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Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance. 青少年特发性脊柱侧凸患者采用不同手术技术对正面曲线矫正和矢状面平衡的影响
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8602
Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny

Background: Surgical correction of adolescent idiopathic scoliosis from the posterior approach can be performed by the "all screws" technique; hybrid technique with screws and hooks; hybrid technique or with screws, hooks, and tapes; or selective fusion (SF) or nonselective fusion (NSF). The aim of the present investigation was to analyze the influence from different operative techniques on frontal curve correction and sagittal profile in patients with adolescent idiopathic scoliosis.

Methods: We conducted a retrospective analysis on 55 consecutive patients with scoliosis who had been treated by posterior instrumented fusion. We collected demographic data and analyzed pre- and postoperative radiographs. Statistical analysis was performed using SPSS version 25. Because data showed normal distribution, t tests were performed.

Results: Twenty-two patients were treated using the hybrid technique with screws and hooks; 25 were treated using the hybrid technique with screws, hooks, and tape; and 8 were treated using the all screws technique. An SF was performed in 32 patients and NSF in 23 patients. There was no significant difference with regard to curve correction of the main curve between the different techniques. Correction of the minor curve was significantly higher in NSF than in SF patients. In SF, there was a correction of the minor curve of 43.9%. Impact on sagittal balance showed no significant differences between NSF and SF.

Conclusion: The different operative techniques did not show a difference with regard to the correction of the main curve. NSF showed a significantly higher degree of correction of the minor curve than SF. However, we still found a correction of 43.9% of the noninstrumented minor curve in SF. Thus, SF and hybrid techniques do not lead to inferior radiographic outcome.

Clinical relevance: SF and hybrid techniques are safe and effective techniques that could be used as an alternative to NSF and all screw fixation in the operative treatment for scoliosis.

Level of evidence: 3:

背景:通过后路手术矫正青少年特发性脊柱侧凸的方法有:"全螺钉 "技术;螺钉和钩子混合技术;混合技术或螺钉、钩子和带子混合技术;选择性融合(SF)或非选择性融合(NSF)。本研究旨在分析不同手术技术对青少年特发性脊柱侧凸患者额曲线矫正和矢状面的影响:我们对55例连续接受后路器械融合术治疗的脊柱侧凸患者进行了回顾性分析。我们收集了人口统计学数据,并分析了术前和术后的X光片。统计分析使用 SPSS 25 版本进行。由于数据呈正态分布,因此进行了 t 检验:22例患者采用螺钉和挂钩混合技术进行治疗;25例患者采用螺钉、挂钩和胶带混合技术进行治疗;8例患者采用全螺钉技术进行治疗。32名患者接受了SF治疗,23名患者接受了NSF治疗。不同技术对主曲线的矫正效果没有明显差异。NSF 患者的小曲线矫正率明显高于 SF 患者。SF患者的小曲线矫正率为43.9%。NSF和SF对矢状平衡的影响无明显差异:结论:不同的手术技术在矫正主要曲线方面没有差异。NSF对小弯的矫正程度明显高于SF。然而,我们仍然发现,SF术中43.9%的非器械小曲线得到了矫正。因此,SF和混合技术并不会导致较差的影像学结果:SF和混合技术是安全有效的技术,可在脊柱侧凸的手术治疗中替代NSF和全螺钉固定:3:
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引用次数: 0
Feasibility and Analgesic Efficacy of Thoracolumbar Dorsal Ramus Nerve Block Using Multiorifice Pain Catheters for Scoliosis Surgery: A Prospective Cohort Study. 脊柱侧凸手术中使用多孔疼痛导管进行胸腰椎背侧神经阻滞的可行性和镇痛效果:前瞻性队列研究。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8601
Tara M Doherty, Ailan Zhang, Alla Spivak, Ellen Kiley, Damon DelBello, Apolonia E Abramowicz, Jeff L Xu

Background: Approximately 38,000 scoliosis surgery correction operations are performed annually in the United States; these operations are associated with considerable postoperative pain which can be difficult to manage. This is largely attributed to an incision spanning multiple vertebral segments with paraspinal muscle dissection and retraction to facilitate the implantation of segmental hardware and rods. Frequently utilized analgesic modalities include intravenous patient-controlled analgesia and epidural analgesia, often in combination. We sought to ascertain the feasibility and analgesic efficacy of continuous thoracolumbar dorsal ramus nerve (TDRN) block using surgically placed multiorifice catheters.

Methods: Forty-two patients diagnosed with idiopathic scoliosis who underwent a posterior spinal fusion (PSF) were enrolled after consent was obtained. Patients were managed utilizing a standardized Enhanced Recovery After Surgery) protocol including a perioperative opioid-sparing regimen. Data were collected at specified time intervals during the recovery period. These data points included pain scores using the Numeric Rating Scale. Parenteral or both oral and parenteral opioid consumption doses were also collected every 4 hours. Any significant postoperative adverse events were recorded as well.

Results: A total of 42 patients had surgically placed TDRN catheters, and 40 patients were included in this study. The patients all reported low to moderate pain scores with low opioid consumption postoperatively, while the TDRN catheter delivery of local anesthetic analgesics did not result in significant complications.

Clinical relevance: A regional technique utilizing TDRN catheters could be a valuable component of the postoperative pain management protocols for PSF surgery, and additional studies are warranted.

Conclusion: This study evaluated the feasibility and analgesic efficacy of TDRN catheters for postoperative pain control following multilevel PSF for idiopathic scoliosis. Continuous local anesthetic delivery through TDRN catheters is a feasible and safe technique for postoperative pain control in these patients. Selective blockade of the dorsal rami might have benefits over epidural analgesia or other regional techniques.

