Journal of Craniovertebral Junction and Spine最新文献

Introduction: There is a lack of consensus on the efficacy and safety of halo vest immobilization (HVI) in elderly patients. The objective of this study was to evaluate HVI's impact on outcomes in patients 60 years or older with cervical spine fractures.

Methods: This was a retrospective study of patients 60 years or older who underwent HVI for treatment of cervical spine fractures between January 2003 and March 2024 at a single institution. Key features of clinical presentation, outcomes at final follow-up, complications, and 1-year mortality rates were recorded.

Results: A total of 54 patients were included for analysis. The average time spent in a halo vest was 2.69 (0.58) months, and the average time to final follow-up was 5.49 (5.84) months. The most common fracture morphologies were the Hangman variant (29.6%) and type III odontoid (29.6%). Forty-nine patients (94.2%) out of 52 patients considered were successfully treated as defined by the lack of need for surgical intervention. Three patients (5.6%) experienced medical complications; two of the three patients died within 30 days of HVI. Lastly, 18 patients (33.3%) experienced HVI instrumentation-related complications, the most common of which was loose halo pins (13.0%).

Conclusion: HVI is associated with lower morbidity and mortality in elderly patients than previously reported and thus may be safely used in this population. However, providers should be mindful of initial clinical presentation and underlying comorbidities when weighing between surgical and nonsurgical intervention.

Introduction and objectives: A number of sophisticated methods have been used to identify the degree of vertebral rotation. This is an experimental model using saw bone and motorized device to identify the possible parameter of vertebral body axial rotation on simple radiographs.

Materials and methods: A sawbones model of the lumbar spine was used in this study. The sawbones was attached to a zigzag motorized rotation device. The device rotated the model vertebra by 1°. Fluoroscopic images were obtained for each pose. We developed a customized program to calculate the indices automatically. Three formulas were used to determine the ratio that corresponds to the rotation angle: (1) ratio of the total width of the vertebral body to the length between the lateral margin and center of two pedicles, (2) ratio of the total width of the vertebral body to the length between two pedicles, and (3) ratio of the length between two pedicles to the total width of the vertebral body.

Results: The correlation coefficient between the rotation angle and formula 1 was -0.9995. The correlation coefficient for the other two parameters was extremely low (0.036 for formula 2 and 0.16 for formula 3).

Conclusions: The rotation angle can be easily and accurately determined by calculating the abovementioned parameters on simple radiographs.

Background: Spinal metastases are the third most common site of metastasis, with around 10% of cancer patients experiencing symptomatic spine involvement. Despite poor overall survival, recent advances in targeted therapies and minimally invasive surgical techniques have made surgery a more viable option for managing metastatic spine disease.

Objective: Our study aims to identify perioperative risk factors associated with poor outcomes following spine surgery in the setting of spinal cord metastasis.

Methods: We used the National Surgical Quality Improvement Program data. Patients with metastatic spine disease undergoing spine surgery were identified. Our primary outcome measure was 30-day morbidity and mortality after surgery. Our secondary outcome was prolonged hospital stay. Logistic regression model for each outcome based on individual characteristics was developed.

Results: A total of 2109 patients were included. The 30-day morbidity and mortality rates were 19.1%. Significant predictors included smoking, more than 10% body weight loss, surgical urgency, dependent status, and preoperative albumin levels. In addition, 28.6% of patients experienced a prolonged hospital stay, with significant predictors including chemotherapy, surgical urgency, dependent status, preoperative hematocrit, neurological deficits, preoperative albumin levels, and surgical complexity.

Conclusion: Our study provides valuable insights into the risk factors associated with mortality, morbidity, and prolonged hospital stay in patients with spinal cord metastasis undergoing spine surgery. These identified factors can be instrumental in assisting clinicians with risk stratification, preoperative optimization, and postoperative care planning, ultimately improving patient outcomes. Further research and validation of these predictive models are warranted to ensure their generalizability and applicability in clinical practice.

Background: Lateral mass intrapedicular screw (LMIS) fixation was introduced in 2021 as a safe and simple alternative method for the fixation of the subaxial cervical spine in the treatment of various cervical spine diseases. The purpose of this study was to evaluate and compare the screw pullout strength of this new technique to the trajectories of two other major methods, the transpedicular screw (TPS) and lateral mass screw (LMS) methods.

Methods: Two hundred and three patients who underwent a cervical computed tomography (CT) scan at our institution were included in the study. A region of interest for each of the three trajectories was selected using axial slices of the cervical vertebra from C3 through C6, and the CT number (Hounsfield unit) was calculated.

