Pub Date : 2024-09-11DOI: 10.1016/j.spinee.2024.08.027
Sehan Park,Gumin Jeong,Chang Ju Hwang,Jae Hwan Cho,Dong-Ho Lee
BACKGROUND CONTEXTAnterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR).PURPOSETo compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR.STUDY DESIGN/SETTINGPropensity score-matched retrospective cohort study PATIENT SAMPLE: Patients with CMR who underwent ACDF or LPF and were followed up for at least 2 years.OUTCOME MEASURESC2-C7 lordosis, C2-C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed.METHODSThe radiographic and clinical outcomes of the two groups were compared.RESULTSEighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2-C7 lordosis (p<0.001) and ROM (p<0.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2-C7 lordosis (p<0.001), while ACDF caused a significant decrease in cervical ROM (p<0.001). ACDF effectively improved neck pain VAS (p<0.001) and NDI (p<0.001), while neck pain did not significantly improve after LPF (p=0.103). Furthermore, neck pain VAS (p=0.026) and NDI (p=0.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=0.502; NDI, p=0.085). Arm pain VAS and JOA score both significantly improved after LPF (p=0.003 and 0.043, respectively) or ACDF (p<0.001 and 0.039, respectively), and postoperative results were not significantly different between the two groups.CONCLUSIONLPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR.LEVEL OF EVIDENCEIII.
{"title":"Laminoplasty with Foraminotomy versus Anterior Cervical Discectomy and Fusion for Cervical Myeloradiculopathy.","authors":"Sehan Park,Gumin Jeong,Chang Ju Hwang,Jae Hwan Cho,Dong-Ho Lee","doi":"10.1016/j.spinee.2024.08.027","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.08.027","url":null,"abstract":"BACKGROUND CONTEXTAnterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR).PURPOSETo compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR.STUDY DESIGN/SETTINGPropensity score-matched retrospective cohort study PATIENT SAMPLE: Patients with CMR who underwent ACDF or LPF and were followed up for at least 2 years.OUTCOME MEASURESC2-C7 lordosis, C2-C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed.METHODSThe radiographic and clinical outcomes of the two groups were compared.RESULTSEighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2-C7 lordosis (p<0.001) and ROM (p<0.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2-C7 lordosis (p<0.001), while ACDF caused a significant decrease in cervical ROM (p<0.001). ACDF effectively improved neck pain VAS (p<0.001) and NDI (p<0.001), while neck pain did not significantly improve after LPF (p=0.103). Furthermore, neck pain VAS (p=0.026) and NDI (p=0.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=0.502; NDI, p=0.085). Arm pain VAS and JOA score both significantly improved after LPF (p=0.003 and 0.043, respectively) or ACDF (p<0.001 and 0.039, respectively), and postoperative results were not significantly different between the two groups.CONCLUSIONLPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR.LEVEL OF EVIDENCEIII.","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND CONTEXTEvaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging.OBJECTIVEThis study aimed to investigate the importance of evaluating gaps using three-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord.STUDY DESIGN/SETTINGRetrospective cohort study.PATIENT SAMPLERetrospective analysis of 116 patients diagnosed with cervical OPLL.OUTCOME MEASURESPresence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated.METHODSLateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined.RESULTSA significant difference in gap detection accuracy was observed between CT and 3D-CT (p = 0.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p = 0.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps co-occurring with T2 high intensity exhibited significantly thinner lesions (p = 0.011) and larger SACs (p = 0.0002). Patients with gaps had a significantly lower JOA scores (p = 0.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms.CONCLUSION3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.
