North American Spine Society Journal最新文献_第10页

2. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020 2.2012 年至 2020 年日本行政数据中转移性脊柱肿瘤手术治疗的趋势

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100340

Kentaro Yamada MD, PhD, Toshitaka Yoshii MD, Mikayo Toba MD, Satoru Egawa MD, Shingo Morishita MD, PhD, Yu Matsukura MD, Hiroyuki Inose MD, PhD, Kiyohide Fushimi MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><p>Spinal metastasis can lead to pain, neurological deficit, and disruption of health-related quality of life, and sometimes needs surgical treatment. Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades.</p></div><div><h3>PURPOSE</h3><p>This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Analysis of nationwide administrative hospital discharge data.</p></div><div><h3>PATIENT SAMPLE</h3><p>This study included spinal surgery cases for metastatic spinal tumors including total en bloc spondylectomy, palliative fusion surgery, laminectomy, and vertebroplasty using the Diagnosis Procedure Combination (DPC) database: a national inpatient database in Japan, from 2012 to 2020.</p></div><div><h3>OUTCOME MEASURES</h3><p>Trends in the surgical treatment for spinal metastasis, patients’ demographics, and in-hospital outcomes were investigated using Jonckheere-Terpstra trend test and Cochran-Armitage test. The outcomes of this analysis were evaluated by (1) in-hospital mortality with the 30-day mortality, (2) length of stay, (3) the proportion of discharge to home, (4) postoperative complication, and (5) unfavorable ambulatory status.</p></div><div><h3>METHODS</h3><p>The number of patients who underwent spinal surgery for nonmetastatic spinal disorders at the institutions that have performed metastatic spine surgeries at least one case in the same year were also investigated. The postoperative unexpected ambulatory was defined as nonambulatory at discharge or a decrease in mobility score of Barthel Index between admission and discharge.</p></div><div><h3>RESULTS</h3><p>This study analyzed 10,321 eligible patients with spinal metastasis with 473,391 patients without spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 877 in 2012 to 1479 in 2020, especially in fusion surgery from 84% in 2012 to 87% in 2020, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2 %. Distributions of the primary site did not change whereas age was getting older. In-hospital death and length of stay decreased over time (9.9%–6.8%, p <0.001; 37 days–30 days, p <0.001). The postoperative complication retained stable (8.0%–8.5%, p=0.52). Postoperative unfavorable ambulatory slightly decreased (39%–36.9%, p=0.003).</p></div><div><h3>CONCLUSIONS</h3><p>During the last decade, surgical treatment for spinal metastasis has increased in Japan. Age at the time of surgery was getting older, whereas the distribution of the primary site of tumors and preoperative comorbidity did not change. In-hospital mortality and length of stay decreased ove

背景背景背景背景脊柱转移瘤可导致疼痛、神经功能缺损和与健康相关的生活质量下降，有时需要手术治疗。癌症诊断/治疗方式和脊柱手术技术都是近年来发展起来的。本研究旨在利用全国范围内的行政医院出院数据，研究脊柱转移瘤手术治疗的最新趋势以及住院患者的预后。研究设计/设定分析全国范围内的行政医院出院数据。患者样本本研究使用诊断程序组合（DPC）数据库（日本全国住院患者数据库），纳入了2012年至2020年期间转移性脊柱肿瘤的脊柱手术病例，包括全脊椎切除术、姑息性融合手术、椎板切除术和椎体成形术。结果测量采用Jonckheere-Terpstra趋势检验和Cochran-Armitage检验对脊柱转移手术治疗、患者人口统计学和住院结果的趋势进行了调查。该分析的结果通过以下方面进行评估：（1）院内死亡率和 30 天死亡率；（2）住院时间；（3）出院回家的比例；（4）术后并发症；（5）不利的卧床状态。方法还调查了当年在至少实施过一例脊柱转移手术的机构中接受脊柱手术治疗非转移性脊柱疾病的患者人数。结果这项研究分析了10,321名符合条件的脊柱转移患者和473,391名未患脊柱转移的患者。脊柱转移瘤的手术治疗从2012年的877例增加到2020年的1479例，增加了1.68倍，尤其是融合手术从2012年的84%增加到2020年的87%，而转移性脊柱手术的比例保持不变，仅略微增加了2%。原发部位的分布没有变化，而年龄却越来越大。院内死亡和住院时间随时间推移而缩短（9.9%-6.8%，p <0.001；37 天-30 天，p <0.001）。术后并发症保持稳定（8.0%-8.5%，P=0.52）。结论近十年来，脊柱转移瘤的手术治疗在日本有所增加。手术时的年龄越来越大，而肿瘤原发部位和术前合并症的分布没有变化。随着时间的推移，院内死亡率和住院时间有所缩短，而出院回家和术后并发症则保持稳定。术后不良卧床时间略有减少。本研究结果可为医疗保健政策或临床研究规划提供有用信息。FDA设备/药物状态本摘要不讨论或包含任何适用设备或药物。

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引用次数: 0

63. Intraoperative blood pressure fluctuation is associated with postoperative C5 palsy in cervical spine surgery: a retrospective observational study 63.术中血压波动与颈椎手术术后 C5 麻痹相关：一项回顾性观察研究

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100401

Toshiki Tsukui MD , Eiji Takasawa MD, PhD , Hirotaka Chikuda MD, PhD

BACKGROUND CONTEXT

Postoperative C5 palsy is a well-recognized complication following cervical spine surgery. However, the precise pathophysiology remains debated given its multifactorial nature. We focused on intraoperative arterial blood pressure (IO-MAP) as a representation of systemic hemodynamic alterations during surgery. We hypothesized that IO-MAP changes may influence the incidence of postoperative C5 palsy.

PURPOSE

This study aimed to investigate the relationship between IO-MAP changes during cervical spine surgery and the occurrence of C5 palsy.

STUDY DESIGN/SETTING

This was a retrospective single-center cohort study. Surgical records were reviewed to identify all patients undergoing cervical spine surgery at our institution from 2010 to 2022.

PATIENT SAMPLE

Our cohort included 74 patients with cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), or other cervical pathologies.

OUTCOME MEASURES

Intraoperative hypotension was defined as ≥5 consecutive drops in IO-MAP to <65 mmHg during surgery, which has been associated with adverse postoperative outcomes like myocardial infarction, acute kidney injury, and mortality. The IO-MAP amplitude was calculated as the difference between maximum and minimum IO-MAP values.

METHODS

Patients were divided into groups with or without C5 palsy (C5 palsy group vs age-matched control group). Demographics, diagnosis, surgical characteristics, and IO-MAP parameters were recorded. Multivariable logistic regression identified independent risk factors for postoperative C5 palsy.

