Spine Surgery and Related Research最新文献

Introduction: Whether the benefits of continued perioperative aspirin therapy in spinal surgery outweigh the risk of perioperative complications remains unclear. This study evaluates the perioperative effects of continuous low-dose aspirin treatment in patients who underwent lumbar decompression alone.

Methods: This single-institute retrospective study included patients who underwent lumbar decompression for L1/2-L5/S1 lesions. The patient characteristics, perioperative parameters, and complications were compared between 103 patients who continued to take 100 mg/day aspirin during the perioperative period (aspirin group) and 653 patients who did not take antiplatelet or anticoagulant drugs (nonaspirin group).

Results: A significantly higher proportion of the patients in the aspirin group were males. The patients in the aspirin group had significantly lower preoperative hemoglobin levels than those in the non-aspirin group (P=0.001 and P=0.044, respectively). No significant differences were detected between the groups in terms of the number of disc decompression levels, duration of surgery, intraoperative blood loss, postoperative drainage volume, number of reoperations required for epidural hematoma formation, or perioperative blood transfusions. No cardiovascular or cerebrovascular ischemic events occurred in either group.

Conclusions: Continuous low-dose aspirin therapy alone during the perioperative period for lumbar decompression did not increase perioperative bleeding or the risk of bleeding-related complications. In conclusion, continuous low-dose aspirin treatment may be acceptable for use in preventing the increased risk of cardiovascular disease caused by aspirin withdrawal in patients undergoing lumbar decompression.

Introduction: Due to global increases in life expectancy, numbers of both super-elderly patients (≥90 years old) and the spine surgeries they undergo are increasing. However, no studies on spine surgery for super-elderly patients have focused on patient-reported outcomes (PROs).

Methods: Subjects were elderly patients (over 75 years old) undergoing spine surgery for degenerative disease (4408 cases) performed at our 13 affiliated centers between April 2017 and August 2021. Surgical procedures, perioperative complications, and PROs were investigated and compared between patients ≥90 years old (SE group) and control patients 75-89 years old (E group).

Results: Although the two groups showed no significant differences in patient background, the SE group showed significantly fewer fusions. The incidence of perioperative complications, including death within 30 days, did not significantly differ between groups. Regarding PROs, there were no significant differences in percentages of patients who achieved minimum clinically important differences in Neck Disability Index, Oswestry Disability Index, or EuroQoL 5 Dimension. There were no significant differences in pre- and postoperative numeric rating scales for each item or patient satisfaction.

Conclusions: There were significant improvements in PROs at 1 year postoperatively in the SE group than in the E group, and there were no significant differences in perioperative complication rates or mortality.

Introduction: This study investigated the mid- to long-term postoperative outcomes of patients with adult spinal deformity (ASD), focusing on physical function and quality of life (QOL). We also compared age-related changes between patients aged 75 years or older (high elderly) and those younger than 75 years (low elderly).

Methods: A total of 47 patients with ASD underwent thoracic-iliac long spinal fusion between August 2013 and September 2014. The study spanned from the preoperative period to at least 5 years postoperatively. Physical function was assessed using isometric hip flexion and knee extension muscle strength, the 6-min walk distance test, the 10-m walk test, and the timed up and go test. QOL was assessed using the Scoliosis Research Society-22 and Oswestry Disability Index. Repeated-measures analysis of variance with a mixed model approach, corrected for multiple comparisons using Bonferroni, was performed.

Results: Of the 47 patients, 21 participated in the study. Patients with ASD showed improved gait ability postoperatively. Hip flexor strength decreased at more than 5 years postoperatively compared with the preoperative strength. Patient-reported outcome (PRO) scores showed continuous improvement postoperatively, regardless of age. Although older patients had lower preoperative and postoperative physical function, their PRO scores significantly improved and remained favorable for more than 5 years postoperatively.

Conclusions: Patients with ASD experienced sustained improvements in walking ability and PRO for more than 5 years postoperatively. The results of this study showed that even among the elderly, PRO scores consistently improved after surgery and remained positive for an extended period.

Introduction: There is a lack of research on the relationship between cervical spinal cord injury (SCI) surgery and symptomatic urinary tract infections (UTIs); hence, this study seeks to fill this critical knowledge gap in postoperative care. This study aims to identify the risk factors for UTIs in patients with traumatic cervical SCI.

Methods: We retrospectively analyzed 187 patients (mean age: 68 years) who underwent cervical SCI surgery between 2017 and 2021. Patients were categorized into UTI and non-UTI groups. Patients with recurrent UTIs were defined as the multiple-UTI group. Preoperative risk factors, including prognostic nutritional index (PNI; 10×serum albumin [g/dL]+0.005×total lymphocyte count [/μL]), were assessed.

Results: Among 187 patients, 99 (52.9%) experienced a UTI within 90 days postoperatively. The majority of patients in the UTI group, that is, 92 patients (92.9%), had an indwelling catheter as urinary management at the time of the UTI. The UTI group faced higher rates of cardiopulmonary dysfunction, bacteremia, longer hospital stays, and increased medical costs. Multiple UTIs were associated with worse outcomes, including increased complications, longer hospital stays, and higher medical costs. PNI at 3 weeks and 4 weeks postoperatively in the multiple-UTI group was significantly lower than in the single-UTI and non-UTI groups. The American Spinal Injury Association impairment scale grade at admission was independently linked to initial UTI occurrence within 90 days after surgery when adjusting for confounding variables.