Level of evidence: 3:

背景:在美国,每年约有 38,000 例脊柱侧弯矫正手术;这些手术会带来相当大的术后疼痛,而且难以控制。这主要是由于手术切口横跨多个椎体节段,需要解剖和牵拉脊柱旁肌肉,以便于植入节段性硬件和棒材。常用的镇痛方式包括患者自控的静脉镇痛和硬膜外镇痛,通常是联合使用。我们试图确定使用手术置入的多孔导管进行连续胸腰椎背侧神经(TDRN)阻滞的可行性和镇痛效果:42名被诊断为特发性脊柱侧凸并接受后路脊柱融合术(PSF)的患者在征得同意后被纳入研究。患者采用标准化的 "术后强化恢复"(Enhanced Recovery After Surgery)方案进行治疗,包括围手术期阿片类药物稀释方案。在恢复期间的特定时间间隔收集数据。这些数据包括使用数字评分量表进行的疼痛评分。此外,还每隔 4 小时收集一次肠外或口服和肠外阿片类药物的消耗剂量。任何重大术后不良事件也会被记录在案:共有 42 名患者通过手术置入了 TDRN 导管,其中 40 名患者被纳入本研究。所有患者术后疼痛评分均为低至中度,阿片类药物用量较少,而 TDRN 导管输送局麻药镇痛剂并未导致明显的并发症:利用 TDRN 导管的区域技术可能是 PSF 手术术后疼痛管理方案的重要组成部分,有必要进行更多研究:本研究评估了TDRN导管用于特发性脊柱侧弯多级PSF术后疼痛控制的可行性和镇痛效果。通过 TDRN 导管持续输送局麻药是一种可行且安全的术后疼痛控制技术。与硬膜外镇痛或其他区域性技术相比,选择性阻断背韧带可能更有优势:3:
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引用次数: 0
Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Renal Cell Carcinoma. 靶向系统疗法和放疗对接受脊柱手术治疗转移性肾细胞癌患者的影响
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8608
Hani Chanbour, Jeffrey W Chen, Gabriel A Bendfeldt, Lakshmi Suryateja Gangavarapu, Matthew E LaBarge, Mahmoud Ahmed, Iyan Younus, Soren Jonzzon, Steven G Roth, Silky Chotai, Brian I Rini, Leo Y Luo, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman

Background: In patients undergoing spine surgery for renal cell carcinoma (RCC), we sought to: (1) describe patterns of postoperative targeted systemic therapy and radiotherapy (RT), (2) compare perioperative outcomes among those treated with targeted systemic therapy to those without, and (3) evaluate the impact of targeted systemic therapy and/or RT on overall survival (OS) and local recurrence (LR).

Methods: A single-institution, retrospective cohort study of patients undergoing spine surgery for metastatic RCC from 2010 to 2021 was undertaken. Treatment groups were RT alone, targeted systemic therapy alone, dual therapy consisting of RT and targeted systemic therapy, and neither therapy. Multivariable Cox regression controlled for age, race, sex, insurance, and preoperative targeted systemic therapy.

Results: Forty-nine patients underwent spine surgery for RCC. Postoperatively, 4 patients (8%) received RT alone, 19 (38.8%) targeted systemic therapy alone, 12 (24.5%) dual therapy, and 13 (28.6%) neither. All groups were similar in demographics, preoperative Karnofsky Performance Score (P = 0.372), tumor size (P = 0.413), readmissions (P = 0.884), complications (P = 0.272), Karnofsky Performance Score (P = 0.466), and Modified McCormick Scale (P = 0.980) at last follow-up. Higher 1-year survival was found in dual therapy (83.3%) compared with other therapies. OS was significantly longer in patients with dual therapy compared with other therapies (log-rank; P = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02-0.31, P < 0.001) showed longer OS in dual therapy compared with other therapies. Seven patients (14.3%) experienced LR, and a similar time to LR was found between groups (log-rank; P = 0.190).

Conclusion: In patients undergoing metastatic spine surgery for RCC, postoperative dual therapy demonstrated significantly higher 1-year survival and OS compared with other therapies.

Clinical relevance: Multidisciplinary management of metastatic RCC is necessary to ensure timely implementation of targeted systemic therapy and RT to improve outcomes.

Level of evidence: 3:

背景:在接受脊柱手术治疗肾细胞癌(RCC)的患者中,我们试图(1)描述术后系统性靶向治疗和放射治疗(RT)的模式;(2)比较接受系统性靶向治疗和未接受系统性靶向治疗患者的围手术期结果;(3)评估系统性靶向治疗和/或RT对总生存期(OS)和局部复发(LR)的影响:方法:对2010年至2021年接受脊柱手术治疗的转移性RCC患者进行了一项单一机构的回顾性队列研究。治疗组别包括单纯 RT、单纯靶向系统疗法、RT 和靶向系统疗法组成的双重疗法以及两种疗法均不适用。多变量考克斯回归控制了年龄、种族、性别、保险和术前靶向系统治疗:49名患者接受了脊柱手术治疗RCC。术后,4 名患者(8%)单独接受了 RT 治疗,19 名患者(38.8%)单独接受了系统靶向治疗,12 名患者(24.5%)接受了双重治疗,13 名患者(28.6%)两者均未接受治疗。所有组别在人口统计学、术前卡诺夫斯基表现评分(P = 0.372)、肿瘤大小(P = 0.413)、再入院率(P = 0.884)、并发症(P = 0.272)、卡诺夫斯基表现评分(P = 0.466)和最后一次随访时的改良麦考密克量表(P = 0.980)方面相似。与其他疗法相比,双重疗法的 1 年生存率更高(83.3%)。与其他疗法相比,采用双重疗法的患者的 OS 明显更长(log-rank;P = 0.010)。多变量考克斯回归(HR = 0.08,95% CI = 0.02-0.31,P < 0.001)显示,与其他疗法相比,双重疗法的患者OS更长。7名患者(14.3%)发生了LR,不同组间发生LR的时间相似(log-rank;P = 0.190):结论:对于接受脊柱转移性RCC手术的患者,术后双重疗法的1年生存率和OS显著高于其他疗法:转移性RCC的多学科管理对于确保及时实施靶向系统治疗和RT以改善预后非常必要:3:
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引用次数: 0
Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology. 骨质疏松症对颈椎退行性病变手术后融合率和并发症影响的系统性回顾和荟萃分析》(Systematic Review and Meta-Analysis of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology)。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8568
Elizabeth A Lechtholz-Zey, Mina Ayad, Brandon S Gettleman, Emily S Mills, Hannah Shelby, Andy Ton, John J S Shin, Jeffrey C Wang, Raymond J Hah, Ram K Alluri

Background: As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity.

Methods: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications.

Results: There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock.

Conclusions: Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery.

Clinical relevance: In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.

Level of evidence: 1:

背景:随着老年人口的增长,骨质疏松症的发病率越来越高,这给外科医生带来了独特的挑战。骨强度和骨质量的下降与硬件故障和骨愈合受损有关,这可能会增加翻修手术率和并发症的发生。本综述旨在确定骨质疏松症对颈椎退行性疾病或畸形患者术后效果的影响:方法:采用《系统综述和元分析首选报告项目》指南和医学主题词表中涉及脊柱手术治疗颈椎退行性疾病和骨质疏松症的术语进行了系统综述。该研究重点关注放射学结果以及手术和医疗并发症:结果:共有16项研究被纳入退行性疾病组,9项被纳入畸形组。在所有退行性研究中,骨质疏松患者在接受颈椎退行性疾病手术治疗时,较低的骨矿物质密度与笼子下沉率增加有关。大多数研究对骨质疏松症与其他结果(如翻修率、再入院率、费用和围手术期并发症)之间的关系报道不一。我们的荟萃分析表明,骨质疏松症患者术后6个月和1年的融合率降低的风险更大。在颈椎畸形矫正方面,虽然个别并发症的发生率与骨质疏松症无关,但骨量较差的患者发生任何并发症的整体风险都可能增加:总体而言,文献表明,骨质疏松患者接受颈椎手术后的结果是多因素的。骨质疏松症似乎是术后发生骨笼下沉和假关节的重要风险因素,而有关医疗和医院相关指标的报告则尚无定论。我们的研究结果突显了护理骨质疏松症患者所面临的挑战,并强调需要进行充分的研究,以了解骨质疏松症如何改变颈椎手术患者的风险指数:在因退行性疾病接受颈椎手术的患者中,骨质疏松症是术后长期并发症--尤其是椎笼下沉和假关节--的重要风险因素。鉴于这些手术的选择性,医疗服务提供者之间应定期开展跨学科合作,以便在颈椎手术前对患者进行医疗优化:1:
{"title":"Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology.","authors":"Elizabeth A Lechtholz-Zey, Mina Ayad, Brandon S Gettleman, Emily S Mills, Hannah Shelby, Andy Ton, John J S Shin, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.14444/8568","DOIUrl":"10.14444/8568","url":null,"abstract":"<p><strong>Background: </strong>As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity.</p><p><strong>Methods: </strong>A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications.</p><p><strong>Results: </strong>There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock.</p><p><strong>Conclusions: </strong>Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery.</p><p><strong>Clinical relevance: </strong>In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433043","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
Comparing the Upper Instrumented Vertebrae Tilt Angle vs Screw Angle in the Development of Proximal Junction Kyphosis After Adult Spinal Deformity Surgery: Which Matters More? 比较上部器械椎体倾斜角度与螺钉角度在成人脊柱畸形手术后近端交界处后凸发展中的作用:哪个更重要?
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8607
Keyan Peterson, Hani Chanbour, Michael Longo, Jeffrey W Chen, Soren Jonzzon, Steven G Roth, Jacquelyn S Pennings, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman

Background: We sought to determine which aspect of the upper instrumented vertebrae (UIV)-tilt angle or screw angle-was more strongly associated with: (1) proximal junctional kyphosis/failure (PJK/F), (2) other mechanical complications and reoperations, and (3) patient-reported outcome measures (PROMs).

Methods: A single-institution, retrospective cohort study was undertaken for patients undergoing adult spinal deformity (ASD) surgery from 2011 to 2017. Only patients with UIV at T7 or below were included. The primary exposure variables were UIV tilt angle (the angle of the UIV inferior endplate and the horizontal) and UIV screw angle (the angle of the UIV screws and superior endplate). Multivariable logistic regression included age, body mass index, osteopenia/osteoporosis, postoperative sagittal vertical axis, postoperative pelvic-incidence lumbar lordosis mismatch, UIV tilt angle, and UIV screw angle.

