Journal of Craniovertebral Junction and Spine最新文献

Background: A significant procedural overlap exists between orthopedic and neurosurgeons with both subspecialties performing adult spinal fusion procedures. However, the prevalence of varying adult spinal fusion procedures performed by orthopedic surgeons, relative to neurosurgeons, is unknown. This study sought to compare the prevalence of spinal fusion procedures among orthopedic and neurosurgeons.

Materials and methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for adult spinal fusion procedures from 2008 to 2016. Procedure prevalence, operative time, and hospital length of stay (LOS) were recorded and analyzed by surgical subspecialty. Spinal fusion cases investigated include all fusions, 2-3-level lumbar fusion, ≥4-level lumbar fusion, anterior cervical discectomy and fusion (ACDF), 3-6-level posterior cervical fusion, and ≥ 6-level posterior cervical fusion.

Results: 67,775 spinal fusions were identified, of which 44,879 (66.2%) were performed by neurosurgeons and 22,896 (33.7%) were performed by orthopedic surgeons. Procedures that involved the lumbar spine were more likely to be performed by orthopedic surgeons while cervical fusions like ACDF were more likely to be performed by neurosurgeons. Orthopedic surgeons had significantly shorter operative times (124.0 vs. 134.0 min, P < 0.001) for 2-3-level lumbar fusions while having a similar patient LOS (4.3 vs. 4.2 days, P = 0.196). The remaining procedures saw no significant difference in operative time and patient LOS between orthopedic and neurosurgeons.

Conclusions: Neurosurgeons performed nearly double the amount of spinal fusion cases compared to orthopedic surgeons, with an even greater disparity seen in ACDFs, while orthopedic surgeons performed significantly more fusions of the lumbar spine. Orthopedic surgeons had shorter operative times for 2-3-level lumbar fusions.

Background: Musculoskeletal pain complaints have a high epidemiological and clinical burden in hemodialysis patients. Previous original studies indicate that low back pain (LBP) may have an important contribution to these complaints. This systematic review aimed to estimate the global prevalence of LBP in chronic hemodialysis patients.

Methods: Systematic review and meta-analysis with Grading of Recommendations Assessment, Development, and Evaluation approach for quality of evidence. Searches were performed in CINAHL, Embase, LILACS, MEDLINE/PubMed, and Scientific Electronic Library Online databases until July 2023. The Inverse Variance Heterogeneity model was used to pool prevalence estimates.

Results: The review included 19 original articles that provided data from 2713 patients. The overall pooled prevalence of LBP was 30.2% (95% confidence interval [CI] =19.0%-42.0%; k = 19 articles). The sex-specific pooled prevalence of LBP was 29.6% (95% CI = 18.7%-41.2%; k = 6 articles) in females and 36.6% (95% CI = 26.0%-47.7%; k = 6 articles) in males. The duration-specific pooled prevalence of LBP was 13.2% (95% CI = 8.6%-18.4%; k = 2 articles) for acute and 30.7% (95% CI = 11.3%-52.2%; k = 7 articles) for chronic LBP. The frequency of LBP estimated over the total number of pain complaints was 39.6% (95% CI = 23.0%-56.8%; k = 10 articles).

Conclusion: The overall estimate shows that three out of 10 hemodialysis patients suffer from LBP. This condition is accountable for nearly 40% of pain complaints in such patients. The quality of evidence for the pooled estimates is low or very low, and future prevalence studies with adequate statistical power and definitions of LBP are needed to provide more accurate data.

Introduction: Pediatric lumbar disc herniation (LDH) presents unique challenges compared to adult cases due to anatomical and developmental differences in the spine. This systematic review aims to consolidate evidence on the management and outcomes of pediatric LDH.

Research question: What are the clinical outcomes and efficacy of conservative and surgical treatments for pediatric LDH?

Materials and methods: A systematic review of studies from 2010 to 2024 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases including PubMed, Embase, Scopus, and Cochrane Library were searched for studies reporting on pediatric LDH treatment outcomes. Pain, disability, recurrence, and complication rates were extracted and assessed. The Joanna Briggs Institute checklist was used to evaluate bias.

