Spine Journal最新文献

Background context: Posterior cervical foraminotomy (PCF) is a motion-preserving procedure for cervical radiculopathy. Traditional guidelines recommend limiting facet resection to less than 50% to preserve spinal stability, a threshold derived from cadaveric biomechanical studies. However, the clinical relevance of this limit has not been fully validated.

Purpose: To evaluate whether facet joint resection exceeding 50% during PCF adversely affects clinical outcomes or radiographic stability.

Study design/setting: Retrospective cohort study conducted at a single tertiary referral center.

Patient sample: A total of 85 patients (204 operated levels) who underwent PCF between 2005 and 2023 were included. Patients were categorized into ≥50% resection (Group O, n=58) and <50% resection (Group C, n=27).

Outcome measures: Clinical outcomes were assessed using self-report instruments, including the Visual Analog Scale (VAS) for neck and arm pain, the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) score. Physiologic parameters were evaluated on radiographs and included C2-C7 Cobb angle, sagittal vertical axis, segmental range of motion (ROM), gliding distance, interspinous distance, disc height, bone bridge formation, and the presence of foraminal restenosis. Functional outcomes were not applicable in this cohort.

Methods: Clinical and radiographic data were assessed preoperatively and at 6 months and 2 years postoperatively. Segment-level analyses were performed using linear mixed-effects models to account for clustering within patients and to evaluate the association between the extent of resection and radiographic changes.

Results: Both groups demonstrated significant postoperative improvement in VAS and NDI scores without inter-group differences at any time point. Spinal alignment and global motion parameters remained comparable during follow-up. Bone bridge formation was more frequent in the ≥50% resection group (66.7% vs. 26.3%, p=.002). At the segmental level, greater resection was significantly associated with modest reductions in gliding (B = -0.016, p=.004) and interspinous distance (B = -0.108, p<.001) at 2 years, without evidence of instability.

Conclusions: Facet resection exceeding 50% during PCF did not compromise clinical outcomes or radiographic stability at 2 years, suggesting similar short-term performance to limited resection. Minor radiographic changes such as accelerated bone bridge formation, were observed, warranting further prospective evaluation of long-term stability. These preliminary findings suggest that surgeons may prioritize complete neural decompression over strict adherence to the 50% threshold when anatomically necessary.

Background context: Low back pain (LBP) is a major global public health concern. However, few large-scale prospective cohort studies have comprehensively examined the relationships among multiple modifiable lifestyle factors, cardiovascular health metrics, and LBP risk.

Purpose: To investigate the associations between healthy lifestyle behaviors, Life's Essential 8 (LE8), and LBP incidence, and identify potentially optimal lifestyle patterns for LBP prevention.

Study design/setting: Large-scale prospective cohort study based on the UK Biobank.

Patient sample: This study included 140,313 participants. During follow-up, 10,036 individuals developed incident LBP, whereas 130,277 remained LBP-free.

Outcome measures: Seven lifestyle factors and 8 cardiovascular health (CVH) metrics were used to calculate lifestyle and LE8 scores. The associations among the overall lifestyle category (ideal, intermediate, and poor), LE8 category (high, moderate, and low CVH), individual lifestyle factors, and incident LBP were assessed.

Methods: Cox proportional hazards models examined the associations among lifestyle score, LE8 CVH score, and LBP risk. In addition, population attributable fractions and cumulative incidence were estimated and sensitivity analyses were performed.

Results: Over a median follow-up of 13.54 years, participants in the intermediate (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.05-1.21) or poor (HR: 1.25, 95% CI: 1.18-1.32) lifestyle categories exhibited significantly higher risks of developing LBP than those in the ideal lifestyle category. Similarly, compared with the high CVH group, individuals with moderate (HR: 1.06, 95% CI: 0.95-1.20) or low (HR: 1.28, 95% CI: 1.10-1.44) scores had elevated LBP risk. Adherence to an ideal lifestyle and maintaining a high CVH status may decrease the risk of incident LBP by 12.26% and 9.29%, respectively. Among the individual factors, prolonged sedentary time (12.62%), elevated body mass index (11.25%), unhealthy sleep patterns (7.01%), abnormal sleep duration (5.28%), current or former smoking (4.61%), insufficient physical activity (3.64%), and poor glycemic status (0.58%) independently associate with increased LBP risk.

Conclusions: A poor lifestyle and low LE8 CVH scores are associated with a higher risk of new-onset LBP. Promoting healthy lifestyles and improved LE8 scores may help mitigate the burden of LBP.

Background context: Spinal lumbar spine stenosis is the most common indication for spinal surgery. A few prospective studies report longer-term outcomes for this population, especially considering radiographic parameters.

Purpose: This study aimed to examine the longer-term patient-rated outcomes (PROs) and radiographic measures in surgically treated lumbar spinal stenosis patients, compare those who underwent revision surgery to those who did not, and identify factors correlated with requiring revision surgery.

Study design: Prospective study of consecutive patients treated for lumbar spinal stenosis.

Patient sample: 211 patients surgically treated for spinal stenosis in a prospective observational cohort with more than 10 years of follow-up OUTCOME MEASURES: Patient-rated outcomes (PROs) evaluated leg pain, back pain, disability, and general health. Radiographic measurements include pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis.