Results: One hundred and seventeen patients underwent adult spinal deformity surgery with a minimum of 2-year follow-up. A total of 41 patients (35.0%) had PJK and 26 (22.2%) had PJF. (1) UIV tilt angle: 96 (82.1%) had lordotic UIV tilt angles, 6 (5.1%) were neutral, and 15 (12.8%) were kyphotic. (2) UIV screw angle: 38 (32.5%) had cranially directed screws, 4 (3.4%) were neutral, and 75 (64.1%) were caudally directed. Both lordotic-angled UIV endplate (OR = 1.06, 95% CI = 1.01-1.12, and P = 0.020) and cranially directed screws (OR = 1.19, 95% CI = 1.07-1.33, and P < 0.001) were associated with higher odds of PJK, with a more pronounced effect of UIV screw angle compared with UIV tilt angle (Wald test, 9.40 vs 4.42). Similar results were found for PJF. Neither parameter was associated with other mechanical complications, reoperations, or patient-reported outcome measures.

Conclusions: UIV screw angle was more strongly associated with development of PJK/F compared with tilt angle. Overall, these modifiable parameters are directly under the surgeon's control and can mitigate the development of PJK/F.

Clinical relevance: Surgeons may consider selecting a UIV with a neutral or kyphotically directed UIV tilt angle when performing ASD surgery with a UIV in the lower thoracic or lumbar region, as well as use UIV screw angles that are caudally directed, for the purprose of decreasing the risk of developing PJK/F.

Level of evidence: 3:

背景:我们试图确定上部器械椎体(UIV)的哪个方面--倾斜角或螺钉角--与以下方面的关系更密切:(1)近端交界处后凸/失败(PJK/F),(2)其他机械并发症和再手术,以及(3)患者报告的结果指标(PROMs):对2011年至2017年期间接受成人脊柱畸形(ASD)手术的患者进行了一项单一机构的回顾性队列研究。仅纳入了T7或以下部位有UIV的患者。主要暴露变量为UIV倾斜角(UIV下终板与水平面的夹角)和UIV螺钉角(UIV螺钉与上终板的夹角)。多变量逻辑回归包括年龄、体重指数、骨质疏松/骨质疏松症、术后矢状纵轴、术后骨盆前凸腰椎前凸不匹配、UIV倾斜角度和UIV螺钉角度:117名患者接受了成人脊柱畸形手术,随访至少2年。共有 41 名患者(35.0%)患有 PJK,26 名患者(22.2%)患有 PJF。(1) UIV 倾斜角度:96 例(82.1%)患者的 UIV 倾斜角度为前凸,6 例(5.1%)为中性,15 例(12.8%)为后凸。(2) UIV螺钉角度:38(32.5%)颅向螺钉,4(3.4%)中性,75(64.1%)尾向。脊柱侧弯的 UIV 终板(OR = 1.06,95% CI = 1.01-1.12,P = 0.020)和颅向螺钉(OR = 1.19,95% CI = 1.07-1.33,P < 0.001)都与较高的 PJK 发生几率相关,与 UIV 倾斜角度相比,UIV 螺钉角度的影响更为明显(Wald 检验,9.40 vs 4.42)。PJF 也有类似的结果。两个参数都与其他机械并发症、再次手术或患者报告的结果指标无关:结论:与倾斜角度相比,UIV螺钉角度与PJK/F的发生关系更大。总体而言,这些可修改的参数都在外科医生的直接控制之下,可以减轻 PJK/F 的发生:外科医生在下胸椎或腰椎区域使用 UIV 进行 ASD 手术时,可考虑选择 UIV 倾斜角度为中性或向后倾斜的 UIV,并使用 UIV 螺钉角度为尾部导向的 UIV,以降低发生 PJK/F 的风险:3:
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引用次数: 0
Complications of Venous Thromboembolism Chemoprophylaxis in Lumbar Laminectomy With and Without Fusion. 腰椎椎板切除术(带或不带融合器)中静脉血栓栓塞化学预防的并发症。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8606
Elizabeth R Stiles, Ashish D Chakraborty, Priscilla Varghese, Aonnicha Burapachaisri, Lindsay Kim, Yong H Kim, Themistocles Stavros Protopsaltis, Charla Fischer
<p><strong>Background: </strong>The benefit of chemoprophylaxis (CPX) agents in preventing venous thromboembolism must be weighed against potential risks. Current literature regarding the efficacy of CPX after laminectomies with or without fusion is limited, with no clear consensus to inform guidelines.</p><p><strong>Objective: </strong>This study evaluated the association between CPX and surgical complications after lumbar laminectomy with and without fusion.</p><p><strong>Study design: </strong>Retrospective study of patients at a single large academic institution.</p><p><strong>Methods: </strong>The medical records of patients who underwent lumbar laminectomies with or without lumbar fusion from 2018 to 2020 were reviewed for demographics, surgical characteristics, CPX agents, postoperative complications, epidural hematomas, and wound drainage. Patients receiving CPX (<i>n</i> = 316) were compared with patients not receiving CPX (<i>n</i> = 316) via <i>t</i> test following propensity score matching, and patients on CPX were further stratified by fusion status.</p><p><strong>Results: </strong>The CPX group had higher body mass index and American Society of Anesthesiologists grades. Rates of venous thromboembolism, epidural hematomas, infections, postoperative incision and drainage, transfusions, wound dehiscence, and reoperation were not associated with CPX. Moist dressings were more frequent, and average days of drain duration were longer with CPX. Overall postoperative complication rate and length of stay (LOS) were greater with CPX. The fusion subgroup had a lower Charlson Comorbidity Index, had a lower American Society of Anesthesiologists grade, was younger, had more women, and underwent more minimally invasive laminectomies. While estimated blood loss, operative times, and LOS were significantly greater in the fusion group, there was no difference in rate of intraoperative and postoperative complications.</p><p><strong>Conclusion: </strong>CPX after lumbar laminectomies with or without fusion was not associated with increased rates of epidural hematomas, wound complications, or reoperation. Patients receiving CPX had more postoperative cardiac complications, but it is possible that surgeons were more likely to prescribe CPX for higher-risk patients. They also had higher rates of ileus and moist dressings, greater LOS, and longer length of drain duration. Patients who underwent lumbar laminectomy with fusion on CPX tended to be lower risk yet incurred greater blood loss, operative times, LOS, cardiac complications, and hematomas/seromas than patients not undergoing fusion.</p><p><strong>Clinical relevance: </strong>This retrospective study compared surgical complications of lumbar laminectomies in patients who received chemoprophylaxis vs patients who did not. Chemoprophylaxis was not associated with increased rates of epidural hematomas, wound complications, or reoperation, but it was associated with higher rates of postoperative cardiac
背景:必须权衡化学预防(CPX)药物在预防静脉血栓栓塞方面的益处和潜在风险。目前有关椎板切除术(带或不带融合术)后 CPX 疗效的文献有限,没有明确的共识可供指南参考:本研究评估了CPX与腰椎间盘切除术(带或不带融合器)后手术并发症之间的关系:研究设计:对一家大型学术机构的患者进行回顾性研究:回顾2018年至2020年接受腰椎板切除术(带或不带腰椎融合术)患者的病历,了解人口统计学、手术特征、CPX药物、术后并发症、硬膜外血肿和伤口引流情况。通过倾向得分匹配后的t检验,将接受CPX治疗的患者(n = 316)与未接受CPX治疗的患者(n = 316)进行比较,并根据融合状态对接受CPX治疗的患者进行进一步分层:结果:CPX 组患者的体重指数和美国麻醉医师协会等级较高。静脉血栓栓塞、硬膜外血肿、感染、术后切开引流、输血、伤口裂开和再次手术的发生率与 CPX 无关。CPX 的湿润敷料使用频率更高,引流时间平均天数更长。CPX 的总体术后并发症发生率和住院时间(LOS)更长。融合术亚组的夏尔森综合指数(Charlson Comorbidity Index)较低,美国麻醉医师协会分级较低,年龄较轻,女性较多,接受的微创椎板切除术较多。虽然融合组的估计失血量、手术时间和住院时间明显更长,但术中和术后并发症的发生率没有差异:结论:腰椎椎板切除术后进行 CPX 并不会增加硬膜外血肿、伤口并发症或再次手术的发生率。接受CPX治疗的患者术后心脏并发症较多,但可能是外科医生更倾向于为高风险患者开CPX处方。他们的回肠梗阻和潮湿敷料发生率也更高、住院时间更长、引流管持续时间更长。与未接受融合手术的患者相比,接受腰椎椎板切除术并在CPX上进行融合的患者风险较低,但失血量、手术时间、住院时间、心脏并发症和血肿/血丝瘤的发生率更高:这项回顾性研究比较了接受化学预防与未接受化学预防的腰椎间盘切除术患者的手术并发症。化学预防与硬膜外血肿、伤口并发症或再次手术的发生率增加无关,但与术后心脏并发症和回肠淤血的发生率增加有关:3:
{"title":"Complications of Venous Thromboembolism Chemoprophylaxis in Lumbar Laminectomy With and Without Fusion.","authors":"Elizabeth R Stiles, Ashish D Chakraborty, Priscilla Varghese, Aonnicha Burapachaisri, Lindsay Kim, Yong H Kim, Themistocles Stavros Protopsaltis, Charla Fischer","doi":"10.14444/8606","DOIUrl":"10.14444/8606","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The benefit of chemoprophylaxis (CPX) agents in preventing venous thromboembolism must be weighed against potential risks. Current literature regarding the efficacy of CPX after laminectomies with or without fusion is limited, with no clear consensus to inform guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study evaluated the association between CPX and surgical complications after lumbar laminectomy with and without fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study of patients at a single large academic institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The medical records of patients who underwent lumbar laminectomies with or without lumbar fusion from 2018 to 2020 were reviewed for demographics, surgical characteristics, CPX agents, postoperative complications, epidural hematomas, and wound drainage. Patients receiving CPX (&lt;i&gt;n&lt;/i&gt; = 316) were compared with patients not receiving CPX (&lt;i&gt;n&lt;/i&gt; = 316) via &lt;i&gt;t&lt;/i&gt; test following propensity score matching, and patients on CPX were further stratified by fusion status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The CPX group had higher body mass index and American Society of Anesthesiologists grades. Rates of venous thromboembolism, epidural hematomas, infections, postoperative incision and drainage, transfusions, wound dehiscence, and reoperation were not associated with CPX. Moist dressings were more frequent, and average days of drain duration were longer with CPX. Overall postoperative complication rate and length of stay (LOS) were greater with CPX. The fusion subgroup had a lower Charlson Comorbidity Index, had a lower American Society of Anesthesiologists grade, was younger, had more women, and underwent more minimally invasive laminectomies. While estimated blood loss, operative times, and LOS were significantly greater in the fusion group, there was no difference in rate of intraoperative and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CPX after lumbar laminectomies with or without fusion was not associated with increased rates of epidural hematomas, wound complications, or reoperation. Patients receiving CPX had more postoperative cardiac complications, but it is possible that surgeons were more likely to prescribe CPX for higher-risk patients. They also had higher rates of ileus and moist dressings, greater LOS, and longer length of drain duration. Patients who underwent lumbar laminectomy with fusion on CPX tended to be lower risk yet incurred greater blood loss, operative times, LOS, cardiac complications, and hematomas/seromas than patients not undergoing fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;This retrospective study compared surgical complications of lumbar laminectomies in patients who received chemoprophylaxis vs patients who did not. Chemoprophylaxis was not associated with increased rates of epidural hematomas, wound complications, or reoperation, but it was associated with higher rates of postoperative cardiac ","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432979","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
Technical Note on the Role of Kambin's Triangle in the Evolution of Total Joint Replacement of the Lumbar Spine. 关于坎宾三角形在腰椎全关节置换术发展过程中的作用的技术说明。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8611
S Craig Humphreys, Louis J Nel, Jon E Block, Scott D Hodges

