North American Spine Society Journal最新文献_第8页

P2. Progenitor cells from iliac crest autograft survive transplantation and contribute to spinal fusion P2.髂嵴自体移植物的祖细胞在移植后存活并促进脊柱融合

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100406

Atsuyuki Kawabata MD

<div><h3>Background Context</h3><p>Posterior lumbar fusion (PLF) is frequently augmented with iliac crest autograft. Although autograft is the gold standard supplement to promote fusion, the molecular mechanism by which it induces bone formation has not been well elucidated. Specifically, it is unknown if progenitor cells within the autograft contribute to the biology of the fusion mass.</p></div><div><h3>Purpose</h3><p>Using an innovative lineage tracing technology in a murine model of PLF, we tested the hypothesis that progenitor cells from iliac crest autograft survive transplantation and contribute to spinal fusion.</p></div><div><h3>Study Design/Setting</h3><p>In vivo study.</p></div><div><h3>Patient Sample</h3><p>Animals: 8-week-old male or female lineage tracing animals, Sox9-CreERT; Ai14(progenitor cells), Collagen1a1-CreERT;Ai9(osteoblast), and Aggrecan-CreERT;Ai9(chondrocytes) were examined.</p></div><div><h3>Outcome Measures</h3><p>Posterolateral bone formation was quantified by microcomputed tomography, from which 2D and 3D reconstruction were produced. To evaluate the presence of tdTomato+ cells within the area of spinal fusion that survive from the donor graft, IVIS imaging and detailed frozen histologic assessment were performed. Frozen sections were likewise stained with hematoxylin and eosin(H&E) and Safranin O and evaluated under light microscopy.</p></div><div><h3>Methods</h3><p>Autograft harvested from the iliac crest of Sox9-CreERT;tdTomato or Aggrecan-Cre ERT;Ai9 or Collagen1a1 Cre ERT were transplanted into the posterolateral gutters between L3 and L5 of non-Cre containing littermates. Following transplantation, recipient mice received tamoxifen (100mg/kg, i.p. twice weekly) to induce recombination and expression of tdTomato(Cy3) until sacrifice. In order to provide comparative analysis, we conducted autograft transplantation harvested from wild-type mouse into each Cre mouse.</p></div><div><h3>Results</h3><p>Mice receiving bone autograft from either transgenic lineage were found to have markedly greater new bone formation and bony bridging of adjacent pedicles compared to sham controls by 6 weeks post implantation. When evaluated at 2 weeks post implantation, histologic analysis demonstrated safranin O staining within the fusion mass, indicating the presence of chondrocyte. By 6 weeks post implantation, positive tdTomato signal from every lineage reporter (SOX), Aggrecan, and COL1) were visible within the fusion mass and found to localize newly formed bone.</p></div><div><h3>Conclusions</h3><p>Using innovative lineage tracing technology, these data indicate that progenitor cells (SOX9) from iliac crest autograft not only survive transplantation but become osteoblasts (COL1) via within the fusion mass. In addition, the presence of a chondrocyte intermediate suggests that the fusion mass is formed through endochondral ossification. Moreover, our data suggests that the periosteum plays a crucial role as a primary source o

背景腰椎后路融合术（PLF）经常使用髂嵴自体移植物。虽然自体移植物是促进融合的金标准补充物，但其诱导骨形成的分子机制尚未得到很好的阐明。具体来说，自体移植物中的祖细胞是否对融合体的生物学特性有贡献尚不清楚。目的通过在PLF小鼠模型中使用创新的血统追踪技术，我们测试了髂嵴自体移植物中的祖细胞在移植后存活并促进脊柱融合的假设。患者样本动物：8周大的雄性或雌性系谱追踪动物，检查Sox9-CreERT; Ai14（祖细胞）、Collagen1a1-CreERT;Ai9（成骨细胞）和Aggrecan-CreERT;Ai9（软骨细胞）。为了评估脊柱融合区域内是否存在从供体移植物中存活下来的tdTomato+细胞，进行了IVIS成像和详细的冷冻组织学评估。方法将从Sox9-CreERT;tdTomato或Aggrecan-Cre ERT;Ai9或Collagen1a1 Cre ERT的髂嵴处采集的自体移植物移植到非Cre同窝小鼠L3和L5之间的后外侧沟中。移植后，受体小鼠接受他莫昔芬（100 毫克/千克，每周两次静脉注射）以诱导重组和tdTomato(Cy3)的表达，直至牺牲。结果发现，与假对照组相比，接受任一转基因血统自体骨移植的小鼠在植入后 6 周内的新骨形成和相邻骨干的骨桥明显增加。在植入后 2 周进行评估时，组织学分析显示融合块内有黄素 O 染色，表明存在软骨细胞。植入后 6 周，融合块内可见来自各系报告基因（SOX）、Aggrecan 和 COL1 的tdTomato 阳性信号，并发现这些信号定位在新形成的骨上。此外，软骨细胞中间体的存在表明，融合块是通过软骨内骨化形成的。此外，我们的数据表明，骨膜作为干细胞的主要来源起着至关重要的作用。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

39. Risk factors for sacroiliac joint fusion after instrumented spinal fusion 39.器械脊柱融合术后骶髂关节融合的风险因素

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100377

Gurmit Singh MD, MHA , Peter Du MD , Spencer Smith BS , Travis Campbell Philipp MD , Jonathan Kark MD , Clifford Lin MD , Jung U. Yoo MD

