Journal of Craniovertebral Junction and Spine最新文献

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.

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.