Journal of Craniovertebral Junction and Spine最新文献

Objective: The odontoid process is an important anatomical structure providing a balance of mobility and stability at the craniocervical junction, with structural and biomechanical associations, and morphology that can be quantified with various measurements. The odontoid tilt angle is a measurement that must be accurately performed and can guide further investigations.

Materials and methods: Retrospective analysis of 100 cervical spinal magnetic resonance imaging was performed on patients investigated for neck pain, with a known history of scoliosis, and compared with 50 control patients. Posterior odontoid tilt and Cobb angles were measured by a musculoskeletal radiology fellow and a fellowship-trained musculoskeletal radiologist with more than 10 years of experience, with descriptive statistics then performed on the measurements.

Results: One hundred and thirty-two patients met the inclusion criteria, across both the scoliosis and control groups. 9 (18%) patients from the control group demonstrated posterior odontoid tilt, compared with 35 (43%) of patients in the scoliosis group. A range of scoliosis curve morphologies were demonstrated: 62 thoracolumbar, 10 thoracic, 9 lumbar, and 1 cervicothoracic, with average Cobb angles of 24.3°, 26.9°, 23.4, and 54°, respectively. There was good interobserver agreement for both measurements and a statistically significant difference in the posterior odontoid tilt measurements between groups (99% confidence interval, P = 0.0064).

Conclusion: We recommend opportunistically assessing for the posterior odontoid tilt (Leaning odontoid tower of BRUMES (Botchu; Raja Rasul; Uldin; Morgan;Elias; Sonal, Shashank, Shirodkar). In cases with a posterior tilt angle >5°, we recommend whole spine imaging to assess for scoliosis in the thoracolumbar spine.

A styloid process >3 cm is known as Eagle's syndrome (ES). This syndrome can lead to neurovascular symptoms. Traumatic atlantoaxial rotatory subluxation (AARS) is very rare in adults. We diagnosed AARS in a patient with ES after high-energy trauma. Posterior C1-2 stabilization was performed under traction. We wanted to discuss the mechanism of AARS in ES based on this case.

Introduction: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used to treat lumbar spine pathologies such as degenerative disc disease and spondylolisthesis. Despite its advantages, standard MIS-TLIF has limitations, including restricted visualization, radiation exposure, and technical challenges. Navigation-assisted modified MIS-TLIF has been developed to enhance precision and safety. This study compares the clinical and radiological outcomes of navigation-assisted modified MIS-TLIF versus standard MIS-TLIF.

Materials and methods: This retrospective study included 66 patients who underwent lumbar fusion surgery between April 2020 and March 2023. Patients were divided into two groups: 30 underwent navigation-assisted modified MIS-TLIF and 36 underwent standard MIS-TLIF. Inclusion criteria included chronic low back pain due to lumbar degenerative conditions unresponsive to conservative management and single level pathology. Parameters evaluated included operative time, blood loss, hospital stay, complication rate, screw placement accuracy, fusion status (Bridwell grading), and functional outcomes assessed using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS).

Results: The navigation-assisted group demonstrated lower blood loss, shorter hospital stays, and fewer complications. Pedicle screw placement accuracy was higher (96.7% vs. 88.9%). Fusion rates were comparable (Grade 1 fusion: 93.3% vs. 88.9%). Both groups showed significant improvement in ODI and VAS scores over 1 year. Final ODI and VAS scores were slightly better in the standard MIS-TLIF group but not statistically significant.

Conclusion: Navigation-assisted modified MIS-TLIF offers improved accuracy, reduced complications, and enhanced perioperative outcomes as compared to standard MIS-TLIF, while achieving similar long-term clinical and radiological results.

Background: Facet joint degeneration represents a common source of low back pain and contributes to the development of lumbar spinal stenosis (LSS). We sought to identify the prevalence of facet syndrome in patients with LSS planned to undergo decompression and placement of facet cages (FFX^® device, SC Medica) and the relationship of medial branch block (MBB) test results with postoperative visual analog scale (VAS) pain scores.

