Seminars in Spine Surgery最新文献

Accurate assessment markers are crucial in the management of lumbar spondylolisthesis, particularly after surgical intervention. Traditional methods to track surgical outcomes primarily rely on patient-reported outcome measures (PROMs), which capture patients’ perspectives on their health and recovery. However, PROMs are subjective and susceptible to bias, affecting their reliability. To overcome these limitations, wearable devices have emerged as valuable tools for tracking real-life mobility and objectively assessing surgical outcomes. These devices provide continuous, remote collection of various health metrics and have been shown to have high efficacy and patient compliance. This chapter reviews the current landscape of combining wearable technology data and PROMs in assessing lumbar surgery outcomes, with a focus on spondylolisthesis patients. Both objective physical activity data and subjective clinical scores demonstrate similar trends in postoperative recovery. However, attempts to correlate these metrics have produced mixed results due to the variation in devices and PROMs used. Establishing standardized protocols for wearable usage and data reporting is crucial for maximizing their utility in monitoring spine patients effectively. Overall, integrating wearable technology with PROMs holds significant potential to enhance postoperative monitoring, improve personalized care, and optimize patient recovery. Future applications may involve predicting outcomes and tailoring interventions based on objective activity data in the early postoperative stage, ultimately leading to better patient outcomes and improved healthcare delivery.

Degenerative lumbar spondylolisthesis is a common condition that predisposes patients to low back pain, radicular pain and on occasion neurologic deficits in the lower extremities. Early identification of instability can help play a role in the treatment of this condition. Non-operative management including physical therapy and interventional treatments can help reduce pain and disability in these patients.

One of the most treated spinal pathologies in the United States is degenerative lumbar spondylolisthesis. While many patients can be treated nonoperatively, some patients ultimately require operative intervention for relief of their symptoms. The optimal operative treatment for degenerative spondylolisthesis is controversial. As the debate regarding laminectomy or laminectomy and fusion remains undecided from a clinical standpoint, the cost of the adding an instrumented fusion to laminectomy may influence which procedure is favored over the long term for this disease process. In this chapter, we discuss randomized controlled trials which evaluate costs associated with laminectomy and fusion and more contemporary analyses which assess the cost of modern fusion technologies. While spinal fusion is often used to treat degenerative spondylolisthesis in the US, the cost-effectiveness of recent fusion technologies suggests that the addition of fusion may only be cost-effective in a specific subset of patients.

Degenerative lumbar spondylolisthesis is one of the most common spinal conditions that is treated in the United States. It is generally treated with non-operative therapy first and many patients ultimately require surgical intervention, which improves quality of life substantially. Across the world, there is significant practice variation regarding whether or not to perform a fusion when patients undergo a decompression of spinal nerves at the level of spondylolisthesis. This chapter explores how randomized clinical trials have helped to inform surgeons and patients about the optimal utilization of fusion surgery. Fusion is the dominant form of surgical treatment in the US and is associated with excellent outcomes. Recent data suggests that fusion might not always be necessary in all cases. The chapter also highlights the importance of modern classification strategies that might help us treat patients with spondylolisthesis more effectively in the future.

Controversy regarding optimal surgical management of degenerative lumbar spondylolisthesis continues despite multiple randomized controlled trials. To this effect a number of registries have been developed, some neurosurgery and spine specific, in an effort to examine patient- and procedure- related factors and their impact on post-operative outcomes. Registries are powerful tools in understanding trends in surgery as well as the safety profile and efficacy of procedures for lumbar spondylolisthesis. This chapter reviews three major registries, NIS, NSQIP, and QOD, and their merits.

Adult spinal deformity causes pain, disability, and alterations in the quality of life of patients. Sagittal alignment and spinopelvic parameters have been established to provide surgeons with correction goals based upon normative population values. Recently, much research has been done to optimize patient outcomes regarding these parameters and at the same time reduce complications such as proximal junction kyphosis. Recently, there has been growing interest in tailoring these alignment goals based on patient age, with an overall intention of achieving a less substantial correction in older patients compared to traditional alignment goals used for younger populations. This review paper will provide a framework of understanding how advanced age impacts the sagittal alignment of the spine, the evidence supporting age-adjusted alignment goals, and also shortcomings and areas for future investigation.

Proximal junctional kyphosis and failure are important complications in reconstructive spine surgery. The impact of proximal junctional pathology on health status is variable, and junctional failure may involve compromise of neural and physical function, and may require revision surgery. The risk factors for proximal junctional kyphosis include multilevel fusion to the sacrum, malalignment of the spine, choice of upper instrumented vertebra, magnitude of realignment, bone and muscle quality, tension band integrity and characteristics of the unfused spine. The pathophysiology of proximal junctional pathology involve fracture and bony failure, ligamentous and soft tissue failure, and combined bone and soft tissue failure. Prevention of proximal junctional pathology is an important goal, and has a significant impact on improving the outcomes and durability of spinal reconstructive surgery. Prevention strategies are derived from an understanding of the underlying causes of junctional pathology. Preoperative planning to determine optimal post-operative alignment, and intraoperative strategies to achieve that alignment are important for prevention of junctional pathology. Preoperative preparation of the patient with optimization of bone quality, extensor muscle strength and body mass index may prevent junctional complications. Surgical strategies including anterior column load sharing and posterior augmentation of fixation are useful for prevention of junctional pathology. Cement augmentation at the upper instrumented vertebra, with possible inclusion of the next cephalad vertebra may be protective of bone failure. Ligamentoplasty and preservation of the tension band may be protective of soft tissue failure. Proximal junctional pathology remains an important complication in spinal reconstructive surgery. Understanding the factors associated with proximal junctional pathology including the mechanisms underlying junctional kyphosis, and awareness of the strategies for avoidance of junctional pathology will empower the surgeon to reduce the risk of post-operative junctional kyphosis and lead to improved outcomes in adult spinal deformity surgery.

This review focuses on the surgical techniques that are used to effectively correct thoracolumbar adult spinal deformity. Preoperative considerations and planning for selecting the appropriate correction technique, level selection, patient positioning, open correction techniques, and minimally invasive correction maneuvers are discussed.