{"title":"Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using three-dimensional computed tomography.","authors":"Hazem Alaa,Nguyen Tran Canh Tung,Tomoya Ueno,Hiroto Makino,Hayato Futakawa,Shoji Seki,Yoshiharu Kawaguchi","doi":"10.1016/j.spinee.2024.08.030","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.08.030","url":null,"abstract":"BACKGROUND CONTEXTEvaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging.OBJECTIVEThis study aimed to investigate the importance of evaluating gaps using three-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord.STUDY DESIGN/SETTINGRetrospective cohort study.PATIENT SAMPLERetrospective analysis of 116 patients diagnosed with cervical OPLL.OUTCOME MEASURESPresence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated.METHODSLateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined.RESULTSA significant difference in gap detection accuracy was observed between CT and 3D-CT (p = 0.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p = 0.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps co-occurring with T2 high intensity exhibited significantly thinner lesions (p = 0.011) and larger SACs (p = 0.0002). Patients with gaps had a significantly lower JOA scores (p = 0.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms.CONCLUSION3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-08DOI: 10.1016/j.spinee.2024.08.021
Tomasz Klepinowski,Natalia Żyłka,Samuel D Pettersson,Jagoda Hanaya,Bartłomiej Pala,Kajetan Łątka,Dominik Taterra,Wojciech Poncyljusz,Christopher S Ogilvy,Leszek Sagan
BACKGROUND CONTEXTOur recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement.PURPOSETo classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP).STUDY DESIGNA retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied.PATIENT SAMPLE908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio.OUTCOME MEASURESThree types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW).METHODSHRVA was defined as C2IsH of ≤ 5 mm and/or C2InH of ≤ 2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤ 4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied.RESULTSPrevalence of at least one HRVA was 24.9% (n = 113 subjects) and 16.2% of PSIS (n = 147 sites). Based on the measurements and K-means clustering, the following three types of HRVA have been distinguished: type 1 - isthmic with only C2IsH being reduced and normal C2InH; type 2 - internal with only C2InH being reduced and C2IsH within normal limits; type 3 - isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted post-hoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed.CONCLUSIONWe present the first classification system for the high-riding vertebral artery distinguishing three types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this classification scheme shall determine its further clinical utility.
{"title":"Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites.","authors":"Tomasz Klepinowski,Natalia Żyłka,Samuel D Pettersson,Jagoda Hanaya,Bartłomiej Pala,Kajetan Łątka,Dominik Taterra,Wojciech Poncyljusz,Christopher S Ogilvy,Leszek Sagan","doi":"10.1016/j.spinee.2024.08.021","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.08.021","url":null,"abstract":"BACKGROUND CONTEXTOur recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement.PURPOSETo classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP).STUDY DESIGNA retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied.PATIENT SAMPLE908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio.OUTCOME MEASURESThree types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW).METHODSHRVA was defined as C2IsH of ≤ 5 mm and/or C2InH of ≤ 2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤ 4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied.RESULTSPrevalence of at least one HRVA was 24.9% (n = 113 subjects) and 16.2% of PSIS (n = 147 sites). Based on the measurements and K-means clustering, the following three types of HRVA have been distinguished: type 1 - isthmic with only C2IsH being reduced and normal C2InH; type 2 - internal with only C2InH being reduced and C2IsH within normal limits; type 3 - isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted post-hoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed.CONCLUSIONWe present the first classification system for the high-riding vertebral artery distinguishing three types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this classification scheme shall determine its further clinical utility.","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-08DOI: 10.1016/j.spinee.2024.09.001