RESULTS

Among 74 patients (mean age 70.5 years; 22 [30%] female), 13 (17.6%) developed postoperative C5 palsy. Age, sex, diagnosis (OPLL 23% vs 18%), spinal fusion rate (54% vs 33%), and intraoperative hypotension incidence (2.5 vs 3.1 episodes per surgery) were comparable between groups (P > 0.05). However, patients with C5 palsy had greater IO-MAP amplitude versus controls (Δ92 vs Δ73 mmHg, P = 0.013). After adjusting for confounders, IO-MAP amplitude remained an independent risk factor for postoperative C5 palsy (odds ratio 1.03, 95% confidence interval 1.00-1.05, P = 0.03). ROC analysis found an IO-MAP amplitude cutoff of Δ67mmHg predicted C5 palsy with 85% sensitivity and 53% specificity (AUC 0.72, 95% CI 0.56-0.87).

CONCLUSIONS

Intraoperative MAP amplitude was closely associated with postoperative C5 palsy occurrence. Our findings emphasize the importance of optimal hemodynamic control to mitigate C5 palsy risk. The gap between maximum and minimum IO-MAP values should be maintained below 67 mmHg.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

背景背景术后 C5 麻痹是颈椎手术后一种公认的并发症。然而，鉴于其多因素性质，确切的病理生理学仍存在争议。我们重点研究了术中动脉血压（IO-MAP），它代表了手术过程中全身血液动力学的改变。我们假设 IO-MAP 变化可能会影响术后 C5 麻痹的发生率。本研究旨在探讨颈椎手术期间 IO-MAP 变化与 C5 麻痹发生率之间的关系。我们的队列包括 74 名患有颈椎脊髓病（CSM）、后纵韧带骨化（OPLL）或其他颈椎病变的患者。结果测量术中 IO-MAP 连续≥5 次下降至 65 mmHg 即为术后低血压，这与心肌梗死、急性肾损伤和死亡率等不良术后结果有关。方法将患者分为有或没有 C5 麻痹的两组（C5 麻痹组与年龄匹配的对照组）。记录人口统计学特征、诊断、手术特征和 IO-MAP 参数。结果74例患者（平均年龄70.5岁；22例[30%]女性）中，13例（17.6%）出现术后C5麻痹。两组患者的年龄、性别、诊断（OPLL 23% vs 18%）、脊柱融合率（54% vs 33%）和术中低血压发生率（每例手术 2.5 vs 3.1 次）相当（P > 0.05）。然而，与对照组相比，C5 麻痹患者的 IO-MAP 振幅更大（Δ92 vs Δ73 mmHg，P = 0.013）。调整混杂因素后，IO-MAP 振幅仍是术后 C5 麻痹的独立风险因素（几率比 1.03，95% 置信区间 1.00-1.05，P = 0.03）。ROC 分析发现，IO-MAP 波幅临界值为 Δ67mmHg 时，预测 C5 麻痹的灵敏度为 85%，特异度为 53%（AUC 0.72，95% CI 0.56-0.87）。我们的研究结果强调了最佳血流动力学控制对降低 C5 麻痹风险的重要性。最大和最小 IO-MAP 值之间的差距应保持在 67 mmHg 以下。FDA 设备/药物状态本摘要未讨论或包含任何适用的设备或药物。

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引用次数: 0

32. The effect of transpedicular injection of rhBMP-2 injection on prevention of proximal junctional kyphosis 32.经关节注射 rhBMP-2 对预防近端交界性脊柱后凸的影响

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100370

Joonhee Park MD , Ho-Joong Kim MD, PhD

BACKGROUND CONTEXT

Several studies have explored strategies to prevent proximal junctional kyphosis (PJK). Our study introduces a novel strategy to address the unresolved issue of PJK in ASD, utilizing recombinant human bone morphogenetic protein-2 (rhBMP-2).

PURPOSE

This study aimed to investigate the preventive effects of upper instrumented vertebrae (UIV) rhBMP-2 injection on PJK and proximal junctional failure (PJF) and to determine whether UIV bone density significantly increases locally.

STUDY DESIGN/SETTING

A retrospective and prospective case-control study.

PATIENT SAMPLE

The sample consists of 154 patients with ASD (adult spine deformity)

OUTCOME MEASURES

Incidence of PJK and PJF and change in the Hounsfield unit of UIV after 1 year of follow-up

METHODS

All surgeries were performed with instrumentation and fusion from iliac to T10. In the experimental group, consisting of 25 patients with ASD, rhBMP-2 injection was administered to the vertebral body of UIV. To minimize performance bias, the control-1 group included 66 patients who had undergone ASD surgery by the same surgeon in the year preceding the commencement of the study. Control-2 consisted of 63 patients who had undergone ASD surgery by the same surgeon during the year following the end of the study for experimental group. Postoperatively, we evaluated the presence of PJK and PJF, change in the Hounsfield unit (HU) of UIV after 1 year of follow-up. The control-1 group was respectively collected data and the experimental group and control-2 group were prospectively collected data.

RESULTS

When comparing baseline characteristics with control groups, a significant difference was observed only in BMI with control-1 (p=0.006), control-total (control-1 + control-2, p=0.026) having a higher BMI than the study group. In the group that received rhBMP-2 at UIV, there were 3 cases (12.0%) of PJK, whereas the control-1 and control-2 had 26 cases (39.4%, BMI-adjusted p=0.010) and 20 cases (31.7%, BMI-adjusted p=0.078), respectively. In the control-total group (combining control-1 and control-2 groups), there were 46 cases (35.7%, BMI-adjusted p=0.025) of PJK. Regarding HU measurements, the UIV that received rhBMP-2 showed a statistically significant increase compared with the preoperative values one year after surgery (p=0.001).

CONCLUSIONS

Injection of rhBMP-2 at the UIV effectively increased trabecular bone density at the UIV, thereby significantly contributing to the prevention of PJK.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

背景 CONTEXT多项研究探讨了预防近端交界性脊柱后凸（PJK）的策略。本研究旨在探讨上器械椎体（UIV）注射 rhBMP-2 对 PJK 和近端连接失败（PJF）的预防作用，并确定 UIV 骨密度是否会显著增加局部骨密度。结果测量随访一年后，PJK 和 PJF 的发生率以及 UIV 的 Hounsfield 单位变化。实验组由 25 名 ASD 患者组成，在 UIV 椎体注射 rhBMP-2。为尽量减少表现偏差，对照-1 组包括 66 名在研究开始前一年由同一外科医生进行过 ASD 手术的患者。对照-2组包括63名患者，他们在实验组研究结束后的一年内由同一外科医生进行了ASD手术。术后，我们评估了 PJK 和 PJF 的存在情况，以及随访 1 年后 UIV 的 Hounsfield 单位（HU）的变化。结果与对照组比较基线特征时，仅在体重指数上观察到显著差异，对照组-1（P=0.006）、对照组-总（对照组-1 +对照组-2，P=0.026）的体重指数高于研究组。在 UIV 时接受 rhBMP-2 的研究组有 3 例（12.0%）PJK，而对照-1 和对照-2 组分别有 26 例（39.4%，经 BMI 调整后 p=0.010）和 20 例（31.7%，经 BMI 调整后 p=0.078）。在对照-总组（结合对照-1 组和对照-2 组）中，PJK 病例为 46 例（35.7%，BMI 调整后 p=0.025）。结论在 UIV 处注射 rhBMP-2 能有效增加 UIV 处的骨小梁密度，从而大大有助于预防 PJK。

