Journal of Craniovertebral Junction and Spine最新文献

Background: Surgical decompression of degenerative lumbar central stenosis, in older patients, has been shown to provide improved outcomes compared to conservative treatment. However, in elderly patients lacking instability, there still lacks a consensus on whether fusion is needed following decompression and whether the argument extends to cases involving multiple levels.

Methods: Patients ≥ 65 years of age undergoing 2-4 multilevel laminectomies were included in the study. Intervertebral displacement was measured as the sagittal translation of each vertebral segment from L1 to S1 from flexion-extension films. Analyses of surgical and clinical outcomes were performed between decompression alone (MD) and decompression with fusion (MDF) groups through independent sample t-tests and Chi-square analyses. Propensity-score analysis was conducted to match patients from each group based on the number of levels decompressed and intervertebral stability.

Results: After groups were propensity-matched based on the number of levels of decompressed and baseline intervertebral displacement (L1-S1), differences were no longer found in baseline characteristics between groups. Estimated blood loss, operative time, and length of stay were all significantly lower in the MD group (all P < 0.001), with a lower rate of postoperative complications (7.7% vs. 30.8%, P = 0.075). At 1 year, MD and MDF groups experienced equivalent clinical outcomes, including radiculopathy, revision, and patient-reported measures.

Conclusion: Our data suggest that in elderly patients with similar baseline traits, multilevel decompression without fusion can provide improved perioperative outcomes with noninferior results at 1 year compared to with fusion.

Aim: The authors report experience with 14 cases where two transfacet screws were used for transfacetal fixation of each joint for stabilization of the lumbar spinal segment and one transfacet screw was used for transfacetal fixation of each joint for stabilization of the cervical spinal segment. The anatomical subtleties of the technique of insertion of screws are elaborated.

Materials and methods: During the period from July 2024 to October 2024, 14 patients having spinal segmental vertical instability related to lumbar canal stenosis were treated in Helmya Military Hospital by insertion of screws into each articular assembly by transfacetal technique. We positioned the patient, then made a wide surgical exposure, and inserted the screws in an appropriate angulation.

Results: During the period of follow-up, all treated patients had high patients' satisfaction rate with relief of symptoms, and spinal levels showed firm bone fusion. There was no complication related to the insertion of the screws. There was no incidence of screw misplacement or implant rejection.

Conclusions: Screw insertion into the firm and largely cortical bones of facets of the lumbar spine can provide robust fixation and firm stabilization of the spinal segment. The large size of the facets provides an opportunity to insert screws at each spinal segment. The firm and cortical bone material and absence of any neural or vascular structure in the course of the screw traverse provide strength and safety to the process.

Background: C2 transpedicular screw fixation is a biomechanically robust technique for upper cervical stabilization yet remains technically demanding due to anatomical complexity.

Study design: This was a retrospective nonrandomized comparative study.

Objective: Using validated radiological classification systems, this study aims to compare the accuracy, malposition rates, and complication profiles of C2 screw placement using both freehand and navigation-assisted approaches.

Materials and methods: Between 2010 and 2019, 100 patients who underwent C2 pedicle screw fixation at two different institutions were included in a retrospective study. There were 197 screws in all: 45 using a freehand technique (FH group) and 152 using a navigation-assisted approach (NA group). Using both Gertzbein-Robbins classification (GRC) and screw zone classification (SZC), screw accuracy was evaluated. Between the groups, demographic, clinical, and surgical data were statistically compared.

Results: The mean age was significantly higher in the NA group (75.37 ± 16.15) than in the FH group (46.29 ± 22.14) (P < 0.001). SZC analysis showed zone 2 placement in 86.7% (FH) and 87.5% (NA) of screws (P = 0.028). GRC analysis revealed that 13.3% of FH screws and 12.5% of NA screws were malpositioned (Grades B-D). No neurovascular complications or screw-related revisions occurred in either group. However, five patients in the NA group required revision due to wound dehiscence.

Conclusions: In C2 pedicle screw placement, both freehand and navigation-assisted techniques showed great accuracy and low complication rates. Although navigation systems provide improved accuracy in the hands of experienced users, the freehand technique remains a safe and efficient alternative. Surgeon experience, patient anatomy, and institutional resources should all help guide the choice of technique.