Conclusions: We found that 52.9% of patients experienced UTIs within 90 days postoperatively. The risk factors for UTI occurrence included the severity of paralysis, indwelling catheter, and poor improvement in the perioperative nutritional status. Early interventions with intermittent catheterization, appropriate antibiotics, and nutrition might be suggested for patients with severe cervical SCI and malnutrition.

Introduction: Gait changes could occur after thoracic to pelvic long-segment corrective fusion surgery, a common procedure for adult spinal deformity (ASD), potentially affecting the occurrence and progression of postoperative hip osteoarthritis. We aimed to clarify postoperative pelvic kinematics in patients with ASD by performing gait analysis using a system based on a smartphone-integrated inertial measurement unit (IMU).

Methods: A total of 21 consecutive outpatients (73.6±4.6 years old, 2 men, 19 women) were enrolled. All had undergone long-segment fusion from the thoracic spine to the pelvis for ASD more than 1 year previously and could walk unassisted. A control group comprised 20 healthy volunteers. The IMU was fixed on the sacrum, and data were collected when subjects walked forward on a flat indoor floor. Acceleration in three axial directions and angular velocity around the three axes were recorded simultaneously during gait, and data were cut out for each gait cycle. Of 1043 features obtained, the top 20 features with the smallest p-value in a statistical comparison were selected. These features, plus gender and age, were classified using gradient boosting machine learning based on the decision tree algorithm. The classification accuracy and relative importance of the feature items were calculated.

Results: The accuracy rate for gait classification between groups was 96.7% and the F1-score was 0.968. The factor that contributed most to the classification of gait in both groups was "y-angular,_change_quantiles,_f_agg="var",_isabs=True,_qh=0.6,_ql=0.2," which means the variance of the change of the absolute value in the pelvic rotation angular velocity in the horizontal plane in the range of 20%-60% of the gait cycle. Its relative importance was 0.351, which was smaller in the group with fusion.

Conclusions: Patients with ASD following long-segment fusion from the thoracic spine to the pelvis apparently have a gait style characterized by suppressed pelvic rotation in the horizontal plane.

Introduction: Intervertebral disc degeneration (IDD) is a primary cause of chronic back pain and disability, highlighting the need for precise detection and grading for effective treatment. This study focuses on developing and validating a convolutional neural network (CNN) with a You Only Look Once (YOLO) architecture model using the Pfirrmann grading system to classify and grade lumbar intervertebral disc degeneration based on magnetic resonance imaging (MRI) scans.

Methods: We developed a deep learning model trained on a dataset of anonymized MRI studies of patients with symptomatic back pain. MRI images were segmented and annotated by radiologists according to the Pfirrmann grading for the datasets. The segmentation MRI-disc image dataset was prepared for three groups: a training set (1,000), a testing set (500), and an external validation set (500) to assess model generalizability without overlapping images. The model's performance was evaluated using accuracy, sensitivity, specificity, F1 score, prediction error, and ROC-AUC.

Results: The AI model showed high performance across all metrics. For Grade I IDD, the model achieved an accuracy of 97%, 95%, and 92% in the training, testing, and external validation sets, respectively. For Grade II, the sensitivity was 100% in both training and testing sets and 98% in the validation set. For Grade III, the specificity was 95.4% in the training set and 94% in both testing and validation sets. For Grade IV, the F1 score was 97.77% in the training set and 95% in both testing and validation sets. For Grade V, the prediction error was 2.3%, 2%, and 2.5% in the training, testing, and validation sets, respectively. The overall ROC-AUC was 97%, 92%, and 95% in the training, testing, and validation sets, respectively.

Conclusions: The AI-based classification model exhibits high accuracy, sensitivity, and specificity in detecting and grading lumbar IDD using the Pfirrmann grading. AI has significantly enhanced diagnostic precision and reliability, providing a powerful tool for clinicians in managing IDD. The potential impact is substantial, although further clinical validation is necessary before integrating this model into routine practice.

Introduction: Meningiomas and schwannomas are common intradural-extramedullary spinal tumors. Because of their different origins, they necessitate different surgical procedures, which makes preoperative diagnosis important.

Methods: In this study, clinical and imaging data for 62 patients diagnosed with either meningioma or schwannoma across multiple institutions were analyzed.

Results: The average age of patients was older (67.6 vs. 58.9 years), and the frequency of females was higher (72% vs. 46%) for meningioma than for schwannoma. Meningiomas were mostly found in the thoracic region (84%), whereas schwannomas were commonly located in the lumbar region (54%). For each tumor type, specific radiological findings were identified. For meningiomas, findings included the ginkgo leaf sign (GLS) (sensitivity 58%, specificity 100%), oval shape (sensitivity 84%, specificity 63%), dural tail sign (DTS) (sensitivity 75%, specificity 100%), and intertumoral calcification (sensitivity 39%, specificity 100%). Combining GLS and DTS greatly improved sensitivity to 89% (specificity 100%). For schwannomas, specific findings included a lobule shape (sensitivity 25%, specificity 95%), dumbbell shape (sensitivity 54%, specificity 100%), and cystic changes (sensitivity 54%, specificity 97%).

Conclusions: GLS may be a specific radiological feature for meningiomas and can aid in diagnosis when combined with DTS. Understanding these distinct radiological characteristics is valuable for preoperative differential diagnosis of intradural-extramedullary spinal tumors.