Spine Journal最新文献_第2页

Preoperative determinants of postoperative expectation fulfillment following elective lumbar spine surgery: an observational study from the Canadian Spine Outcome Research Network (CSORN).

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-03 DOI: 10.1016/j.spinee.2025.01.010

Vishwajeet Singh, Raymond Andrew Glennie, Eugene K Wai, Michael Weber, Raphaele Charest-Morin, Najmedden Attabib, Chris Small, Adrienne M Kelly, Supriya Singh, Bernard LaRue, Sean Christie, Daryl Fourney, Jerome Paquet, Andrew Nataraj, Nicholas Dea, Neil Manson, Christopher S Bailey, Yoga Raja Rampersaud, Alexandra Soroceanu, Charles G Fisher, Andrew J Schoenfeld, Greg McIntosh, Kenneth Thomas

Background context: Preoperative patient factors determining expectation fulfillment from elective lumbar surgeries are poorly defined.

Purpose: To identify preoperative factors associated with the levels of expectation fulfillment following elective lumbar spine surgery.

Study design/ setting: This retrospective cohort study used the Canadian Spine Outcome Research Network (CSORN) registry data with participants enrolled between January 2015 and December 2020. The registry prospectively enrolled surgical patients to treat spinal disorders from twenty-three sites. Participating patients completed preoperative and follow-up questionnaires, including information on surgery expectations. Patients recorded their levels of expectation fulfillment on a Likert scale of 1 to 5, with responses ranging from Completely met (5) to Not applicable (1) in 7 expectation dimensions.

Patient sample: Consecutive patients with 4 lumbar conditions (spinal stenosis, disc herniation, degenerative disc disease, or degenerative spondylolisthesis) and those with complete 1-year follow-up questionnaires were included. Patients treated for thoracic or cervical pathologies and nonelective lumbar conditions were excluded. A total of 5389 patients who underwent surgery and completed 1-year follow-up questionnaires out of 6971 eligible patients were included. Patients' socio-demographics, lifestyle, health status, and clinical factors were examined.

Outcome measures: The primary outcome was the association between expectation fulfillment and preoperative patient factors.

Methods: Patient factors were described for the expectation fulfillment categories using descriptive statistics. Bivariable and multivariable associations between patient factors and expectation fulfillment were estimated with ordinal logistic regression models. Point estimates represented as odd ratios, and 95% CIs were reported.

Results: The mean age of the participants was 59.5 years, with 49.8% (2683) of them being women. Unmet expectations ranged from 6.7% to 25.7%, with improvement in general physical capacity being the most important expectation fulfilled from surgery for 20% of patients. Factors such as longer symptom duration (OR: 0.74; 95% CI: 0.63-0.86), previous lumbar spine surgery (OR: 0.63; 95% CI: 0.46, 0.89), and reoperations (OR: 0.36; 95% CI: 0.2, 0.63) were associated with higher unmet expectations in the leg pain reduction dimension. Similar results were noted across all other expectation dimensions.

Conclusion: Utilizing information on the preoperative factors in presurgical consultations can improve patient satisfaction and expectations from surgery.

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引用次数: 0

Clinical outcomes following elective lumbar spine surgery in patients living with dementia.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-03 DOI: 10.1016/j.spinee.2025.01.040

Patawut Bovonratwet, Kaitlyn E Holly, Lingwei Xiang, Rachel R Adler, Clancy J Clark, Karen Sepucha, Samir K Shah, Dae Hyun Kim, John Hsu, Joel S Weissman, Andrew J Schoenfeld

Background context: As the population ages and surgical techniques improve, more elderly patients with dementia are being considered for treatment of spinal disorders. However, the combined impact of procedural intensity and anesthesia exposure can exacerbate surgical risks, leading to more complex recoveries and postoperative morbidity.

Purpose: To compare postsurgical outcomes of patients living with dementia who received elective lumbar spine surgery with a comparable group of patients without dementia.

Study design/setting: Retrospective analysis using national Medicare claims.

Patient sample: We identified Medicare beneficiaries living with dementia who underwent elective lumbar spine surgery between 2017 and 2018. This cohort was compared to Medicare beneficiaries who received comparable surgeries but without a diagnosis of dementia.

Outcome measures: The primary outcome was any adverse event (AAE) within 180 days of surgery, with postoperative intensive interventions considered in parallel with other clinical outcomes.

Methods: We employed inverse probability of treatment weights to adjust for confounding. We compared outcomes between cohorts using adjusted hazard ratios (aHR) from Cox-proportional hazard models and Fine-and-gray models considering death as a competing risk.

Results: We included 101,313 patients. Within 180 days of surgery, patients with dementia had an increased hazard of AAE than those without dementia (aHR 1.30; 95% CI 1.21,1.40). Patients with dementia also demonstrated a greater hazard of mortality (aHR 1.75, 95%CI 1.33, 2.29) and postoperative intensive interventions (aHR 1.64, 95% CI 1.08, 2.49) over the same time frame.

Conclusions: We found a significantly increased risk of adverse events among patients living with dementia undergoing lumbar spine surgery. We believe these risks were previously underappreciated because of the focus on urgent procedures (e.g., hip and odontoid fractures) in prior research evaluating postoperative outcomes for patients with dementia. Our results suggest the need for greater caution when recommending elective, high-intensity, surgical interventions for patients living with dementia.

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引用次数: 0

Letter to the editor regarding "What are the risk factors for a second osteoporotic vertebral compression fracture?" by Sang Hoon Hwang, et al.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-03 DOI: 10.1016/j.spinee.2025.01.039

Sung Hyeon Noh

引用次数: 0

Obesity is an independent risk factor for postoperative pulmonary embolism after anterior cervical discectomy and fusion 肥胖是颈椎前路椎间盘切除和融合术后肺栓塞的独立风险因素。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.028

Haseeb E. Goheer BS , Christopher G. Hendrix MD , Linsen T. Samuel MD, MBA , Alden H. Newcomb MD, MS , Jonathan J. Carmouche MD, MBA

BACKGROUND

Over the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database.