<div><h3>BACKGROUND CONTEXT</h3><p>Chronic back pain after a spinal fusion is multifactorial, but one factor is the development of adjacent segment disease, which occurs at a pooled annual incidence of about 2% a year. Fusion constructs extending to the sacrum increase angular motion and stress across the sacroiliac (SI) joint, which can lead to accelerated degeneration of the joint. The rate of SI joint degeneration after lumbar/lumbosacral fusion has been reported in one prospective study to be upwards of 75%, which was significantly higher than the control group of 38.2%. Because of the high incidence of degeneration after spinal fusions, some surgeons advocate for simultaneous SI joint fusion at the time of the primary spinal fusion. In a retrospective analysis of a prospectively maintained database, none of the patients undergoing simultaneous SI joint fusion with spinal fusion experienced postoperative SI joint pain, while 44.6% of those without simultaneous SI joint fusion did develop such pain. However, most studies have been institution-specific reporting and subsequent systematic reviews. There has been no large-scale database study looking at the risk factors for future SI joint fusion after spinal fusion.</p></div><div><h3>PURPOSE</h3><p>To identify risk factors for SI joint fusion after instrumented spinal fusion.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>PearlDiver BiscayneBay database.</p></div><div><h3>OUTCOME MEASURES</h3><p>Odds ratios.</p></div><div><h3>METHODS</h3><p>Patients were identified from the PearlDiver BiscayneBay database (Colorado Springs, CO, USA). Patients who underwent 1-level (CPT: 22840), 3-6-level (22842), and 7-13-level posterior spinal instrumentation (22843 and 22844) were identified, excluding patients with fusions in the cervical spine (22595 and 22600). Patients were separated based on whether or not they received an SI joint fusion after their spinal fusion (27280 and 27279). The following patient factors and their association with future SI joint fusion were evaluated: age, gender, obesity, fibromyalgia, diabetes, tobacco use, prior SI joint injection, and spinal fusion length. A logistic regression as well as a machine learning logistic regression model was performed to evaluate the associations between patient factors and incidence of SI joint fusion.</p></div><div><h3>RESULTS</h3><p>A total of 539,042 patients underwent posterior instrumentation with 5981 patients also undergoing SI joint fusion at a later date. Factors associated with future SI joint fusion included female gender, patients with obesity, fibromyalgia, diabetes, tobacco use, and prior SI joint injection. Construct lengths of 3-6 and 7-13 were statistically associated with the patient undergoing future SI joint fusion. Prior SI joint injection had the highest odds ratio for undergoing future SI joint fusion (OR: 8.73; 95% CI: 8.28-9.20), followed by 7-13 level fus

背景 CONTEXT脊柱融合术后的慢性背痛是多因素造成的，但其中一个因素是邻近节段疾病的发生，每年的发病率约为 2%。延伸至骶骨的融合器会增加骶髂关节（SI）的角度运动和应力，从而导致关节加速退化。据一项前瞻性研究报告，腰椎/腰骶部融合术后的骶髂关节退化率高达 75%，明显高于对照组的 38.2%。由于脊柱融合术后的退变发生率较高，一些外科医生主张在进行主要脊柱融合术时同时进行 SI 关节融合术。在一项对前瞻性数据库的回顾性分析中，接受脊柱融合术同时进行SI关节融合术的患者无一出现术后SI关节疼痛，而未同时进行SI关节融合术的患者中有44.6%出现此类疼痛。然而，大多数研究都是针对特定机构的报告和随后的系统性回顾。目前还没有大规模的数据库研究来探讨脊柱融合术后未来发生 SI 关节融合术的风险因素。方法从 PearlDiver BiscayneBay 数据库（美国科罗拉多州科罗拉多斯普林斯）中确定患者。确定了接受 1 级（CPT：22840）、3-6 级（22842）和 7-13 级脊柱后路器械植入术（22843 和 22844）的患者，但不包括颈椎融合术（22595 和 22600）患者。根据脊柱融合术后是否接受 SI 关节融合术（27280 和 27279），对患者进行了分类。对以下患者因素及其与未来 SI 关节融合术的关系进行了评估：年龄、性别、肥胖、纤维肌痛、糖尿病、吸烟、既往 SI 关节注射和脊柱融合术长度。结果共有 539,042 名患者接受了后路器械治疗，其中 5981 名患者日后也接受了 SI 关节融合术。与未来 SI 关节融合术相关的因素包括女性、肥胖患者、纤维肌痛患者、糖尿病患者、吸烟患者和曾接受过 SI 关节注射的患者。从统计学角度看，3-6和7-13的结构长度与患者日后接受SI关节融合术有关。曾接受过 SI 关节注射的患者将来接受 SI 关节融合术的几率比最高（OR：8.73；95% CI：8.28-9.20），其次是 7-13 级融合术（OR：2.59；95% CI：2.40-2.78）和 3-6 级融合术（OR：1.49；95% CI：1.41-1.57）。将接受 SI 关节融合术的患者与不接受该手术的患者在年龄上没有明显差异。进行的逻辑回归显示，之前的 SI 关节融合术（OR：8.14；97.5% CI：7.71-8.59）、7-13 级融合术（OR：3.76；97.5% CI：3.48-4.07）和 3-6 级融合术（OR：1.54；97.5% CI：1.46-1.62）与未来的 SI 关节融合术关系最大。我们的机器学习逻辑回归模型（准确率：81.7%；灵敏度：60.1%；特异性：82.0%）发现，既往的 SI 关节融合与既往的 SI 关节注射关系最为密切，其次是 7-13 级融合和 3-6 级融合。结论我们的研究发现，脊柱融合术后需要进行后续 SI 关节融合术的最大预测因素是既往的 SI 关节注射。我们还发现，较长的构造与未来 SI 关节融合的风险增加有关。这是首次针对脊柱融合术后SI关节融合风险因素进行的大规模数据库研究。这些结果有助于外科医生评估未来 SI 关节融合的风险以及是否需要同时进行手术。FDA 器械/药物状态本摘要未讨论或包含任何适用的器械或药物。

