Evaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging.
OBJECTIVE
This study aimed to investigate the importance of evaluating gaps using 3-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord.
STUDY DESIGN/SETTING
Retrospective cohort study.
PATIENT SAMPLE
Retrospective analysis of 116 patients diagnosed with cervical OPLL.
OUTCOME MEASURES
Presence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated.
METHODS
Lateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined.
RESULTS
A significant difference in gap detection accuracy was observed between CT and 3D-CT (p=.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p=.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps cooccurring with T2 high intensity exhibited significantly thinner lesions (p=.011) and larger SACs (p=.0002). Patients with gaps had a significantly lower JOA scores (p=.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms.
CONCLUSIONS
3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.
{"title":"Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography","authors":"Hazem Alaa , Nguyen Tran Canh Tung MD, PhD , Tomoya Ueno , Hiroto Makino MD, PhD , Hayato Futakawa MD , Shoji Seki MD, PhD , Yoshiharu Kawaguchi MD, PhD","doi":"10.1016/j.spinee.2024.08.030","DOIUrl":"10.1016/j.spinee.2024.08.030","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Evaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to investigate the importance of evaluating gaps using 3-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Retrospective analysis of 116 patients diagnosed with cervical OPLL.</div></div><div><h3>OUTCOME MEASURES</h3><div>Presence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated.</div></div><div><h3>METHODS</h3><div>Lateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined.</div></div><div><h3>RESULTS</h3><div>A significant difference in gap detection accuracy was observed between CT and 3D-CT (p=.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p=.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps cooccurring with T2 high intensity exhibited significantly thinner lesions (p=.011) and larger SACs (p=.0002). Patients with gaps had a significantly lower JOA scores (p=.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms.</div></div><div><h3>CONCLUSIONS</h3><div>3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 69-79"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.spinee.2024.09.010
Andreas Seas BSE , Tanner J. Zachem BSE , Bruno Valan ME , Christine Goertz PhD , Shiva Nischal MB, BChir, BA (Cantab), BSc (Hons) , Sully F. Chen BS , David Sykes MD , Troy Q. Tabarestani BS , Benjamin D. Wissel MD , Elizabeth R. Blackwood MS, BA , Christopher Holland MD, PhD , Oren Gottfried MD , Christopher I. Shaffrey MD , Muhammad M. Abd-El-Barr MD, PhD
BACKGROUND CONTEXT
Low back pain (LBP) remains the leading cause of disability globally. In recent years, machine learning (ML) has emerged as a potentially useful tool to aid the diagnosis, management, and prognostication of LBP.
PURPOSE
In this review, we assess the scope of ML applications in the LBP literature and outline gaps and opportunities.
STUDY DESIGN/SETTING
A scoping review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.
METHODS
Articles were extracted from the Web of Science, Scopus, PubMed, and IEEE Xplore databases. Title/abstract and full-text screening was performed by two reviewers. Data on model type, model inputs, predicted outcomes, and ML methods were collected.
RESULTS
In total, 223 unique studies published between 1988 and 2023 were identified, with just over 50% focused on low-back-pain detection. Neural networks were used in 106 of these articles. Common inputs included patient history, demographics, and lab values (67% total). Articles published after 2010 were also likely to incorporate imaging data into their models (41.7% of articles). Of the 212 supervised learning articles identified, 168 (79.4%) mentioned use of a training or testing dataset, 116 (54.7%) utilized cross-validation, and 46 (21.7%) implemented hyperparameter optimization. Of all articles, only 8 included external validation and 9 had publicly available code.
CONCLUSIONS
Despite the rapid application of ML in LBP research, a majority of articles do not follow standard ML best practices. Furthermore, over 95% of articles cannot be reproduced or authenticated due to lack of code availability. Increased collaboration and code sharing are needed to support future growth and implementation of ML in the care of patients with LBP.
背景情况：腰背痛（LBP）仍然是全球致残的主要原因。近年来，机器学习（ML）已成为辅助腰背痛诊断、管理和预后的潜在有用工具。目的：在本综述中，我们评估了ML在腰背痛文献中的应用范围，并概述了差距和机遇：研究设计/背景：根据《系统综述和荟萃分析的首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews，PRISMA-ScR）指南进行了范围界定综述：从 Web of Science、Scopus、PubMed 和 IEEE Xplore 数据库中提取文章。由两名审稿人对文章标题/摘要和全文进行筛选。收集了有关模型类型、模型输入、预测结果和 ML 方法的数据：结果：总共发现了 223 项发表于 1988-2023 年间的独特研究，其中略高于 50%的研究侧重于低背痛检测。其中 106 篇文章使用了神经网络。常见的输入包括患者病史、人口统计学和化验值（共占 67%）。2010 年之后发表的文章也有可能将成像数据纳入其模型中（41.7% 的文章）。在确定的 212 篇监督学习文章中，168 篇（79.4%）提到使用了训练或测试数据集，116 篇（54.7%）使用了交叉验证，46 篇（21.7%）实施了超参数优化。在所有文章中，只有 8 篇文章包含外部验证，9 篇文章有公开代码：尽管人工智能在枸杞多糖研究中应用迅速，但大多数文章并没有遵循标准的人工智能最佳实践。此外，由于缺乏可用代码，超过 95% 的文章无法复制或验证。需要加强合作和代码共享，以支持ML在枸杞多糖症患者护理中的未来发展和实施。
{"title":"Machine learning in the diagnosis, management, and care of patients with low back pain: a scoping review of the literature and future directions","authors":"Andreas Seas BSE , Tanner J. Zachem BSE , Bruno Valan ME , Christine Goertz PhD , Shiva Nischal MB, BChir, BA (Cantab), BSc (Hons) , Sully F. Chen BS , David Sykes MD , Troy Q. Tabarestani BS , Benjamin D. Wissel MD , Elizabeth R. Blackwood MS, BA , Christopher Holland MD, PhD , Oren Gottfried MD , Christopher I. Shaffrey MD , Muhammad M. Abd-El-Barr MD, PhD","doi":"10.1016/j.spinee.2024.09.010","DOIUrl":"10.1016/j.spinee.2024.09.010","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) remains the leading cause of disability globally. In recent years, machine learning (ML) has emerged as a potentially useful tool to aid the diagnosis, management, and prognostication of LBP.</div></div><div><h3>PURPOSE</h3><div>In this review, we assess the scope of ML applications in the LBP literature and outline gaps and opportunities.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A scoping review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.</div></div><div><h3>METHODS</h3><div>Articles were extracted from the Web of Science, Scopus, PubMed, and IEEE Xplore databases. Title/abstract and full-text screening was performed by two reviewers. Data on model type, model inputs, predicted outcomes, and ML methods were collected.</div></div><div><h3>RESULTS</h3><div>In total, 223 unique studies published between 1988 and 2023 were identified, with just over 50% focused on low-back-pain detection. Neural networks were used in 106 of these articles. Common inputs included patient history, demographics, and lab values (67% total). Articles published after 2010 were also likely to incorporate imaging data into their models (41.7% of articles). Of the 212 supervised learning articles identified, 168 (79.4%) mentioned use of a training or testing dataset, 116 (54.7%) utilized cross-validation, and 46 (21.7%) implemented hyperparameter optimization. Of all articles, only 8 included external validation and 9 had publicly available code.</div></div><div><h3>CONCLUSIONS</h3><div>Despite the rapid application of ML in LBP research, a majority of articles do not follow standard ML best practices. Furthermore, over 95% of articles cannot be reproduced or authenticated due to lack of code availability. Increased collaboration and code sharing are needed to support future growth and implementation of ML in the care of patients with LBP.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 18-31"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.spinee.2024.09.017