Materials and methods: LSS patients undergoing decompression and placement of facet cages performed for a period of 1 year were included. Patients who did not undergo an MBB test prior to surgery were excluded.

Results: A total of 22 patients met the inclusion criteria for the study. The mean age was 69.4 ± 12.9 years with a majority of patients (63.6%) being female. Sixteen of the 22 (73%) patients had a positive MBB test. VAS scores were similar at baseline between the MBB positive and negative subgroups. The improvement in postoperative VAS back scores compared to baseline was greater for patients with a positive block test compared to those with a negative test (-4.7 vs. -1.8, respectively). As expected with the decompression part of the procedure, the improvement of VAS leg scores was similar for patients with positive and negative block tests compared to baseline.

Conclusion: The present study documents the high prevalence of facet syndrome in patients with LSS and the clinical benefits associated with the use of facet fusion cages to reduce facet-generated back pain.

Study design: The study design was a retrospective cohort.

Objective: The objective of the study was to validate the relationship between Hounsfield units (HU) and subsidence, including multilevel anterior cervical discectomy and fusion (ACDF). Cage/graft subsidence commonly occurs after ACDF. Prior work on 1-level ACDF found increased subsidence rates in patients with lower HUs.

Materials and methods: Adults who underwent 1-3 level ACDF at a tertiary center and had preoperative computed tomography scans were included (2018-2022). HUs were assessed ~5 mm caudal to the superior endplate. Six-month postoperative radiographs were evaluated for cage/graft positioning, screw loosening, and subsidence. Receiver operating characteristic curves and area under the curve (AUC) assessed the predictive value of segmental/minimum/maximum HU for screw loosening and/or subsidence.

Results: Forty-two patients (82 levels) were included - demographics were similar among patients with versus without subsidence at any level. Average HU, segmental HU, segmental HU above and below 343.7 HU, minimum HU, and maximum HU were similar between patients with versus without subsidence at any level. Among the HU measurements, the maximum AUC was 0.554 (95% confidence interval 0.421-0.687) for screw loosening as predicted by minimum HU with a cutoff of 313 HU. Subsidence was more associated with middle positioning compared to anterior (28.0% vs. 10.5%, P = 0.046).

Conclusions: Contrary to prior literature, this study found no association and minimal predictive ability of segmental, minimum, or maximum HU values and subsidence or screw loosening after 1-3 level ACDF. Middle positioning was associated with cage/graft subsidence. This suggests that central positioning of the cage/graft is a risk factor for subsidence, potentially due to softer cancellous bone centrally.

Introduction: Favorable clinical outcomes have been reported for cervical disc arthroplasty (CDA), particularly in preserving motion and reducing adjacent segment disease compared with anterior cervical discectomy and fusion. However, evidence on the uptake of CDA in clinical practice remains limited. This study aimed to analyze Australian population trends in CDA over the past 6 years.

Methods: The 6-year incidence of CDA in adult patients from 2019 to 2024 was analyzed using the Medicare Benefits Schedule (MBS) database. Data were stratified by sex and year, with population adjustments to account for demographic changes over the study period.

Results: A total of 4216 CDA procedures were performed in Australia under the MBS over the 6-year period. The annual mean case volume was 702.7 cases. Procedure volumes remained relatively stable from 2019 to 2021, with a reduction in case numbers thereafter. The highest concentration of procedures occurred in the 35-54 (62.28%) age group (P < 0.001). The distribution across sex was similar, with 2147 cases (50.93%) in males and 2069 cases (49.07%) in females.

Conclusions: Although there is growing evidence supporting the safety and efficacy of CDA, its utilization in Australia has remained stable over the past 6 years, with the highest uptake among young to middle-aged patients. Further analysis of utilization trends may help identify factors influencing adoption and guide future surgical practice.

Background: The surgical treatment of high-grade spondylolisthesis remains a complex and multifaceted task requiring an individual approach in each case. The diverse treatment modalities and conflicting techniques used in this treatment indicate a limited understanding of this condition in modern medicine. In this study, we report our results on implementing a modified in situ technique for the surgical treatment of high-grade spondylolisthesis.