Jan Hambrecht,Paul Köhli,Erika Chiapparelli,Krizia Amoroso,Ranqing Lan,Ali E Guven,Gisberto Evangelisti,Marco D Burkhard,Koki Tsuchiya,Roland Duculan,Jennifer Shue,Andrew A Sama,Frank P Cammisa,Federico P Girardi,Carol A Mancuso,Alexander P Hughes
BACKGROUND CONTEXTThe Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections.PURPOSETo analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery.STUDY DESIGNRetrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively.PATIENT SAMPLEA total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67 ± 8 years, and the mean BMI was 30 ± 6 kg/m2.OUTCOME MEASURESThe analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS.METHODSThe analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all pre-post paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p<0.05.RESULTSImprovement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4 ± 1.3), lifting (3.2 ± 1.9), and standing (3.4 ± 1.3). The lowest preoperative functional limitations were observed in sleeping (1.6 ± 1.3), personal care (1.6 ± 1.4), traveling (1.6 ± 1.2) and sitting (1.5 ± 1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p<0.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (-2.6), with 89% of patients experiencing improvement, standing (-2.4) with 87% of patients experiencing improvement, and pain intensity (-2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were personal care (-0.6), sitting (-0.7), and sleeping (-0.9). The study found that female patients had a significantly higher preoperative disability in various subsections but showed greater improvement in
背景 CONTEXThe Oswestry Disability Index（ODI）是一种广泛使用的患者报告结果测量法（PROM），用于评估腰椎病变患者的功能状态。外科医生使用 ODI 来确定术后的初始状态并监测进展。编制的 ODI 数据可用于比较不同的手术技术。退行性腰椎滑脱症（DLS）通常会导致背痛和神经源性跛行等症状，影响生活质量和 ODI 所反映的日常生活活动。尽管对脊柱手术后的 ODI 变化进行了大量研究，但人们对不同 ODI 分项的特征和变化知之甚少。目的分析选择性腰椎手术 2 年后总 ODI 和 ODI 分项的基线特征和变化。研究设计对 2016 年至 2018 年期间因退行性腰椎滑脱症接受脊柱手术的前瞻性入组患者进行回顾性分析。ODI在术前和术后2年进行评估。患者样本研究共纳入265名患者，其中60%为女性。结果测量分析考虑了手术前后 ODI 评分的差异，以及 DLS 选择性腰椎手术 2 年后所有 ODI 分项的变化。研究排除了 2 年后未进行 ODI 随访的患者。研究采用 Wilcoxon Signed Rank 检验法对所有前后配对样本进行检验。Wilcoxon 秩和检验用于总体 ODI 和 ODI 小节分析的性别和程序比较。以年龄和体重指数分别作为自变量，对总体和分部特定 ODI 结果进行单变量线性回归。结果242名患者（91%）的ODI有所改善。疼痛强度（3.4 ± 1.3）、提举（3.2 ± 1.9）和站立（3.4 ± 1.3）方面的基线残疾值最高。术前功能限制最少的是睡眠（1.6 ± 1.3）、个人护理（1.6 ± 1.4）、旅行（1.6 ± 1.2）和坐（1.5 ± 1.4）。在 2 年的随访中，所有问题和总体 ODI 均有明显改善（均 p<0.001）。绝对改善最大的 ODI 分项是疼痛程度改变（-2.6），89% 的患者有所改善；站立（-2.4），87% 的患者有所改善；疼痛强度（-2.1），81% 的患者有所改善。改善最少的小项是个人护理（-0.6）、坐姿（-0.7）和睡眠（-0.9）。研究发现，与男性患者相比，女性患者术前在各分项的残疾程度明显较高，但在总 ODI 方面的改善幅度更大（P=0.001）。此外，女性患者在坐姿（p＜0.001）、出行（p＜0.001）、社交（p＜0.001）和睡眠（p=0.018）方面的改善程度明显更高。年龄较大的患者在坐姿（p=0.005）和睡眠（p=0.002）方面的改善程度明显较低。体重指数越高，疼痛程度的改善程度越小（p=0.025），各分项的基线残疾程度越高。与仅接受减压术的患者相比，接受减压术和融合术的患者在多个分项的基线残疾程度明显更高。单纯减压术和减压加融合术在 ODI 整体改善程度和各分项改善程度方面没有明显差异。这一洞察力对于改善术前教育和有效管理患者对术后可能出现的特定部位残疾的预期非常有价值。
{"title":"The Disaggregation of the Oswestry Disability Index in Patients undergoing Lumbar Surgery for Degenerative Lumbar Spondylolisthesis.","authors":"Jan Hambrecht,Paul Köhli,Erika Chiapparelli,Krizia Amoroso,Ranqing Lan,Ali E Guven,Gisberto Evangelisti,Marco D Burkhard,Koki Tsuchiya,Roland Duculan,Jennifer Shue,Andrew A Sama,Frank P Cammisa,Federico P Girardi,Carol A Mancuso,Alexander P Hughes","doi":"10.1016/j.spinee.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.09.001","url":null,"abstract":"BACKGROUND CONTEXTThe Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections.PURPOSETo analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery.STUDY DESIGNRetrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively.PATIENT SAMPLEA total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67 ± 8 years, and the mean BMI was 30 ± 6 kg/m2.OUTCOME MEASURESThe analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS.METHODSThe analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all pre-post paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p<0.05.RESULTSImprovement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4 ± 1.3), lifting (3.2 ± 1.9), and standing (3.4 ± 1.3). The lowest preoperative functional limitations were observed in sleeping (1.6 ± 1.3), personal care (1.6 ± 1.4), traveling (1.6 ± 1.2) and sitting (1.5 ± 1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p<0.