Jinyun Zhao MD , Lifu Zheng MD , Guoyu Dai MD , Yi Sun MD , Rundong He MD , Zhide Liu MD , Yuxin Jin MD , Tianding Wu MD , Jianzhong Hu MD , Yong Cao MD , Chunyue Duan MD
<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) is a pervasive issue, causing substantial economic burden and physical distress worldwide. Facet joint osteoarthritis (FJ OA) is believed to be a significant contributor to this problem. However, the precise role of chondrocyte senescence in FJ OA remains unclear, as does whether the clearance of chondrocyte senescence can alleviate the progression of FJ OA.</div></div><div><h3>PURPOSE</h3><div>The goal of this study was to understand the potential of Dasatinib (D) and Quercetin (Q) as a treatment to clear chondrocyte senescence during the progression of FJ OA.</div></div><div><h3>STUDY DESIGN</h3><div>We used a preclinical bipedal standing mice model with the administration of Dasatinib (D) (5 mg/kg) and Quercetin (Q) (50 mg/kg) after 10 weeks of bipedal standing.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Human degenerative lumbar facet joint (LFJ) samples were obtained to investigate the relationship between chondrocyte cellular senescence and LFJ osteoarthritis (OA). Subsequently, we established an in vitro model of excessive mechanical stress on chondrocytes and an in vivo bipedal standing mice model to induce LFJ OA. IHC (immunohistochemistry) staining in vivo and SA-β-gal staining, qRT-PCR and Western blot analysis were applied to test the senolytic effect of the combination of Dasatinib (D) and Quercetin (Q). IHC staining and X-ray microscope were also performed to examine the contribution of D+Q to the anabolism in cartilage and subchondral bone recoupling. Immunofluorescence and Western blot analysis in vitro and IHC staining in vivo were conducted to assess the impact of D+Q on the regulation of the NF-κB pathway activation during chondrocyte senescence.</div></div><div><h3>RESULTS</h3><div>We observed that facet joint cartilage degeneration is associated with chondrocyte cellular senescence in both human and mouse degenerative samples. Following treatment with D+Q in vitro, cellular senescence was significantly reduced. Upon oral gavage administration of D+Q in the bipedal standing mice model, decreased cellular senescence and reversed chondrocyte anabolism were observed. Furthermore, administration of D+Q maintained subchondral bone remodeling homeostasis and potentially reversed the activation of the NF-κB pathway in chondrocytes of the lumbar facet joint.</div></div><div><h3>CONCLUSIONS</h3><div>In summary, our investigation unveiled a significant correlation between chondrocyte senescence and LFJOA. Treatment with the senolytic combination of D+Q in FJ OA yielded a notable reduction in chondrocyte senescence, along with a decrease in the release of SASP factors. Additionally, it facilitated the promotion of cartilage anabolism, maintenance of subchondral bone coupling, and amelioration of NF-κB pathway activation.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>Our outcomes revealed that D+Q, the renowned combination used for senolytic treatment, alleviate the pro
{"title":"Senolytics cocktail dasatinib and quercetin alleviate chondrocyte senescence and facet joint osteoarthritis in mice","authors":"Jinyun Zhao MD , Lifu Zheng MD , Guoyu Dai MD , Yi Sun MD , Rundong He MD , Zhide Liu MD , Yuxin Jin MD , Tianding Wu MD , Jianzhong Hu MD , Yong Cao MD , Chunyue Duan MD","doi":"10.1016/j.spinee.2024.09.017","DOIUrl":"10.1016/j.spinee.2024.09.017","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) is a pervasive issue, causing substantial economic burden and physical distress worldwide. Facet joint osteoarthritis (FJ OA) is believed to be a significant contributor to this problem. However, the precise role of chondrocyte senescence in FJ OA remains unclear, as does whether the clearance of chondrocyte senescence can alleviate the progression of FJ OA.</div></div><div><h3>PURPOSE</h3><div>The goal of this study was to understand the potential of Dasatinib (D) and Quercetin (Q) as a treatment to clear chondrocyte senescence during the progression of FJ OA.</div></div><div><h3>STUDY DESIGN</h3><div>We used a preclinical bipedal standing mice model with the administration of Dasatinib (D) (5 mg/kg) and Quercetin (Q) (50 mg/kg) after 10 weeks of bipedal standing.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Human degenerative lumbar facet joint (LFJ) samples were obtained to investigate the relationship between chondrocyte cellular senescence and LFJ osteoarthritis (OA). Subsequently, we established an in vitro model of excessive mechanical stress on chondrocytes and an in vivo bipedal standing mice model to induce LFJ OA. IHC (immunohistochemistry) staining in vivo and SA-β-gal staining, qRT-PCR and Western blot analysis were applied to test the senolytic effect of the combination of Dasatinib (D) and Quercetin (Q). IHC staining and X-ray microscope were also performed to examine the contribution of D+Q to the anabolism in cartilage and subchondral bone recoupling. Immunofluorescence and Western blot analysis in vitro and IHC staining in vivo were conducted to assess the impact of D+Q on the regulation of the NF-κB pathway activation during chondrocyte senescence.</div></div><div><h3>RESULTS</h3><div>We observed that facet joint cartilage degeneration is associated with chondrocyte cellular senescence in both human and mouse degenerative samples. Following treatment with D+Q in vitro, cellular senescence was significantly reduced. Upon oral gavage administration of D+Q in the bipedal standing mice model, decreased cellular senescence and reversed chondrocyte anabolism were observed. Furthermore, administration of D+Q maintained subchondral bone remodeling homeostasis and potentially reversed the activation of the NF-κB pathway in chondrocytes of the lumbar facet joint.</div></div><div><h3>CONCLUSIONS</h3><div>In summary, our investigation unveiled a significant correlation between chondrocyte senescence and LFJOA. Treatment with the senolytic combination of D+Q in FJ OA yielded a notable reduction in chondrocyte senescence, along with a decrease in the release of SASP factors. Additionally, it facilitated the promotion of cartilage anabolism, maintenance of subchondral bone coupling, and amelioration of NF-κB pathway activation.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>Our outcomes revealed that D+Q, the renowned combination used for senolytic treatment, alleviate the pro","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 184-198"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.spinee.2024.12.024
Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee
Background context: Baseline severities of sagittal malalignment and degrees of pelvic compensation may affect postsurgical outcomes differently after adult spinal deformity (ASD) surgery, even if the patients achieved optimal correction of sagittal malalignment.