Methods: PROs were prospectively collected preoperatively and at 3 months, 1 year, 2 years, and 3 years postoperatively. In the present study an attempt was made to follow-up with patients on a longer-term. PROs were compared to normative values, and longitudinal regression models for repeated measures were used to compare PROs between patients who had revision and those who did not.

Results: Out of 211 patients, 50/192 (26%) had at least 1 revision surgery. 98 patients completed PROs and radiographic assessments with a median follow-up time of 12 years (range 9-15 years). By 12 years, the results demonstrated that these patients, on average, had a significant loss of general and spine-specific function initially achieved through surgery while maintaining a relative improvement in pain compared to baseline scores. Compared to normative values, these 98 patients had worse back pain, leg pain, and disability 12 years after surgery (p<0.001). Patients who had revision had worse SF-36 mental functioning (SF-36 MCS) before surgery (p=0.025). Patients who had undergone revision had worse disability, physical function, and pain compared to those who did not have revision surgery. At 12 years, patients who underwent revision surgery had clinically worse lumbar lordosis (12 years: 47° vs. 41°, p=0.010) and pelvic incidence-lumbar lordosis mismatch (10° vs. 16°, p=0.048).

Conclusion: Surgery initially improved this patient cohort PROs but yielded lasting benefits only for pain scores, not for function, at the 12-year follow-up period. Compared to the normative population, this cohort exhibited a lower quality of life in the long-term after surgery. Patients who had revision surgery reported worse physical functioning and pain compared to patients who did not require revision surgery.

Background context: Correction beyond age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) targets (age-adjusted PI-LL overcorrection) is believed to increase the risk of proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery. However, this association has not been analyzed after adjusting for confounding variables.

Purpose: To investigate whether age-adjusted PI-LL overcorrection independently increases the risk of PJF after accounting for potential confounders.

Study design: Retrospective cohort study using prospectively collected data from a single tertiary spine center.

Patient sample: A total of 177 patients who underwent lower thoracic (T8-T10) to sacropelvic fusion for ASD between 2015 and 2022, with a 2-year follow-up.

Outcome measures: PJF, defined as structural failure including proximal junctional angle ≥20°, vertebral fracture, fixation failure, myelopathy, or revision surgery.

Methods: Patients were grouped by 6-week postoperative PI-LL status into under-, matched-, and over-correction groups based on age-adjusted PI-LL targets. Unadjusted and confounder-adjusted logistic regression analyses were conducted to evaluate the association between PI-LL correction and PJF. Confounding variables were those predictive of PJF and significantly imbalanced across correction groups.

Results: The unadjusted analysis showed a significantly higher PJF incidence in the overcorrection group compared to the matched correction group (47.2% vs. 27.1%, p=.004). However, after adjustment, age-adjusted PI-LL correction was no longer associated with PJF risk. Advanced age (odds ratio [OR]=1.075, p=.048), lack of transverse process hook fixation (OR=5.225, p=.001), and high preoperative thoracic kyphosis (OR=1.046, p=.003) were independent risk factors for PJF.

Conclusions: Overcorrection relative to age-adjusted PI-LL target does not independently increase PJF risk when key confounders are considered. Surgeons should focus on individual patient and surgical factors-particularly age, thoracic alignment, and prophylactic strategies-rather than relying solely on PI-LL correction thresholds in ASD surgical planning.

Background context: Whether the width of laminectomy is a risk factor for the development of C5 palsy (C5P) remains controversial, partly due to confounding variables inherent in retrospective clinical studies.

Purpose: To investigate the relationship between laminectomy width, posterior shift of the spinal cord, and elongation of the anterior rootlets using an animal model.

Study design: Basic in vivo experimental study.

Methods: Eighteen Sprague-Dawley rats were randomly assigned to three groups: Group L (limited laminectomy, N = 6), Group W (wide laminectomy, N = 6), and Group S (sham surgery, N = 6). Animals were evaluated pre and postoperative days 3, 10, and 14. The widths of the laminectomy, posterior spinal cord shift, and anterior rootlet length were quantified using computed tomography-myelogram images. Motor evoked potentials (MEPs) were recorded from the deltoid (C5-C6 innervated) and triceps brachii (C7-T1 innervated) muscles.

Results: Postoperative posterior shift of the cervical cord was observed in both experimental groups. However, Group W showed significantly greater displacement than Group L at the C4-C6 vertebral levels on postoperative days 10 and 14, corresponding to a greater elongation of the C5-C7 anterior rootlets. MEP latency of the deltoid muscle was significantly longer in Group W than in Group L at postoperative days 10 and 14, and significantly longer than in Group S at all postoperative time points. Conversely, no statistically significant differences in MEP latency of the triceps brachii were observed among all groups.

Conclusions: Limited laminectomy may prevent C5P by minimizing elongation of the intradural anterior rootlets caused by gradual posterior shift of the cervical spinal cord.

Clinical significance: This study provides insights for clinicians regarding C5 palsy prevention. By limiting the width of degree of laminectomy, posterior shift of the spinal cord, and thus elongation of the anterior rootlets, can be reduced. These findings support the hypothesis that root tethering from spinal cord shift is a likely mechanism of C5P.