Context: Hospital procedural volume is often linked to outcomes and costs, but whether this relationship holds for posterior cervical fusion (PCF) remains unclear.

Aims: The objective of this study was to evaluate whether hospital PCF volume is associated with complications, discharge disposition, and hospital costs.

Settings and design: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS) from 2016 to 2022.

Subjects and methods: Elective PCF encounters were analyzed, with hospitals stratified by annual PCF volume (low, intermediate, high). Survey-weighted multivariable logistic regression estimated odds of cardiovascular complications, overall adverse events, and nonroutine discharge; linear regression assessed total costs and lengths of stay (LOS). Models adjusted for demographic, clinical, and hospital covariates.

Statistical analysis used: Survey-weighted regression with odds ratios (ORs), coefficients, and 95% confidence intervals (CIs). Significance was set at P < 0.05.

Results: We included 163,230 weighted elective PCF cases. Baseline characteristics differed across volume groups (P < 0.001) except for sex (P = 0.163). Compared with low-volume hospitals, high-volume hospitals had higher odds of cardiovascular complications (OR 1.87, 95% CI 1.70-2.06, P < 0.001), overall adverse events (OR 1.30, 95% CI 1.21-1.40, P < 0.001), and non-routine discharge (OR 1.09, 95% CI 1.02-1.16, P = 0.008). High-volume hospitals were also associated with higher total costs (coefficient: $4298; 95% CI $3468-$5128; P < 0.001), with no significant difference in LOS (P = 0.387).

Conclusions: Hospital PCF volume is tied to complications, nonroutine discharges, and higher costs, challenging the volume-outcome paradigm and underscoring adjustment for patient complexity and case mix in benchmarking and allocation.

Urge urinary incontinence (UI) due to brainstem disorders is not well known. Here, we report a case of UI due to a dural arteriovenous fistula (dAVF) in the craniocervical junction (CCJ). The cases were two men, aged 71 and 44 years, who developed the disease due to UI. Both patients developed quadriplegia within a few months, and further examination revealed dAVF of the CCJ. Treatment resolved the quadriplegia, but urinary problems persisted. Urge UI may be due to vascular disorders of the brain stem, so early diagnosis is important. If a dAVF is diagnosed, prompt surgical treatment is useful.

Personalized medicine (PM) is transforming spine care by shifting from standardized, "one-size-fits-all" treatments to patient-specific strategies informed by genetic, environmental, psychosocial, and technological factors. Spinal disorders remain a leading cause of disability and healthcare burden worldwide. PM offers a promising approach to addressing their complexity through genomics, advanced imaging, artificial intelligence (AI), and biomarker profiling, enabling tailored interventions that improve diagnostic accuracy, predict treatment outcomes, and guide decisions between surgical and conservative approaches. Key themes include genetic susceptibility to disc degeneration, integration of polygenic risk scores, genotype-based pharmacologic decisions, and AI-driven diagnostics and surgical planning. Innovative tools such as three-dimensional printing, robotic navigation, and wearable technologies are further personalizing care. However, significant barriers, such as high costs, fragmented data systems, workforce gaps, and ethical concerns, limit widespread adoption. Looking forward, emerging technologies like smart implants, clustered regularly interspaced short palindromic repeats-based therapies, and neural interfaces promise to reshape spine care. To fully realize these benefits, future efforts must address affordability, regulatory reform, and clinician training. While this review highlights promising trends, limitations include potential selection bias and rapidly evolving evidence that may outpace current literature. Overall, PM holds great promise to deliver more precise, effective, and patient-centered spine care.

Context: Semaglutide, a glucagon-like protein-1 receptor agonist used in diabetes and obesity management, has demonstrated perioperative benefits in other surgical populations. However, its role in spine surgery remains unclear.

Aims: This study aims to evaluate whether patients undergoing single-level lumbar fusion demonstrate: (1) fewer medical complications; (2) surgical complications; and (3) healthcare utilization as measured by readmissions and costs.