{"title":"32. The effect of transpedicular injection of rhBMP-2 injection on prevention of proximal junctional kyphosis","authors":"Joonhee Park MD , Ho-Joong Kim MD, PhD","doi":"10.1016/j.xnsj.2024.100370","DOIUrl":"10.1016/j.xnsj.2024.100370","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Several studies have explored strategies to prevent proximal junctional kyphosis (PJK). Our study introduces a novel strategy to address the unresolved issue of PJK in ASD, utilizing recombinant human bone morphogenetic protein-2 (rhBMP-2).</p></div><div><h3>PURPOSE</h3><p>This study aimed to investigate the preventive effects of <strong>u</strong>pper instrumented vertebrae (UIV) rhBMP-2 injection on PJK and proximal junctional failure (PJF) and to determine whether UIV bone density significantly increases locally.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective and prospective case<strong>-</strong>control study.</p></div><div><h3>PATIENT SAMPLE</h3><p>The sample consists of <strong>154</strong> patients with ASD (<strong>a</strong>dult spine deformity)</p></div><div><h3>OUTCOME MEASURES</h3><p>Incidence of PJK and PJF and change in the Hounsfield unit of UIV after 1 year of follow-up</p></div><div><h3>METHODS</h3><p>All surgeries were performed with instrumentation and fusion from iliac to T10. In the experimental group, consisting of 25 patients with ASD, rhBMP-2 injection was administered to the vertebral body of UIV. To minimize performance bias, the control-1 group included 66 patients who had undergone ASD surgery by the same surgeon in the year preceding the commencement of the study. Control-2 consisted of 63 patients who had undergone ASD surgery by the same surgeon during the year following the end of the study for experimental group. Postoperatively, we evaluated the presence of PJK and PJF, change in the Hounsfield unit (HU) of UIV after 1 year of follow-up. The control-1 group was respectively collected data and the experimental group and control-2 group were prospectively collected data.</p></div><div><h3>RESULTS</h3><p>When comparing baseline characteristics with control groups, a significant difference was observed only in BMI with control-1 (p=0.006), control-total (control-1 + control-2, p=0.026) having a higher BMI than the study group. In the group that received rhBMP-2 at UIV, there were 3 cases (12.0%) of PJK, whereas the control-1 and control-2 had 26 cases (39.4%, BMI-adjusted p=0.010) and 20 cases (31.7%, BMI-adjusted p=0.078), respectively. In the control-total group (combining control-1 and control-2 groups), there were 46 cases (35.7%, BMI-adjusted p=0.025) of PJK. Regarding HU measurements, the UIV that received rhBMP-2 showed a statistically significant increase compared with the preoperative values <strong>one</strong> year after surgery (p=0.001).</p></div><div><h3>CONCLUSIONS</h3><p>Injection of rhBMP-2 at the UIV effectively increased trabecular bone density at the UIV, thereby significantly contributing to the prevention of PJK.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100370"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000635/pdfft?md5=62b4287bf22f2eb161dcd0de6e71f4f7&pid=1-s2.0-S2666548424000635-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

17. Comparison of clinical results between minimally invasive cervical foraminotomy and anterior cervical decompression and fusion for cervical radiculopathy 17.微创颈椎椎板切除术与颈椎前路减压融合术治疗颈椎病的临床效果比较

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100355

Akihito Minamide MD, PhD , Shizumasa Murata MD , Yasutsugu Yukawa MD, PhD , Ryo Taiji MD , Takuhei Kozaki MD, PhD , Masanari Takami MD, PhD , Shunji Tsutsui MD, PhD , Yutaka Nohara MD , Hiroshi Taneichi MD , Hiroshi Yamada MD, PhD , Andrew Simpson MD, MBA

<div><h3>BACKGROUND CONTEXT</h3><p>As a surgical procedure for cervical radiculopathy, anterior cervical decompression and fusion (ACDF) or posterior foraminotomy is generally performed. Recently, the efficacy of minimally invasive cervical posterior foraminotomy has been reported. However, few studies have compared the postoperative clinical outcomes of minimally invasive cervical foraminotomy with those of ACDF. Nor have complications from their surgical procedure been compared.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study was to clarify the efficacy of cervical microendoscopic foraminotomy (CMEF) compared with ACDF for the treatment of cervical disorders with radiculopathy.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study design is a retrospective subgroup analysis of a prospectively collected cohort analysis.</p></div><div><h3>PATIENT SAMPLE</h3><p>Consecutive patients with cervical radiculopathy who required surgical treatment were enrolled. The patients were diagnosed with cervical radiculopathy due to disc herniation or degenerative spondylosis on imaging including MRI and CT scan. Surgical treatment was selected when conservative treatment for more than 3 months was not effective. All enrolled patients (n = 79) underwent CMEF or ACDF.</p></div><div><h3>OUTCOME MEASURES</h3><p>All patients were reviewed postoperatively for greater than 1 year. The preoperative and 1-year follow-up evaluations included neurological assessment. The primary outcome measure was the numeric rating scale (NRS) for neck and arm pain with a minimal clinically important difference defined as >15%. Secondary outcomes were assessed with additional patient reported outcomes measures (PROMs).</p></div><div><h3>METHODS</h3><p>Nominal variables were compared using the Chi-squared test, or Fisher's exact test if the sample was ≤10. The Mann – Whitney test was used to compare medians of ordinal variables and the independent-samples t-test was used to compare the means of continuous variables. The complication rate was analyzed using a matched-pairs t-test. To evaluate changes in the NRS score following each surgery a repeated-measures analysis of variance was used. A p-value ≤0.05 was defined, a-priori, as statistically significant.</p></div><div><h3>RESULTS</h3><p>CMEF was performed in 55 patients and 24 patients underwent ACDF. The mean preoperative NRS for neck and arm pain was respectively 5.6 and 6.0 points in the CMEF group and 5.2 and 5.6 points in the ACDF group (p>0.05). In both groups, their NRS improved significantly 1 year after surgery (p<0.05), and there were no significant differences between the groups (p>0.05). The VAS of surgical satisfaction was 82 mm in the CMEF group and 83 mm in the ACDF group (p>0.05). There was no significant difference between the groups in SF-36. As for perioperative complications, in the CMEF group, 3 patients had temporary muscle weakness over MMT1 grade, and 2 patients had temporary progress

