Spine Journal最新文献

Background context: Scoliosis is a potential postoperative complication of various pediatric cardiothoracic conditions.

Purpose: To investigate the incidence of scoliosis in pediatric lung transplant patients and explore the factors associated with its development.

Study design: Retrospective observational study.

Patient sample: About 330 consecutive lung transplant recipients at a single institution between April 2002 and June 2022.

Outcome measures: The incidence of scoliosis.

Methods: After excluding 45 patients with <1 year of follow-up, 285 patients were analyzed: 43 pediatric (≤17 years) and 242 adult (>18 years) patients. Data on baseline demographics, Cobb angle measurements pre- and posttransplant, and lung volumes at 1-year posttransplant in pediatric patients were collected. The prevalence of scoliosis was compared between pediatric and adult patients. Additionally, the impact of lung volume differences (right minus left) on scoliosis progression was assessed.

Results: Pediatric (n=43) and adult (n=242) patients had a mean age of 10.3 and 44.9 years, respectively. Scoliosis was significantly more prevalent in pediatric patients, with 30.2% having a Cobb angle >10° and 13.9% having a Cobb angle >20°, compared to 11.5% and 1.6% in adults, respectively. Pediatric patients with Cobb angles >20° exhibited significant lung volume differences 1-year posttransplant. Lung volume disparities increased the risk of scoliosis progression, particularly in patients with unilateral lung collapse.

Conclusions: Pediatric lung transplant recipients have a higher incidence of significant scoliosis than adult recipients. Posttransplant lung volume disparities, especially in cases of unilateral lung collapse, may contribute to scoliosis progression. Routine spinal assessments are necessary for managing scoliosis in pediatric lung transplant patients to prevent curvature progression and ensure long-term musculoskeletal health.

Background context: Associations between magnetic resonance imaging (MRI)-detected lumbar intervertebral disc degeneration (LDD) and LBP are often of modest magnitude. This association may be larger in specific patient subgroups.

Purpose: To examine whether the association between LDD and LBP is modified by underlying genetic predispositions to pain.

Study design: Cross-sectional study in UK Biobank (UKB) and Twins UK.

Patient samples: A genome-wide association study (GWAS) of the number of anatomical chronic pain locations was conducted in 347,538 UKB participants. The GWAS was used to develop a genome-wide polygenic risk score (PRS) in a holdout sample of 30,000 UKB participants. The PRS model was then used in analyses of 645 TwinsUK participants with standardized LDD MRI assessments.

Outcome measures: Ever having had LBP associated with disability lasting ≥1 month (LBP1).

Methods: Using the PRS as a proxy for "genetically-predicted propensity to pain", we stratified TwinsUK participants into PRS quartiles. A "basic" model examined the association between an LDD summary score (LSUM) and LBP1, adjusting for covariates. A "fully-adjusted" model also adjusted for PRS quartile and LSUM x PRS quartile interaction terms.

Results: In the basic model, the odds ratio (OR) of LBP1 was 1.8 per standard deviation of LSUM (95% confidence interval [CI] 1.4-2.3). In the fully-adjusted model, there was a statistically significant LSUM-LBP1 association in quartile 4, the highest PRS quartile (OR=2.5 [95% CI 1.7-3.7], p=2.6×10^-6), and in quartile 3 (OR=2.0, [95% CI 1.3-3.0]; p=.002), with small-magnitude and/or nonsignificant associations in the lowest 2 PRS quartiles. PRS quartile was a significant effect modifier of the LSUM-LBP1 association (interaction p≤.05).

Conclusions: Genetically-predicted propensity to pain modifies the LDD-LBP association, with the strongest association present in people with the highest genetic propensity to pain. Lumbar MRI findings may have stronger connections to LBP in specific subgroups of people.

Background context: Lumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups.

Purpose: To evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results.

Study design: Retrospective analysis.

Patient sample: We retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years.

Outcome measure: The following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters.

Methods: From 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected.

Results: Compared to Group L, Group E exhibited a lower intraoperative blood loss (p<.001), higher final main curve correction rate (p=.037), smaller postop compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate postop (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006).

Conclusions: This study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

Background context: Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear.

Purpose: To determine the influence of DTs on PROs 1 year after cervical spine surgery.

Study design: Retrospective cohort.

Patient sample: Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation.

Outcome measures: Analysis included patients' characteristics, perioperative complications, and PROs both preoperatively and at 1 year postoperatively.

Methods: This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and 1 year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into 2 groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs.

Results: Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs.

Conclusions: Patients with dural tears showed nearly equivalent postoperative outcomes at 1 year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management.

Background: Intraoperative 3D imaging with cone-beam CT (CBCT) improves assessment of implant position and reduces complications in spine surgery. It is also used for image-guided surgical techniques, resulting in improved quality of care. However, in some cases, metal artifacts can reduce image quality and make it difficult to assess pedicle screw position and reduction.

Purpose: The objective of this study was to investigate whether a change in CBCT acquisition trajectory in relation to pedicle screw position during dorsal instrumentation can reduce metal artifacts and consequently improve image quality and clinical assessability.

Study design: Experimental cadaver study.