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (-2.6), with 89% of patients experiencing improvement, standing (-2.4) with 87% of patients experiencing improvement, and pain intensity (-2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were personal care (-0.6), sitting (-0.7), and sleeping (-0.9). The study found that female patients had a significantly higher preoperative disability in various subsections but showed greater improvement in","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.spinee.2024.08.026
Hongmei Song,Mingxin Yu,Yang Song,Shuanglin Deng
BACKGROUNDSpinal teratomas and lipomas, both adult and pediatric cases, are rare diseases with many similarities, but have yet to be systematically compared.PURPOSETo systematically compare spinal teratomas and lipomas to optimize management.STUDY DESIGNRetrospective PATIENT SAMPLE: Symptomatic spinal teratoma and lipoma patients surgically treated at our center.OUTCOME MEASURESAnatomical distribution, clinical manifestations, resection status, and outcomes.METHODSSpinal teratoma and lipoma patients with complete data treated during 2008-2023 in our center were enrolled. Electrophysiological monitoring was routinely performed after 2012. Patient characteristics, anatomical distribution, clinical manifestations, surgical resection, and outcomes were analyzed.RESULTSWe enrolled 86 teratoma patients (71 adults) and 51 lipoma patients (39 adults). Most tumors were lumbosacral lesions; cervical/thoracic involvement was more common with lipomas. Pain, the most frequent manifestation, was more common in teratomas. Gross total resection (GTR) was achieved in 51.1% and 49% of teratomas and lipomas, respectively. Electrophysiological monitoring increased the GTR rate from 38.8% to 48.6%. Age independently predicted (OR: 1.040, 95% CI: 1.008-1.078) GTR/near-total resection (NTR). Symptom relief occurred in 81.4% teratoma patients and 64.7% lipoma patients. Recurrence/symptomatic progression occurred in 19 teratomas and 7 lipomas after a median of 95 and 115 months, respectively. Adult lipoma patients without spinal dysraphism had lower recurrence rates. GTR (HR: 0.172, 95% CI: 0.02557-0.7028) and lesion length (HR: 1.351, 95% CI: 1.138-1.607) independently predicted recurrence/progression.CONCLUSIONSGTR should be pursued for adult/pediatric spinal teratomas and pediatric spinal lipomas. For adult spinal lipoma patients without dysraphism, conservative surgery could be considered.
{"title":"A retrospective analysis of spinal teratomas and spinal lipomas: overlaps and differences in presentation, surgical treatments, and outcomes.","authors":"Hongmei Song,Mingxin Yu,Yang Song,Shuanglin Deng","doi":"10.1016/j.spinee.2024.08.026","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.08.026","url":null,"abstract":"BACKGROUNDSpinal teratomas and lipomas, both adult and pediatric cases, are rare diseases with many similarities, but have yet to be systematically compared.PURPOSETo systematically compare spinal teratomas and lipomas to optimize management.STUDY DESIGNRetrospective PATIENT SAMPLE: Symptomatic spinal teratoma and lipoma patients surgically treated at our center.OUTCOME MEASURESAnatomical distribution, clinical manifestations, resection status, and outcomes.METHODSSpinal teratoma and lipoma patients with complete data treated during 2008-2023 in our center were enrolled. Electrophysiological monitoring was routinely performed after 2012. Patient characteristics, anatomical distribution, clinical manifestations, surgical resection, and outcomes were analyzed.RESULTSWe enrolled 86 teratoma patients (71 adults) and 51 lipoma patients (39 adults). Most tumors were lumbosacral lesions; cervical/thoracic involvement was more common with lipomas. Pain, the most frequent manifestation, was more common in teratomas. Gross total resection (GTR) was achieved in 51.1% and 49% of