背景 CONTEXTA 作为一种治疗颈椎病的手术方法，通常采用颈椎前路减压融合术（ACDF）或后路椎板切除术。最近，有报道称微创颈椎后椎板切除术疗效显著。然而，很少有研究将微创颈椎椎间孔板切除术与 ACDF 的术后临床效果进行比较。本研究旨在明确颈椎显微内窥镜椎板切除术（CMEF）与 ACDF 相比在治疗颈椎病方面的疗效。患者经磁共振成像和 CT 扫描等影像学检查确诊为椎间盘突出症或退行性脊椎病引起的颈椎病。如果保守治疗超过 3 个月仍无效，则选择手术治疗。所有入选患者（n = 79）均接受了 CMEF 或 ACDF。术前和 1 年随访评估包括神经评估。主要结果测量指标是颈部和手臂疼痛的数字评分量表（NRS），最小临床重要差异定义为>15%。方法采用Chi-squared检验对名义变量进行比较，如果样本≤10，则采用费雪精确检验。曼-惠特尼检验用于比较序数变量的中位数，独立样本 t 检验用于比较连续变量的均值。并发症发生率采用配对 t 检验进行分析。为了评估每次手术后 NRS 评分的变化，采用了重复测量方差分析。结果55名患者接受了CMEF手术，24名患者接受了ACDF手术。CMEF 组患者术前颈部和手臂疼痛的平均 NRS 分别为 5.6 分和 6.0 分，ACDF 组患者术前颈部和手臂疼痛的平均 NRS 分别为 5.2 分和 5.6 分（p>0.05）。两组患者术后一年的 NRS 均有明显改善（p<0.05），组间无显著差异（p>0.05）。CMEF 组的手术满意度 VAS 为 82 mm，ACDF 组为 83 mm（p>0.05）。两组在SF-36方面无明显差异。围手术期并发症方面，CMEF 组有 3 名患者出现 MMT1 级以上的暂时性肌无力，2 名患者出现暂时性进行性麻木。结论两组颈椎病伴根性病变患者在随访1年时的临床症状均有所改善，具有可比性。然而，两组患者的一过性神经功能衰退在临床上存在重要差异。CMEF出现了一些与神经根相关的并发症，而ACDF出现了吞咽困难。

{"title":"17. Comparison of clinical results between minimally invasive cervical foraminotomy and anterior cervical decompression and fusion for cervical radiculopathy","authors":"Akihito Minamide MD, PhD , Shizumasa Murata MD , Yasutsugu Yukawa MD, PhD , Ryo Taiji MD , Takuhei Kozaki MD, PhD , Masanari Takami MD, PhD , Shunji Tsutsui MD, PhD , Yutaka Nohara MD , Hiroshi Taneichi MD , Hiroshi Yamada MD, PhD , Andrew Simpson MD, MBA","doi":"10.1016/j.xnsj.2024.100355","DOIUrl":"10.1016/j.xnsj.2024.100355","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>As a surgical procedure for cervical radiculopathy, anterior cervical decompression and fusion (ACDF) or posterior foraminotomy is generally performed. Recently, the efficacy of minimally invasive cervical posterior foraminotomy has been reported. However, few studies have compared the postoperative clinical outcomes of minimally invasive cervical foraminotomy with those of ACDF. Nor have complications from their surgical procedure been compared.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study was to clarify the efficacy of cervical microendoscopic foraminotomy (CMEF) compared with ACDF for the treatment of cervical disorders with radiculopathy.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study design is a retrospective subgroup analysis of a prospectively collected cohort analysis.</p></div><div><h3>PATIENT SAMPLE</h3><p>Consecutive patients with cervical radiculopathy who required surgical treatment were enrolled. The patients were diagnosed with cervical radiculopathy due to disc herniation or degenerative spondylosis on imaging including MRI and CT scan. Surgical treatment was selected when conservative treatment for more than 3 months was not effective. All enrolled patients (n = 79) underwent CMEF or ACDF.</p></div><div><h3>OUTCOME MEASURES</h3><p>All patients were reviewed postoperatively for greater than 1 year. The preoperative and 1-year follow-up evaluations included neurological assessment. The primary outcome measure was the numeric rating scale (NRS) for neck and arm pain with a minimal clinically important difference defined as >15%. Secondary outcomes were assessed with additional patient reported outcomes measures (PROMs).</p></div><div><h3>METHODS</h3><p>Nominal variables were compared using the Chi-squared test, or Fisher's exact test if the sample was ≤10. The Mann – Whitney test was used to compare medians of ordinal variables and the independent-samples t-test was used to compare the means of continuous variables. The complication rate was analyzed using a matched-pairs t-test. To evaluate changes in the NRS score following each surgery a repeated-measures analysis of variance was used. A p-value ≤0.05 was defined, a-priori, as statistically significant.</p></div><div><h3>RESULTS</h3><p>CMEF was performed in 55 patients and 24 patients underwent ACDF. The mean preoperative NRS for neck and arm pain was respectively 5.6 and 6.0 points in the CMEF group and 5.2 and 5.6 points in the ACDF group (p>0.05). In both groups, their NRS improved significantly 1 year after surgery (p<0.05), and there were no significant differences between the groups (p>0.05). The VAS of surgical satisfaction was 82 mm in the CMEF group and 83 mm in the ACDF group (p>0.05). There was no significant difference between the groups in SF-36. As for perioperative complications, in the CMEF group, 3 patients had temporary muscle weakness over MMT1 grade, and 2 patients had temporary progress","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100355"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000489/pdfft?md5=088a5e97774981d474fb24a0926419ad&pid=1-s2.0-S2666548424000489-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

P15. Impact of age on the occurrence of vascular complications in patients undergoing anterior lumbar approach surgery P15.年龄对腰椎前路手术患者血管并发症发生率的影响

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100419

Richard D. Guyer MD , Jun-Young Ahn MD , Emily Courtois MS , Scott L Blumenthal MD , Donna D. Ohnmeiss PhD