PURPOSE

The purpose of this study was to analyze obesity level's influence on perioperative complication rates in patients undergoing ACDF.

STUDY DESIGN/SETTING

A retrospective cohort, large multicenter database study.

PATIENT SAMPLE

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551.

OUTCOME MEASURES

Medical and surgical complications within thirty days of operation.

METHODS

Patients were categorized into four BMI groups: nonobese (BMI 18.5−29.9 kg/m²), obese class I (BMI 30−34.9 kg/m²), obese class II (BMI 35−39.9 kg/m²), and obese class III (BMI ≥40 kg/m²). A univariate analysis conducted for demographic variables and preoperative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to nonobese patients.

RESULTS

About 64,718 patients were identified of whom 33,365 were nonobese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs 0.24%, p=.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 vs 0.15%, p=.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs 0.4%, p<.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129−2.599); OR: 2.213, 95% CI (1.349−3.559); OR: 2.207, 95% CI (1.190--3.892), respectively).

CONCLUSIONS

Risk for postoperative PEs after an ACDF was significantly higher for obese classes I-III compared to nonobese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.

背景：在过去十年中，美国肥胖症的发病率与颈椎椎间盘切除前路融合术（ACDF）的需求同步上升。之前的研究评估了较小患者群体中肥胖等级在颈椎手术中的作用。目的：本研究旨在分析肥胖程度对接受 ACDF 患者围手术期并发症发生率的影响：回顾性队列、大型多中心数据库研究：患者样本：通过查询美国外科学院国家外科质量改进计划（ACS-NSQIP）数据库，确定在2011年至2020年间接受过选择性ACDF手术的患者，并使用当前程序术语（CPT）代码22551：结果测量：术后三十天内的医疗和手术并发症：将患者分为四个 BMI 组：非肥胖（BMI 18.5-29.9 kg/m2）、肥胖 I 级（BMI 30-34.9 kg/m2）、肥胖 II 级（BMI 35-39.9 kg/m2）和肥胖 III 级（BMI ≥40 kg/m2）。对人口统计学变量和术前合并症进行的单变量分析发现，年龄、性别、种族、吸烟状况、需要药物治疗的高血压、糖尿病、充血性心力衰竭病史、出血性疾病病史和慢性阻塞性肺病是风险因素。采用卡方检验比较各组并发症的发生率。随后进行了多变量逻辑回归分析，以调整这些术前风险因素，并比较 I-III 级肥胖与非肥胖患者：结果：共发现 64,718 名患者，其中 33,365 人为非肥胖患者，17,190 人为肥胖 I 级患者，8,608 人为肥胖 II 级患者，5,555 人为肥胖 III 级患者。肥胖 I-III 级患者的手术部位感染（0.33%、0.36%、0.41% 对 0.24%，P = 0.039）和肺栓塞（PE）（0.25%、0.31%、0.29 对 0.15%，P = 0.003）发生率较高。肥胖I-III级的输血发生率较低（0.23%、0.17%、0.27% vs 0.4%，P < 0.001），肥胖I级、肥胖II级和肥胖III级分别独立增加了PE的风险（OR：1.716，95% CI (1.129-2.599)；OR：2.213，95% CI (1.349-2.3.559)；OR：2.207，95% CI (1.190-3.892)）：结论：与非肥胖患者相比，肥胖 I-III 级患者在 ACDF 术后发生 PE 的风险明显更高。这些发现可能进一步支持在围手术期采取额外的预防措施。

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引用次数: 0

Risk factors for progression of nucleus pulposus degeneration in the lumbar intervertebral disc: a retrospective analysis using the disc signal intensity index.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2025.01.036

Koki Tsuchiya, Ichiro Okano, Ali E Guven, Paul Köhli, Jan Hambrecht, Gisberto Evangelisti, Erika Chiapparelli, Marco D Burkhard, Jennifer Shue, Federico P Girardi, Frank P Cammisa, Andrew A Sama, Alexander P Hughes

<p><strong>Background/context: </strong>Degenerative disc changes are associated with low back pain and negatively impact quality of life. Disc degeneration process usually starts with nucleus pulposus change. There is uncertainty about the risk factors associated with the progression of disc nucleus degeneration due to the lack of an objective evaluation method. Pfirrmann grade, which assesses the morphological characteristics of a disc on T2-weighted MRI images on a scale of 1 to 5, is 1 of the most frequently used assessment systems. This method inherently has a degree of subjectivity that may lead to inaccurate and inconsistent grading. A recent study introduced the disc signal intensity index (DSI2) for quantitative assessment of nucleus pulposus degeneration with promising results in identifying of risk factors for progression of disc degeneration.</p><p><strong>Purpose: </strong>The aim of this study was to investigate the risk factors for the progression of nucleus pulpous degeneration in the lumbar vertebral disc on longitudinal MRI data using DSI2.</p><p><strong>Study design/setting: </strong>Retrospective longitudinal study PATIENT SAMPLE: Patients with lumbar MRIs at least 3 years apart and did not undergo the lumbar spine surgery between both time points were included.</p><p><strong>Outcome measures: </strong>Potential contributing factors were collected that included age, biological sex, race, body mass index (BMI), current smoking status, alcohol consumption, history of previous lumbar decompression surgery, and comorbidities such as congestive heart failure (CHF), myocardial infarction, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and rheumatoid arthritis.</p><p><strong>Methods: </strong>Disc nucleus degeneration was assessed using the DSI2 and Pfirrmann grade on T2- weighted MRI. The DSI2 values are based on the mean signal of disc spaces within a circular region of interest (ROI), which was adjusted by the signal intensity of cerebrospinal fluid (CSF) on the midsagittal plane. Three ROIs were set per disc (anterior 1/3, middle, posterior 1/3), and the mean values of all 3 measurements from L1/2 to L5/S1 disc space were utilized. Discs with complete collapse and no space for ROI selection were excluded. The difference in DSI2 scores between these 2 time points were compared. Multivariate linear mixed regression analysis was conducted to determine the factors associated with disc degenerative changes.</p><p><strong>Results: </strong>A total of 325 patients and 1,439 discs were included in the final analysis. 173 patients (53.2%) were female and the median age of all patients was 60.1 years. The mean (SD) DSI2 score was 0.177 (0.074) for thefirst MRI and 0.184 (0.081) for the second MRI. The Pfirrmann grading for the first MRI timepoint were as follows: 23 discs (1.42%) were Grade 1, 377 discs (23.2%) were Grade 2, 583 discs (35.9%) were Grade 3, 456 discs (28.1%) were Grade 4, and 186 discs (11.5%) were