Results: The review included 861 pediatric patients across 14 studies, with a mean age of 14.88 years and a male predominance (59.6%). The most commonly affected levels were L5/S1 (53%) and L4/L5 (43.8%). Conservative treatment was employed in 9.9% (n = 66), whereas microdiscectomy, endoscopic discectomy, and fusion were performed in 53.7% (n = 360), 32.2% (n = 216), 4.2% (n = 28), respectively. Postoperatively, improvements in pain (Visual Analog Scale: 6.15-1.33) and disability (Oswestry Disability Index: 42.09-7.01) were noted. The recurrence rate was 1.7% postoperatively and 42.4% following conservative management (average follow-up period of 23.78 months). Complication rate was 3%.

Discussion and conclusion: Pediatric LDH is primarily associated with sports-related trauma. Minimally invasive techniques such as endoscopic and microdiscectomy demonstrate good early and long-term outcomes, and low complications and recurrence rates. There is a paucity of studies comparing management techniques, particularly ones discussing conservative management, which may represent underreporting.

Background: Cervical sagittal alignment maintains horizontal gaze, supports the axial load of the skull, and has a reciprocal relationship to the cervicothoracic sagittal alignment. Studies are being conducted on different ethnicities, but little literature exists about cervical sagittal alignment and correlation chains in the Indian population. Therefore, we decided to study the impact of cervical and cervicothoracic alignment on horizontal gaze.

Methods: This is a retrospective cross-sectional study where an asymptomatic adult population from India was enrolled between 18 and 50 years old. The following parameters were measured on lateral cervical x-ray: McGregor slope (McGS), C0-C2 angle, C1-C2 angle, C2 slope, Cervical Lordosis (CL) C2-C7, C7 slope, sagittal vertical axis C2-C7, thoracic inlet angle, neck tilt and T1 slope (T1S). The results were stratified in upper and lower cervical alignment, cervicothoracic alignment, and horizontal gaze parameters (McGS) using Pearson's correlation coefficient.

Results: One hundred and four individuals were included. C7 Slope strongly correlated with T1S (r = 0.675, P = 0.000) and a chain of correlation was found between T1S with CL: C2-C7 (r = --0.602), then C0-C2 angle (r = --0.483) and C1-C2 angle (r = --0.592), finally, the McGS (Horizontal Gaze) (r = -0.709), all with P ≤≤ 0.000. The highest correlation was between the C2 Slope and T1S - CL mismatch (r = -0.946, P = 0.000).

Conclusion: In the Indian population, a statistically significant correlation chain was found between the upper and lower cervical alignment parameters, cervicothoracic alignment parameters, and horizontal gaze parameters. T1S and C7 Slope are the foundation for starting this correlation chain between the cervical sagittal alignment and the horizontal gaze. In addition, a very important role of the C2 Slope in the cervical sagittal alignment was observed.

Background: Pierre Roussouly et al. classified four distinct types of sagittal profiles in normal individuals based on their sacral slope (SS). It was modified by Laouissat et al., (theoretical) including a fifth type.

Study design: The study design was a cross-sectional study.

Objective: The objective of this study was to identify and classify the types of sagittal alignment present in an asymptomatic Indian population using the parameters established by Roussouly et al. and modified by Laouissat et al.

Methods: The inclusion criteria were asymptomatic adults between 18 and 50 years old, without history of spinal surgery or significant musculoskeletal disorders. The sagittal profile was classified according to the Roussouly modified (theoretical) classification. The spinopelvic parameters were measured using Surgimap and the correlation analysis was performed using Pearson's correlation coefficient.

