Journal of Craniovertebral Junction and Spine最新文献

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.

Background: Surgical management of odontoid fractures in the cervical spine is utilized to promote higher fusion rates, reduce medical complications, and limit mortality. Delay in surgical management of operative odontoid fractures after hospital admission, however, may be associated with greater rates of adverse events and length of stay. We sought to evaluate the effect of surgical delay on unplanned reoperation and increased length of stay following anterior fixation of odontoid fractures.

Materials and methods: A retrospective observational study was conducted on patients who underwent anterior fixation for an odontoid fracture from 2013 to 2022, utilizing the National Surgical Quality Improvement Program database. Eligibility for inclusion was age >18 years and current procedural terminology codes 22,318 and 22,319. Outcomes, including length of stay, mortality, and reoperation, were compared between cohorts. Prolonged time between hospital admission and surgery ≥48 h was assessed as a predictor of clinical outcomes.

Results: Among 265 patients, 85 (32.1%) had a surgical delay. Age, sex, race, body mass index, and other medical comorbidities were statistically similar at baseline between groups. Surgical delay was associated with greater length of stay (8.2 vs. 4.5 days, P = 0.012) and unplanned reoperation (11.8% vs. 3.3%, P = 0.011), and trended toward association with readmission (9.4% vs. 3.3%, P = 0.072). Multivariate Poisson regression demonstrated that surgical delay independently predicted length of stay (χ ² = 257.75, P < 0.001) and unplanned reoperation (χ ² = 5.24, P < 0.001), but not readmission (χ ² = 3.21, P = 0.073).

Conclusion: Surgical delay was an independent and significant predictor of increased length of stay and reoperation. These results suggest that surgery should be performed promptly within 48 h when indicated to minimize the risk of adverse outcomes.

Objective: The objective of the study was to determine if adult spinal deformity (ASD) patients with spinal cord stimulators (SCS) or intrathecal drug delivery devices (IDDD) have more chronic opioid consumption or worse surgical outcomes than a matched cohort.

Methodology: We conducted a retrospective matched comparison of implanted (SCS [n = 11] or IDDD [n = 3]) and nonimplanted ASD patients (n = 40) who underwent corrective spine surgery at a single center. We evaluated their intraoperative characteristics, long-term postoperative complications, radiographic correction, and chronic opioid use, measured as use on more than 50% of days for >6 months pre-or postoperative and total morphine mg equivalents (MME) and MME per dose.

Results: We found no difference in the rate of chronic opioid use between the implanted and nonimplanted ASD cohort: 6 m preoperative: 50% (n = 7) versus 40% (n = 16), admission: 71% (10) versus 45% (18), 6 m postoperative: 64.3% (9) versus 32.5% (13), final follow-up (FFU): 64.3% (9) versus 37.5% (15), P > 0.05. Similarly, there was no difference in total MME: 6 m preoperative: 101.3 ± 177.8 versus 37.3 ± 89.4, admission: 68.2 ± 77.8 versus 45.3 ± 129.9, 6 m postoperative: 59.8 ± 83.1 versus 20.8 ± 46.9, FFU: 51.2 ± 68.7 versus 31.1 ± 55.5, P > 0.05 for all. Implanted patients had higher OR time (implanted: 734.9 [103.4] vs. nonimplanted: 637.2 [147.8] min, P = 0.0272), intraoperative blood requirement (2.1 [1.6] µ pRBCs vs. 1.1 [1.5] µ, P = 0.0500), and rate of dural tears (42.9% (6/14) vs. 15% (6/40).

Conclusion: This study indicates that implanted ASD patients are not at increased risk for chronic opioid use and do not have worse postoperative compilation rates than nonimplanted patients.

Background: Iliac screws (IS) and sacral 2 alar-ISs are common methods for spinopelvic fixation but can result in symptomatic prominence or need for future sacroiliac (SI) joint fusion. A modification of the countersunk ISs technique includes a partial resection of the posterior superior iliac spine (PSIS) and countersinking of the screw head to minimize prominence. We investigate the need for surgical SI joint fusion and pain outcomes following the use of countersunk IS with partial resection of the PSIS.

Methods: We identified patients from 2010 to 2024 who underwent spinopelvic fixation with countersunk IS with a minimum of 2 years follow-up. Variables collected included age, sex, body mass index (BMI), smoking status, SI joint fusion, IS site pain, construct infection, skin breakdown, IS revision due to pain or infection, and symptomatic screw prominence. Descriptive statistics were reported.

Results: Five hundred and forty-six patients who underwent 1088 IS placements were included. The sample had a mean age of 64.5 years, was 65.3% female, and had a mean BMI of 28.3 kg/m². There were no cases of SI joint fusion after IS fixation. IS site pain was noted in 27 (4.9%) patients, however, screw prominence on the physical exam was not observed. IS were revised or removed in 5 (0.9%) patients due to site pain unresponsive to nonsurgical treatment.

Conclusion: We observed low rates of future surgical SI joint fusion for SI joint pain or reoperations due to IS prominence or screw-related pain with countersunk IS. Future comparative studies are necessary to support these conclusions.

Objective: To evaluate whether patients with myeloradiculopathy experience better improvement in patient-reported outcome measures (PROMs) from the addition of foraminotomy in the setting of posterior cervical decompression and fusion (PCDF).

Methods: Adult patients who underwent ≥≥ 3-level PCDF (2017-2022) at a single tertiary center were retrospectively identified. Patients were included if their indication was myeloradiculopathy - patients were excluded if they had a combined anterior/posterior approach, an indication of infection/tumor/trauma, or incomplete 1-year PROMs. Operative notes were evaluated to identify the patients who had a foraminotomy specifically for neuro-decompression. Patients with or without foraminotomy were evaluated for demographic/surgical variables, surgical outcomes, and PROMs. Appropriate statistics were performed, alpha was set at 0.05.

Results: One hundred and seven PCDF patients were identified (33.6% foraminotomy and 66.4% nonforaminotomy). The two groups were similar regarding demographics and surgical metrics including cut-to-close and OR time and estimated blood loss. The two groups were similar in readmission rate at 30- and 90-days postoperatively, 1-year reoperation, and discharge disposition. Modified Japanese orthopedic association, short form-12 physical component score and mental component score, neck disability index, and visual analog scale (VAS) neck scores were similar between groups at all time points. The foraminotomy group had worse baseline VAS arm scores (5.56 ± 2.63 vs. 4.00 ± 2.69, P = 0.015) as well as greater improvement in VAS arm scores (-2.99 ± 3.22 vs. -1.25 ± 3.06, P = 0.035) at 1 year.

Conclusion: Patients who had a foraminotomy experienced greater improvement in arm pain at 1-year follow-up without an increase in surgical time, hospital stay, or complications. The present study suggests that, for the appropriately selected patient undergoing PCDF for myeloradiculopathy, performing intentional foraminal decompression leads to improved outcomes at 1 year without altering surgical morbidity.