Purpose: To investigate whether postsurgical outcomes vary according to baseline sagittal alignment and pelvic compensation status in patients achieving adequate correction relative to age-adjusted alignment target in ASD surgery.
Study design/setting: Retrospective study PATIENT SAMPLE: Patients who underwent ≥ 5-level fusion to the pelvis for ASD; achieved matched correction relative to age-adjusted pelvic incidence (PI)-lumbar lordosis (LL); and completed ≥ 2-year follow-up.
Outcome measures: Radiographic results, mechanical failures, and clinical outcomes METHODS: Patients were divided into three groups based on baseline sagittal vertical axis (SVA) and pelvic tilt (PT)/PI ratio (median value of PT/PI ratio = 0.61): Group A (SVA < 5 cm), Group B (SVA ≥ 5 cm and PT/PI ratio <0.61, and Group C (SVA ≥ 5 cm and PT/PI ratio ≥ 0.61). Radiographic results, mechanical failures, and clinical outcomes were compared among the three groups.
Results: A total of 153 patients were included in the study. They were predominantly female (89.5%), with a mean age of 68.3 years. The mean follow-up duration was 49.0 months. There were 50 patients in group A (SVA < 5cm), 53 in group B (SVA ≥ 5cm and low PT/PI), and 50 in group C (SVA ≥ 5cm and high PT/PI). No significant differences were observed in all radiographic parameters at six weeks. At the last follow-up, the PI-LL was comparable among the three groups; however, the SVA was significantly greater in groups B and C than in group A (46.5mm and 46.9mm vs. 31.5mm, p=.039). The PT at the last follow-up was significantly lower in group B than in group A and C (22.4° vs. 26.0° and 28.2°, respectively, p=.001). The rates of mechanical failure and subsequent revision surgery and did not differ among the groups. The final clinical outcomes were comparable among the three groups.
Conclusions: This study revealed that patients in groups B and C were likely to have a suboptimal sagittal alignment status at the last follow-up compared with those in group A. Tailored approaches considering patient's baseline alignment and compensatory status are recommended to optimize the final sagittal alignment status.
{"title":"Postsurgical outcomes differ according to baseline sagittal alignment status even in patients achieving adequate correction relative to age-adjusted alignment target for adult spinal deformity.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1016/j.spinee.2024.12.024","DOIUrl":"10.1016/j.spinee.2024.12.024","url":null,"abstract":"<p><strong>Background context: </strong>Baseline severities of sagittal malalignment and degrees of pelvic compensation may affect postsurgical outcomes differently after adult spinal deformity (ASD) surgery, even if the patients achieved optimal correction of sagittal malalignment.</p><p><strong>Purpose: </strong>To investigate whether postsurgical outcomes vary according to baseline sagittal alignment and pelvic compensation status in patients achieving adequate correction relative to age-adjusted alignment target in ASD surgery.</p><p><strong>Study design/setting: </strong>Retrospective study PATIENT SAMPLE: Patients who underwent ≥ 5-level fusion to the pelvis for ASD; achieved matched correction relative to age-adjusted pelvic incidence (PI)-lumbar lordosis (LL); and completed ≥ 2-year follow-up.</p><p><strong>Outcome measures: </strong>Radiographic results, mechanical failures, and clinical outcomes METHODS: Patients were divided into three groups based on baseline sagittal vertical axis (SVA) and pelvic tilt (PT)/PI ratio (median value of PT/PI ratio = 0.61): Group A (SVA < 5 cm), Group B (SVA ≥ 5 cm and PT/PI ratio <0.61, and Group C (SVA ≥ 5 cm and PT/PI ratio ≥ 0.61). Radiographic results, mechanical failures, and clinical outcomes were compared among the three groups.</p><p><strong>Results: </strong>A total of 153 patients were included in the study. They were predominantly female (89.5%), with a mean age of 68.3 years. The mean follow-up duration was 49.0 months. There were 50 patients in group A (SVA < 5cm), 53 in group B (SVA ≥ 5cm and low PT/PI), and 50 in group C (SVA ≥ 5cm and high PT/PI). No significant differences were observed in all radiographic parameters at six weeks. At the last follow-up, the PI-LL was comparable among the three groups; however, the SVA was significantly greater in groups B and C than in group A (46.5mm and 46.9mm vs. 31.5mm, p=.039). The PT at the last follow-up was significantly lower in group B than in group A and C (22.4° vs. 26.0° and 28.2°, respectively, p=.001). The rates of mechanical failure and subsequent revision surgery and did not differ among the groups. The final clinical outcomes were comparable among the three groups.</p><p><strong>Conclusions: </strong>This study revealed that patients in groups B and C were likely to have a suboptimal sagittal alignment status at the last follow-up compared with those in group A. Tailored approaches considering patient's baseline alignment and compensatory status are recommended to optimize the final sagittal alignment status.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background context: The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.
Purpose: To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.
Design: Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.
Outcome measures: The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.
Methods: The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.
Results: Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071).
Conclusion: Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.