背景：椎间盘退行性病变与腰痛有关，并对生活质量产生负面影响。椎间盘退变过程通常始于髓核变化。由于缺乏客观的评估方法，与椎间盘髓核退变进展相关的风险因素尚不确定。Pfirrmann 分级法是最常用的评估系统之一，该方法在 T2 加权磁共振成像上以 1 至 5 级评估椎间盘的形态特征。这种方法本身具有一定的主观性，可能导致分级不准确和不一致。最近的一项研究引入了椎间盘信号强度指数（DSI2）对髓核变性进行定量评估，并在确定椎间盘变性进展的风险因素方面取得了可喜的成果。目的：本研究旨在使用 DSI2 通过纵向 MRI 数据调查腰椎间盘髓核变性进展的风险因素：回顾性纵向研究：结果测量：收集的潜在诱因包括年龄、生理性别、种族、体重指数（BMI）、当前吸烟状况、饮酒量、既往腰椎减压手术史以及充血性心力衰竭（CHF）、心肌梗死、糖尿病、慢性阻塞性肺病、高血压和类风湿性关节炎等合并症：采用T2加权磁共振成像的DSI2和Pfirrmann分级评估椎间盘髓核变性。DSI2值基于一个圆形感兴趣区（ROI）内椎间盘间隙的平均信号，该感兴趣区根据中矢状面上脑脊液（CSF）的信号强度进行调整。每个椎间盘设置三个 ROI（前 1/3、中间、后 1/3），并利用从 L1/2 到 L5/S1 椎间盘间隙的所有三个测量值的平均值。椎间盘完全塌陷和没有空间供选择ROI的椎间盘被排除在外。比较这两个时间点之间 DSI2 分数的差异。进行了多变量线性混合回归分析，以确定与椎间盘退行性改变相关的因素：共有 325 名患者和 1439 个椎间盘被纳入最终分析。173名患者（53.2%）为女性，所有患者的中位年龄为60.1岁。第一次磁共振成像的 DSI2 平均（标清）分数为 0.177 (0.074)，第二次磁共振成像的 DSI2 平均（标清）分数为 0.184 (0.081)。第一次 MRI 的 Pfirrmann 分级如下：23 个椎间盘（1.42%）为 1 级，377 个椎间盘（23.2%）为 2 级，583 个椎间盘（35.9%）为 3 级，456 个椎间盘（28.1%）为 4 级，186 个椎间盘（11.5%）为 5 级。多变量线性混合回归分析表明，年龄越大（P=0.030），充血性心力衰竭越严重（P=0.030）：本研究表明，年龄和充血性心力衰竭是椎间盘髓核变性进展的风险因素。这些见解有助于确定腰椎退行性病变的高危患者，并指导有关预防措施的进一步研究。DSI2 方法为未来的椎间盘研究提供了一种前景广阔的替代评估方法。

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引用次数: 0

Expandable versus static transforaminal lumbar interbody fusion (TLIF) cages: comparing radiographic outcomes and complication profiles 可膨胀与静态经椎间孔腰椎椎体融合器（TLIF）固定架：放射学结果与并发症概况比较。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.030

Alexander M. Crawford MD, MPH , Brendan M. Striano MD, MPH , Matthew R. Bryan BS , Ikechukwu C. Amakiri MD, MBA , Donnell L. Williams BS , Andrew T. Nguyen BS , Malina O. Hatton BS , Andrew K. Simpson MD, MBA, MHS , Andrew J. Schoenfeld MD, MSc

Background Context

Expandable transforaminal lumbar interbody fusion (TLIF) cages have become popular in recent years due to anticipated advantages of increased disc height, improved segmental lordosis, and ease of implantation. Such benefits have not been conclusively demonstrated in the literature.

Purpose

To determine whether expandable cages increase disc height and segmental lordosis in a durable way following surgery and compare complication profiles between cage types.

Study Design/Setting

Retrospective cohort study conducted within a large academic health system involving 31 different spine surgeons.

Patient Sample

Adults undergoing single-level TLIF for an indication other than infection, tumor, trauma, or revision instrumentation from 2021 to 2023.

Outcome Measures

Our primary outcomes were changes in segmental disc height, segmental lordosis, and L4-S1 lordosis at 2 weeks, 6 months, and 1 year following surgery relative to baseline. Our secondary outcomes were frequencies of incidental durotomies, surgical site infections, readmissions, death, subsidence, and unplanned return to the operating room.