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引用次数: 0

33. Comparative clinical outcomes of minimally invasive decompression alone for patients with degenerative scoliosis: a focus on severe cases over 20° 33.退行性脊柱侧凸患者单纯微创减压术的临床疗效比较：重点关注 20° 以上的严重病例

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100371

Tomoyuki Asada MD , Chad Z. Simon , Nishtha Singh , Olivia Tuma BS , Tejas Subramanian BS , Kasra Araghi BS , Amy Lu BS , Eric Mai BS , Ashley Kim BA , Myles Allen MBChB, BS , Maximilian Korsun BS , Joshua Zhang BS , Cole Kwas BA , Sumedha Singh MD, MBBS , Annika Heuer MD , James Dowdell MD , Evan Sheha MD

<div><h3>BACKGROUND CONTEXT</h3><p>Degenerative scoliosis (DS) is a prevalent condition in the elderly population. Minimally invasive (MI) decompression, preserving posterior soft tissues and posterior ligamentous complex, is one of the treatment options for lumbar canal stenosis with DS. While MI decompression is a recognized treatment for lumbar canal stenosis in DS patients, its efficacy specifically in severe DS (Cobb angle >20°) is not well-documented.</p></div><div><h3>PURPOSE</h3><p>This study aimed to evaluate the clinical outcomes of MI decompression with severe. degenerative scoliosis and identify predictors of poor outcomes.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective review of a prospectively collected multi-surgeon registry.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients who underwent MI lumbar decompression alone were included and divided into DS and control groups based on a Cobb angle threshold of 20°.</p></div><div><h3>OUTCOME MEASURES</h3><p>We compared Patient-Reported Outcomes and Measures (PROMs), including ODI, VAS back, VAS leg, SF-12 PCS and MCS, and PROMIS-PF between groups at the postoperative ≤3 months and ≥1 year postoperatively, focusing on MCID achievement at ≥1 year time point.</p></div><div><h3>METHODS</h3><p>Data on demographics, comorbidities, spinal alignment, normalized total psoas area (NTPA), and surgical levels were collected. Decompression locations were labeled "scoliosis-related" when the decompression levels included the range of end vertebrae of the Cobb angle, and "outside" when the decompression operative levels did not include the end vertebrae. Matched cohorts were created by variable-ratio greedy matching for comparison, and multivariable regression analysis identified factors impending MCID achievement in ODI for DS patients.</p></div><div><h3>RESULTS</h3><p>A total of 253 patients were included in the study, with 41 patients in the DS group and 212 in the control group, all of whom underwent MI decompression. After matching for age, gender, osteoporosis status, NTPA, and preoperative ODI, the final matched cohort included 33 DS and 58 control patients. At ≥1 year time point, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs control 69.0%, P=0.047) and SF-12 PCS (DS: 41.4% vs control 70.6%, P=0.020). The multivariable analysis conducted in the DS group revealed that scoliosis-related decompression (Odds ratio: 9.9, P=0.028) was an independent factor associated with failure to achieve MCID in ODI at the ≥1-year postoperative time point.</p></div><div><h3>CONCLUSIONS</h3><p>Our findings suggest that in DS patients with a Cobb angle >20 degrees, MI lumbar decompression may yield suboptimal disability and physical function improvements. These results underscore the need for careful surgical planning, particularly regarding decompression at the end vertebrae of the Cobb angle.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract

背景 CONTEX退行性脊柱侧凸（DS）是老年人群中的一种常见病。保留后方软组织和后方韧带复合体的微创（MI）减压术是治疗腰椎管狭窄症的方法之一。虽然MI减压术是公认的治疗DS患者腰椎管狭窄的方法，但其对重度DS（Cobb角20°）的疗效却没有得到充分证明。本研究旨在评估MI减压术对重度退行性脊柱侧凸的临床疗效，并确定不良疗效的预测因素。患者样本纳入单独接受 MI 腰椎减压术的患者，并根据 20° 的 Cobb 角度阈值将其分为 DS 组和对照组。结果测量我们比较了各组患者在术后≤3个月和≥1年时的患者报告结果和测量指标（PROMs），包括ODI、VAS背部、VAS腿部、SF-12 PCS和MCS以及PROMIS-PF，重点是≥1年时的MCID成就。当减压水平包括Cobb角的椎体末端范围时，减压位置被标记为 "脊柱侧凸相关"；当减压手术水平不包括椎体末端时，减压位置被标记为 "外部"。通过可变比率贪婪匹配法建立了匹配队列进行比较，并通过多变量回归分析确定了DS患者ODI达到MCID的潜在因素。结果该研究共纳入253例患者，其中DS组41例，对照组212例，所有患者均接受了MI减压术。在对年龄、性别、骨质疏松症状况、NTPA 和术前 ODI 进行配对后，最终配对组包括 33 名 DS 患者和 58 名对照组患者。在≥1年的时间点上，DS组的ODI（DS：45.5% vs 对照组69.0%，P=0.047）和SF-12 PCS（DS：41.4% vs 对照组70.6%，P=0.020）MCID达标率明显较低。对 DS 组进行的多变量分析显示，脊柱侧凸相关减压（Odds ratio：9.9，P=0.028）是术后≥1 年时间点 ODI 未能达到 MCID 的独立相关因素。这些结果强调了谨慎手术规划的必要性，尤其是对 Cobb 角末端椎体的减压。

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引用次数: 0

50. Lower neighborhood socioeconomic status influences medical complications, emergency department utilization and costs after 1-2 level lumbar fusion 50.较低的社区社会经济地位影响 1-2 级腰椎融合术后的医疗并发症、急诊使用率和费用