{"title":"Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery.","authors":"Yuta Sawada, Shinji Takahashi, Hiroyuki Yasuda, Masaki Terakawa, Sadahiko Konishi, Minori Kato, Hiromitsu Toyoda, Akinobu Suzuki, Koji Tamai, Masayoshi Iwamae, Yuki Okamura, Yuto Kobayashi, Hiroaki Nakamura, Hidetomi Terai","doi":"10.1016/j.spinee.2024.12.021","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.12.021","url":null,"abstract":"<p><strong>Background context: </strong>The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.</p><p><strong>Purpose: </strong>To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.</p><p><strong>Design: </strong>Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.</p><p><strong>Outcome measures: </strong>The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.</p><p><strong>Methods: </strong>The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.</p><p><strong>Results: </strong>Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071).</p><p><strong>Conclusion: </strong>Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.spinee.2024.12.023
Peter G Passias, Pooja Dave, Justin S Smith, Renaud Lafage, Oluwatobi O Onafowokan, Peter Tretiakov, Jamshaid Mir, Breton Line, Bassel Diebo, Alan H Daniels, Jeffrey L Gum, Robert Eastlack, D Kojo Hamilton, Dean Chou, Eric O Klineberg, Khaled M Kebaish, Stephen Lewis, Munish C Gupta, Han Jo Kim, Lawrence G Lenke, Christopher P Ames, Christopher I Shaffrey, Frank J Schwab, Virginie Lafage, Shay Bess, Robert Hostin, Douglas C Burton
<p><strong>Background context: </strong>While the treatment of adult spinal deformity (ASD) has increasingly favored surgical correction, the incidence of revision surgery remains high. Yet, little has been explored on the association between the etiology of reoperation and patient outcomes.</p><p><strong>Purpose: </strong>To assess the impact of the etiology of revision surgery on postoperative outcomes.</p><p><strong>Study design/setting: </strong>Retrospective cohort analysis.</p><p><strong>Patient sample: </strong>891 ASD patients.</p><p><strong>Outcome measures: </strong>Complications, radiographic parameters, disability metrics.</p><p><strong>Methods: </strong>Operative ASD patients with at least 1 revision stratified by etiology (mechanical [Mech] -pseudoarthrosis, thoracic decompensation without junctional failure, x-ray malalignment, implant failure, implant malposition, PJK ± major malalignment; infection [Infx]-early vs late onset, major vs minor; wound [Wound]; SI pain [SI Pain]). Excluded multiple etiologies, and intraoperative or medical complications. Data from the immediate visit prior to the final revision was used as baseline (rBL). Follow-up based on visits best aligned to time points after final revision. Radiographic parameters SVA, PI-LL, and PT were used to assess alignment post-revision via ANOVA. Multivariate analysis controlling for relevant covariates assessed outcome differences after final revision surgery.</p><p><strong>Results: </strong>891 MET INCLUSION (AGE: 60.40±14.17, 77% F, BMI: 27.97±5.87 KG/M2, CCI: : 1.80±1.73). Etiology groups were as follows: Mech: 432; Infx: 296; Wound: 65; SI Pain: 98. Surgically, Infx had lower rates of osteotomy, interbody fusion, and decompression (p<.05). Infx and SI Pain demonstrated similar correction in radiographics SVA, PI-LL, and PT (p>.05), whereas Mech had significantly less improvement by 2 years (p<.003) that improved by 5 years. Compared to without revision, the odds of MCID in ODI were 48.6% lower across groups (OR: 0.514 [.280, .945], p=.032). Indications of x-ray malalignment were 93.0% less likely to reach MCID (OR: 0.071, [.006, .866], p=.038). Similarly, implant failure negatively impacted rates of MCID (40% vs. 15.2%, p=.029). Those with PJK had 57% lower odds of MCID (33% vs 54%, OR: .43, [0.2, 0.9] p= 0.023), further negated by major malalignment (OR: 0.05, [.07, .97], p=.02). Indications of pseudarthrosis, thoracic decompensation, implant malposition were not significant. Major sepsis had lower rates of MCID compared to minor (6.4% vs. 21.2%), and early onset infection improved compared to late (OR: 1.43, [1.17, 2.98], p<.001). In the early follow-up period, the Mech group has significantly worse SRS Pain and Mental Health scores compared to other groups (1-year: Mech 1.56 vs Infx 0.83 vs SI Pain 0.72, p<0.001; 2-year: 1.88 vs 0.71 vs 0.76, p=0.034). Complication rates increased with the number of revisions and with mechanical indication (all p<.05). At 5 years,
{"title":"Cause and Effect of Revisions in Adult Spinal Deformity Surgery: A Multicenter Study on Outcomes Based on Etiology.","authors":"Peter G Passias, Pooja Dave, Justin S Smith, Renaud Lafage, Oluwatobi O Onafowokan, Peter Tretiakov, Jamshaid Mir, Breton Line, Bassel Diebo, Alan H Daniels, Jeffrey L Gum, Robert Eastlack, D Kojo Hamilton, Dean Chou, Eric O Klineberg, Khaled M Kebaish, Stephen Lewis, Munish C Gupta, Han Jo Kim, Lawrence G Lenke, Christopher P Ames, Christopher I Shaffrey, Frank J Schwab, Virginie Lafage, Shay Bess, Robert Hostin, Douglas C Burton","doi":"10.1016/j.spinee.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.12.023","url":null,"abstract":"<p><strong>Background context: </strong>While the treatment of adult spinal deformity (ASD) has increasingly favored surgical correction, the incidence of revision surgery remains high. Yet, little has been explored on the association between the etiology of reoperation and patient outcomes.</p><p><strong>Purpose: </strong>To assess the impact of the etiology of revision surgery on postoperative outcomes.</p><p><strong>Study design/setting: </strong>Retrospective cohort analysis.</p><p><strong>Patient sample: </strong>891 ASD patients.</p><p><strong>Outcome measures: </strong>Complications, radiographic parameters, disability metrics.</p><p><strong>Methods: </strong>Operative ASD patients with at least 1 revision stratified by etiology (mechanical [Mech] -pseudoarthrosis, thoracic decompensation without junctional failure, x-ray malalignment, implant failure, implant malposition, PJK ± major malalignment; infection [Infx]-early vs late onset, major vs minor; wound [Wound]; SI pain [SI Pain]). Excluded multiple etiologies, and intraoperative or medical complications. Data from the immediate visit prior to the final revision was used as baseline (rBL). Follow-up based on visits best aligned to time points after final revision. Radiographic parameters SVA, PI-LL, and PT were used to assess alignment post-revision via ANOVA. Multivariate analysis controlling for relevant covariates assessed outcome differences after final revision surgery.</p><p><strong>Results: </strong>891 MET INCLUSION (AGE: 60.40±14.17, 77% F, BMI: 27.97±5.87 KG/M2, CCI: : 1.80±1.73). Etiology groups were as follows: Mech: 432; Infx: 296; Wound: 65; SI Pain: 98. Surgically, Infx had lower rates of osteotomy, interbody fusion, and decompression (p<.05). Infx and SI Pain demonstrated similar correction in radiographics SVA, PI-LL, and PT (p>.05), whereas Mech had significantly less improvement by 2 years (p<.003) that improved by 5 years. Compared to without revision, the odds of MCID in ODI were 48.6% lower across groups (OR: 0.514 [.280, .945], p=.032). Indications of x-ray malalignment were 93.0% less likely to reach MCID (OR: 0.071, [.006, .866], p=.038). Similarly, implant failure negatively impacted rates of MCID (40% vs. 15.2%, p=.029). Those with PJK had 57% lower odds of MCID (33% vs 54%, OR: .43, [0.2, 0.9] p= 0.023), further negated by major malalignment (OR: 0.05, [.07, .97], p=.02). Indications of pseudarthrosis, thoracic decompensation, implant malposition were not significant. Major sepsis had lower rates of MCID compared to minor (6.4% vs. 21.2%), and early onset infection improved compared to late (OR: 1.43, [1.17, 2.98], p<.001). In the early follow-up period, the Mech group has significantly worse SRS Pain and Mental Health scores compared to other groups (1-year: Mech 1.56 vs Infx 0.83 vs SI Pain 0.72, p<0.001; 2-year: 1.88 vs 0.71 vs 0.76, p=0.034). Complication rates increased with the number of revisions and with mechanical indication (all p<.05). At 5 years,","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.spinee.2024.12.022