Results: A total of 104 participants (62 females and 42 males) were recruited and it was observed 26 (25%) participants with Type 1, 12 (11.5%) with the Type 2, 26 (25%) with Type 3, 30 (28.8%) Type 3AP, and 10 (9.6%) participants with the Type 4. Furthermore, the study showed that the Type 3 anteverted pelvic (AP) had similar characteristics compared with the Laouissat's study. The pelvic incidence shows a correlation with SS (r = 0.602, P = 0.001) and pelvic tilt (r = 0.613, P = 0.001). SS is also correlated with lumbar lordosis (r = 0.734, P = 0.001).

Conclusion: The analysis of the study showed that the Type 3 AP is the sagittal profile more frequency according to the theoretical Roussouly classification in the asymptomatic Indian population.

Background: Although posterior lumbar fusions (PLFs) have risen in popularity due to minimally invasive techniques and favorable outcomes, complications still arise. Studies show relatively constant rates of postoperative complications from 2006 to 2016, but there are limited studies evaluating outcomes after 2016. Consequently, we aim to investigate trends in postoperative complications for PLFs from 2009 to 2022.

Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried for single-level PLFs between 2006 and 2022. Patients between 2006 and 2008 were excluded due to limited sample size. Inclusion criteria included >18 years old and Current Procedural Terminology code 22612. Baseline demographics and comorbidities were recorded. Annual 30-day complication rates of wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions (IBTs), and mortality were recorded. Analysis of variance and multivariable Poisson log-linear regression were performed to compare complication rates between years and outcomes between 2020-2022 and 2017-2019.

Results: Wound infection rates declined from 3.7% in 2009 to 2.7% in 2019, with an increase to 3.0% by 2022 (P = 0.015). IBT decreased significantly, from 20.58% in 2010 to 9.40% in 2022 (P < 0.001). Sepsis rates fell from 2.15% in 2009 to 0.88% in 2022 (P = 0.017). The average length of stay decreased from 2009 to 2019 (P < 0.001). Wound infection (P = 0.006) and pneumonia (P = 0.039) rates significantly increased between 2020 and 2022.

Conclusion: Rates of older age, diabetes, and hypertension increased among PLF patients between 2009 and 2022, while most complication rates remained constant. Rates of wound infection, IBT, sepsis, and average length of stay have improved since 2009 despite an increase in wound infection and pneumonia from 2020 to 2022.

Purpose: The purpose of the study was to compare the results of anterior cervical discectomy and fusion (ACDF) using standalone cages versus cages with anterior plating for multilevel cervical disc disease with a 2-year follow-up.

Background: ACDF is a commonly performed procedure in cases of neural compression caused by osteophytes or disc material. Some spine surgeons have reported unsatisfactory outcomes and fusion rates secondary to a high rate of cage subsidence and pseudoarthrosis. Internal fixation using anterior cervical plate has been developed as an adjunct to ACDF to enhance the stability provided by the intervertebral cages.

Patients and methods: A total number of 60 consecutive patients diagnosed with multilevel cervical disc disease (two or more) underwent ACDF with or without additional anterior plating, between August 2021 and March 2022. Only 50 patients completed the follow-up which was ranged from 20 to 26 months.

Results: There were no significant differences between the two groups regarding age and sex. Comparing the pre and postoperative Visual Analog Scale (VAS) for both neck pain and brachialgia and neck disability index (NDI) in both groups was statistically significant. There was no significant statistical difference between the two groups regarding the postoperative clinical outcomes. There was a significant statistical difference in the fused segment lordotic angle (FSA) being greater in the plating group.

Conclusion: The use of stand-alone cages in two-level ACDF or more in our study had a shorter operative time and hospital stay when compared to ACDF with anterior plating with greater FSA in the plate group but with no difference in clinical outcome after 2-year follow-up.