<div><h3>Background Context</h3><p>With increased longevity, the number of patients with symptomatic, degenerative spinal conditions is increasing. Anterior approach lumbar spinal surgery may facilitate use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of anterior approach lumbar spinal surgery, risks related to vascular injury in older patients have been described in the literature.</p></div><div><h3>Purpose</h3><p>The purpose of this study was to investigate the impact of age on the incidence of vascular complications in a large series of patients undergoing anterior lumbar approach surgery.</p></div><div><h3>Study Design/Setting</h3><p>This was a retrospective cohort study.</p></div><div><h3>Patient Sample</h3><p>The study was based on 751 consecutive patients who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation, total disc replacement (TDR), or hybrid surgery (ALIF and TDR) for the treatment of degenerative spinal pathology. Patients with surgeries greater than 3 levels, or who underwent surgery for fracture, tumor, complex deformity, or involving a lateral approach were excluded.</p></div><div><h3>Outcome Measures</h3><p>The primary outcome measures were the incidence of intraoperative vascular injuries and postoperative vascular complications (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)).</p></div><div><h3>Methods</h3><p>Charts were reviewed to collect general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications. Rates of vascular complications were compared across age groups divided by decade of age. Data were also analyzed comparing the mean age of patients with no vascular complications to those in each of the vascular complication subgroups.</p></div><div><h3>Results</h3><p>The overall mean age was 50.4 years (range 20-83 years). The majority of patients (53.1%) underwent combined ALIF/posterior surgery, 31.7% underwent TDR, 11.3% underwent ALIF, and the remaining patients underwent hybrid surgery. With respect to the number of levels operated: 468 were 1-level, 253 were 2-level, and 30 were 3-level. Mean estimated blood loss was 91.3 mL (range 10-2800 ml). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins. The mean blood loss in these cases was 721 ml and all were successfully repaired intraoperatively. Postoperatively, 6 patients, 0.8%, developed DVT and/or PE (one patient had both intra and postoperative vascular complications). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates (all p>.38). Additionally, there were no statistically significant differences in the mean ages of patients with vs those without vascular complications (all p>.17

背景随着寿命的延长，有症状的退行性脊柱疾病患者的人数也在增加。前路腰椎手术有助于使用椎板覆盖面更大、前凸度更高的椎间器。尽管前路腰椎手术有其优势，但文献中也描述了老年患者血管损伤的相关风险。本研究旨在调查在接受前路腰椎手术的大量患者中，年龄对血管并发症发生率的影响。患者样本该研究基于751例连续接受独立前路腰椎间融合术（ALIF）、ALIF联合后路融合术和/或器械治疗、全椎间盘置换术（TDR）或混合手术（ALIF和TDR）治疗脊柱退行性病变的患者。结果测量主要结果测量术中血管损伤和术后血管并发症（深静脉血栓形成（DVT）和/或肺栓塞（PE））的发生率。方法回顾图表收集患者的一般描述性数据、手术细节、术中血管损伤和术后血管并发症。比较了不同年龄组的血管并发症发生率，按年龄段划分。此外，还对无血管并发症患者的平均年龄与各血管并发症亚组患者的平均年龄进行了比较分析。大多数患者（53.1%）接受了ALIF/后路联合手术，31.7%接受了TDR手术，11.3%接受了ALIF手术，其余患者接受了混合手术。手术水平数方面，468 例为 1 水平，253 例为 2 水平：468例为1级，253例为2级，30例为3级。平均估计失血量为 91.3 毫升（范围为 10-2800 毫升）。共有 15 名患者（2.0%）出现血管并发症。术中损伤髂动脉或髂腰静脉的有 10 例（1.3%）。这些病例的平均失血量为 721 毫升，均在术中成功修复。术后，6 名患者（0.8%）出现深静脉血栓和/或 PE（一名患者同时出现术中和术后血管并发症）。在年龄方面，术中、术后或合并血管并发症的发生率没有显著差异（所有 p>.38）。此外，有血管并发症与无血管并发症患者的平均年龄在统计学上也无显著差异（均为 p>.17）。进一步的分析证实，年龄与血管事件之间缺乏关系不能归因于手术层次数或仅前路手术与前路/后路手术等可能的混杂因素。没有发现血管并发症与患者年龄之间的关系。虽然接受前路腰椎手术的老年患者通常会更担心血管并发症，但这些数据表明，年龄增长并不一定是这种方法的禁忌症。

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引用次数: 0

P1. Comparison in the accuracy of thoraco-lumbo-sacral orthosis designed by a conventional contact casting technique with a plaster bandage versus by a new noncontact 3D digital scanning technique P1.传统石膏绷带接触铸造技术与新型非接触式三维数字扫描技术设计的胸腔-椎体-骶骨矫形器的准确性比较

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100405

Masao Ryu MD

This abstract has been previously published as part of the ISSLS 2022 proceedings. For full access to the abstract, please visit the following URL: http://issls-2022.m.issls.currinda.com/schedule/session/330/abstract/3098.

本摘要曾作为《ISSLS 2022》论文集的一部分出版。如需获取摘要全文，请访问以下网址：http://issls-2022.m.issls.currinda.com/schedule/session/330/abstract/3098。

引用次数: 0

60. Surgery for spinal stenosis in achondroplasia: causes of reoperation and reduction of risks 60.软骨发育不全椎管狭窄手术：再次手术的原因和降低风险

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100398

Arun Hariharan MD , Hans K Nugraha MD , Aaron Huser DO , David Feldman MD

<div><h3>BACKGROUND CONTEXT</h3><p>Individuals with achondroplasia are prone to symptomatic spinal stenosis requiring surgery. However, the optimal surgical management remains unknown. There is no data on the revision rate or causes of revision in patients with achondroplasia who have undergone previous spine surgery.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study was to review the patients with achondroplasia who have undergone surgery for spinal stenosis to determine the rate of revision, review the causes of revision and determine if spinal construct was related to the need for revision.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective review was conducted over an 8-year period of all patients with achondroplasia at a single institution that serves as a large referral center for patients with skeletal dysplasias.</p></div><div><h3>PATIENT SAMPLE</h3><p>Thirty-three surgeries from 130 patients.</p></div><div><h3>OUTCOME MEASURES</h3><p>Type of surgery was placed into four categories: decompression only without fusion, decompression with a short fusion (T10 or distal for the upper instrumented vertebra [UIV])(short fusion) decompression with a long fusion (T9 or proximal as the UIV) (long fusion) and decompression with a long fusion and interbody caudally (interbody). Need for revision (binary), cause of the revision (proximal junctional kyphosis, pseudarthrosis and symptomatic stenosis/recurrence of stenosis) and previous revision (binary) were also documented</p></div><div><h3>METHODS</h3><p>Patient demographics, surgical dates, indications for surgery and type of surgery were recorded. Descriptive statistics were calculated. Statistical analysis was performed using R (R Core Team 2022, Vienna, Austria.). Fisher's exact test was used to determine if an association existed between construct type and need for revision as well as revision causes. Pairwise comparisons were again performed using Fisher's Exact test but with a Bonferroni correction. Multivariate logistic regression was performed to determine if any of the construct types could predict the need for revision and/or cause of revision. Odds ratios were calculated based on significant findings in the Fisher's Exact test and logistic regression coefficients. Significance was set at p < 0.05.</p></div><div><h3>RESULTS</h3><p>Thirty-three of the 130 (21.5%) patients with achondroplasia required spinal stenosis surgery. Twenty-four individuals who met the criteria were selected for analysis. The initial spine surgery was at an average age of 18.7 years (SD 10.1 years). Nine patients (37.5%) required revision surgeries, 3 required multiple revisions. Five of 9 (55.6%) of the revisions had primary surgery at an outside institution. Revision surgeries were due to caudal pseudarthrosis (8), proximal junctional kyphosis (PJK) (7), and new neurological symptoms (7). Short fusions (T10 or distal) had a significantly higher likelihood of developing proximal junctional kyp

