Journal of Craniovertebral Junction and Spine最新文献

Hemivertebra is a rare congenital spinal anomaly often diagnosed in childhood due to progressive scoliosis. Initial diagnosis of hemivertebra in adulthood is uncommon, and standardized treatment protocols are not well established. This report presents a case of successful management of an L4 hemivertebra in an adult using oblique lateral interbody fusion (OLIF) with O-arm navigation. The patient, a 55-year-old, presented with chronic lower back pain and thigh pain exacerbated by standing and walking. Imaging studies revealed an L4 hemivertebra with mild scoliosis and foraminal stenosis caused by degenerative change. The patient underwent OLIF with O-arm navigation, followed by short-segment fixation with pedicle screws. Postoperative imaging confirmed appropriate implant positioning. The patient experienced complete resolution of symptoms except for mild sensory disturbance in the left thigh, with stable outcomes at the 2-year follow-up. The OLIF technique, guided by O-arm navigation, allowed precise adjustments to the anatomical characteristics of the hemivertebra, minimizing surgical invasion, and avoiding extensive corrective fixation. This approach resulted in favorable outcomes, suggesting its viability as a treatment for adult hemivertebra with minimal scoliosis. Furthermore, the use of intraoperative navigation addressed the anatomical abnormalities associated with adult hemivertebra, reducing the reliance on repeated fluoroscopic imaging and minimizing the risk of complications. OLIF with O-arm navigation is an effective and minimally invasive treatment option for adult hemivertebra, providing symptom relief and favorable outcomes.

Aims: The primary objective of this study is to evaluate the hypotheses that postoperative sagittal imbalance influences the development of adjacent segment degeneration (ASDeg) in patients who have undergone an anterior cervical discectomy with fusion (ACDF).

Settings and design: This was a retrospective cohort study.

Subjects and methods: We analyzed 63 patients with ACDF with a minimum of 2 years of follow-up. In the imaging evaluation, sagittal balance parameters were included, as well as radiographic parameters that target the development of ASDeg. In addition, discrimination was made between arthrodesis techniques.

Statistical analysis used: Categorical variables were compared using the Chi-square test and Fisher's exact test. Continuous variables were compared using t-test when the data were normally distributed and Wilcoxon tests when the distribution was not normal.

Results: Patients with postoperative imbalance presented with radiographic ASDeg at a rate of 26% (n = 5) versus 22% (n = 9) in patients with postoperative balance, this difference was not significant (P = 0.7). In those who underwent surgery with plate, we found that 23% (n = 4) developed ASDeg versus 22% (n = 1) of patients with anterior cervical arthrodesis with cage-plate and 27% (n = 10) of patients who underwent interbody device surgery, with this difference being nonsignificant (P = 0.7).

Conclusion: We concluded that neither postoperative imbalance nor the type of arthrodesis in patients undergoing ACDF for degenerative pathology showed a positive correlation with the development of radiographic cervical ASDeg at an average follow-up of 8 years.

Background: Sarcopenia, a manifestation of frailty characterized by muscle loss, is associated with adverse postoperative events in spinal patients. Its role in postlaminoplasty kyphotic deformities (PKDs) remains unknown.

Objective: This study evaluates the relationship between paraspinal muscle sarcopenia and PKD using qualitative and quantitative methods.

Materials and methods: A retrospective review was conducted on cervical myelopathy patients treated with laminoplasty between January 2019 and January 2022 at a tertiary care center. Inclusion criteria included pre- and 1-year postoperative X-rays and magnetic resonance imaging within 6 months presurgery. PKD was defined as loss of cervical lordosis greater than -10° based on the C2-7 Cobb angle. Fatty infiltration was evaluated using Goutallier classification and voxel quantification.

Results: Among 44 patients, 4 developed PKD. Qualitatively, 32 patients were classified as Goutallier 0-1.5, 6 were Goutallier 1.5-2.5, and 6 Goutallier 2.5-4. There is a significant association between the Goutallier grade and PKD occurrence after 1 year (P = 0.00085). Quantitatively, the average fatty infiltration percentage for the kyphotic patients was 23.3% ± 5.81% versus 13.8% ± 9.83% for nonkyphotic patients. A significant association was found between the percentage of fatty infiltration and the PKD after 1 year (P = 0.045). The optimal fat cutoff between kyphotic and nonkyphotic patients was 23% (P = 0.056).

Conclusions: The present study demonstrated that patients with higher degree of fatty infiltration were associated with PKD. Based on our results, patients with increased cervical paraspinal degeneration may have increased risk of developing PKD. With this information, surgeons may be better equipped to predict the risk of PKD.

Background: Congenital block vertebrae (BV) is a common condition resulting from segmentation disorders during embryonic development, leading to the fusion of adjacent vertebrae. BV at C2-C3 (cervical vertebrae 2^nd-3^rd) level is the most common segmentation anomaly. Labeling this correctly is the requirement for exact labeling of the spine. Diagnosing BV may not be challenging; however, differentiating BV from the long C2 can be tricky. Our study proposes a novel method of recognizing BV by measuring their height to aid in accurately distinguishing BV from normal vertebrae.

Methods: This retrospective study compared C2 vertebral heights between two groups: 50 patients with normal cervical spine magnetic resonance imaging (MRI) and 30 patients with congenital fusion at the C2-C3 levels. Using T2-weighted midsagittal MRI images, the height of the C2 vertebra was measured from the tip of the odontoid process to the posteroinferior part of the vertebra. Data analysis was performed using independent t-tests to evaluate the differences in measurements.

Results: The mean C2 vertebral height for the normal cervical spine group was 33.22 mm, while the congenital fusion group exhibited a significantly higher mean height of 45.59 mm. These findings were statistically significant, indicating that a C2 vertebral height exceeding 33 mm is atypical in normal individuals. Our proposed threshold measurement aids in distinguishing between single vertebrae and BV.

Conclusion: Our study provides a novel method for assessing C2 vertebral body height to aid in the numbering of cervical spine to enhance diagnostic accuracy in particular in patients with congenital anomalies.

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."