Jing Li, Yonggui Wu, Hao Liu, Can Guo, Junqi Zhang, Kangkang Huang, Tingkui Wu, Ying Hong, Yang Meng, Chen Ding, Beiyu Wang, Xin Rong
<p><strong>Background context: </strong>Hybrid surgery (HS), which involves both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (ACDR), is increasingly used to treat multilevel cervical disc degenerative disease, yielding satisfactory clinical outcomes. Early fusion is critical after anterior cervical fusion surgeries, but there are no studies comparing the rate of early fusion of HS with that of ACDF.</p><p><strong>Purpose: </strong>The purpose of this study was to compare the rate of early fusion (3-6 months postoperatively) of two-level HS with that of two-level ACDF surgery.</p><p><strong>Study design: </strong>The fusion statuses of consecutive patients who underwent two-level ACDF were compared with those of consecutive patients who underwent HS, which involves both ACDF and ACDR.</p><p><strong>Patient sample: </strong>The study included 860 patients who underwent two-level ACDF or HS for CDDD. After the patients who did not meet the study criteria were excluded, 376 patients were included (165 males, 211 females).</p><p><strong>Outcome measures: </strong>Radiographic measures included fusion rate of the ACDF level. Self-report measures included visual analog scale (VAS) neck, VAS arm, neck disability index (NDI), satisfaction with the surgery and other symptoms reported by patients during the follow-ups.</p><p><strong>Methods: </strong>Eight hundred sixty patients who underwent two-level ACDF or HS for cervical disc degenerative disease between January 2015 and January 2023 at our hospital were screened. After excluding the patients who did not meet the study criteria, 376 patients were included (165 males, 211 females). The patients who underwent dual-segment ACDF were categorized into the ACDF-ACDF (FF) group (n=205), while those who underwent dual-segment HS were divided into the ACDF-ACDR (FR) group (n=82) and the ACDR-ACDF (RF) group (n=89) on the basis of the relative positions of the segments selected for ACDF and ACDR. The fusion rates of the segments subjected to ACDF and the clinical outcomes, including the neck VAS score, arm VAS score, NDI score, and other complications, were compared among the three groups at 3 months, 6 months, and 1 year postoperatively. Fusion was defined as the formation of a continuous bone bridge in the target fusion area, as observed on three-dimensional computed tomography (CT) images.</p><p><strong>Results: </strong>The average age of the patients in the FF group was higher than that of the patients in the FR and RF groups (p<0.001). At 3 months postoperatively, the fusion rate was 70.7% (58/82) in the FR group, 39.5% (162/410) in the FF group, and 42.7% (78/89)in the RF group (P<0.001). At 6 months postoperatively, the fusion rate was 74.6% (306/410) in the FF group, 91.5% (75/82) in the FR group, and 87.6% (78/89) in the RF group (P<0.001). At 1 year postoperatively, the fusion rate was 91.9% (377/410) in the FF group, 98.8% (81/82) in the FR group, and 100% (89/89) in
{"title":"Does Two-level Hybrid Surgery Promote Early Fusion Compared with Two-level Anterior Cervical Discectomy and Fusion?","authors":"Jing Li, Yonggui Wu, Hao Liu, Can Guo, Junqi Zhang, Kangkang Huang, Tingkui Wu, Ying Hong, Yang Meng, Chen Ding, Beiyu Wang, Xin Rong","doi":"10.1016/j.spinee.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.12.022","url":null,"abstract":"<p><strong>Background context: </strong>Hybrid surgery (HS), which involves both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (ACDR), is increasingly used to treat multilevel cervical disc degenerative disease, yielding satisfactory clinical outcomes. Early fusion is critical after anterior cervical fusion surgeries, but there are no studies comparing the rate of early fusion of HS with that of ACDF.</p><p><strong>Purpose: </strong>The purpose of this study was to compare the rate of early fusion (3-6 months postoperatively) of two-level HS with that of two-level ACDF surgery.</p><p><strong>Study design: </strong>The fusion statuses of consecutive patients who underwent two-level ACDF were compared with those of consecutive patients who underwent HS, which involves both ACDF and ACDR.</p><p><strong>Patient sample: </strong>The study included 860 patients who underwent two-level ACDF or HS for CDDD. After the patients who did not meet the study criteria were excluded, 376 patients were included (165 males, 211 females).</p><p><strong>Outcome measures: </strong>Radiographic measures included fusion rate of the ACDF level. Self-report measures included visual analog scale (VAS) neck, VAS arm, neck disability index (NDI), satisfaction with the surgery and other symptoms reported by patients during the follow-ups.</p><p><strong>Methods: </strong>Eight hundred sixty patients who underwent two-level ACDF or HS for cervical disc degenerative disease between January 2015 and January 2023 at our hospital were screened. After excluding the patients who did not meet the study criteria, 376 patients were included (165 males, 211 females). The patients who underwent dual-segment ACDF were categorized into the ACDF-ACDF (FF) group (n=205), while those who underwent dual-segment HS were divided into the ACDF-ACDR (FR) group (n=82) and the ACDR-ACDF (RF) group (n=89) on the basis of the relative positions of the segments selected for ACDF and ACDR. The fusion rates of the segments subjected to ACDF and the clinical outcomes, including the neck VAS score, arm VAS score, NDI score, and other complications, were compared among the three groups at 3 months, 6 months, and 1 year postoperatively. Fusion was defined as the formation of a continuous bone bridge in the target fusion area, as observed on three-dimensional computed tomography (CT) images.</p><p><strong>Results: </strong>The average age of the patients in the FF group was higher than that of the patients in the FR and RF groups (p<0.001). At 3 months postoperatively, the fusion rate was 70.7% (58/82) in the FR group, 39.5% (162/410) in the FF group, and 42.7% (78/89)in the RF group (P<0.001). At 6 months postoperatively, the fusion rate was 74.6% (306/410) in the FF group, 91.5% (75/82) in the FR group, and 87.6% (78/89) in the RF group (P<0.001). At 1 year postoperatively, the fusion rate was 91.9% (377/410) in the FF group, 98.8% (81/82) in the FR group, and 100% (89/89) in ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.spinee.2024.12.025
Mudan Huang, Jiawei Di, Lei He, Na Li, Zhenming Tian, Longyou Xiao, Ruijue Zhu, Tianwei He, Mao Pang, Bin Liu, Limin Rong
Background context: Spinal cord injury (SCI) causes neural circuit interruption and permanent functional damage. Magnetic stimulation in humans with SCI aims to engage residual neural networks to improve neurological functional, but the detailed mechanism remains unknown.