背景中心软骨发育不全患者容易出现症状性椎管狭窄，需要进行手术治疗。然而，最佳的手术治疗方法仍然未知。本研究旨在对接受过椎管狭窄手术的软骨发育不全患者进行复查，以确定复查率、复查原因，并确定脊柱结构是否与复查需求有关。研究设计/背景对一家大型骨骼发育不良患者转诊中心的所有软骨发育不全患者进行了为期 8 年的回顾性研究。结果测量将手术类型分为四类：仅减压无融合、减压加短融合（T10或上器械椎体[UIV]远端）（短融合）、减压加长融合（T9或UIV近端）（长融合）、减压加长融合和尾椎椎体间融合（椎体间融合）。此外，还记录了翻修需要（二进制）、翻修原因（近端交界性脊柱后凸、假关节和无症状狭窄/狭窄复发）和之前的翻修情况（二进制）。计算描述性统计数字。使用 R（R Core Team 2022，奥地利维也纳）进行统计分析。费雪精确检验用于确定构造类型与翻修需求及翻修原因之间是否存在关联。配对比较再次使用费雪精确检验，但进行了 Bonferroni 校正。进行多变量逻辑回归以确定是否有任何结构类型可以预测翻修需求和/或翻修原因。根据费舍尔精确检验和逻辑回归系数的显著性结果计算出概率。结果130名软骨发育不全患者中有33名（21.5%）需要进行椎管狭窄手术。符合标准的 24 人被选中进行分析。首次脊柱手术的平均年龄为 18.7 岁（标准差 10.1 岁）。9名患者（37.5%）需要进行翻修手术，其中3人需要多次翻修。9例翻修手术中有5例（55.6%）的初次手术是在外部机构进行的。翻修手术的原因包括尾椎假关节（8例）、近端交界性脊柱后凸（PJK）（7例）和新的神经症状（7例）。短融合（T10 或远端）发生近端交界性脊柱后凸的可能性明显更高，几率比为 31.2（P = 0.007，95% CI 1.6-2479.6）。此外，与没有尾椎椎体间融合器的长融合器相比，没有尾椎椎体间融合器的短融合器更容易发生尾椎假关节（p = 0.044）。结论在软骨发育不全患者中，椎管狭窄手术率为 21.5%，翻修风险为 37.5%，主要原因是假关节、PJK 和复发性神经症状。外科医生应考虑将脊柱手术作为患者生活计划的一部分进行讨论，并应考虑对所有患者的狭窄水平进行广泛减压和长融合术，并在尾椎水平使用椎体间笼以降低翻修风险。

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引用次数: 0

6. Predictive factors for bladder function recovery following OPLL surgery: a comprehensive analysis 6.OPLL 手术后膀胱功能恢复的预测因素：综合分析

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100344

Yusuke Setojima MD , Kengo Fujii MD, PhD , Toru Funayama MD, PhD , Masashi Yamazaki MD, PhD , Masao Koda MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><p>Neurogenic bladder dysfunction poses a significant challenge in patients with ossification of posterior longitudinal ligaments (OPLL), affecting both bladder storage and voiding function. Predicting postsurgery bladder function outcomes in OPLL patients is essential for counselling, rehabilitation planning, and discharge. However, no valid prediction rule is currently available for bladder outcomes.</p></div><div><h3>PURPOSE</h3><p>This study aims to discover the independent factors for predicting the recovery of bowel function one year after surgery for OPLL patients.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>A total of 477 patients treated surgically for OPLL at various departments between 2014 and 2018 were reviewed. The treatment modalities included anterior and posterior surgical approaches and combined both, involving procedures such as corpectomy, discectomy, laminoplasty, laminectomy, and fusion. Exclusion criteria for the study were: (i) patients with a preoperative JOA score of 3 points in bladder function and (ii) patients with less than one year of follow-up after surgery. Among the remaining 192 patients analyzed, consisting of 145 men and 47 women with a mean age of 68 (standard deviation [SD]: 11.0), 2 groups were formed: the improved group (n=125) with a postoperative JOA score increase of 3 points in bladder function, and the unimproved group (n=67) with a postoperative JOA score under 2 points. JOA score consists of 6 domains: motor function in the upper extremities (MU), motor function in the lower extremities (ML), sensory function in the upper extremities (SU), sensory function in the trunk (ST), sensory function in the lower extremities (SL), and bladder function, with a minimum total score of 0 and maximum of 17. Univariable and multivariable analyses were executed using the Cox proportional hazards regression model. This study investigates factors at the initial visit, including age, sex, BMI, comorbidities, preoperative JOA score, OPLL occupation ratio, and K-line.</p></div><div><h3>RESULTS</h3><p>The improved group comprised 94 men and 31 women, with a mean age of 65 (standard deviation: 10.8) years. The unimproved group included 51 men and 16 women, with a mean age of 70 (standard deviation [SD]: 10.4) years. Among the improved group, 106 patients (84%) had comorbidities, and 42 patients (34%) had diabetes. The mean OPLL occupation ratio was 44.7 (SD: 16), and the mean preoperative JOA MU score was 2.41 (SD: 0.81), ML 2.05 (SD: 0.4), SU 1 (SD: 0.92), ST 1.66 (SD: 0.53), SL 1.34 (SD: 0.58), and total score of 9.98 (SD: 2.27). In the unimproved group, 56 patients (83%) had comorbidities and 23 patients (34%) had diabetes. The mean OPLL occupation ratio was 45.7 (15.7), and the mean preoperative JOA MU score was 1.93 (SD: 1.13), ML 1.3 (SD: 0.92), SU 0.88 (SD:

背景背景神经源性膀胱功能障碍是后纵韧带骨化症（OPLL）患者面临的一项重大挑战，会影响膀胱储尿和排尿功能。预测 OPLL 患者手术后的膀胱功能结果对于咨询、康复计划和出院至关重要。本研究旨在发现预测 OPLL 患者术后一年肠道功能恢复的独立因素。研究设计/设定N/受试者样本/结局测量N/方法回顾了 2014 年至 2018 年期间在不同科室接受手术治疗的 OPLL 患者，共计 477 例。治疗方式包括前路和后路手术方式以及两者的结合，涉及的手术包括椎间盘切除术、椎间盘切除术、椎板成形术、椎板切除术和融合术。研究的排除标准是(i) 术前膀胱功能 JOA 评分为 3 分的患者；(ii) 术后随访不足一年的患者。在分析的其余 192 名患者中，男性 145 人，女性 47 人，平均年龄 68 岁（标准差 [SD]：11.0），分为两组：术后膀胱功能 JOA 评分提高 3 分的改善组（125 人）和术后 JOA 评分低于 2 分的未改善组（67 人）。JOA 评分包括 6 个方面：上肢运动功能（MU）、下肢运动功能（ML）、上肢感觉功能（SU）、躯干感觉功能（ST）、下肢感觉功能（SL）和膀胱功能，总分最低为 0 分，最高为 17 分。采用 Cox 比例危险回归模型进行单变量和多变量分析。本研究调查了初诊时的因素，包括年龄、性别、体重指数、合并症、术前 JOA 评分、OPLL 占位比和 K 线。结果改善组包括 94 名男性和 31 名女性，平均年龄 65 岁（标准差：10.8）。未改善组包括 51 名男性和 16 名女性，平均年龄为 70 岁（标准差 [SD]：10.4）。在病情好转组中，106 名患者（84%）患有合并症，42 名患者（34%）患有糖尿病。平均 OPLL 占用率为 44.7（标准差：16），术前 JOA MU 平均得分为 2.41（标准差：0.81），ML 2.05（标准差：0.4），SU 1（标准差：0.92），ST 1.66（标准差：0.53），SL 1.34（标准差：0.58），总分 9.98（标准差：2.27）。在未改善组中，56 名患者（83%）患有合并症，23 名患者（34%）患有糖尿病。平均 OPLL 占用率为 45.7 (15.7)，术前 JOA MU 平均得分为 1.93 (SD: 1.13)，ML 1.3 (SD: 0.92)，SU 0.88 (SD: 0.48)，ST 1.35 (SD: 0.70)，SL 1.12 (SD: 0.59)，总得分为 7.65 (SD: 3.24)。多变量分析发现，年龄（P = 0.003）、术前 JOA ML（P < 0.001）和术前 JOA ST 对术后膀胱功能恢复有显著影响。利用接收器操作特征曲线，确定术前 JOA ML 临界值为 1.5 点（P < 0.001），作为膀胱功能完全恢复的阈值。灵敏度为 0.582，特异度为 0.776。相反，术前 JOA SL 临界值为 1.5 点 (P < 0.001) 时，膀胱功能完全恢复。结论利用接收器操作特征曲线，确定术前 JOA ML 和 SL 临界值为 1.5 点（P < 0.001）时，膀胱功能可完全恢复。年龄、术前 JOA ML 和术前 JOA ST 被确定为预测术后膀胱功能的相关因素。这些发现为临床医生优化患者护理和提高预后精确性提供了宝贵的见解，有助于管理患有神经源性膀胱功能障碍的 OPLL 患者。

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引用次数: 0

56. Effects of cecompression surgery and erythropoietin combination on a rat model of compressive myelopathy 56.减压手术和红细胞生成素联合疗法对压迫性脊髓病大鼠模型的影响

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100394

Yuki Shiratani MD , Takeo Furuya MD, PhD , Satoshi Maki MD, PhD , Juntaro Maruyama MD , Kyota Kitagawa MD , Seiji Ohtori MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><p>In clinical practice, treatment options for severe myelopathy are currently limited, primarily involving surgical interventions such as decompression surgery. Although decompression surgery is an established treatment in terms of efficacy and safety, the degree of postoperative symptom recovery and the time required for recovery vary among individuals. Therefore, it is worthwhile to explore additional treatment methods that can enhance postoperative outcomes. Erythropoietin (EPO) is a medication known for its hematopoietic effects; however, it has also attracted attention for its neuroprotective and remyelination properties.</p></div><div><h3>PURPOSE</h3><p>The objective of this study is to investigate the effects of combining EPO administration with decompression surgery in a rat model of cervical compressive myelopathy.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Eight-week-old female SD rats were used. After removing the C6 lamina, a hydroexpansive sheet (3 × 5 × 0.7mm) was inserted under the C4/5 lamina to create a chronic spinal cord compression model. Following sheet insertion, weekly behavioral evaluations (Basso, Beattie and Bresnahan score: BBB score, Grid runway test) were conducted, and rats with BBB scores of 13 or lower between weeks 4 and 8 were considered to have developed myelopathy. The BBB score serves as an assessment scale for evaluating the function of a rat's hindlimbs. In the Grid runway test, rats are made to walk on a wire mesh, and the number of times their hindlimbs fall through the grid is measured. To evaluate spinal canal occupancy of sheets, we used micro-CT. Rats with myelopathy were divided into three groups: Control group (sham surgery and subcutaneous saline injection), Decompression group (laminectomy, sheet removal, and subcutaneous saline injection), and Decompression-EPO group (laminectomy, sheet removal, and subcutaneous EPO injection). Behavioral evaluations were conducted for 8 weeks after the onset of myelopathy. Blood samples were collected from the tail vein every 2 weeks, and the administration of EPO was monitored by measuring Hb levels. After 8 weeks, spinal cords were harvested for Luxol fast blue (LFB) staining and immunohistochemical staining (Myeline Basic Protein: MBP, Growth Associated Protein 43: GAP-43, and stuff).</p></div><div><h3>RESULTS</h3><p>Starting at 4 weeks postintervention, Hb levels in the decompression-EPO group were significantly higher than those in the other two groups. No significant differences were observed in spinal canal occupancy among the three groups at the onset of myelopathy. At 8 weeks postintervention, BBB scores were 12.1(±0.8), 13.4(±1.0), and 14.1(±1.4) for the Control, Decompression, and Decompression-EPO groups, respectively, with a significant difference observed between Decompression-EPO and Cont