Methods: A human cadaver was instrumented with pedicle screws in the thoracic and lumbar spine region (Th11 to L5). Then, the acquisition trajectory of the CBCT (Cios Spin, Siemens, Germany) to the pedicle screws was systematically changed in 5° steps in angulation (-30° to +30°) and swivel (-25° to +25°). Subsequently, radiological evaluation was performed by 3 blinded, qualified raters on image quality using 9 questions (including anatomical structures, implant position, appearance of artifacts) with a score (1-5 points). For statistical evaluation, the image quality of the different acquisition trajectories was compared to the standard acquisition trajectory and checked for significant differences.

Results: The angulated acquisition trajectory significantly increased the score for subjective image quality (p<.001) as well as the clinical assessability of pedicle screw position (p<.001) with particularly strong effects on subjective image quality in the vertebral pedicle region (d=1.61). Swivel of the acquisition trajectory significantly improved all queried domains of subjective image quality (p<.001) as well as clinical assessability of pedicle screw position (p<.001).

Conclusions: In this cadaver study, the angulation as well as the swivel of the acquisition trajectory led to a significantly improved image quality in intraoperative 3D imaging (CBCT) with a constant isocenter. The data show that maximizing the angulation/swivel angle towards 30°/25° provides the best tested subjective image quality and enhances clinical assessability. Therefore, a correct adjustment of the acquisition trajectory can help to make intraoperative revision decisions more reliably.

Clinical significance: The knowledge of enhanced image quality by changing the acquisition trajectory in intraoperative 3D imaging can be used for the assessment of critical screw positions in spine surgery. The implementation of this knowledge requires only a minor change of the current intraoperative imaging workflow without additional technical equipment and could further reduce the need for revision surgery.

Background context: Upper cervical complex fractures are associated with high rates of neurological damage and mortality. The Dickman's classification is widely used in the diagnosis of upper cervical complex fractures. However, it falls short of covering the full spectrum of complex fractures. This limitation hinders effective diagnosis and treatment of these injuries.

Purpose: To address the diagnostic gap in upper cervical complex fractures, the study introduces a novel classification system for these injuries, assessing its reliability and usability.

Study design: Proposal of a new classification system for upper cervical complex fractures.

Patient sample: The study comprised the clinical data of 242 patients with upper cervical complex fractures, including 32 patients treated at our hospital, along with an additional 210 cases from the literature.

Outcome measures: The interobserver and intra-observer reliability (kappa coefficient, κ) of this classification system were investigated by 3 spine surgeons. The 3 researchers independently reevaluated the upper cervical complex fracture classification system 3 months later.

Methods: The proposed classification categorizes upper cervical complex fractures into 3 main types: Type I combines odontoid and Hangman's fractures into 2 subtypes; Type II merges C1 with odontoid/Hangman's fractures into 3 subtypes; and Type III encompasses a combination of C1, odontoid, and Hangman's fractures, divided into 2 subtypes. Meanwhile, a questionnaire was administered in 15 assessors to evaluate the system's ease of use and clinical applicability.

Results: A total of 45 cases (18.6%) unclassifiable by Dickman's classification were successfully categorized using our system. The mean κ value of inter-observer reliability was 0.783, indicating substantial reliability. The mean κ value of intraobserver reliability was 0.862, indicating almost perfect reliability. Meanwhile, thirteen assessors (87.7%) stated that the classification system is easy to remember, easy to apply, and they expressed intentions to apply it in clinical practice in the future.

Conclusions: This system not only offers high confidence and reproducibility but also serves as a precise guide for clinicians in formulating treatment plans. Future prospective applications are warranted to further evaluate this classification system.

Background context: Intervertebral disc degeneration (IDD) affects numerous people worldwide. The role of inflammation is increasingly recognized but remains incompletely resolved. Peripheral molecules could access neovascularized degenerated discs and contribute to the ongoing pathology.

Purpose: To assess a large array of plasma molecules in patients with IDD to identify biomarkers associated with specific spinal pathologies and prognostic biomarkers for the surgery outcome.

Design: Prospective observational study combining clinical data and plasma measures.

Patient sample: Plasma samples were collected just before surgery. Extensive clinical data (age, sex, smoking status, Modic score, glomerular filtration rate, etc.) were extracted from clinical files from 83 patients with IDD undergoing spine surgery.

Outcome measures: Recovery 2 months postsurgery as assessed by the treating neurosurgeon.

Methods: Over 40 biological molecules were measured in patients' plasma using multiplex assays. Statistical analyses were performed to identify associations between biological and clinical characteristics (age, sex, Body Mass Index (BMI), smoking status, herniated disc, radiculopathy, myelopathy, stenosis, MODIC score, etc.) and plasma levels of biological molecules.

Results: Plasma levels of Neurofilament Light chain (NfL) were significantly elevated in patients with myelopathy and spinal stenosis compared to herniated disc. Plasma levels of C- reactive protein (CRP), Neurofilament Light chain (NfL), and Serum Amyloid A (SAA) were negatively associated, while CCL22 levels were positively associated with an efficient recovery 2 months postsurgery.

Conclusions: Our results show that CRP and CCL22 plasma levels combined with the age of the IDD patient can predict the 2-month postsurgery recovery (Area Under the Curve [AUC]=0.883). Moreover, NfL could become a valuable monitoring tool for patients with spinal cord injuries.