Hypothesis: In high-grade lumbar spondylosis, especially grades IV and V, posterior fixation using a specially designed transpedicular screw is effective in terms of adequate decompression and reliable stabilization leading to intervertebral fusion.

Methods: This study is a prospective review of 24 consecutive patients with grades IV and V lumbar spine malalignment who underwent surgery between 2019 and 2022. The surgical technique was unique in that it allowed the surgeon to perform extensive spinal canal decompression, deformity reduction, and fixation with custom-designed pedicle screws in a single stage. Patients were followed at 3, 6, and 12 months and then annually. Clinical, radiological, visual analogue scale (VAS), and Oswestry disability index (ODI) data were collected.

Results: Among 24 patients with high-grade spondylolisthesis at the L5-S1 level, good results were achieved in 62.5% of patients. The median follow-up period was 16 months (12; 24 months). All patients, except one case, had bone fusion at the level of vertebral fixation within 6 months. The radiographic parameters after surgery showed statistically significant differences. No deep infections were recorded. The mean VAS and ODI scores demonstrated improvement in pain and disability.

Conclusions: This procedure allows for adequate reduction of severe spondylolisthesis with favorable clinical and radiological results. Despite the need for surgical intervention, the procedure was safe and reproducible.

Background: Lumbar spondylolisthesis often necessitates surgical intervention when conservative treatments fail. Posterior lumbar interbody fusion (PLIF) using either polyetheretherketone (PEEK) cages or autografts is a common approach, but their comparative outcomes remain unclear. This study compares the clinical and radiologic outcomes of these two techniques in patients with Grade 1 and 2 lumbar spondylolisthesis.

Materials and methods: In this retrospective cohort study, 101 patients underwent PLIF with either a PEEK cage (n = 48) or autograft (n = 53). Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiographic parameters, intraoperative metrics, and complications were also analyzed.

Results: Preoperative characteristics, including VAS, ODI, and radiographic parameters, were similar between the groups (P > 0.05). Postoperatively, the cage group showed significantly greater ODI improvement (P = 0.012), while VAS scores were comparable (P = 0.773). The cage group had higher intraoperative blood loss (P = 0.022), but operative time, complications, and hospital stay were similar. Radiographically, the cage group achieved better local lumbar lordosis postoperatively (P = 0.038).

Conclusion: Both PEEK cages and autografts are effective for PLIF in low-grade spondylolisthesis, offering comparable pain relief and radiologic outcomes. PEEK cages provide better short-term functional improvement and segmental alignment but result in higher intraoperative blood loss.

Background: Knowledge of the lumbar pedicle anatomy is vital for preoperative surgical planning of pedicle screw fixation procedures in orthopedic surgery. The morphology of lumbar vertebrae has both genetic and ethnic variations.

Study design: Retrospective cohort study.

Objective: The objective of the study was to estimate morphometric characteristics of the lumbar vertebrae relevant for pedicle screw placements in the Saudi population and compare it with CT-based studies in other population groups.

Materials and methods: CT scans of 300 Saudi patients (M = 150; F = 150) were reviewed. The dimensions of the lumbar pedicle, pedicle axis angle, and chord length (CL) of the L1-L5 vertebrae were measured by two investigators. The Mann-Whitney test was used to compare the genders.

Results: There was no inter-observer bias. There was no difference between the sides. Transverse pedicle diameter (TPD) increased from L1 to L5 with mean values of 5.76-13.62 mm, respectively. The longest CL was at L3 with a mean of 50.92 mm. The length of the pedicle decreased from L1 to L5 with mean values of 16.01-9.93 mm, respectively. The height of the pedicle (PH) showed a similar trend with a decrease from 9.75 to 8.3 mm. The pedicle axis angle trajectory followed a gradual medial angulation pattern of 12.68˚-28.23˚ from L1 to L5.

Conclusions: The TPD, CL, and PH showed statistically significant differences among the genders. Statistical significance was also noted among pedicle parameters compared with other population groups.