We provide a historical and technical perspective on the evolution of Kambin's triangle as a safe working corridor for percutaneous access to the intervertebral disc to an anatomically expanded space to accommodate and facilitate open lumbar total joint replacement. The nearly 6-decade progression from intradiscal access in the intact lumbar spine to an enlarged working space following facetectomy to accommodate a transforaminal lumbar interbody fusion, and eventual further expansion via pedicle vertebral body osteotomy to support motion preservation with total joint replacement, represents a unique evolutionary pathway in surgical technique development. For each of these steps in evolution, we detail and provide the historical context of the corresponding surgical modifications required to expand the original anatomical boundaries of Kambin's triangle. It is postulated that the introduction of machine learning technologies coupled with innovations in robotics, materials science, and advanced imaging will further accelerate and refine the adaptation of more complex, precise, and efficacious surgical procedures to treat spinal degeneration via this working corridor.

我们从历史和技术角度介绍了坎宾三角区的演变过程,坎宾三角区是经皮进入椎间盘的安全工作通道,也是解剖学上扩大的空间,可容纳并促进开放式腰椎全关节置换术。从完整腰椎的椎间盘内入路,到椎板切除术后扩大的工作空间,以容纳经椎间孔腰椎椎体融合术,再到最终通过椎弓根椎体截骨术进一步扩大工作空间,以支持全关节置换术的运动保护,近六十年的发展历程代表了手术技术发展的独特演进路径。对于上述每一步演变,我们都详细介绍并提供了相应的手术修改的历史背景,这些手术修改是扩大 Kambin 三角区的原始解剖学边界所必需的。据推测,机器学习技术的引入,加上机器人技术、材料科学和先进成像技术的创新,将进一步加速和完善更复杂、更精确、更有效的外科手术,通过这条工作走廊治疗脊柱退行性病变。
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引用次数: 0
Titanium-Coated Polyetheretherketone Cages Vs Full Titanium Cages for Stand-Alone 1- or 2-Level Anterior Cervical Discectomy and Fusion: A Comparative Study. 钛涂层聚醚醚酮保持架与全钛保持架用于独立的单层或双层颈椎前路椎间盘切除和融合术:比较研究。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8610
Franziska C S Altorfer, Christoph J Laux, Dimitri Graf, Tobias Götschi, Frederik Abel, Mazda Farshad, José M Spirig

Background: Anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disease often includes an intervertebral cage, which restores disc height and lordosis while promoting fusion . Cage materials include titanium (TTN) or polyetheretherketone (PEEK). Controversy in material selection stems from higher fusion rates with TNN, despite a higher subsidence rate, while PEEK cages demonstrate superior preservation of interspace height. Combining the advantages of both materials, TTN-coated PEEK (TCPEEK) cages were developed, featuring a PEEK core with similar stiffness to the bone, enveloped with a TTN coat, improving osteointegration. However, the potential superiority of TCPEEK over TTN cages has not been investigated. This study aimed to compare clinical and radiographic outcomes following single- or double-level ACDF using either TTN or TCPEEK cages.

Methods: This retrospective single-center study included patients undergoing single- or double-level ACDF between 2017 and 2019. Clinical outcomes included the Neck Disability Index and revision surgery incidence. Radiographic parameters included cervical and segmental lordosis, C2 to C7 sagittal vertical axis, fusion, subsidence, and adjacent segment degeneration at a minimum 12-month follow-up.

Results: A total of 45 patients (16 TTN; 29 TCPEEK) and 58 cervical levels (21 TTN; 37 TCPEEK) were included. Both cages significantly improved Neck Disability Index scores (TTN -10.0; TCPEEK -14.1) without significant differences. Two single-level TCPEEK patients required revision surgery due to non-union. In the radiological assessments, no significant difference was found for subsidence rates (TTN 52.4%; TCPEEK 56.8%), adjacent segment degeneration, cervical and segmental lordosis, and changes in C2 to C7 sagittal vertical axis. Though not statistically significant, fusion rates trended slightly higher with TTN (90.5%) vs TCPEEK cages (86.5%).

Conclusion: TTN and TCPEEK cages achieve satisfactory clinical and radiological outcomes in single- or double-level ACDF. This finding suggests that the choice between them can be based on other factors, such as surgeon preference or availability, rather than specific material properties.

Clinical relevance: This study found that the selection of ACDF cage material did not affect clinical outcomes.