teratomas and lipomas, respectively. Electrophysiological monitoring increased the GTR rate from 38.8% to 48.6%. Age independently predicted (OR: 1.040, 95% CI: 1.008-1.078) GTR/near-total resection (NTR). Symptom relief occurred in 81.4% teratoma patients and 64.7% lipoma patients. Recurrence/symptomatic progression occurred in 19 teratomas and 7 lipomas after a median of 95 and 115 months, respectively. Adult lipoma patients without spinal dysraphism had lower recurrence rates. GTR (HR: 0.172, 95% CI: 0.02557-0.7028) and lesion length (HR: 1.351, 95% CI: 1.138-1.607) independently predicted recurrence/progression.CONCLUSIONSGTR should be pursued for adult/pediatric spinal teratomas and pediatric spinal lipomas. For adult spinal lipoma patients without dysraphism, conservative surgery could be considered.","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.spinee.2024.06.559
Sarthak Mohanty BS, Fthimnir Hassan MPH, Erik Lewerenz BS, LaRae Klarenbeek-Micthell DPTPT OCS, David Ruderman DPTPT, Eric Schaum DPT, Joseph Lombardi MD, Zeeshan Sardar MD MSc, Ronald A. Lehman MD, Lawrence G. Lenke MD
{"title":"116. Machine learning clustering of preoperative fitness and its prognostic value following adult spinal deformity correction","authors":"Sarthak Mohanty BS, Fthimnir Hassan MPH, Erik Lewerenz BS, LaRae Klarenbeek-Micthell DPTPT OCS, David Ruderman DPTPT, Eric Schaum DPT, Joseph Lombardi MD, Zeeshan Sardar MD MSc, Ronald A. Lehman MD, Lawrence G. Lenke MD","doi":"10.1016/j.spinee.2024.06.559","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.06.559","url":null,"abstract":"","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.spinee.2024.06.547
Ankita Das BS, Oluwatobi Onafowokan MBBS, Paritash Tahmaseb Pour MD, Jamshaid Mir MD, Nathan Lorentz MD, Jordan Lebovic MD MBA, Matthew Steven Galetta BA, Nitin Agarwal MD, Nima Alan MD, Neel Anand MD, Robert K. Eastlack MD, Thomas J Buell MD, Renaud Lafage MSc, Rafael De la Garza Ramos MD, Alan H Daniels MD, Christopher I. Shaffrey MD, Peter Gust Passias MD
{"title":"104. The more the merrier? Integration of vertebral pelvic angles PJK thresholds to existing alignment schemas for prevention of mechanical complications after adult spinal deformity surgery","authors":"Ankita Das BS, Oluwatobi Onafowokan MBBS, Paritash Tahmaseb Pour MD, Jamshaid Mir MD, Nathan Lorentz MD, Jordan Lebovic MD MBA, Matthew Steven Galetta BA, Nitin Agarwal MD, Nima Alan MD, Neel Anand MD, Robert K. Eastlack MD, Thomas J Buell MD, Renaud Lafage MSc, Rafael De la Garza Ramos MD, Alan H Daniels MD, Christopher I. Shaffrey MD, Peter Gust Passias MD","doi":"10.1016/j.spinee.2024.06.547","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.06.547","url":null,"abstract":"","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.spinee.2024.06.557
Samuel Ezeonu BA, Alyssa Capasso BS, Nicholas Vollano, Juan Rodriguez-Rivera BS, Constance Maglaras PhD, Tina Raman MD, Yong H. Kim MD, Charla R. Fischer MD
{"title":"114. Assessment of clinical outcomes and pain management of single-level lumbar laminectomy between unilateral biportal endoscopic, tubular, and open approaches","authors":"Samuel Ezeonu BA, Alyssa Capasso BS, Nicholas Vollano, Juan Rodriguez-Rivera BS, Constance Maglaras PhD, Tina Raman MD, Yong H. Kim MD, Charla R. Fischer MD","doi":"10.1016/j.spinee.2024.06.557","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.06.557","url":null,"abstract":"","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.spinee.2023.06.295
S. Blumenthal, Emily C. Courtois, Cody W. Griffin, R. Guyer, J. Zigler, Jessica L. Shellock, D. Ohnmeiss
{"title":"P70. Incidence of implant removal or revision surgery after cervical total disc replacement in a consecutive series of 1,615 patients beginning with the first case experience in 2003","authors":"S. Blumenthal, Emily C. Courtois, Cody W. Griffin, R. Guyer, J. Zigler, Jessica L. Shellock, D. Ohnmeiss","doi":"10.1016/j.spinee.2023.06.295","DOIUrl":"https://doi.org/10.1016/j.spinee.2023.06.295","url":null,"abstract":"","PeriodicalId":22961,"journal":{"name":"The Spine Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139346529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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