Methods

Radiographic variables were collected from our institutional imaging registry. Demographics and surgical characteristics were abstracted from chart review. Generalized linear modeling was used for each primary outcome, with cage type (expandable vs static) as our primary predictor and age, biologic sex, race, CCI, year of surgery, duration of surgery, invasiveness of surgery, surgeon specialty (Orthopedics vs Neurosurgery), and level of surgery as covariates.

Results

Our cohort consisted of 417 patients with a mean age of 62. Static cages were used in 306 patients and expandable cages in 111. Expandable cages were associated with increased changes in disc height relative to static cages at 2 weeks (1.1 mm [0.2–1.9]; p=.01) and 6 months (1.2 mm [0.2–2.3]; p=.02) following surgery, but differences were no longer significant at 1 year (0.4 mm [−0.9–1.8]; p=.4). Expandable cages were found to subside more commonly than static cages (14.1% vs 6.6%; p=.04). No significant differences between cage types were identified in lordotic parameters at any timepoint (p=0.25 to p=0.97).

Conclusions

Expandable cages were associated with an initial increase in disc height relative to static cages, but this difference diminished with the first year of surgery, likely due to a higher rate of subsidence within the expandable cohort.

背景情况：可扩张的经椎间孔腰椎椎体融合术（TLIF）保持架近年来很受欢迎，因为它具有增加椎间盘高度、改善节段前凸、易于植入等预期优势。目的：确定可扩张椎间融合器是否能在术后持久增加椎间盘高度和节段前凸，并比较不同类型椎间融合器的并发症情况：患者样本：患者样本：2021-2023年间因感染、肿瘤、外伤或翻修器械以外的适应症接受单水平TLIF手术的成人：我们的主要结果是术后2周、6个月和1年时节段椎间盘高度、节段前凸和L4-S1前凸相对于基线的变化。我们的次要结果是偶发性穹隆切口、手术部位感染、再入院、死亡、下沉和意外返回手术室的频率：方法：我们从本机构的影像登记处收集了放射学变量。方法：放射学变量来自本机构的影像学登记，人口统计学和手术特征来自病历审查。对每个主要结果采用广义线性建模，笼型（可扩张与静态）作为主要预测因子，年龄、生物性别、种族、CCI、手术年份、手术持续时间、手术侵袭性、外科医生专业（骨科与神经外科）和手术级别作为协变量：我们的队列由 417 名患者组成，平均年龄为 62 岁。306名患者使用了静态支架，111名患者使用了可扩张支架。术后2周（1.1 mm [0.2-1.9]; p=0.01）和6个月（1.2 mm [0.2-2.3]; p=0.02）时，可扩张椎间盘保持架与静态保持架相比可增加椎间盘高度的变化，但术后1年时差异不再显著（0.4 mm [-0.9-1.8]; p=0.4）。与静态保持架相比，可扩张保持架更容易消退（14.1% vs 6.6%; p=0.04）。不同类型的脊柱前凸参数在任何时间点均无差异（P=0.25-0.97）：结论：与静态椎间盘保持架相比，可扩张椎间盘保持架与最初的椎间盘高度增加有关，但这种差异在手术第一年后逐渐减小，这可能是由于可扩张椎间盘保持架队列中的下陷率较高。

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引用次数: 0

Multirod posterior occipitocervical instrumentation constructs: a biomechanical analysis and initial case series of 10 patients with complex craniocervical pathology 多杆式后枕颈椎器械结构：生物力学分析和 10 例复杂颅颈病变患者的初始病例系列。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.022

Andrew P. Collins MD , Muzammil Mumtaz PhD , Sudharshan Tripathi MS , Shruthi K. Varier MS , Alexander W. Turner PhD , Aaron J. Clark MD, PhD , Vijay K. Goel PhD , Alekos A. Theologis MD

<div><h3>BACKGROUND CONTEXT</h3><div>Stabilization of the occipitocervical (OC) junction with posterior instrumentation plays a vital role in addressing a spectrum of pathologies. Due to limited bone surfaces of the occiput and C1 lamina, achieving union across the OC junction is challenging.</div></div><div><h3>PURPOSE</h3><div>To explore the biomechanics and a clinical series of patients treated with multirod constructs across the OC junction using a novel occipital plate with single- and dual-headed, modular tulip heads.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Biomechanical analysis and retrospective case series.</div></div><div><h3>PATIENT SAMPLE</h3><div>Adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.</div></div><div><h3>OUTCOME MEASURES</h3><div>OC–C4 range of motion (ROM), maximum von Mises stress on the rods, and adjacent segment ROMs and intradiscal parameters. Patient demographics, revision operations, rod breakages, wound complications.</div></div><div><h3>METHODS</h3><div>A validated occiput-cervical finite element (FE) model was used to simulate OC–C4 cervical fixation under multidirectional pure moment loading. A total of 4 rod configurations were simulated: (A) 2-rod-Ti (4.0 mm titanium rods); (B) 2-rod-CoCr (3.5 mm cobalt chrome rods); (C) 3-rods (4.0 mm titanium rods); (D) 4-rods (4.0 mm titanium rods). The aforementioned measures were compared. A retrospective analysis was also performed of adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.</div></div><div><h3>RESULTS</h3><div>Biomechanically, lowest primary rod stresses were observed for 3- and 4-rod constructs. Compared to 2-rod-Ti (121.8 MPa), 2-rod-CoCr showed a 43.2% stress increase in the rods, while 3- and 4-rods experienced rod stress reductions of 20% and 23.2%, respectively. No appreciable differences in OC–C4 ROM, C4–5 ROM, and C4–5 discal stresses were found between multirod and 2-rod constructs. Maximum occipital and C4 screw stresses were decreased in multirod constructs compared to 2-rods, with least stresses noted in the 4-rod construct. Maximum plate stresses were slightly increased in the 4-rod construct compared to 2- and 3-rod fixation, though the forces were largely similar among the constructs. Ten patients (average age 66.4±10.6 years; 8 males) were assessed clinically. Nine of the ten operations were for primary stabilization of pathological fractures and associated craniocervical and/or atlantoaxial instability using 4-rods across the OC junction. At an average follow-up time of 1.58±0.5 years (range, 1–2.3 years), there were no instrumentation failures, no adjacent segment failures, and no wound complications.</div></div><div><h3>CONCLUSIONS</h3><div>In this proof-of-concept investigation, multiple rods (3- and 4-rods) across the OC junction using a novel occipital plate with single- and dual-headed, modular tulips was safe and