Level of evidence: 3:

背景:用于手术治疗颈椎退行性疾病的前路颈椎椎间盘切除和融合术(ACDF)通常包括椎间孔镜,在促进融合的同时恢复椎间盘的高度和前凸。椎间笼材料包括钛(TTN)或聚醚醚酮(PEEK)。在材料选择上存在争议的原因是,尽管钛椎间盘笼的下沉率较高,但其融合率却更高,而聚醚醚酮椎间盘笼则能更好地保持椎间隙高度。结合两种材料的优点,TTN 涂层 PEEK(TCPEEK)保持架应运而生,其特点是 PEEK 核心具有与骨相似的硬度,外层包裹着 TTN,从而提高了骨整合性。然而,TCPEEK 与 TTN 骨架相比的潜在优越性尚未得到研究。本研究旨在比较使用 TTN 或 TCPEEK 骨架的单层或双层 ACDF 的临床和影像学结果:这项回顾性单中心研究纳入了2017年至2019年期间接受单层或双层ACDF的患者。临床结果包括颈部残疾指数和翻修手术发生率。影像学参数包括颈椎和节段前凸、C2至C7矢状纵轴、融合、下沉以及至少12个月随访时的邻近节段退变:共纳入 45 名患者(16 名 TTN;29 名 TCPEEK)和 58 个颈椎水平(21 名 TTN;37 名 TCPEEK)。两种颈椎固定架都能明显改善颈部残疾指数评分(TTN -10.0;TCPEEK -14.1),但无明显差异。两名单层 TCPEEK 患者因未愈合而需要进行翻修手术。在放射学评估中,在下沉率(TTN 52.4%;TCPEEK 56.8%)、邻近节段退变、颈椎和节段前凸、C2 至 C7 矢状垂直轴的变化方面没有发现明显差异。尽管没有统计学意义,但TTN(90.5%)与TCPEEK保持架(86.5%)的融合率略有上升趋势:结论:在单层或双层 ACDF 中,TTN 和 TCPEEK 保持架都能达到令人满意的临床和放射学效果。结论:TTN 和 TCPEEK 骨架在单层或双层 ACDF 中均可获得令人满意的临床和放射效果,这一结果表明,在这两种骨架之间做出选择时,可以考虑其他因素,如外科医生的偏好或可用性,而不是特定的材料特性:临床相关性:本研究发现,ACDF笼材料的选择并不影响临床结果:3:
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引用次数: 0
Surgical Management of Thoracolumbar Adjacent Segment Disease: Techniques and Outcomes in 107 Patients Undergoing Surgical Intervention. 胸腰椎相邻节段疾病的外科治疗:107例接受手术干预患者的技术和疗效。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8599
Malek Bashti, Manav Daftari, Gregory D Brusko, Aria M Jamshidi, Eric B Singh, James V Boddu, Vignessh Kumar, Michael M H Yang, Michael Y Wang

Background: Adjacent segment disease (ASD) is a known sequela of thoracolumbar instrumented fusions. Various surgical options are available to address ASD in patients with intractable symptoms who have failed conservative measures. However, the optimal treatment strategy for symptomatic ASD has not been established. We examined several clinical outcomes utilizing different surgical interventions for symptomatic ASD.

Methods: A retrospective review was performed for a consecutive series of patients undergoing revision surgery for thoracolumbar ASD between October 2011 and February 2022. Patients were treated with endoscopic decompression (N = 17), microdiscectomy (N = 9), lateral lumbar interbody fusion (LLIF; N = 26), or open laminectomy and fusion (LF; N = 55). The primary outcomes compared between groups were re-operation rates and numeric pain scores for leg and back at 2 weeks, 10 weeks, 6 months, and 12 months postoperation. Secondary outcomes included time to re-operation, estimated blood loss, and length of stay.

Results: Of the 257 patients who underwent revision surgery for symptomatic ASD, 107 patients met inclusion criteria with a minimum of 1-year follow-up. The mean age of all patients was 67.90 ± 10.51 years. There was no statistically significant difference between groups in age, gender, preoperative American Society of Anesthesiologists scoring, number of previously fused levels, or preoperative numeric leg and back pain scores. The re-operation rates were significantly lower in LF (12.7%) and LLIF cohorts (19.2%) compared with microdiscectomy (33%) and endoscopic decompression (52.9%; P = 0.005). Only LF and LLIF cohorts experienced significantly decreased pain scores at all 4 follow-up visits (2 weeks, 10 weeks, 6 months, and 12 months; P < 0.001 and P < 0.05, respectively) relative to preoperative scores.

Conclusion: Symptomatic ASD often requires treatment with revision surgery. Fusion surgeries (either stand-alone lateral interbody or posterolateral with instrumentation) were most effective and durable with respect to alleviating pain and avoiding additional revisions within the first 12 months following revision surgery.

Clinical relevance: This study emphasizes the importance of risk-stratifying patients to identify the least invasive approach that treats their symptoms and reduces the risk of future surgeries.

Level of evidence: 3:

背景:邻近节段疾病(ASD)是已知的胸腰椎器械融合术后遗症。对于有顽固症状且保守治疗无效的患者,有多种手术方案可用于治疗邻近节段疾病。然而,针对有症状的 ASD 的最佳治疗策略尚未确定。我们研究了利用不同手术干预治疗症状性 ASD 的几种临床结果:我们对2011年10月至2022年2月期间接受胸腰椎ASD翻修手术的一系列患者进行了回顾性研究。患者接受了内窥镜减压术(17 例)、显微椎间盘切除术(9 例)、侧腰椎椎间融合术(26 例)或开放式椎板切除融合术(55 例)。各组间比较的主要结果是再次手术率以及术后2周、10周、6个月和12个月时腿部和背部的数字疼痛评分。次要结果包括再次手术时间、估计失血量和住院时间:在因症状性 ASD 而接受翻修手术的 257 名患者中,有 107 名患者符合纳入标准,随访时间至少为 1 年。所有患者的平均年龄为(67.90 ± 10.51)岁。各组患者在年龄、性别、术前美国麻醉医师协会评分、既往融合水平数量或术前腿痛和背痛数字评分方面均无统计学差异。与显微椎间盘切除术(33%)和内窥镜减压术(52.9%;P = 0.005)相比,LF 组(12.7%)和 LLIF 组(19.2%)的再次手术率明显较低。只有LF和LLIF组在所有4次随访(2周、10周、6个月和12个月;P < 0.001和P < 0.05,分别为P < 0.001和P < 0.05)中的疼痛评分均较术前评分明显下降:结论:有症状的ASD通常需要通过翻修手术进行治疗。融合手术(独立外侧椎间融合或后外侧加器械融合)在缓解疼痛和避免翻修手术后12个月内再次翻修方面最为有效和持久:这项研究强调了对患者进行风险分级的重要性,以确定能治疗其症状并降低未来手术风险的微创方法:3:
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引用次数: 0
Biomechanical Motion Changes in Adjacent and Noncontiguous Segments Following Single-Level Anterior Cervical Discectomy and Fusion: A Computed Tomography-Based 3D Motion Capture Study. 单层前路颈椎椎间盘切除和融合术后相邻和非相邻节段的生物力学运动变化:基于计算机断层扫描的 3D 运动捕捉研究。
IF 1.7 Q2 SURGERY Pub Date : 2024-07-04 DOI: 10.14444/8605
Darren R Lebl, Kathleen N Meyers, Franziska C S Altorfer, Hamidreza Jahandar, Theresa J C Pazionis, Joseph Nguyen, Patrick F O'Leary, Timothy M Wright

Background: Anterior cervical discectomy and fusion (ACDF) is known to elicit adverse biomechanical effects on immediately adjacent segments; however, its impact on the kinematics of the remaining nonadjacent cervical levels has not been understood. This study aimed to explore the biomechanical impact of ACDF on kinematics beyond the immediate fusion site. We hypothesized that compensatory motion following single-level ACDF is not predictably distributed to adjacent segments due to compensation from noncontiguous levels.

Methods: Six fresh-frozen cervical spines (C2-T1) underwent fluoroscopic screening and sagittal and coronal reformats from computed tomography scans and were utilized to grade segmental degeneration. Each specimen was tested to 30° of flexion and extension intact and following single-level ACDF at the C5-C6 level. The motions of each vertebral body were tracked using 3-dimensional (3D) motion capture into an inverse kinematics model, facilitating correlations between the 3D reconstruction from computed tomography images and the 3D motion capture data. This model was used to calculate each level's flexion/extension range of motion (ROM).

Results: Single-level fusion at the C5-C6 level across all specimens resulted in a significant motion reduction of -6.8° (P = 0.002). No significant change in ROM occurred in the immediate adjacent segments C4-C5 (P = 0.07) or C6-C7 (P = 0.15). Hypermobility was observed in 2 specimens (33%) exclusively in adjacent segments. In contrast, the other 4 spines (66%) displayed hypermobility at noncontiguous segments. Hypermobility occurred in 42% (5/12) of the adjacent segments, 28% (5/18) of the noncontiguous segments, and 50% (3/6) of the cervicothoracic segments.

Conclusion: Single-level ACDF impacts ROM beyond adjacent segments, extending to noncontiguous levels. Compensatory motion, not limited to adjacent levels, may be influenced by degenerative changes in noncontiguous segments. Surprisingly, hypermobility may not occur in adjacent segments after ACDF.

Clinical relevance: Overall, the multifaceted biomechanical effects of ACDF underscore the need for a comprehensive understanding of cervical spine dynamics beyond immediate adjacency, and it needs to be taken into consideration when planning single-level ACDF.

Level of evidence: 4:

背景:众所周知,颈椎前路椎间盘切除和融合术(ACDF)会对紧邻节段产生不利的生物力学影响;然而,其对其余非相邻颈椎水平运动学的影响还不清楚。本研究旨在探讨 ACDF 对紧邻融合部位以外的运动学的生物力学影响。我们假设,由于非相邻水平的代偿,单水平 ACDF 后的代偿运动在相邻节段的分布无法预测:方法:我们对 6 个新鲜冷冻的颈椎(C2-T1)进行了透视检查和计算机断层扫描的矢状面和冠状面重整,并对节段退变进行了分级。在 C5-C6 水平的单水平 ACDF 之后,对每个样本进行了 30° 的屈伸测试。每个椎体的运动都通过三维(3D)运动捕捉跟踪到一个逆运动学模型中,从而促进了计算机断层扫描图像的三维重建与三维运动捕捉数据之间的关联。该模型用于计算每个水平的屈伸运动范围(ROM):结果:在所有标本中,C5-C6 水平的单水平融合导致运动幅度显著减小 -6.8°(P = 0.002)。紧邻的 C4-C5 节段(P = 0.07)或 C6-C7 节段(P = 0.15)的活动度无明显变化。有两个标本(33%)仅在邻近节段观察到活动度过高。与此相反,其他 4 个脊柱(66%)在非相邻节段表现出过度活动。42%的相邻节段(5/12)、28%的非相邻节段(5/18)和50%的颈胸节段(3/6)出现活动度过高:结论:单水平 ACDF 对 ROM 的影响超出了邻近节段,延伸至非连续水平。不局限于相邻节段的补偿性运动可能会受到非相邻节段退行性病变的影响。令人惊讶的是,ACDF术后邻近节段可能不会出现过度活动:总体而言,ACDF的多方面生物力学效应强调了全面了解颈椎动态的必要性,而不仅仅局限于邻近节段,在计划单水平ACDF时需要考虑到这一点:4:
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引用次数: 0
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International Journal of Spine Surgery
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