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100388

Adam Gordon MD , Faisal Elali BS, BA

<div><h3>BACKGROUND CONTEXT</h3><p>Socioeconomic status (SES) has been demonstrated to be an important prognostic factor among patients undergoing spine surgery. Measures of socioeconomic disadvantage may enable improved targeting of measures to prevent and recognize potential increased healthcare utilization in these disadvantaged patients. The Area Deprivation Index (ADI) is a validated and weighted index comprised of 17 census-based markers of material deprivation and poverty.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study was to utilize a large nationwide administrative claims database to determine whether patients with high ADI (greater disadvantage) undergoing 1-2 level lumbar fusion (LF) is associated with differences in: 1) medical complications; 2) emergency department (ED) utilization; 3) readmission rates; and 4) costs of care.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective query of all primary 1-2 level lumbar fusions for degenerative lumbar pathology was performed using a large United States private insurance claims database from January 1st, 2010 to October 31st, 2020.</p></div><div><h3>PATIENT SAMPLE</h3><p>Cohorts of interest were queried using Current Procedural Terminology (CPT) codes and International Classification of Disease, Ninth/Tenth Revision (ICD-9), ICD-10 codes. ADI is reported on a scale of 0-100 with higher numbers associated with greater disadvantage. Percentile was documented for each zip code for all states. The study group consisted of patients undergoing primary LF in zip codes associated with high ADI (90%+) as established by previously published studies. The control cohort consisted of LF patients who underwent surgery in zip codes not defined by the study group (0-89%). Patients with high ADI were 1:1 propensity score matched to controls by age, gender, and Elixhauser Comorbidity Index (ECI). This yielded 34,442 patients in total, evenly matched between the two cohorts.</p></div><div><h3>OUTCOME MEASURES</h3><p>Primary endpoints of the study were to compare 90-day medical complications, 90-day ED utilization, 90-day readmission rates, and 90-day costs of care.</p></div><div><h3>METHODS</h3><p>Multivariable logistic regression models were used to calculate the odds-ratios (OR) and 95% confidence intervals (95%CI) of ADI on 90-day medical complications, ED utilization, and readmission rates. A Shapiro-Wilks test was performed to assess for normality of distribution followed by Welch's T tests for the continuous variables lengths of stay and costs. P-values less than 0.05 were considered to be statistically significant.</p></div><div><h3>RESULTS</h3><p>Patients undergoing 1-2 level LF with a high ADI incurred significantly higher rates and odds of developing respiratory failures (1.17 vs 0.87%; OR: 1.35, 95%CI: 1.09 - 1.67, p=0.005). The remaining medical complications including pneumonia (2.60 vs 2.55%; OR: 1.02, 95%CI: 0.89 - 1.16, p=0.785), acute kidney injuries (2.61 vs 2.29%; OR:

背景 CONTEXTS 社会经济地位（SES）已被证明是脊柱手术患者预后的一个重要因素。衡量社会经济劣势可以提高措施的针对性，预防和识别这些弱势患者可能增加的医疗保健使用。地区贫困指数（ADI）是一个经过验证的加权指数，由 17 个基于人口普查的物质匮乏和贫困指标组成。本研究的目的是利用一个大型的全国性行政索赔数据库来确定接受 1-2 级腰椎融合术（LF）的高 ADI（贫困程度更高）患者是否与以下方面的差异有关：1）医疗并发症；2）急诊：研究设计/设定使用大型美国私人保险理赔数据库，对 2010 年 1 月 1 日至 2020 年 10 月 31 日期间因腰椎退行性病变而进行的所有 1-2 级腰椎融合术进行了回顾性查询。患者样本使用当前程序术语 (CPT) 代码和国际疾病分类第九/十修订版 (ICD-9)、ICD-10 代码对相关群体进行了查询。ADI 以 0-100 为单位进行报告，数字越大，表示处境越不利。所有州的每个邮政编码都记录了百分位数。研究组由接受初级 LF 治疗的患者组成，这些患者所在的邮政编码与之前发表的研究确定的高 ADI（90% 以上）相关。对照组由在研究组未定义的邮政编码（0-89%）内接受手术的 LF 患者组成。高 ADI 患者与对照组按年龄、性别和 Elixhauser 综合征指数 (ECI) 进行了 1:1 的倾向性评分匹配。结果测量该研究的主要终点是比较 90 天医疗并发症、90 天急诊室使用率、90 天再入院率和 90 天护理成本。方法使用多变量逻辑回归模型计算 ADI 对 90 天医疗并发症、急诊室使用率和再入院率的几率比 (OR) 和 95% 置信区间 (95%CI)。对连续变量住院时间和费用进行了 Shapiro-Wilks 检验以评估分布的正态性，然后进行了 Welch's T 检验。结果接受 1-2 级 LF 且 ADI 较高的患者发生呼吸衰竭的比率和几率明显更高（1.17 vs 0.87%；OR：1.35，95%CI：1.09 - 1.67，P=0.005）。其余内科并发症包括肺炎（2.60 vs 2.55%；OR：1.02，95%CI：0.89 - 1.16，P=0.785）、急性肾损伤（2.61 vs 2.29%；OR：1.14，95%CI：0.99 - 1.31，P=0.056）、深静脉血栓（0.19% vs 0.17%；OR：1.14，95%CI：0.69 - 1.89，p=0.611）、脑血管意外（1.29% vs 1.31%；OR：0.99，95%CI：0.82 - 1.19，p=0.886）和总体医疗并发症总数（23.35% vs 22.93%；OR：1.02，95%CI：0.97 - 1.08，p=0.441）在组间相似。尽管高 ADI 患者的再入院率低于对照组（8.43% vs 9.13%；OR：0.92，95%CI：0.85-0.99，P=0.021），但高 ADI 患者在 90 天内的 ED 就诊率和几率明显更高（9.67% vs 8.91%；OR：1.10，95%CI：1.02- 1.18，P=0.014）。高 ADI 患者的手术当天总支出（49,878 美元 vs 42,886 美元）和 90 天总支出（54,459 美元 vs 47,044 美元）更高（p<0.001）。尽管再入院率较低，但社会经济处境不利的患者（高 ADI）在术后 90 天内使用急诊室的比例较高。包括 ADI 在内的邻里劣势衡量标准可用于为医疗保健政策提供信息并改善出院后护理。