Purpose: This study evaluates functional recovery and neural circuitry improvements in rodent with double-target (brain and spinal cord) magnetic stimulation (DTMS) treatment and explores the effect of DTMS on the modulation of glial cells in vivo and in vitro.
Study design: In vivo animal study.
Methods: SCI model rats at T10 level were induced via a weight-drop method and underwent long-time DTMS treatment. A series of behavioral assessments and tissue staining were used to evaluate neurological function and neural circuitry improvements. More importantly, single-cell RNA sequencing was conducted to identify the most significant glial cells after DTMS treatment. Furthermore, transmission electron microscopy, western blotting, immunofluorescence staining, TUNEL staining, Annexin V-FITC apoptosis kit and Lipid ROS kit were used to explore the mechanism underlying the observed changes. Study funding sources: National Natural Science Foundation of China (Grant number: U22A20297; Dollar amount: 62500); Key Research and Development Program of Guangzhou (Grant number: 202206060003; Dollar amount: 63750). There are no conflicts of interest or disclosures to report.
Results: DTMS promoted the improvements of motor and sensory neural circuitry by modulating remyelination and neuronal survival, while silencing growth-associated protein 43 (GAP43) in oligodendrocytes suppressed these effects of DTMS in vivo. Mechanically, GAP43 played a crucial part to promote the branching and mature of oligodendrocytes and axonal regeneration via anti-apoptotic and anti-oxidative stress effects. Furthermore, oligodendrocytes subjected to magnetic stimulation exerted neuroprotective effects on neurons by secreting exosomes containing GAP43.
Conclusions: Our study revealed the neuroprotection of DTMS on SCI. The GAP43 in oligodendrocytes were associated with this relationship between magnetic stimulation and myelin and neuronal regeneration after SCI.
Clinical significance: The current study demonstrated the beneficial effects of DTMS on SCI based on functional, electrophysiological, cellular and histological evidence. According to these findings, we expect DTMS to make a positive and significant difference for SCI therapeutic screening.
背景背景：脊髓损伤（SCI）导致神经回路中断和永久性功能损伤。对脊髓损伤患者进行磁刺激的目的是利用残余神经网络来改善神经功能，但具体机制尚不清楚。目的：本研究评估双靶（脑脊髓）磁刺激（DTMS）治疗啮齿动物的功能恢复和神经回路的改善，并探讨DTMS对体内和体外神经胶质细胞的调节作用。研究设计：体内动物研究。方法：采用减重法诱导T10水平的脊髓损伤模型大鼠，并给予长时间DTMS治疗。使用一系列行为评估和组织染色来评估神经功能和神经回路的改善。更重要的是，我们进行了单细胞RNA测序，以鉴定DTMS处理后最显著的胶质细胞。通过透射电镜、western blotting、免疫荧光染色、TUNEL染色、Annexin V-FITC凋亡检测试剂盒、脂质ROS检测试剂盒等方法探讨其变化机制。研究经费来源：国家自然科学基金(批准号：U22A20297；金额：62500美元)；广州市重点研发计划(资助号：202206060003；金额：63750美元)。没有任何利益冲突或披露需要报告。结果：DTMS通过调节髓鞘再生和神经元存活促进运动和感觉神经回路的改善，而在体内沉默少突胶质细胞中的生长相关蛋白43 （growth-associated protein 43, GAP43）抑制了DTMS的这些作用。机制上，GAP43通过抗凋亡和抗氧化应激作用促进少突胶质细胞分支、成熟和轴突再生。此外，受磁刺激的少突胶质细胞通过分泌含有GAP43的外泌体对神经元发挥神经保护作用。结论：本研究揭示了DTMS对脊髓损伤的神经保护作用。少突胶质细胞中的GAP43与磁刺激与髓磷脂和脊髓损伤后神经元再生的关系有关。临床意义：目前的研究基于功能、电生理、细胞和组织学证据证明了DTMS对脊髓损伤的有益作用。根据这些发现，我们期望DTMS对脊髓损伤的治疗筛选有积极和显著的影响。
{"title":"Double-target magnetic stimulation attenuates oligodendrocyte apoptosis and oxidative stress impairment after spinal cord injury via GAP43.","authors":"Mudan Huang, Jiawei Di, Lei He, Na Li, Zhenming Tian, Longyou Xiao, Ruijue Zhu, Tianwei He, Mao Pang, Bin Liu, Limin Rong","doi":"10.1016/j.spinee.2024.12.025","DOIUrl":"10.1016/j.spinee.2024.12.025","url":null,"abstract":"<p><strong>Background context: </strong>Spinal cord injury (SCI) causes neural circuit interruption and permanent functional damage. Magnetic stimulation in humans with SCI aims to engage residual neural networks to improve neurological functional, but the detailed mechanism remains unknown.</p><p><strong>Purpose: </strong>This study evaluates functional recovery and neural circuitry improvements in rodent with double-target (brain and spinal cord) magnetic stimulation (DTMS) treatment and explores the effect of DTMS on the modulation of glial cells in vivo and in vitro.</p><p><strong>Study design: </strong>In vivo animal study.</p><p><strong>Methods: </strong>SCI model rats at T10 level were induced via a weight-drop method and underwent long-time DTMS treatment. A series of behavioral assessments and tissue staining were used to evaluate neurological function and neural circuitry improvements. More importantly, single-cell RNA sequencing was conducted to identify the most significant glial cells after DTMS treatment. Furthermore, transmission electron microscopy, western blotting, immunofluorescence staining, TUNEL staining, Annexin V-FITC apoptosis kit and Lipid ROS kit were used to explore the mechanism underlying the observed changes. Study funding sources: National Natural Science Foundation of China (Grant number: U22A20297; Dollar amount: 62500); Key Research and Development Program of Guangzhou (Grant number: 202206060003; Dollar amount: 63750). There are no conflicts of interest or disclosures to report.</p><p><strong>Results: </strong>DTMS promoted the improvements of motor and sensory neural circuitry by modulating remyelination and neuronal survival, while silencing growth-associated protein 43 (GAP43) in oligodendrocytes suppressed these effects of DTMS in vivo. Mechanically, GAP43 played a crucial part to promote the branching and mature of oligodendrocytes and axonal regeneration via anti-apoptotic and anti-oxidative stress effects. Furthermore, oligodendrocytes subjected to magnetic stimulation exerted neuroprotective effects on neurons by secreting exosomes containing GAP43.</p><p><strong>Conclusions: </strong>Our study revealed the neuroprotection of DTMS on SCI. The GAP43 in oligodendrocytes were associated with this relationship between magnetic stimulation and myelin and neuronal regeneration after SCI.</p><p><strong>Clinical significance: </strong>The current study demonstrated the beneficial effects of DTMS on SCI based on functional, electrophysiological, cellular and histological evidence. According to these findings, we expect DTMS to make a positive and significant difference for SCI therapeutic screening.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.spinee.2024.12.003
Harsh Wadhwa, Matthew Rohde, Jayme C B Koltsov, Akaila Cabell, Matthew Smuck, Serena S Hu, John P Kleimeyer