Randomized clinical trials (RCTs) on vertebroplasty are crucial for guiding the treatment of vertebral compression fractures, but their overlooked statistical fragility can undermine clinical reliability. Minor outcome changes may overturn significant findings, risking unreliable evidence, and impacting patient care. This study assessed the fragility of significant outcomes in vertebroplasty RCTs, hypothesizing high sensitivity to such changes. PubMed, Embase, and MEDLINE were searched for RCTs on vertebroplasty reporting dichotomous outcomes. The fragility index (FI) and reverse FI quantified the number of outcome reversals needed to change statistical significance for significant and nonsignificant results, respectively. The fragility quotient (FQ) was calculated as the FI divided by the study sample size. Subgroup analysis was conducted by outcome category. A total of 276 outcomes from RCTs were analyzed. The median FI was 5 (interquartile range [IQR]: 4-5), with a FQ of 0.053 (IQR: 0.019-0.088). Statistically significant outcomes (n = 36) had a median FI of 3 (IQR: 2-4) and FQ of 0.034 (IQR: 0.018-0.051), whereas nonsignificant outcomes (n = 240) showed a median FI of 5 (IQR: 4-5) and FQ of 0.062 (IQR: 0.021-0.088). Fracture-related outcomes were the most robust (FI: 5, FQ: 0.088), whereas cement leakage was the most fragile (FI: 3, FQ: 0.041). Pain outcomes had an FI of 5 (FQ: 0.062), and complications and vertebroplasty versus kyphoplasty outcomes were more robust (FI: 5, FQ: 0.013). Patients lost to follow-up exceeded the FI in 79% of outcomes. The statistical findings in vertebroplasty RCTs are fragile and warrant cautious interpretation. A small number of outcome reversals or consistent postoperative follow-up can shift the significance of the results. Standardized reporting of P values alongside FI and FQ metrics is recommended to help clinicians evaluate the robustness of study findings.

High-grade spondylolisthesis (HGS) remains a difficult entity to treat, given the high rate of complications following surgical correction of such a spinal deformity. Reduction of spondylolisthesis may be associated with traction injury to the L5 nerve root due to stretching. We report on two cases of HGS where a novel surgical technique of offset rods was used for partial reduction of spondylolisthesis thereby reducing L5 nerve root traction. Both cases had more than 50% correction of translation with good correction of slip angle and satisfactory clinical outcomes were achieved at the final follow-up. In this study, we report on two cases of HGS treated with offset rod constructs. These rod constructs provide partial reduction, improving slip angle at the listhesis while reducing nerve root stress caused by full reduction and fixation. In comparison to previously described constructs, offset rods provide greater construct modularity and freedom to create constructs better suited to each patient's pathology.

Context: Cervical disc arthroplasty (CDA) is a safe and effective treatment for cervical spine conditions, with increasing utilization. As the population over 65 grows, understanding the suitability of CDA in older patients is critical.

Aims: This study evaluates differences in postoperative complications, hospital course, and costs between patients aged 18 and 65 and those over 65 undergoing CDA.

Settings and design: This was a retrospective cohort study using the National Inpatient Sample, a nationally representative database of U.S. hospital discharges.

Subjects and methods: Patients undergoing single-level CDA from 2016 to 2020 were identified. The cohort was divided into two groups: 18-65 years and >65 years. Propensity score matching (1:5) was applied based on sex, race, obesity, chronic lung disease, and the Elixhauser Comorbidity Index. Outcomes included postoperative complications, length of stay (LOS), hospital costs, and discharge disposition. Statistical significance was set at P < 0.05.

Statistical analysis used: Propensity score matching ensured group balance. Chi-square tests and Student's t-tests assessed outcomes, with a Benjamini-Hochberg adjustment for multiple comparisons.

Results: After matching, 4550 cases from the 18 to 65 years of group and 910 from the >65 group were analyzed. Dysphagia rates were higher in the older cohort (8.8% vs. 3.8%, P = 0.007). LOS was significantly longer for older patients (2.15 ± 0.20 days vs. 1.38 ± 0.04 days, P < 0.001). Hospital costs were higher in the >65 group ($25,900 ± 1000 vs. $22,500 ± 400, P = 0.005), and nonroutine discharge was more common (19.2% vs. 7.1%, P < 0.001).

Conclusions: Older patients undergoing CDA experience more complications, longer hospital stays, and higher costs, highlighting the need for tailored care strategies.