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引用次数: 0

14. Does posterior cord compression by ligamentum flavum adversely affect clinical outcome of anterior cervical discectomy and fusion? 14.黄韧带对后方脊髓的压迫是否会对颈椎椎间盘前路切除术和融合术的临床效果产生不利影响？

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100352

Sehan Park MD , Dong-Ho Lee MD, PhD

This abstract has been previously published as part of the 2024 International Meeting on Advanced Spine Techniques proceedings. For full access to the abstract, please visit the following URL: https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf.

本摘要曾作为 2024 年国际先进脊柱技术会议论文集的一部分发表。如需获取摘要全文，请访问以下网址：https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf。

引用次数: 0

5. Are atypical Hangman's fractures becoming typical? 5.非典型刽子手骨折是否正在成为典型骨折？

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100343

Hiroyuki Katoh MD, PhD , Daisuke Sakai MD, PhD , Masahiko Watanabe MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><p>A traditional Hangman's fracture (HF) is a bilateral fracture traversing the pars interarticularis of C2, but there is wide variability in the fracture patterns that separate the anterior elements of the C2 vertebrae from the posterior elements. One type of fracture that is increasingly being observed is the atypical HF, in which the posterior aspect of the C2 vertebral body, not the bilateral pars, is involved. While a typical HF separates the anterior elements from the posterior elements of the C2 vertebrae and increases the available space for the spinal cord, the space remaining for the spinal cord does not increase secondary to fracture in the case of an atypical HF, leading to a higher risk of neurologic injury.</p></div><div><h3>PURPOSE</h3><p>In this study, we review HFs treated at a single tertiary care university hospital, especially focusing on the fracture pattern and clinical characteristics associated with HFs.</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>The subjects of this study are the 35 HF cases treated at our institution between 2010 and 2021, comprised of 22 males and 13 females with an average age of 60.6 years. The etiology, fracture pattern, neurological status, and vertebral artery (VA) integrity were retrospectively examined from hospital records.</p></div><div><h3>RESULTS</h3><p>The injury was caused by a traffic accident in 12 cases, a fall in 12 cases, tripping in 9 cases, and struck by a falling object in 2 cases. There were 6 cases of spinal cord injury (SCI) in this series, of which 2 cases with polytrauma died soon after arriving at the hospital: one traffic accident case and another case in that was struck by a falling steel plate. According to the Levine and Edwards Classification, there were 23 cases with Type 1, 6 cases with Type 2, 2 cases with Type 2a, and 4 cases with Type 3 injuries (of which 2 are the cases that died). There were 13 typical HFs and 22 atypical HFs in which the posterior aspect of the C2 vertebral body and not the pars was involved in at least one side. The pattern of fracture of atypical HFs, according to the Li classification, was 10 cases of Type A1, 1 case of Type A2, 7 cases of Type B1, and 4 cases of Type B2. There was no significant difference in the number of cases with SCI between the typical and atypical HF cases. Twenty<em><sup>-</sup></em>four cases had VA integrity examined either through enhanced CT or MR angiography and 7 cases (20%) were diagnosed with VA injury. All 7 cases were closely followed without any intervention and no complications were observed. VA hypoplasia was suspected in 3 cases, and no VA injury was found the remaining 14 cases.</p></div><div><h3>CONCLUSIONS</h3><p>In our series, more atypical cases with vertebral body involvement were observed than traditional HFs, suggesting that atypical HFs m

背景 CONTEXTA 传统的刽子手骨折（HF）是横跨 C2 椎体关节间旁的双侧骨折，但将 C2 椎体前部与后部分开的骨折形态存在很大差异。非典型高频骨折是越来越多被观察到的一种骨折类型，在这种骨折中，C2椎体的后方而非双侧关节旁受到累及。典型的高频将 C2 椎体的前部元素与后部元素分开，增加了脊髓的可用空间，而在非典型高频的情况下，脊髓的剩余空间不会因骨折而增加，从而导致神经损伤的风险更高。目的在本研究中，我们回顾了在一家三级甲等大学医院治疗的高频病例，尤其关注与高频病相关的骨折模式和临床特征。结果12例因交通事故受伤，12例因摔倒受伤，9例因绊倒受伤，2例因被高空坠物砸伤。该系列共有 6 例脊髓损伤（SCI）病例，其中 2 例多发性创伤病例在入院后不久死亡：1 例为交通事故，另 1 例为被坠落的钢板砸伤。根据 Levine 和 Edwards 的分类，23 例为 1 型损伤，6 例为 2 型损伤，2 例为 2a 型损伤，4 例为 3 型损伤（其中 2 例死亡）。在 13 例典型高频和 22 例非典型高频中，至少有一侧的 C2 椎体后方而非椎旁受累。根据李氏分类法，非典型高频骨折的模式为 A1 型 10 例，A2 型 1 例，B1 型 7 例，B2 型 4 例。典型和非典型高频的 SCI 例数无明显差异。24 例患者通过增强 CT 或 MR 血管造影检查了 VA 的完整性，其中 7 例（20%）被确诊为 VA 损伤。对所有 7 例病例都进行了密切随访，未采取任何干预措施，也未观察到并发症。结论在我们的系列研究中，观察到的椎体受累的非典型病例多于传统的高频病例，这表明非典型高频病可能需要重新命名。此外，与文献报道不同的是，非典型高频病例与较高的神经损伤无关。其中一个原因可能是我们的病例中更多的是低能量创伤的老年病例，而不像以往的报告那样，交通事故是造成伤害的主要原因。日本人口老龄化被认为是其中一个原因，高频模式特征的这种变化可能预示着其他国家也会出现这种情况。幸运的是，可能与低能量创伤的流行有关，VA 损伤并未导致脑血管并发症，但有 11 例未评估 VA 损伤的事实令人担忧。