<p><strong>Background context: </strong>Cervical epidural steroid injections (CESIs) are commonly used in management of cervical pathology. While severe complications have been reported, they are rare, and thus their incidence and risk factors have not been well characterized.</p><p><strong>Purpose: </strong>To determine the incidence of complications 7, 30, and 90 days after CESI and to identify associated risk factors.</p><p><strong>Study design: </strong>Retrospective cohort study of a large, national administrative claims database (Meritive<sup>TM</sup> Marketscan®).</p><p><strong>Patient sample: </strong>The study included 229,412 patients (mean age 52.2 ± 11.3 years, 57.1% female) undergoing 448,209 CESIs from 2008 to 2015.</p><p><strong>Outcome measures: </strong>Complication rates following CESI, and risk factors for complication.</p><p><strong>Methods: </strong>Adults undergoing a CESI with active enrollment for one year prior to and 90 days after CESI were included. Patients with neoplasm, fracture, infection, inflammatory spondyloarthropathy or prior cervical surgery within one year preceding CESI were excluded. Multivariable repeated measures logistic regression models were used to identify risk factors for complications at 7, 30, and 90 days. Complications were stratified into procedural and medical complications. Each time point was modeled separately with Bonferroni adjustment for the multiple time points.</p><p><strong>Results: </strong>Complications increased from 1.7% to 4.1%, to 8.0% within 7, 30, and 90 days, respectively. Procedural complications occurred in 0.6% of cases within 7 days, with neurologic complications occurring in 0.5% of cases. Medical complications occurred in 1.1%, 3.6%, and 7.2% within 7, 30 and 90 days, respectively. After multivariable risk adjustment, a transforaminal approach was associated with greater odd for procedural complications within 7 days relative to an interlaminar approach (p<0.001), with an odds ratio (95% confidence interval) of 1.55 (1.35, 1.77). The transforaminal approach also was associated with greater odds of neurologic complications at 7 days [1.69 (1.45, 1.95); p<0.001]. A myelopathy diagnosis was not associated with risk of overall, procedural, medical, or neurological complications. The most influential factors independently associated with greater odds of any complication within 30 days included anticoagulant prescription [5.40 (4.55, 6.41); p<0.001] and history of venous thromboembolism [3.01 (2.40, 3.77); p<0.001]. The factors most strongly associated with procedural complications at 7 days included history of neurologic deficit [3.04 (2.65, 3.50); p<0.001] and antiplatelet medication prescription [2.21 (1.49, 3.27); p=0.003].</p><p><strong>Conclusions: </strong>Complications following CESIs are infrequent. Neurologic complications were most common among procedural complications at 0.5% at 7 days. The transforaminal approach was associated with higher procedural complication
{"title":"Incidence and risk factors for complications following cervical epidural steroid injections.","authors":"Harsh Wadhwa, Matthew Rohde, Jayme C B Koltsov, Akaila Cabell, Matthew Smuck, Serena S Hu, John P Kleimeyer","doi":"10.1016/j.spinee.2024.12.003","DOIUrl":"10.1016/j.spinee.2024.12.003","url":null,"abstract":"<p><strong>Background context: </strong>Cervical epidural steroid injections (CESIs) are commonly used in management of cervical pathology. While severe complications have been reported, they are rare, and thus their incidence and risk factors have not been well characterized.</p><p><strong>Purpose: </strong>To determine the incidence of complications 7, 30, and 90 days after CESI and to identify associated risk factors.</p><p><strong>Study design: </strong>Retrospective cohort study of a large, national administrative claims database (Meritive<sup>TM</sup> Marketscan®).</p><p><strong>Patient sample: </strong>The study included 229,412 patients (mean age 52.2 ± 11.3 years, 57.1% female) undergoing 448,209 CESIs from 2008 to 2015.</p><p><strong>Outcome measures: </strong>Complication rates following CESI, and risk factors for complication.</p><p><strong>Methods: </strong>Adults undergoing a CESI with active enrollment for one year prior to and 90 days after CESI were included. Patients with neoplasm, fracture, infection, inflammatory spondyloarthropathy or prior cervical surgery within one year preceding CESI were excluded. Multivariable repeated measures logistic regression models were used to identify risk factors for complications at 7, 30, and 90 days. Complications were stratified into procedural and medical complications. Each time point was modeled separately with Bonferroni adjustment for the multiple time points.</p><p><strong>Results: </strong>Complications increased from 1.7% to 4.1%, to 8.0% within 7, 30, and 90 days, respectively. Procedural complications occurred in 0.6% of cases within 7 days, with neurologic complications occurring in 0.5% of cases. Medical complications occurred in 1.1%, 3.6%, and 7.2% within 7, 30 and 90 days, respectively. After multivariable risk adjustment, a transforaminal approach was associated with greater odd for procedural complications within 7 days relative to an interlaminar approach (p<0.001), with an odds ratio (95% confidence interval) of 1.55 (1.35, 1.77). The transforaminal approach also was associated with greater odds of neurologic complications at 7 days [1.69 (1.45, 1.95); p<0.001]. A myelopathy diagnosis was not associated with risk of overall, procedural, medical, or neurological complications. The most influential factors independently associated with greater odds of any complication within 30 days included anticoagulant prescription [5.40 (4.55, 6.41); p<0.001] and history of venous thromboembolism [3.01 (2.40, 3.77); p<0.001]. The factors most strongly associated with procedural complications at 7 days included history of neurologic deficit [3.04 (2.65, 3.50); p<0.001] and antiplatelet medication prescription [2.21 (1.49, 3.27); p=0.003].</p><p><strong>Conclusions: </strong>Complications following CESIs are infrequent. Neurologic complications were most common among procedural complications at 0.5% at 7 days. The transforaminal approach was associated with higher procedural complication ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.spinee.2024.12.002
S Harrison Farber, Alton J Oldham, Luke K O'Neill, Anna G U Sawa, Alexis C Ratliff, Ahmed Doomi, Bernardo de Andrada Pereira, Juan S Uribe, Brian P Kelly, Jay D Turner