Results: A total of 4872 data points were collected. The average age of the patients was 59.5 years. The male-to-female ratio was 135:68. The number of patients over the age of 65 was 93. The average CT numbers were 511.9 for TPS, 473.1 for LMS, and 598.5 for LMIS. There was a significant difference in the CT number among the three trajectories, even when adjusted for sex and age.

Conclusion: LMIS is a promising alternative to the common methods used for subaxial cervical spine fixation that has a significant pullout strength. This approach is worth considering in many patients.

Background: Intramedullary tumors represent only 10% of the spectrum of spinal tumors. Their management is not an easy task and depends essentially on the surgical resection which can be very challenging. The main aim of our study was to analyze the complication rate in intramedullary tumors as well as postoperative outcome after intramedullary tumor resection.

Methods: This was a retrospective analysis of data from the "DWG-Register" of patients who have undergone operative treatment for primary intramedullary tumors in 170 departments from January 2017 to May 2021. Since 2017, pre-, intra-, and postoperative data until demission from the hospital have been continually collected in the "DWG-Register" (a total of 179,955 in a period of 4 years in 170 departments).

Results: In total, 307 primary intramedullary tumors in the spine were identified; n = 248 (Group 1) had nonoperative complications and n = 59 had a complication related to the surgical procedure (Group 2); taking this in to account, die complication rate was 19.2%. The incidence of complications was: epidural hematoma n = 5 (8.4%), paresis n = 23 (38.9%), bowel/bladder dysfunction n = 15 (25.4%), wound infection n = 5 (8.4%), medullary injury n = 2 (3.4%), cerebrospinal fluid (CSF) leakage n = 15 (25.4%), and reintervention with hematoma, abscess, or surgical CSF leakage management in n = 22 (37.2%). The risk of permanent morbidity increased with a thoracic level, masculine gender, a long clinical history, presence of epidural hemorrhage, blood transfusion, and surgery on a recurrent tumor.

Conclusion: Medullary tumors are a rare entity with a relative high complication rate (20%). Improvement of symptoms postoperative depends on several factors such as operated level, masculine gender, a long clinical history, presence of epidural hemorrhage, blood transfusion, and surgery on a recurrent tumor. In rare pathologies such as intramedullary tumors, the data from the DWG Register can be used to describe spinal surgery care in "real life."

Aim and background: This study aimed to investigate the relationship between cervical spinal alignment and the center of gravity (COG) of the head in patients with Chiari malformation (CM) compared to healthy individuals. CM is characterized by the herniation of posterior fossa structures through the foramen magnum, potentially affecting head positioning and craniovertebral junction biomechanics. Understanding these biomechanical changes is crucial for improving diagnostic and treatment strategies.

Materials and methods: This retrospective study included 102 CM patients and 71 healthy controls. Radiological measurements were obtained from cervical X-rays, with seven reference points used to calculate angles related to head positioning and cervical curvature. Angular parameters, including cranial incidence (CI), cranial slope (CS), cranial tilt (CT), C7 slope (C7S), and spinocranial angle (SCA), were analyzed to determine correlations with the COG of the head. Statistical analyses were performed using t-tests, ROC analysis, and Pearson/Spearman correlation tests.

Results: CM patients had significantly higher CI, CT, STT, and SCA angles compared to controls (P < 0.05), indicating an anterior displacement of the head's COG. The CS angle was lower in CM patients (P < 0.05), reflecting a more flexed head position. No significant differences were found in C7S and C2T angles between groups, suggesting similar cervical curvature. ROC analysis demonstrated high sensitivity and specificity of the angular measurements for diagnosing CM.

Conclusion: CM patients exhibit distinct biomechanical alterations, including an anterior shift of the COG and a more flexed head position. These findings highlight the potential of angular measurements as noninvasive diagnostic tools for CM. Future studies should explore the implications of these biomechanical changes on CM progression and treatment outcomes.

Introduction: There is a paucity of information or guidelines regarding return to sports activities after posterior scoliosis surgery for adolescent idiopathic scoliosis (AIS).

Research question: Review the rate of return to sports and correlation to Lenke type following surgery for AIS in a tertiary center for pediatric spinal deformity.

Materials and methods: Ninety patients were identified to have undergone surgery for AIS from 2016 to 2017 and were sent a return to sport questionnaire. Sixty-six responses were received and analyzed. For comparison, Lenke classification was divided into Subgroup 1 (Lenke type 1 and 2), Subgroup 2 (Lenke type 3 and 4), and Subgroup 3 (Lenke type 5 and 6).