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引用次数: 0

15. Long-term outcomes of vertebral body sliding osteotomy for the treatment of cervical myelopathy: a minimum of 5-year follow-up 15.椎体滑动截骨术治疗颈椎病的长期疗效：至少 5 年的随访

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100353

Dong-Ho Lee MD, PhD , Sung Tan Cho MD , Sehan Park MD

This abstract has been previously published as part of the 2023 Spineweek proceedings. For full access to the abstract, please visit the following URL: https://www.sosort.org/resources/Documents/Spineweek_2023_oral_abstracts_final-1.pdf.

本摘要曾作为 2023 Spineweek 论文集的一部分出版。如需获取摘要全文，请访问以下网址：https://www.sosort.org/resources/Documents/Spineweek_2023_oral_abstracts_final-1.pdf。

引用次数: 0

P32. Morphological analysis of OPLL progression in cervical spinal cord injury cases treated with posterior fusion P32.后路融合术治疗颈脊髓损伤病例中 OPLL 进展的形态学分析

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100436

Kento Inomata MD , Kota Suda MD, PhD , Keiichi Nakai MD , Miki Komatsu MD, PhD , Satoko Matsumoto Harmon MD, PhD

<div><h3>Background Context</h3><p>The patients with cervical ossification of the posterior longitudinal ligament (OPLL) have a high frequency in Asian, with a reported incidence of 6.3% in Japan. The presence of OPLL is a risk factor for cervical spinal cord injury, with some cases resulting from minor trauma such as falls. In previous studies, the characteristics of OPLL after surgery were mentioned, however, there is no consensus on cervical spinal cord injury with OPLL after fusion surgery.</p></div><div><h3>Purpose</h3><p>To investigate the natural progress of ossification in cervical spinal cord injury cases with OPLL treated by posterior fusion surgery.</p></div><div><h3>Study Design/Setting</h3><p>Study design is retrospective study.</p></div><div><h3>Patient Sample</h3><p>The subjects included 42 cases of cervical spinal cord injuries with OPLL that underwent posterior fusion surgery between 2017 and 2021 and were amenable to follow-up with CT for more than 6 months.</p></div><div><h3>Outcome Measures</h3><p>N/A.</p></div><div><h3>Methods</h3><p>We investigated the presence or absence of union of the OPLL at the level of the spinal cord injury on postoperative CT and the presence or absence of ossification of the anterior longitudinal ligament (OALL) on CT at the time of injury. We measured the thickness of OPLL at the level of injury by CT at the time of injury and 6 months after surgery and calculated the difference in the thickness of OPLL. We divided the subjects into two groups: one with the union of OPLL after surgery and one without union. We performed comparative analyses between the two groups and binary logistic regression analyses on the differences in thickness of OPLL, DM, and OALL. In addition, we assessed the rates of union for OPLL and OALL longitudinally at intervals of 3 months, 6 months, 1 year, and 2 years postoperatively.</p></div><div><h3>Results</h3><p>The mean age at the time of injury was 69.0 (44-87) years, the mean observation period was 15.9 (6-63) months, including 38 males and 4 females, the mean BMI was 25.0 (19.0-34.6) kg/m<sup>2</sup>, and 14 cases had DM. At the final observation, 30 cases (71.4%) got the union of OPLL at the level of the injury, and the mean time from injury to the union of OPLL was 8.4 (2-28) months. Thirty patients had OALL on CT at the time of injury. The mean difference in the thickness of the OPLL between the time of injury and 6 months after surgery was -0.07 (-1.2-0.6) mm, with no diameter enlargement. There were no significant differences between the 2 groups in age, gender, BMI, presence of DM, and the difference in the thickness of OPLL. In the group with the union of OPLL, they had OALL at the time of injury significantly by Pearson's chi-square test (p=.007). We found OALL as an independent factor in the binary logistic regression analysis. the rate of transformation into continuous type both OPLL and OALL at intervals of 3 months, 6 months, 1 year, and 2 years were as follo