背景情况：使用后路器械稳定枕颈（OC）交界处在治疗各种病症方面发挥着至关重要的作用。研究设计/设置：生物力学分析和回顾性病例系列：研究设计/设置：生物力学分析和回顾性病例系列：研究设计：生物力学分析和回顾性病例系列：结果测量：OC-C4活动范围（ROM）、杆上的最大von Mises应力、邻近节段ROM和椎间盘内参数。患者人口统计学、翻修手术、杆断裂、伤口并发症：方法：使用经过验证的枕颈部有限元（FE）模型模拟多方向纯力矩加载下的 OC-C4 颈椎固定。共模拟了 4 种杆件配置：(A) 2-杆-钛（4.0 毫米钛杆）；(B) 2-杆-钴铬（3.5 毫米钴铬杆）；(C) 3-杆（4.0 毫米钛杆）；(D) 4-杆（4.0 毫米钛杆）。对上述措施进行了比较。此外，我们还对在一家机构接受颈椎后路多连杆横跨 OC 交界处构建的成人进行了回顾性分析：结果：从生物力学角度来看，3 根和 4 根连杆结构的主要连杆应力最低。与 2-连杆-钛（121.8 兆帕）相比，2-连杆-铬合金连杆的应力增加了 43.2%，而 3-连杆和 4-连杆的连杆应力分别降低了 20% 和 23.2%。多连杆和双连杆结构的 OC-C4 ROM、C4-5 ROM 和 C4-5 椎间盘应力没有明显差异。与双杆结构相比，多杆结构的枕骨和C4螺钉的最大应力有所降低，而4杆结构的应力最小。与双连杆和三连杆固定相比，四连杆结构的最大钢板应力略有增加，但各种结构的应力基本相似。临床评估了 10 名患者（平均年龄 66.4 ± 10.6 岁；8 名男性）。10 例手术中有 9 例是使用横跨 OC 交界处的 4 根连杆对病理性骨折和相关的颅颈和/或寰枢椎不稳进行初次稳定。平均随访时间为 1.58 ± 0.5 年（1 - 2.3 年），无器械故障、无邻近节段故障、无伤口并发症：在这项概念验证研究中，使用带有单头和双头模块化郁金香的新型枕骨板，将多根（3 根和 4 根）横跨 OC 交界处，可安全有效地稳定 OC 交界处。随附的 FE 分析表明，与双杆结构相比，多杆结构降低了主杆应力，降低了枕骨和 C4 螺钉的应力，而枕骨板应力则基本相似。还需要更多的临床研究来证实这些发现，并确定多杆结构在 OC 交界处的最终用途。

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引用次数: 0

Deep learning model for automated diagnosis of degenerative cervical spondylosis and altered spinal cord signal on MRI 用于自动诊断退行性颈椎病和磁共振成像脊髓信号改变的深度学习模型。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.015

Aric Lee MBBS, MMed, FRCR , Junran Wu BSc (Hons) , Changshuo Liu BSc (Hons) , Andrew Makmur MBBS, BmedSc, MMed, FRCR , Yong Han Ting MBBS, FRCR , Faimee Erwan Muhamat Nor MBBCh, BAO (Hons), FRCR, Mmed , Loon Ying Tan MBBS, FRCR , Wilson Ong MBBS, FRCR , Wei Chuan Tan MBBS, FRCR , You Jun Lee MBBS , Juncheng Huang MBBS , Joey Chan Yiing Beh MBBS, FRCR , Desmond Shi Wei Lim MBBS, FRCR , Xi Zhen Low MBBS, FRCR , Ee Chin Teo MMRT , Yiong Huak Chan PhD , Joshua Ian Lim MBBS , Shuxun Lin MBBS, MRCS, MMed, FRCSEd , Jiong Hao Tan MBBS, MRCS, MMed, FRCS (Orth) , Naresh Kumar MBBS, MS, DNB, FRCS, FRCS, DM , James Thomas Patrick Decourcy Hallinan MBChB (Hons), BSc (Hons), FRCR

BACKGROUND CONTEXT

A deep learning (DL) model for degenerative cervical spondylosis on MRI could enhance reporting consistency and efficiency, addressing a significant global health issue.

PURPOSE

Create a DL model to detect and classify cervical cord signal abnormalities, spinal canal and neural foraminal stenosis.

STUDY DESIGN/SETTING

Retrospective study conducted from January 2013 to July 2021, excluding cases with instrumentation.

PATIENT SAMPLE

Overall, 504 MRI cervical spines were analyzed (504 patients, mean=58 years±13.7[SD]; 202 women) with 454 for training (90%) and 50 (10%) for internal testing. In addition, 100 MRI cervical spines were available for external testing (100 patients, mean=60 years±13.0[SD];26 women).

OUTCOME MEASURES

Automated detection and classification of spinal canal stenosis, neural foraminal stenosis, and cord signal abnormality using the DL model. Recall(%), inter-rater agreement (Gwet's kappa), sensitivity, and specificity were calculated.

