good alignment without direct visual repair of the injured area. Electroshock wounds generally result in deep tissue damage, resulting in deep tissue necros

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引用次数: 0

The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 1. Definition, Epidemiology, and Natural History. 腰椎管狭窄症临床实践指南要点，2021:1。定义、流行病学和自然史。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0079

Miho Sekiguchi

Based on a historical background, LSS is not a single disease but a combination of various symptoms. At present, there is no uniform view on the definition of LSS. Disorders of the nervous and/or vascular elements are caused by the lumbar spinal canal or intervertebral foramen (anatomically not included in the spinal canal), and they induce symptoms in patients with LSS. In this edition, the diagnostic criteria (draft) of the 1 edition were revised, and the diagnostic criteria for LSS are proposed as follows: 1) presence of pain and numbness from the buttocks to the lower limbs, 2) symptoms from the buttocks to the lower limbs that appear or are exacerbated by continuous standing or walking and are alleviated with the maintenance of a forward flexion or sitting position, 3) either with or without low back pain, and 4) presence of findings of degenerative stenosis in imaging results, such as MRI, that can explain clinical findings. There is no consensus on the LSS definition as the etiology and pathological changes have not been completely elucidated.

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引用次数: 0

The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 3. Conservative Treatment. 腰椎管狭窄症临床实践指南要点，2021:3。保守治疗。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0081

Katsushi Takeshita

The

引用次数: 0

Introduction to the Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021. 腰椎管狭窄症临床实践指南要点介绍，2021年。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2023-0109

引用次数: 0

Correlation between Respiratory Dysfunction and Dysphagia in Individuals with Acute Traumatic Cervical Spinal Cord Injury. 急性外伤性颈脊髓损伤患者呼吸功能障碍与吞咽困难的关系。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0180

Yuki Matsumoto, Tetsuo Hayashi, Yuichi Fujiwara, Kensuke Kubota, Muneaki Masuda, Osamu Kawano, Takeshi Maeda

Introduction: Aspiration pneumonia is one of the most frequent and fatal life-threatening complications among individuals with acute traumatic cervical spinal cord injury (CSCI). However, the mechanism of dysphagia among individuals with CSCI is not well understood. Morbidity and mortality associated with CSCI may result from the interplay between respiratory dysfunction and dysphagia. This study aimed to elucidate the effect of respiratory dysfunction on the swallowing function of individuals with acute traumatic CSCI.

Methods: A prospective cohort study was conducted involving 54 individuals with acute traumatic CSCI who were admitted within 2 weeks following injury. Dysphagia was evaluated using the Dysphagia Severity Scale (DSS) and the Functional Oral Intake Scale (FOIS). Respiratory function was evaluated by measuring the cough peak flow (CPF), forced expiratory volume in 1 s (FEV_1.0), FEV_1.0/forced vital capacity (FEV_1.0%), and percent vital capacity (%VC). We recorded these parameters at weeks 2, 4, 8, and 12 following injury and analyzed pertinent changes over time and significant correlations.

Results: Among 54 individuals (46 men and 8 women) recruited in this study, 48 (88.9%) had restrictive ventilatory impairment and 17 (31.5%) had severe dysphagia (DSS level 1-4) 2 weeks following injury. However, respiratory function and swallowing function significantly improved thereafter. CPF, FEV_1.0, and %VC were significantly correlated with the severity of dysphagia during each period.

Conclusions: Restrictive ventilatory impairment, poor cough force, and dysphagia are closely related, and the evaluation of respiratory function plays an important role in evaluating dysphagia.

吸入性肺炎是急性外伤性颈脊髓损伤(CSCI)患者中最常见和致命的危及生命的并发症之一。然而，CSCI患者的吞咽困难机制尚不清楚。CSCI的发病率和死亡率可能与呼吸功能障碍和吞咽困难的相互作用有关。本研究旨在探讨呼吸功能障碍对急性创伤性CSCI患者吞咽功能的影响。方法:对54例外伤后2周内入院的急性外伤性CSCI患者进行前瞻性队列研究。使用吞咽困难严重程度量表(DSS)和功能性口服摄入量表(FOIS)评估吞咽困难。通过测定咳嗽峰值流量(CPF)、1s用力呼气量(FEV1.0)、FEV1.0/用力肺活量(FEV1.0%)、肺活量百分比(%VC)评价呼吸功能。我们在受伤后的第2、4、8和12周记录了这些参数，并分析了随时间的相关变化和显著相关性。结果:在本研究招募的54名患者(46名男性和8名女性)中，48名(88.9%)出现限制性呼吸功能障碍，17名(31.5%)在损伤后2周出现严重吞咽困难(DSS等级1-4)。但术后呼吸功能和吞咽功能明显改善。CPF、FEV1.0、%VC与各时期吞咽困难严重程度显著相关。结论:限制性呼吸功能障碍、咳嗽力差与吞咽困难密切相关，呼吸功能评价在吞咽困难评价中起重要作用。

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引用次数: 1

Effects of Spina Bifida Occulta on Bone Union in Fifth Lumbar Spondylolysis. 隐性脊柱裂对第五腰椎峡部裂骨愈合的影响。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0255

Hisanori Gamada, Masaki Tatsumura, Shun Okuwaki, Toru Funayama, Masashi Yamazaki

Introduction: The effect of spina bifida occulta (SBO) on bone union in lumbar spondylolysis is controversial. The study aim was to assess the effect of SBO on bone union after conservative treatment of L5 spondylolysis, the most common level.

Methods: The study included 191 lesions in 145 patients (mean age, 14.0 years) with conservatively treated L5 spondylolysis. We examined the relationships between bone union after conservative treatment and the number of SBOs, levels, and single or multilevel status. Fisher's exact probability test, chi-square test, and Welch's T test were performed.