背景颈椎后纵韧带骨化症（OPLL）患者在亚洲发病率很高，据报道日本的发病率为 6.3%。颈椎后纵韧带骨化症是颈椎脊髓损伤的危险因素之一，其中一些病例是由于轻微外伤（如跌倒）引起的。研究设计/研究背景研究设计为回顾性研究。患者样本受试者包括在2017年至2021年期间接受后路融合手术治疗的42例颈脊髓损伤伴OPLL病例，均可接受CT随访6个月以上.结果测量N/A.方法我们调查术后CT上脊髓损伤水平的OPLL有无结合，以及受伤时CT上前纵韧带（OALL）有无骨化。我们在受伤时和术后 6 个月通过 CT 测量受伤水平的 OPLL 厚度，并计算 OPLL 厚度的差异。我们将受试者分为两组：一组术后 OPLL 融合，另一组未融合。我们对两组进行了比较分析，并对 OPLL 厚度、DM 和 OALL 的差异进行了二元逻辑回归分析。结果受伤时平均年龄为 69.0（44-87）岁，平均观察时间为 15.9（6-63）个月，其中男性 38 例，女性 4 例，平均体重指数为 25.0（19.0-34.6）kg/m2，14 例患有 DM。最终观察结果显示，30 例（71.4%）患者的 OPLL 在损伤处发生了粘连，从损伤到 OPLL 粘连的平均时间为 8.4（2-28）个月。30例患者在受伤时CT显示有OALL。受伤时与术后6个月之间OPLL厚度的平均差异为-0.07（-1.2-0.6）毫米，直径没有扩大。两组患者在年龄、性别、体重指数（BMI）、是否患有糖尿病以及 OPLL 厚度差异方面均无明显差异。通过皮尔逊卡方检验（P=.007），OPLL结合组在受伤时有明显的OALL。在二元逻辑回归分析中，我们发现 OALL 是一个独立的因素。OPLL 和 OALL 在 3 个月、6 个月、1 年和 2 年的时间间隔内转化为连续型的比率如下：结论本研究表明，脊柱融合手术对 OPLL 转变为连续型和防止其骨化厚度增加有一定作用。约 70% 的颈椎 OPLL 在后路融合手术水平上转变为连续型，OPLL 和 OALL 转变为连续型的比率在特定时期内呈逐渐上升趋势。鉴于 OPLL 争议转化组在受伤时 OALL 的发生率明显较高，颈椎 OPLL 中可能存在具有 OPLL 结合因素的亚组。颈椎脊髓损伤伴有OPLL的后路融合手术后患者的OPLL厚度没有增加，瘫痪情况也没有恶化。FDA设备/药物状态本摘要不讨论也不包括任何适用的设备或药物。

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引用次数: 0

Does hydrogen peroxide help mitigate the incidence of Cutibacterium acnes in cervical spine surgeries? 过氧化氢是否有助于降低颈椎手术中痤疮杆菌的发病率？

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100514

Maria Cecilia Madariaga DO , Nicholas A. O'Malley DO, MS , Hannah Groff DO , Matthew Alben DO , Aidan Papalia DO, MBA , Joshua Fogel PhD , Jeffrey Thompson DO , Alexios Apazidis MD

Background

Surgical site infection (SSI) is a common yet serious complication of cervical spine surgery. While initially thought to be clinically insignificant, Cutibacterium acnes (C. acnes) is an important cause of infection. The purpose of this study was to investigate the ability of a hydrogen peroxide (H₂O₂) application during standard presurgical skin preparation to reduce the burden of C. acnes in patients undergoing cervical spine surgery.

Methods

This was a retrospective review of prospectively collected data. Subjects were randomly assigned to either standard surgical preparation plus H₂O₂ (experimental) or without H₂O₂ (control). Prescrub, postscrub, and dermal cultures were obtained to assess the C. acnes burden after cultures on an aerobic and anaerobic growth medium were held for 21 days. Multivariate analysis was conducted to determine factors associated with presence of C. acnes. Outcome measures included the results of intraoperative cultures and the development of a SSI within 90 days postoperatively.

Results

Patients (n=86) undergoing elective 2- or 3-level fusion via anterior approach were included. Prior to application of the antiseptic solution, 65% (28/43) of the experimental cohort and 77% (33/43) of the control cohort had positive C. acnes cultures (p=.34). Following application of antiseptic solution, there were no differences in positive C. acnes culture rates between the experimental and control cohorts in the epidermal (30% vs. 28%, p=1.00) or dermal (40% vs. 42%, p=1.00) cultures. No differences in the rates of C. acnes eradication from preantiseptic to postantiseptic application occurred for epidermal (p=1.00) or dermal (p=1.00) skin layers. None of the factors were associated with positive C. acnes epidermal cultures on multivariable logistic regression analysis (p>.05).

Conclusions

While there is potential for H₂O₂ to reduce the positive culture rate of C. acnes in cervical spine patients, no difference was seen when compared to standard surgical skin preparation.

背景手术部位感染（SSI）是颈椎手术常见但严重的并发症。痤疮杆菌（Cutibacterium acnes，C. acnes）最初被认为在临床上无足轻重，但却是造成感染的重要原因。本研究旨在探讨在标准术前皮肤准备过程中应用过氧化氢（H2O2）能否减轻颈椎手术患者的痤疮丙酸杆菌负担。受试者被随机分配到加 H2O2 的标准术前准备（实验组）或不加 H2O2 的标准术前准备（对照组）。在需氧和厌氧生长培养基上培养 21 天后，对擦洗前、擦洗后和皮肤进行培养，以评估痤疮丙酸杆菌的负担。进行多变量分析以确定与痤疮丙酸杆菌存在相关的因素。结果包括术中培养结果和术后 90 天内发生 SSI 的情况。在使用抗菌溶液前，实验组 65% （28/43）和对照组 77% （33/43）的痤疮丙酸杆菌培养呈阳性（p=.34）。使用消毒液后，实验组和对照组的表皮（30% 对 28%，p=1.00）或真皮（40% 对 42%，p=1.00）痤疮丙酸杆菌培养阳性率没有差异。从使用抗腐剂前到使用抗腐剂后，表皮层（p=1.00）或真皮层（p=1.00）的痤疮丙酸杆菌根除率没有差异。结论虽然 H2O2 有可能降低颈椎病患者的痤疮丙酸杆菌培养阳性率，但与标准的手术备皮相比并无差异。