METHODS

Utilizing axial T2-weighted gradient echo and sagittal T2-weighted images, a transformer-based DL model was trained on data labeled by an experienced musculoskeletal radiologist (12 years of experience). Internal testing involved data labeled in consensus by 2 musculoskeletal radiologists (reference standard, both with 12-years-experience), 2 subspecialist radiologists, and 2 in-training radiologists. External testing was performed.

RESULTS

The DL model exhibited substantial agreement surpassing all readers in all classes for spinal canal (κ=0.78, p<.001 vs κ range=0.57–0.70 for readers) and neural foraminal stenosis (κ=0.80, p<.001 vs κ range=0.63–0.69 for readers) classification. The DL model's recall for cord signal abnormality (92.3%) was similar to all readers (range: 92.3–100.0%). Nearly perfect agreement was demonstrated for binary classification (grades 0/1 vs 2/3) (κ=0.95, p<.001 for spinal canal; κ=0.90, p<.001 for neural foramina). External testing showed substantial agreement using all classes (κ=0.76, p<.001 for spinal canal; κ=0.66, p<.001 for neural foramina) and high recall for cord signal abnormality (91.9%). The DL model demonstrated high sensitivities (range:83.7%–92.4%) and specificities (range:87.8%–98.3%) on both internal and external datasets for spinal canal and neural foramina classification.

CONCLUSIONS

Our DL model for degenerative cervical spondylosis on MRI showed good performance, demonstrating substantial agreement with the reference standard. This tool could assist radiologists in improving the efficiency and consistency of MRI cervical spondylosis assessments in clinical practice.

背景情况：针对 MRI 上退行性颈椎病的深度学习（DL）模型可以提高报告的一致性和效率，从而解决一个重要的全球健康问题。目的：创建一个 DL 模型，用于检测和分类颈髓信号异常、椎管和神经孔狭窄：患者样本：总共分析了 504 例 MRI 颈椎（504 例患者，平均年龄（58 岁）±13.7[SD]；202 例女性），其中 454 例用于培训（90%），50 例（10%）用于内部测试。此外，还有 100 个核磁共振颈椎图像用于外部测试（100 名患者，平均年龄（60 岁）±13.0[标准差]；26 名女性）：使用 DL 模型对椎管狭窄、神经孔狭窄和脊髓信号异常进行自动检测和分类。计算召回率（%）、评分者之间的一致性（Gwet's kappa）、灵敏度和特异性：利用轴向 T2 加权梯度回波和矢状 T2 加权图像，在一位经验丰富的肌肉骨骼放射科医生（12 年经验）标注的数据上训练了基于变压器的 DL 模型。内部测试包括由两名肌肉骨骼放射科医生（参考标准，均有 12 年经验）、两名放射科亚专科医生和两名在训放射科医生共同标注的数据。进行了外部测试：结果：DL 模型在椎管的所有级别上都表现出了极大的一致性，超过了所有读者（κ=0.78，p 结论：我们的 DL 模型对 MRI 上的退行性颈椎病显示出良好的性能，与参考标准的一致性很高。该工具可帮助放射科医生在临床实践中提高核磁共振颈椎病评估的效率和一致性。

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引用次数: 0

A cost-effectiveness analysis of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain 骨内椎基底神经消融术治疗慢性腰背痛的成本效益分析。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.016

Matthew Smuck MD , Zachary L. McCormick MD , Chris Gilligan MD , Mary K. Hailey , Michelle L. Quinn , Anthony Bentley BSc, MSc , Kaylie Metcalfe BSc, MSc , Benjamin Bradbury BSc , Dylan J. Lukes PhD , Rod S. Taylor MSc, PhD

BACKGROUND CONTEXT

Randomized trials have demonstrated the superiority of intraosseous basivertebral nerve ablation (BVNA) compared with sham and standard care in terms of improvements in pain, disability, and health-related quality of life in patients with vertebrogenic chronic low back pain (cLBP).

PURPOSE

To assess the cost effectiveness of BVNA in patients with vertebrogenic cLBP compared to standard care alone.

STUDY DESIGN/SETTING

A model-based economic analysis.

PATIENT SAMPLE

Base case analysis used INTRACEPT, a randomized trial comparing BVNA with standard care in 140 patients with vertebrogenic cLBP, recruited from 23 sites across the United States, with a follow-up, up to 5 years. Scenario analyses compared data from the Surgical Multicenter Assessment of Radiofrequency Ablation for the Treatment of Vertebrogenic Back Pain (SMART) randomized trial against a sham control, and a single-arm study.

OUTCOME MEASURES

Costs and quality-adjusted life years (QALYs) were calculated to determine the incremental cost-effectiveness ratio (ICER).

METHODS

A cost-effectiveness model was built in Microsoft Excel to evaluate the costs and health outcomes of patients undergoing BVNA using the Intracept Procedure (Relievant Medsystems) to treat vertebrogenic cLBP from a US payor perspective. Alternative scenario sensitivity analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the model results. QALYs were discounted at 3.0% per year.

RESULTS

Base case analysis showed that BVNA relative to standard care alone was a cost-effective strategy for the management of patients with vertebrogenic cLBP, with an ICER of US$11,376 per QALY at a 5-year time horizon from introduction of the procedure. Modeling demonstrated a >99% probability that this was cost effective in the US, based on a willingness-to-pay threshold of US$100,000 to US$150,000. Various sensitivity and scenario analyses produced ICERs that all remained below this threshold.

CONCLUSIONS

BVNA with the Intracept Procedure offers patients with vertebrogenic cLBP, clinicians, and healthcare systems a cost-effective treatment compared to standard care alone.