Settings and design: A retrospective cohort study using a national claims database from 2010 to 2021.

Subjects and methods: Patients with diabetes mellitus undergoing single-level lumbar fusion were identified and matched 1:5 using propensity scores based on age, sex, body mass index, smoking status, diabetes-related complications, insulin/metformin use, and Elixhauser Comorbidity Index (semaglutide: N =3452; controls: N =15,486). Outcomes included 90-day medical/surgical complications, readmissions, and costs. Multivariate logistic regression was used to calculate odds ratios, 95% confidence intervals, and P values, with statistical significance set at P < 0.003 after Bonferroni correction.

Statistical analysis used: Multivariate logistic regression for binary outcomes; cost comparisons conducted with appropriate statistical adjustments.

Results: No significant differences were observed in rates of cerebrovascular accidents, myocardial infarctions, venous thromboembolism, pneumonia, hypoglycemia, or surgical site infections (SSIs) (P > 0.05 for all). Semaglutide users had significantly lower 90-day readmission rates (8.7% vs. 11.4%, P < 0.0001) and reduced 90-day costs-of-care (P < 0.0001). A trend toward fewer SSIs was noted (2.5% vs. 3.2%, P = 0.018), though not statistically significant.

Conclusions: Semaglutide use before single-level lumbar fusion is associated with reduced 90-day readmissions and costs without increasing complication risk.

Multidisciplinary meetings (MDMs) are increasingly central to spinal oncology, where complex decision-making must balance neurological, oncological, biomechanical, and systemic factors. This review aims to analyze the structure, clinical value, limitations, and future directions of MDMs in the management of spinal tumors. Narrative review of the literature on MDMs in spinal oncology, focusing on their impact on diagnosis, treatment planning, surgical coordination, and longitudinal care. Articles were selected from PubMed and Google Scholar databases and supplemented with international consensus documents and high-level evidence on decision frameworks. MDMs improve diagnostic accuracy, reduce unnecessary surgeries, and enhance treatment sequencing and outcome, especially in cases of metastatic epidural spinal cord compression. Structured frameworks facilitate individualized decisions based on shared parameters. However, variability persists in access, role participation, and documentation practices. Emerging technologies may improve triage and equity, while standardized prognostic models support better outcome prediction. MDMs represent a critical element of modern spine tumor care but require standardization, institutional support, and integration of patient-centered tools. Future models should prioritize continuity across the disease course, equitable access, and the use of structured clinical frameworks to support data-driven and ethically grounded decision-making.

Introduction: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common treatments for cervical radiculopathy and myelopathy. While ACDF remains the gold standard, CDA is gaining popularity due to the benefit of motion preservation. However, national trends in outcomes between these procedures remain unclear.

Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients aged >18 who underwent ACDF or CDA between 2012 and 2022, using CPT codes 22551 and 22856. Annual rates of demographics, comorbidities, and 30-day complications were analyzed. Univariate analysis evaluated outcomes including readmission, reoperation, and length of stay (LOS).

Results: We identified 93,989 ACDF and 8708 CDA patients. From 2012 to 2022, the proportion of ACDF cases declined from 96.3% to 90.2%, while CDA cases increased from 3.7% to 9.9%. ACDF patients were older (55.7 vs. 46.8 years) and had higher body mass index (30.6 vs. 29.6) (P < 0.001). Diabetes increased in both cohorts (ACDF: 15.3%-20.7%; CDA: 5.9%-11.3%), as did hypertension (ACDF: +8.7%; CDA: +5.4%) (P < 0.001). Steroid use (+2.2%, P < 0.001) and chronic obstructive pulmonary disease (+1.0%, P = 0.021) rose in ACDF only. LOS decreased in ACDF (1.94-1.76 days, P < 0.001) but rose in CDA (1.10-1.15 days, P = 0.023). Readmissions increased in both (ACDF: 2.9%-3.25%; CDA: 0.74%-1.01%, P < 0.001).

Conclusion: CDA continues to show favorable short-term outcomes compared to ACDF but remains less utilized overall. These trends may guide surgical planning and patient counseling in cervical spine care.