背景 CONTEXT在临床实践中，目前治疗严重脊髓病的方法有限，主要涉及减压手术等外科干预措施。虽然减压手术在疗效和安全性方面都是一种成熟的治疗方法，但术后症状的恢复程度和恢复所需的时间因人而异。因此，值得探索能提高术后效果的其他治疗方法。本研究的目的是在颈椎压迫性脊髓病大鼠模型中研究将 EPO 给药与减压手术相结合的效果。移除 C6 椎板后，在 C4/5 椎板下插入水膨胀片（3 × 5 × 0.7mm）以创建慢性脊髓压迫模型。插入垫片后，每周对大鼠进行行为评估（Basso、Beattie 和 Bresnahan 评分：BBB 评分，网格跑道测试），在第 4 至第 8 周期间，BBB 评分达到或低于 13 分的大鼠被视为患上脊髓病。BBB 评分是评估大鼠后肢功能的一种评估标准。在网格跑道测试中，让大鼠在铁丝网上行走，并测量其后肢穿过网格的次数。为了评估片状物的椎管占用率，我们使用了显微 CT。患有脊髓病的大鼠被分为三组：对照组（假手术和皮下注射生理盐水）、减压组（椎板切除术、切除椎板和皮下注射生理盐水）和减压-EPO 组（椎板切除术、切除椎板和皮下注射 EPO）。行为评估在脊髓病发后 8 周进行。每 2 周从尾静脉采集一次血样，并通过测量血红蛋白水平来监测 EPO 的注射情况。8 周后，采集脊髓进行卢克索快蓝（LFB）染色和免疫组化染色（肌线碱性蛋白：MBP、生长相关蛋白 43：GAP-43 和 stuff）。结果从干预后 4 周开始，减压-EPO 组的 Hb 水平明显高于其他两组。在脊髓病发病初期，三组的椎管占位率无明显差异。干预后 8 周，对照组、减压组和减压-EPO 组的 BBB 评分分别为 12.1（±0.8）、13.4（±1.0）和 14.1（±1.4），减压-EPO 组与对照组之间存在明显差异（p<0.05）。结论针对脊髓受压区域，与对照组相比，减压-EPO组皮质脊髓束的LFB染色和MBP阳性面积比显著升高，表明EPO可能促进了轴突再髓鞘化，有助于改善干预后8周的行为结果。在大鼠压迫性脊髓损伤模型中，减压手术和 EPO 联合疗法的疗效得到了证实；但是，这种方法优于单独减压手术的可能性尚未确定。

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引用次数: 0

3. Risk factors and frequency of occurrence of lumbar spine disease in young male American football players - A 6-year cohort study using lumbar spine MRI and X-rays 3.美式橄榄球年轻男运动员腰椎疾病的风险因素和发病频率--利用腰椎核磁共振成像和 X 射线进行的一项为期 6 年的队列研究

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100341

Tsuyoshi Iida MD, PhD, Morito Takano MD, PhD, Tomohiro Hikata MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><p>N/A</p></div><div><h3>PURPOSE</h3><p>It is known from experience that the risk of lumbar spine disorders such as lumbar disc herniation and lumbar spondylolysis is increased in American football players. However, no large-scale prospective study has been conducted, and the risk factors and frequency are not clear. The purpose of this study is to investigate the risk factors and frequency of occurrence of lumbar spine disease among young male American football players.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>N/A</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>We enrolled 306 subjects, who gave consent to participate in this study, between 2005 and 2017. All subjects were male, aged 15-16 years (first-year of high school students in Japan). We evaluated subjects’ demographic data (height, weight, BMI, and position in American football), lumbar spine MRI and X-rays which were taken at the start of competition, 3 years, and 6 years later.</p></div><div><h3>RESULTS</h3><p>Of the 306 subjects, 103 (33.7%) could be successfully followed up to the last observation. The subjects with Pfirrmann classification grade IV or higher disc degeneration as assessed by MRI, significantly increased from 8.8% at the start of competition, to 33.3% at 3 years later and 48.0% at 6 years later (p<0.001). The progression of disc degeneration on MRI was frequently observed in L4/5 and L5/S levels at final follow up (L1/2; 1.0%, L2/3; 1.0%, L3/4; 4.9%, L4/5; 25.5%, L5/S1; 32.4%). The position of lineman was the only risk factor for the progression of disc degeneration (p=0.049). The subjects with herniated discs protruding more than 5 mm from the posterior wall of the vertebral body, significantly increased from 3.9% at the start of competition, to 23.5% at 3 years later and 33.3% at 6 years later (p<0.001). The prevalence of lumbar disc herniation on MRI at final follow up were L1/2; 1.0%, L2/3; 0%, L3/4; 0%, L4/5; 25.5%, and L5/S1; 32.4%. Lineman, weight, and BMI were risk factors for disc herniation (p=0.015, 0.013, 0.019 each), but the results of differential analysis by each position showed that neither weight nor BMI differed significantly in any position (p<0.05). X-ray findings revealed that the rate of lumbar spondylolysis was 3.9% at the start of competition, compared to 7.8% at 3 years later and 9.8% at 6 years later, but this change was not statistically significant (p = 0.17).</p></div><div><h3>CONCLUSIONS</h3><p>From this study, it was found that American football competition was a risk for the progression of disc degeneration and herniation in lower lumbar. Especially, the position of lineman seemed to be involved with significant risk factors, and body weight and BMI were confounding factors. Previous reports have shown differences in disc degeneration and herniation occurrences in lower lumbar depending on the athletic competition typ

背景背景背景背景/目的根据经验，美式橄榄球运动员患腰椎间盘突出症和腰椎滑脱症等腰椎疾病的风险会增加。然而，目前还没有进行过大规模的前瞻性研究，风险因素和发病频率也不清楚。本研究旨在调查年轻男性美式足球运动员中腰椎疾病的风险因素和发生频率。研究设计/设置N/受试者样本/结果测量N/方法我们在 2005 年至 2017 年间招募了 306 名同意参与本研究的受试者。所有受试者均为男性，年龄为 15-16 岁（日本高中一年级学生）。我们评估了受试者的人口统计学数据（身高、体重、体重指数和在美式足球中的位置）、腰椎 MRI 和 X 光片（分别在比赛开始时、3 年后和 6 年后拍摄）。经磁共振成像评估，Pfirrmann 分级 IV 级或以上椎间盘退变的受试者明显增加，从比赛开始时的 8.8%增至 3 年后的 33.3%和 6 年后的 48.0%（p<0.001）。在最终随访中，L4/5 和 L5/S 水平经常出现 MRI 上的椎间盘退变（L1/2；1.0%，L2/3；1.0%，L3/4；4.9%，L4/5；25.5%，L5/S1；32.4%）。后卫位置是导致椎间盘退化的唯一风险因素（P=0.049）。椎间盘突出超过椎体后壁 5 毫米的受试者从比赛开始时的 3.9%，显著增加到 3 年后的 23.5%和 6 年后的 33.3%（p<0.001）。最终随访时，磁共振成像显示腰椎间盘突出症的发病率分别为 L1/2；1.0%；L2/3；0%；L3/4；0%；L4/5；25.5% 和 L5/S1；32.4%。线路工、体重和体重指数是椎间盘突出症的危险因素（p=0.015、0.013、0.019），但每个位置的差异分析结果显示，体重和体重指数在任何位置都没有显著差异（p<0.05）。X 射线检查结果显示，腰椎间盘突出症的发病率在比赛开始时为 3.9%，3 年后为 7.8%，6 年后为 9.8%，但这一变化在统计学上并不显著（P = 0.17）。尤其是后卫位置似乎与重要的危险因素有关，体重和体重指数是混杂因素。以往的报告显示，椎间盘退化和腰椎间盘突出症的发生率因运动竞赛类型而异。预计美式橄榄球的比赛特点（不同位置的比赛特点迥异）将导致腰椎疾病发生风险的差异。

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引用次数: 0