背景情况：随机试验证明，与假性治疗和标准治疗相比，椎体内椎体基底神经消融术（BVNA）在改善椎源性慢性腰背痛（cLBP）患者的疼痛、残疾和健康相关生活质量方面更具优势。目的：评估椎源性慢性腰背痛患者接受BVNA治疗与单独接受标准治疗的成本效益：研究设计/设置：基于模型的经济分析：基础病例分析使用了 INTRACEPT，这是一项随机试验，对 140 名椎体源性 cLBP 患者的 BVNA 与标准护理进行了比较，这些患者是从美国 23 个地点招募的，随访时间长达 5 年。情景分析比较了射频消融治疗椎体源性背痛（SMART）随机试验与假对照以及单臂研究的数据：计算成本和质量调整生命年 (QALY)，以确定增量成本效益比 (ICER)：用 Microsoft Excel® 建立了一个成本效益模型，从美国支付方的角度评估使用 Intracepture 程序（Relievant Medsystems）进行 BVNA 治疗椎源性 cLBP 患者的成本和健康结果。为评估模型结果的稳健性，还进行了替代方案敏感性分析和概率敏感性分析。QALYs的贴现率为每年3.0%：基础病例分析表明，相对于单纯的标准护理，BVNA 是治疗椎源性 cLBP 患者的一种经济有效的策略，在引入该手术的 5 年时间跨度内，每 QALY 的 ICER 为 11,376 美元。根据 100,000 美元至 150,000 美元的支付意愿阈值，建模结果表明，在美国，这种方法具有成本效益的可能性大于 99%。各种敏感性分析和情景分析得出的ICER均低于这一临界值：结论：与单纯标准治疗相比，采用 Intracept 程序的 BVNA 为椎体源性 cLBP 患者、临床医生和医疗系统提供了一种经济有效的治疗方法。

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引用次数: 0

Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis 治疗腰椎间盘突出症的椎间盘切除术与椎体后凸切除术：系统回顾与荟萃分析。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.007

Luca Ambrosio MD , Gianluca Vadalà MD, PhD , Elisabetta de Rinaldis MS , Sathish Muthu MS, MD , Stipe Ćorluka MD , Zorica Buser PhD , Hans-Jörg Meisel MD, PhD , S. Tim Yoon MD, PhD , Vincenzo Denaro MD , AO Spine Knowledge Forum Degenerative

<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain and may require surgical treatment in case of persistent pain and/or neurological deficits. Conventional discectomy involves removing the herniated fragment and additional material from the disc space, potentially accelerating disc degeneration and contributing to chronic LBP. Conversely, by resecting the herniated fragment only, sequestrectomy may reduce postoperative LBP while increasing the risk of LDH recurrence.</div></div><div><h3>PURPOSE</h3><div>To compare discectomy versus sequestrectomy in terms of risk of reherniation, reoperation rate, complications, pain, satisfaction, and perioperative outcomes (operative time, blood loss, length of stay [LOS]).</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review and meta-analysis.</div></div><div><h3>METHODS</h3><div>A systematic search of PubMed/MEDLINE and Scopus databases was performed through May 1, 2024 for both randomized and nonrandomized studies. The search was conducted according to PRISMA guidelines. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. The quality of the evidence was evaluated according to the GRADE approach. Relevant outcomes were pooled for meta-analysis.</div></div><div><h3>RESULTS</h3><div>A total of 16 articles (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies) published between 1991 and 2020 involving 2009 patients were included for analysis. No significant differences were noted between discectomy versus sequestrectomy in terms of risk of reherniation (OR: 0.85, 95% CI: 0.57 to 1.26, p=.42), reoperation rate (OR: 0.95, 95% CI: 0.64 to 1.40, p=.78), and complications (OR: 1.03, 95% CI: 0.50 to 2.11, p=.94). Although LBP (MD: −0.06, 95% CI: −0.39 to 0.28, p=.74) and leg pain intensity (MD: 0.11, 95% CI: −0.21 to 0.42, p=.50) were similar postoperatively, significantly better outcomes were reported by patients treated with sequestrectomy at 1 year (leg pain: MD: 0.37, 95% CI: 0.19 to 0.54, p<.0001) and 2 years (LBP: MD: 0.19, 95% CI: 0.03 to 0.34, p=.02; leg pain: MD: 0.20, 95% CI: 0.09 to 0.31, p=.0005). Sequestrectomy also resulted in a higher patient satisfaction (OR: 0.60, 95% CI: 0.40 to 0.90, p=.01) and shorter operative time (MD: 8.71, 95% CI: 1.66 to 15.75, p=.02), while blood loss (MD: 0.18, 95% CI: −2.31 to 2.67, p=.89) and LOS (MD: 0.02 days, 95% CI: −0.07 to 0.12, p=.60) did not significantly differ compared to discectomy.</div></div><div><h3>CONCLUSIONS</h3><div>Based on the current evidence, discectomy and sequestrectomy do not significantly differ in terms of risk of reherniation, reoperation rate, and postoperative complications. Patients treated with sequestrectomy may benefit from a marginally higher pain improvement, better satisfaction outcomes, and a shorter operative time, although the clinical relevance of these differences

