Journal of Craniovertebral Junction and Spine最新文献

Background: Pedicle screw augmentation with polymethylmethacrylate (PMMA) is a technique used to reduce the risk of pedicle screw pullout, loss of screw fixation, and implant failure in patients at high risk of mechanical complications.

Study design: This was a retrospective observational study.

Objective: The objective of this study was to describe a modification of the classic augmentation technique of conventional pedicular screw instrumentation in spinal surgery.

Methods: A retrospective analysis was performed on 47 patients over the age of 65 years who underwent spinal surgery using the proposed cement augmentation technique and were followed for 2 years. High-viscosity cement was injected into tapped vertebral pedicles, followed by the insertion of traditional pedicle screws. Patient selection was based on detailed preoperative clinical and imaging evaluations. Outcomes measured included the rate of complications, particularly cement leakage (CL), and the occurrence of neurological or vascular deficits.

Results: A total of 47 patients were treated with 700 conventional screws. A total of 26/700 screws (3.71%) showed CL. According to the modified Yeom classification for CL, 9/700 (0.71%) were type S, 9/700 (0.71%) were type B, and 8/700 (0.57%) were type I; there were no neurological or vascular complications. There were no mechanical complications at 2 years.

Conclusions: This modified augmentation technique for conventional pedicle screws is an alternative for spinal instrumentation in elderly patients with a low incidence of clinically significant complications and also reduces procedure time by facilitating pedicle screw placement.

Background and objectives: Ponticulus posticus (PP), also known as arcuate foramen or Kimmerle's anomaly, is an atlas (C1) bone anomaly in the form of a bone bridge. This study aims to determine the prevalence of PP in two hospitals in Surabaya, Indonesia, and to determine the risk factors for PP and its impact on the thickness of the C1 lamina.

Materials and methods: We conducted a retrospective analysis using a total sampling technique of computed tomography scan results from 121 patients at Dr. Soetomo Surabaya Hospital's and Mitra Keluarga Surabaya Hospital's Department of Neurosurgery. The study included patients aged 18 and aging who met the inclusion criteria. We assessed the relationship between C1 morphological characteristics and PP prevalence, with particular focus on laminar thickness measurements.

Results: The study found a prevalence of PP of 15.7%. The mean thickness of the posterior arch lamina with PP was 3.3 ± 0.95 mm on the right side and 3.4 ± 1.0 mm on the left side. Although these figures are not statistically significant, both were thinner than the lamina without PP. The study also found that the prevalence of PP increases with age, with a significant value of P < 0.001.

Conclusions: The average thickness of the posterior lamina arch containing PP has a smaller value but is not statistically significant. In this study, significant statistical results were obtained to suggest that the prevalence of PP increases with age (degenerative).

Study design: Literature review.

Objectives: Review prehabilitation techniques used for elective spine surgery to create a comprehensive list of recommendations.

Methods: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching three electronic databases from 1997 to 2021. Pertinent literature reporting information on prehabilitation, applicable to spine surgery, was identified. Seventy studies were selected for further analysis. Findings from the literature were reinforced by practices employed by the authors.

Results: Preoperative smoking cessation should be achieved 3-4 weeks before elective spine surgery. Preoperative weight loss programs to reach a goal BMI <35 kg/m² may be a viable solution to minimize wound complications and surgical site infections. To minimize the negative impact of cardiopulmonary comorbidities, patients can enroll in an exercise program prior to surgery. Patients should abstain from alcohol before elective spine surgery. Patients with osteoporosis may benefit from supplementation with Vitamin D, calcium, and parathyroid hormone. Opioids should be weaned to complete cessation 6-8 weeks before surgery. Preoperative cognitive behavioral therapy (CBT) and education seem to be the most beneficial in reducing complications associated with psychiatric comorbidities. Patients should engage in a comprehensive prehabilitation regimen.

Conclusion: Targeting patient risk factors with personalized interventions can improve postoperative outcomes in patients undergoing elective spine surgery.

Study design: Retrospective review of a single institution cohort.

Objective: To assess the injury characteristics and outcomes in patients who suffered trauma to the cervical spine and vertebral artery injury (VAI).

Methods: This was a retrospective study of patients admitted to our trauma center with osseous or ligamentous cervical spine injury and VAI. Imaging findings were reviewed to classify the fracture types and fracture extension into transverse foramina was noted. Electronic medical records were reviewed to capture the mechanism of injury, discharge disposition, neurologic status, and mortality. Kaplan-Meier analysis was performed to determine the mean survival time and cumulative survival rate.

Results: Ultimately, 30 patients were included for the analysis. The mean age was 56 years old (range: 18-91 years). There were four major subgroups of cervical injuries: unilateral facet fractures (9 patients, 30%), occipital-cervical junction fractures (15 patients, 50%), translation or distraction injuries (3 patients, 10%), and injuries without extension into transverse foramina (20 patients, 67%). Left-sided VAIs were more common than right-sided (60% vs. 37%). Twelve patients (40%) initially presented with neurological symptoms. Nine patients (30%) died by final follow-up; the mean survival time for the cohort was 704.5 days (95% confidence interval: 440.1-968.9 days).

Conclusion: The laterality of facet fractures and fractures extending into the transverse foramina are associated with VAI sidedness. Various mechanisms may account for injury presentation, including rotation and hyperflexion. Given that patients may initially present without neurologic deficits, it is recommended that cervical trauma protocols integrate computed tomography angiography to reduce morbidity and mortality.

Introduction: The susceptibility of the thoracolumbar junction to injury is attributed mainly to the transition from a relatively rigid thoracic kyphosis to a more mobile lumbar lordosis that occurs at thoracic T11 to lumbar L2 level.

Materials and methods: We present our experience of management of 87 patients of single-level injury who presented with or without neurological deficit between March 2014 and October 2018. All adult patients (18-59 years) were included who were selected for management by single-level posterior transpedicular fixation and followed up for a minimum of 12 months.

Results: The male-to-female ratio in our study was 6.3:1 with a mean age of 32 years. Forty-eight percent were in the work-productive age group of 31-40 years. The L1 vertebra was the most commonly fractured (47%) followed by D12, L2, and D11 vertebra, respectively. Thoracolumbar injury classification severity score 6 was the most common score at presentation. More than 80% patients had some degree of neurological deficit on American Spinal Injuries Association grading with Grade C being the most common pattern of presentation of spinal cord neurological deficit. About 25% patients had some degree of neurological improvement at 12 months follow-up. Among them, 10% achieved an ambulatory status from a bed-ridden status signifying the importance of surgical management in appropriately selected patients.

Conclusions: Single-level transpedicular fixation can be offered to a group of selected patients for rehabilitative purposes. This is the largest study discussing only junctional thoracolumbar injuries and also outcomes in single-level posterior instrumentation.

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.