<p><strong>Background context: </strong>Cage subsidence is a complication of interbody fusion associated with poor clinical outcomes. 3D-printed titanium interbody cages allow for the alteration of features such as stiffness and porosity. However, the influence of these features on subsidence and their biological effects on fusion have not been rigorously evaluated.</p><p><strong>Purpose: </strong>This 2-part study sought to determine how changes in 3D-printed titanium cage parameters affect subsidence using an in vitro bone model (Part 1) and biological fusion using an in vivo sheep model (Part 2).</p><p><strong>Study design: </strong>Biomechanical foam block model.</p><p><strong>Methods: </strong>In Part 1 of this study, 9 implant types were tested (8 per implant type). The implant types included 7 3D-printed titanium interbody cages with various surface areas, porosities, and surface topographies, along with 1 standard polyetheretherketone (PEEK) cage and 1 solid titanium cage. Subsidence testing was performed in a standardized foam block model using 2 different densities of foam. Digital imaging correlation was used to determine the relative vertical displacement of the interbody cage-foam block construct.</p><p><strong>Results: </strong>Subsidence decreased as the surface contact area with the bone model increased (all p≤.01). Increased porous surface topography increased subsidence, while a nonporous surface significantly decreased subsidence (all p<.001). Subsidence did not differ based on changes in implant porosity (all p≥.35) or material property/modulus (all p≥.19). Subsidence was significantly decreased with the higher density foam (p<.001). The stiffness of the implant was affected by porosity (all p<.02) and smooth surface topography (p=.01) but not by lumen size (all p≥.15). Stiffness did not differ between porous titanium and PEEK implants (p=.96), which were both less stiff than solid titanium implants (both p<.001). Surface area negatively correlated with subsidence (r=-0.786, p=.012) but was not correlated with stiffness (r=0.560, p=.12).</p><p><strong>Conclusions: </strong>Implant surface area and surface topography greatly influenced interbody subsidence. Apparent stiffness, implant porosity, and material property did not affect subsidence in this in vitro model. Higher foam density also led to lower subsidence than low-density foam. Biological response in the in vivo setting likely also influences clinical subsidence, which is evaluated in the companion study (Part 2).</p><p><strong>Clinical significance: </strong>This study provides valuable information regarding the new 3D-printed titanium technology. We showed that cage surface area and surface topography were the implant design parameters that had the greatest influence on the development of interbody subsidence. Moreover, bone mineral density was the factor that had the greatest effect on subsidence prevention. These data support patient optimization before surgery and
{"title":"Optimization of 3D-printed titanium interbody cage design. Part 1: in vitro biomechanical study of subsidence.","authors":"S Harrison Farber, Alton J Oldham, Luke K O'Neill, Anna G U Sawa, Alexis C Ratliff, Ahmed Doomi, Bernardo de Andrada Pereira, Juan S Uribe, Brian P Kelly, Jay D Turner","doi":"10.1016/j.spinee.2024.12.002","DOIUrl":"10.1016/j.spinee.2024.12.002","url":null,"abstract":"<p><strong>Background context: </strong>Cage subsidence is a complication of interbody fusion associated with poor clinical outcomes. 3D-printed titanium interbody cages allow for the alteration of features such as stiffness and porosity. However, the influence of these features on subsidence and their biological effects on fusion have not been rigorously evaluated.</p><p><strong>Purpose: </strong>This 2-part study sought to determine how changes in 3D-printed titanium cage parameters affect subsidence using an in vitro bone model (Part 1) and biological fusion using an in vivo sheep model (Part 2).</p><p><strong>Study design: </strong>Biomechanical foam block model.</p><p><strong>Methods: </strong>In Part 1 of this study, 9 implant types were tested (8 per implant type). The implant types included 7 3D-printed titanium interbody cages with various surface areas, porosities, and surface topographies, along with 1 standard polyetheretherketone (PEEK) cage and 1 solid titanium cage. Subsidence testing was performed in a standardized foam block model using 2 different densities of foam. Digital imaging correlation was used to determine the relative vertical displacement of the interbody cage-foam block construct.</p><p><strong>Results: </strong>Subsidence decreased as the surface contact area with the bone model increased (all p≤.01). Increased porous surface topography increased subsidence, while a nonporous surface significantly decreased subsidence (all p<.001). Subsidence did not differ based on changes in implant porosity (all p≥.35) or material property/modulus (all p≥.19). Subsidence was significantly decreased with the higher density foam (p<.001). The stiffness of the implant was affected by porosity (all p<.02) and smooth surface topography (p=.01) but not by lumen size (all p≥.15). Stiffness did not differ between porous titanium and PEEK implants (p=.96), which were both less stiff than solid titanium implants (both p<.001). Surface area negatively correlated with subsidence (r=-0.786, p=.012) but was not correlated with stiffness (r=0.560, p=.12).</p><p><strong>Conclusions: </strong>Implant surface area and surface topography greatly influenced interbody subsidence. Apparent stiffness, implant porosity, and material property did not affect subsidence in this in vitro model. Higher foam density also led to lower subsidence than low-density foam. Biological response in the in vivo setting likely also influences clinical subsidence, which is evaluated in the companion study (Part 2).</p><p><strong>Clinical significance: </strong>This study provides valuable information regarding the new 3D-printed titanium technology. We showed that cage surface area and surface topography were the implant design parameters that had the greatest influence on the development of interbody subsidence. Moreover, bone mineral density was the factor that had the greatest effect on subsidence prevention. These data support patient optimization before surgery and ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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