背景情况：腰椎间盘突出症（LDH）是导致腰痛（LBP）和腿痛的主要原因之一，如果出现持续性疼痛和/或神经功能紊乱，可能需要进行手术治疗。传统的椎间盘切除术包括切除椎间盘突出的碎片和椎间盘间隙中的其他物质，这可能会加速椎间盘退变并导致慢性腰背痛。目的：从再疝风险、再手术率、并发症、疼痛、满意度和围手术期结果（手术时间、失血量、住院时间[LOS]）等方面比较椎间盘切除术与椎间盘切除术的效果：研究设计：系统回顾和荟萃分析：方法：在 2024 年 5 月 1 日前对 PubMed/MEDLINE 和 Scopus 数据库进行了系统检索。随机和非随机研究。检索根据 PRISMA 指南进行。使用 RoB-2 和 MINORS 工具评估纳入研究的偏倚风险。根据 GRADE 方法对证据质量进行评估：共纳入了 1991 年至 2020 年间发表的 16 篇文章（1 篇随机对照试验和 2 篇随访研究、6 篇前瞻性研究和 7 篇回顾性研究）进行分析，其中包括 2009 名患者。在再疝风险（OR：0.85，95% CI：0.57 至 1.26，P=0.42）、再手术率（OR：0.95，95% CI：0.64 至 1.40，P=0.78）和并发症（OR：1.03，95% CI：0.50 至 2.11）方面，椎间盘切除术与椎体后凸切除术没有明显差异。虽然术后LBP（MD：-0.06，95% CI：-0.39至0.28，P=0.74）和腿痛强度（MD：0.11，95% CI：-0.21至0.42，P=0.50）是相似的，但在 1 年（腿痛：MD：0.37，95% CI：0.19 至 0.54）和 2 年（LBP：MD：0.19，95% CI：0.03 至 0.34，p=0.02；腿痛：MD：0.20，95% CI：0.34，p=0.74）时，采用序贯切除术治疗的患者的预后明显更好：MD：0.20，95% CI：0.09 至 0.31，p=0.0005）。与椎间盘切除术相比，接骨切除术的患者满意度更高（OR：0.60，95% CI：0.40至0.90，P=0.01），手术时间更短（MD：8.71，95% CI：1.66至15.75，P=0.02），而失血量（MD：0.18，95% CI：-2.31至2.67，P=0.89）和LOS（MD：0.02天，95% CI：-0.07至0.12，P=0.60）没有显著差异：根据目前的证据，椎间盘切除术和椎体后凸切除术在再疝风险、再手术率和术后并发症方面没有明显差异。椎间盘切除术和椎间孔镜切除术在再疝风险、再手术率和术后并发症方面没有明显差异。采用椎间孔镜切除术治疗的患者可能会从疼痛改善程度略高、满意度更好和手术时间更短中获益，但这些差异的临床意义还需要更大规模的前瞻性随机研究来验证。

{"title":"Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis","authors":"Luca Ambrosio MD , Gianluca Vadalà MD, PhD , Elisabetta de Rinaldis MS , Sathish Muthu MS, MD , Stipe Ćorluka MD , Zorica Buser PhD , Hans-Jörg Meisel MD, PhD , S. Tim Yoon MD, PhD , Vincenzo Denaro MD , AO Spine Knowledge Forum Degenerative","doi":"10.1016/j.spinee.2024.09.007","DOIUrl":"10.1016/j.spinee.2024.09.007","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain and may require surgical treatment in case of persistent pain and/or neurological deficits. Conventional discectomy involves removing the herniated fragment and additional material from the disc space, potentially accelerating disc degeneration and contributing to chronic LBP. Conversely, by resecting the herniated fragment only, sequestrectomy may reduce postoperative LBP while increasing the risk of LDH recurrence.</div></div><div><h3>PURPOSE</h3><div>To compare discectomy versus sequestrectomy in terms of risk of reherniation, reoperation rate, complications, pain, satisfaction, and perioperative outcomes (operative time, blood loss, length of stay [LOS]).</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review and meta-analysis.</div></div><div><h3>METHODS</h3><div>A systematic search of PubMed/MEDLINE and Scopus databases was performed through May 1, 2024 for both randomized and nonrandomized studies. The search was conducted according to PRISMA guidelines. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. The quality of the evidence was evaluated according to the GRADE approach. Relevant outcomes were pooled for meta-analysis.</div></div><div><h3>RESULTS</h3><div>A total of 16 articles (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies) published between 1991 and 2020 involving 2009 patients were included for analysis. No significant differences were noted between discectomy versus sequestrectomy in terms of risk of reherniation (OR: 0.85, 95% CI: 0.57 to 1.26, p=.42), reoperation rate (OR: 0.95, 95% CI: 0.64 to 1.40, p=.78), and complications (OR: 1.03, 95% CI: 0.50 to 2.11, p=.94). Although LBP (MD: −0.06, 95% CI: −0.39 to 0.28, p=.74) and leg pain intensity (MD: 0.11, 95% CI: −0.21 to 0.42, p=.50) were similar postoperatively, significantly better outcomes were reported by patients treated with sequestrectomy at 1 year (leg pain: MD: 0.37, 95% CI: 0.19 to 0.54, p<.0001) and 2 years (LBP: MD: 0.19, 95% CI: 0.03 to 0.34, p=.02; leg pain: MD: 0.20, 95% CI: 0.09 to 0.31, p=.0005). Sequestrectomy also resulted in a higher patient satisfaction (OR: 0.60, 95% CI: 0.40 to 0.90, p=.01) and shorter operative time (MD: 8.71, 95% CI: 1.66 to 15.75, p=.02), while blood loss (MD: 0.18, 95% CI: −2.31 to 2.67, p=.89) and LOS (MD: 0.02 days, 95% CI: −0.07 to 0.12, p=.60) did not significantly differ compared to discectomy.</div></div><div><h3>CONCLUSIONS</h3><div>Based on the current evidence, discectomy and sequestrectomy do not significantly differ in terms of risk of reherniation, reoperation rate, and postoperative complications. Patients treated with sequestrectomy may benefit from a marginally higher pain improvement, better satisfaction outcomes, and a shorter operative time, although the clinical relevance of these differences","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 211-226"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331029","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}

引用次数: 0