Results: The SBO incidence was 53%, with at least one SBO at any vertebral level. SBO at S1 (p=0.034) or S2 (p=0.0003), two SBOs (p=0.0018), and three SBOs (p=0.011) were associated with a lower bone union rate. The bone union rate was significantly lower for lesions with SBOs at both S1 and S2 than without (42% vs. 79%; p<0.0001).

Conclusions: The SBO incidence in L5 spondylolysis was 53%. SBO at S1 or S2 and a higher number of SBOs were associated with lower bone union rates. In particular, the bone union rate of lesions with SBOs at both S1 and S2 was <50%.

隐蔽性脊柱裂(SBO)对腰椎峡部裂患者骨愈合的影响是有争议的。本研究的目的是评估SBO对最常见的L5级峡部裂保守治疗后骨愈合的影响。方法:该研究包括145例(平均年龄14.0岁)保守治疗的L5峡部裂患者的191个病变。我们研究了保守治疗后骨愈合与sbo数量、水平、单节段或多节段状态之间的关系。进行Fisher精确概率检验、卡方检验和Welch T检验。结果:SBO发生率为53%，在任何椎段至少有1例SBO。SBO在S1 (p=0.034)或S2 (p=0.0003)， 2个SBO (p=0.0018)和3个SBO (p=0.011)与较低的骨愈合率相关。在S1和S2有SBOs的病变的骨愈合率明显低于无SBOs的病变(42% vs. 79%;结论:L5型峡部裂的SBO发生率为53%。S1或S2的SBO以及SBO数量的增加与较低的骨愈合率相关。特别是在S1和S2有SBOs的病变的骨愈合率为

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引用次数: 0

Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis. 完全性运动麻痹伴颈脊髓损伤慢性期肺炎的发病率及危险因素。

IF 1.2 Q3 Medicine

Spine Surgery and Related Research

Pub Date : 2023-07-27 DOI: 10.22603/ssrr.2022-0254

Chikara Ushiku, Kota Suda, Takehiro Michikawa, Satoko Matsumoto Harmon, Miki Komatsu, Osahiko Tsuji, Masahiko Takahata, Mitsuru Saito, Norimasa Iwasaki, Akio Minami

Introduction: Pneumonia is one of the leading causes of acute- and chronic-phase mortality in patients with cervical spinal cord injury (CSCI) with quadriplegia. The risk factors for chronic-phase pneumonia recurrence in CSCI are still unknown. This study aimed to investigate the incidence of pneumonia in the chronic phase after injury and to identify its risk factors.

Methods: This retrospective clinical observational study included patients with CSCI with American Spinal Injury Association Impairment Scale grades of A or B admitted to our center within 72 h of CSCI injury who started treatment and were available for follow-up for at least 90 days. The patients were assessed for incidences of pneumonia and its associations with clinical characteristics, including risk factors at the time of injury. Patients in whom pneumonia developed within 30 days postadmission and those after 30 days of hospitalization were comparatively examined using univariate and multivariate analyses.

Results: Pneumonia occurred in 36% of the 69 enrolled patients throughout the study period and in 20% of all patients after 30 days of hospitalization. Multivariate analysis of risk factors for pneumonia showed that atelectasis (adjusted OR [aOR], 95% confidence interval [CI]: 4.9, 1.2-20.0), enteral feeding (aOR [95% CI]: 13.3 [3.0-58.9]), mechanical ventilation (aOR [95% CI]: 4.0 [1.0-15.0]), and tracheotomy (aOR [95% CI]: 14.6 [2.3-94.6]) within 30 days of admission were significantly associated with the occurrence of pneumonia even after 30 days of hospitalization.

Conclusions: The risk factors for developing pneumonia in the chronic phase were atelectasis, enteral feeding, mechanical ventilation, and tracheotomy within 30 days of hospitalization. This study suggests that treatment of atelectasis, long-term respiratory muscle rehabilitation, and training to improve swallowing function are essential to prevent the recurrence of pneumonia after 30 days of hospitalization.

简介:肺炎是导致颈脊髓损伤(CSCI)伴四肢瘫痪患者急性和慢性期死亡的主要原因之一。慢性脊髓损伤慢性肺炎复发的危险因素尚不清楚。本研究旨在调查损伤后慢性期肺炎的发病率，并确定其危险因素。方法:本回顾性临床观察研究纳入美国脊髓损伤协会损伤分级为A或B级的CSCI患者，这些患者在CSCI损伤后72小时内入院，并开始治疗，随访时间至少为90天。评估患者肺炎的发生率及其与临床特征的关系，包括受伤时的危险因素。采用单因素和多因素分析对入院后30天内发生肺炎的患者和住院后30天发生肺炎的患者进行比较研究。结果:在整个研究期间，69名入组患者中有36%发生肺炎，住院30天后，所有患者中有20%发生肺炎。肺炎危险因素的多因素分析显示，入院30天内肺不张(调整后的OR [aOR]， 95%可信区间[CI]: 4.9, 1.2-20.0)、肠内喂养(aOR [95% CI]: 13.3[3.0-58.9])、机械通气(aOR [95% CI]: 4.0[1.0-15.0])、气管切开(aOR [95% CI]: 14.6[2.3-94.6])与住院30天后的肺炎发生显著相关。结论:慢性期发生肺炎的危险因素为住院30天内肺不张、肠内喂养、机械通气和气管切开术。本研究提示，治疗肺不张、长期呼吸肌康复、训练改善吞咽功能对预防住院30天后肺炎复发至关重要。

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