{"title":"Does hydrogen peroxide help mitigate the incidence of Cutibacterium acnes in cervical spine surgeries?","authors":"Maria Cecilia Madariaga DO , Nicholas A. O'Malley DO, MS , Hannah Groff DO , Matthew Alben DO , Aidan Papalia DO, MBA , Joshua Fogel PhD , Jeffrey Thompson DO , Alexios Apazidis MD","doi":"10.1016/j.xnsj.2024.100514","DOIUrl":"10.1016/j.xnsj.2024.100514","url":null,"abstract":"<div><h3>Background</h3><p>Surgical site infection (SSI) is a common yet serious complication of cervical spine surgery. While initially thought to be clinically insignificant, <em>Cutibacterium acnes</em> (<em>C. acnes)</em> is an important cause of infection. The purpose of this study was to investigate the ability of a hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) application during standard presurgical skin preparation to reduce the burden of <em>C. acnes</em> in patients undergoing cervical spine surgery.</p></div><div><h3>Methods</h3><p>This was a retrospective review of prospectively collected data. Subjects were randomly assigned to either standard surgical preparation plus H<sub>2</sub>O<sub>2</sub> (experimental) or without H<sub>2</sub>O<sub>2</sub> (control). Prescrub, postscrub, and dermal cultures were obtained to assess the <em>C. acnes</em> burden after cultures on an aerobic and anaerobic growth medium were held for 21 days. Multivariate analysis was conducted to determine factors associated with presence of <em>C. acnes</em>. Outcome measures included the results of intraoperative cultures and the development of a SSI within 90 days postoperatively.</p></div><div><h3>Results</h3><p>Patients (n=86) undergoing elective 2- or 3-level fusion via anterior approach were included. Prior to application of the antiseptic solution, 65% (28/43) of the experimental cohort and 77% (33/43) of the control cohort had positive <em>C. acnes</em> cultures (p=.34). Following application of antiseptic solution, there were no differences in positive <em>C. acnes</em> culture rates between the experimental and control cohorts in the epidermal (30% vs. 28%, p=1.00) or dermal (40% vs. 42%, p=1.00) cultures. No differences in the rates of <em>C. acnes</em> eradication from preantiseptic to postantiseptic application occurred for epidermal (p=1.00) or dermal (p=1.00) skin layers. None of the factors were associated with positive <em>C. acnes</em> epidermal cultures on multivariable logistic regression analysis (p>.05).</p></div><div><h3>Conclusions</h3><p>While there is potential for H<sub>2</sub>O<sub>2</sub> to reduce the positive culture rate of <em>C. acnes</em> in cervical spine patients, no difference was seen when compared to standard surgical skin preparation.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"19 ","pages":"Article 100514"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002075/pdfft?md5=fa65d314629e450c6b106af624b6d78b&pid=1-s2.0-S2666548424002075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702562","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

19. Revision rates after single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: an observational study with 5-year minimum follow-up 19.单水平颈椎间盘关节置换术与前路颈椎椎间盘切除术和融合术后的复发率：一项至少随访 5 年的观察性研究

Q3 Medicine

North American Spine Society Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.xnsj.2024.100357

Adam M. Gordon MD , Faisal Elali BS, BA

BACKGROUND CONTEXT

Prospective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.

PURPOSE

The aims were to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) or Anterior Cervical Discectomy and Fusion (ACDF).

STUDY DESIGN/SETTING

Retrospective case-control observational study.

PATIENT SAMPLE

A nationwide United States population database from 2010 to 2021 was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up.

OUTCOME MEASURES

Objectives were to compare the rates of all-cause 5-year revisions for those undergoing single level CDA versus ACDF and assess the risk factors associated with requiring revision surgery.

METHODS

Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, individual comorbidities, and overall Elixhauser comorbidity index (ECI). Multivariate logistic regression models were used to calculate odds ratios (OR) of revision surgery within 5 years of the primary procedure while controlling for age, sex, and individual comorbidities comprising the ECI. P values less than 0.001 were significant.

RESULTS

After successful ratio matching, a total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revision within 5 years was 1.24% for CDA and 9.23% for ACDF (P<0.001). After adjustment, patients undergoing single level ACDF has significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P<0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P<0.0001), depression (OR: 1.23; P<0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003).

CONCLUSIONS

In this observational study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients on nationwide reported revision rates up to 5-years from single level CDA or ACDF.

FDA Device/Drug Status

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

背景 CONTEX前瞻性研究比较了 CDA 和 ACDF 的患者报告结果、邻近节段退变和长期翻修情况。目的比较接受初级单水平颈椎间盘关节置换术（CDA）或前路颈椎椎间盘切除融合术（ACDF）的患者5年全因翻修率和风险因素。研究设计/背景回顾性病例对照观察研究。患者样本查询了 2010 年至 2021 年美国全国人口数据库中因颈椎退行性病变接受初级单水平 CDA 或 ACDF 手术的患者。方法将接受 CDA 治疗的患者与接受 ACDF 治疗的患者按年龄、性别、个人合并症和总的 Elixhauser 合并症指数 (ECI) 以 1:5 的比例进行配对。多变量逻辑回归模型用于计算初次手术后 5 年内进行翻修手术的几率比（OR），同时控制年龄、性别和包括 ECI 在内的各种合并症。结果经过成功的比值匹配，共有32953名患者接受了单层CDA（5640人）或ACDF（27313人），随访时间最短为5年。5 年内各种原因的翻修发生率，CDA 为 1.24%，ACDF 为 9.23%（P<0.001）。经调整后，接受单层 ACDF 的患者在 5 年内发生全因性翻修的几率明显更高（OR：8.09；P<0.0001）。与翻修相关的其他患者特异性因素包括药物滥用史（OR：1.51；P<0.0001）、抑郁症（OR：1.23；P<0.0001）、心律失常（OR：1.21；P=0.0008）、高血压（OR：1.20；P=0.结论在这项对近 33,000 例单层次颈椎手术进行了至少 5 年随访的观察性研究中，接受 CDA 的患者全因翻修率显著较低。外科医生可以利用这些数据，就全国范围内报告的单层 CDA 或 ACDF 5 年后的翻修率为患者提供咨询。FDA 器械/药物状态本摘要未讨论或包含任何适用的器械或药物。

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引用次数: 0