Results: The average age at the time of surgery was 14.81 (11-18) years. There were Lenke 1 (31), Lenke 2 (7), Lenke 3 (12), Lenke 4 (8), Lenke 5 (7), and Lenke 6 (1). The average number of levels fused was 10.27 (7-16). 89.3% of patients returned to school between 1 and 3 months. 19.6% of patients returned to physical education (PE) within 7-12 months, while 31.8% returned to running within 4-6 months. 7.5% of patients did not do PE and 18.2% never ran after surgery. 63.6% of patients returned to contact sports after surgery, majority within 7-12 months. 91% of patients felt that they were able to achieve their preoperative performance level. Comparing the subgroups, 92% of Subgroup 1 returned to school within 2 months, while majority of them returned to PE and running within 6 months. 60% of them returned to the same level of contact/noncontact sports level prior to surgery and 40% within 6 months. Patients in Subgroup 2 and 3 returned later to school. Patients in Subgroup 2 and 3 returned later to school, PE and running with less patients returning to contact/noncontact sports.

Conclusion: This study was able to identify Lenke classification as an important predictor of patients returning to school, PE, and running earlier along with return to preoperative levels of contact/noncontact sports.

Introduction: The Schanz screw system was developed for manual reduction of traumatic sagittal deformity of thoracic and lumbar vertebral fracture. The aim of this study was to evaluate clinical and radiological effectiveness of this system in the surgical treatment of thoracolumbar burst fractures (TLBFs) with severe kyphotic deformity without neurological deficit.

Materials and methods: A retrospective analysis was conducted on 101 patients who underwent short posterior fixation with transpedicular Schanz screws between 2012 and 2022 for single-level (T12 or L1) TLBFs. Clinical outcomes (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) and radiological parameters (sagittal alignment and spinal canal dimensions) were assessed with a minimum 2-year follow-up.

Results: A total of 101 TLBFs patients with an average age of 48.1 years (range: 26-65) were included in this study. Intraoperative reduction of the Sagittal Kyphosis (SK) achieved an average of 12.31° ± 8.1°°, with a mean sagittal index (SI) correction of 15.23° ± 4.24°. At a minimum 2-year follow-up, the total amount of kyphosis reduction was maintained, with no significant difference between immediate postoperative and early follow-up measurements. Load-sharing score >8, body mass index >26, preoperative radiological parameters (SI, SK, and anterior body height [ABH] ratio), and postoperative ABH ratio were identified as significant predictors of correction loss >10°. At the final follow-up, all patients had minimal disability, with an average ODI of 7.9%. VAS scores also showed significant improvement, indicating substantial clinical effectiveness of the Schanz screw system in managing these complex spinal injuries.

Discussion: The Schanz screw system proved to be an effective and reliable method for treating TLBFs with severe kyphosis. The system's ability to achieve and maintain deformity reduction, coupled with favorable clinical outcomes, supported its use in the surgical management of these challenging spinal injuries.

Conclusion: The Schanz screw system offered a viable treatment option for severe kyphotic deformity in TLBFs.

Context: Thoracolumbar spine fractures are frequent and the treatments are debatable because of the lack of randomized control studies and of low number of patient series. Percutaneous Vertebral Body Augmentation using SpineJack prosthesis (SJPVBA) followed by bracing is an available mini-invasive technique. The aim of the study was to assess the imaging and functional results of the largest homogeneous cohort of SJPVBA.

Materials and methods: Every patient who sustained a posttraumatic thoracolumbar vertebral fractures treated by SJPVBA from the January 6, 2012, to January 6, 2020, was retrosepctively included. The main outcome measure was the height of the vertebral body (anterior/middle/posterior parts) on the sagittal computed tomography scan. The secondary outcome measures were a 11-point Likert scale for the pain and the Oswestry Disability Questionnaire for the quality of life. All the data were compared at different times: preoperative versus day after the procedure versus at least 3 months versus (if disposable) a long-term special consultation just before the publication.

Results: SPJVBA is a simple, quick (52-min-long on average) reliable, efficacious method to significantly improve the vertebral height (+3.5 mm and 4.3 mm of the anterior and middle vertebral heights, P < 10^-5), to correct kyphosis and relieve pain (-6.5/10 on the Likert scale for pain). We also showed that there is a significant vertebral height decrease between day 1 (-2.1 mm and - 0.7 mm of the anterior and middle vertebral heights, P < 10^-5 and 0.005, respectively) and 3 months but not between 3 months and the last consultation with a mean follow-up of 37 months (-0.1 mm and - 0.2 mm of the anterior and middle vertebral heights, P = 0.277 and 0.4289, respectively).

Conclusions: SPJVBA is a simple, quick, reliable, efficacious method to improve the vertebral height, to correct kyphosis and relieve pain.