Asian Spine Journal最新文献

Study design: Retrospective study.

Purpose: To compare clinical and radiographic outcomes of patients undergoing anterior cervical decompression surgery with and without resecting the posterior longitudinal ligament (PLL).

Overview of literature: Resection of the PLL during anterior cervical decompression surgery is still a controversial topic among spine surgeons.

Methods: All patients undergoing anterior cervical decompression surgery from October 2018 to December 2023 were included in this cohort. The PLL was preserved in patients with cervical spondylosis with only axial neck pain, cervical spine injuries with an intact PLL and intervertebral disc, PLL ossification with double layer signs on magnetic resonance imaging studies, and cervical spine metastasis. Clinical outcomes were used to evaluate the visual analog scale for neck pain and a modified Japanese Orthopedic Association score. Radiographs were used to evaluate the device-level Cobb angle (CA), segmental CA, global CA, and sagittal vertical axis, and they were compared with postoperative measurements at 1 year.

Results: A total of 102 patients underwent surgical intervention. In 36 patients, PLL was preserved. The retractor time was shorter in the non-PLL resection group and was statistically significant (p=0.046). The non-PLL resection group had fewer complications, but this was not statistically significant (p=0.787). Both clinical and radiographic outcomes were improved after surgery, and there were no statistically significant outcome differences between the resection and non-resection groups.

Conclusions: Resecting the PLL in patients undergoing anterior cervical spine surgery may prolong retractor time and could potentially result in postoperative complications. However, it does not significantly affect radiographic outcomes regarding cervical spine alignment compared to patients where the PLL was not cut.

Study design: Observational study.

Purpose: Cervical parameters play a vital role in maintaining global spinal sagittal alignment, but their correlation with spinopelvic parameters remains unclear. This study aimed to investigate potential direct correlations between cervical sagittal alignment and spinopelvic alignment in an asymptomatic population.

Overview of literature: Previous studies have demonstrated a direct relationship between pelvic parameters, lumbar lordosis (LL), and thoracic kyphosis (TK), as well as a direct correlation between cervical lordosis (CL) and TK. However, the direct influence of pelvic parameters and LL on cervical parameters remains unclear, warranting further research.

Methods: This study involved 104 asymptomatic adults (females 62 [59.6%]) aged 18-50 years. Whole-spine standing lateral radiographs were obtained, and the pelvic, lumbar, thoracic, cervicothoracic, and cervical parameters were studied. Pearson's correlation coefficient was used to assess correlations, with a significance threshold of p<0.05.

Results: The mean age of participants was 38.27±9.93 years. The pelvic incidence (PI) significantly correlated with C7 slope (r=-0.212, p=0.05). The pelvic tilt (PT) exhibited significant correlations with T1 slope-CL mismatch (r=-0.229, p=0.05) and C2 slope (r=-0.202, p=0.05). Furthermore, PI-LL mismatch showed a significant correlation with TIA (r=-0.197, p=0.05), T1 slope (r=-0.228, p=0.05), and C7 slope (r=-0.251, p=0.05).

Conclusions: This study reveals a significant correlation between cervical and spinopelvic parameters, emphasizing the interconnectedness of pelvic, lumbar, thoracic, and cervical spine parameters.

Study design: A multicenter retrospective cohort study.

Purpose: To analyze the development of infectious complications from civilian gunshot wounds to the spine and their association with the type of prophylactic antibiotics administered and the duration of administration.

Overview of literature: Despite the risk for infections following spinal gunshot wounds, no standardized guidelines exist for their management. The limited and low-quality evidence available underscores the need for further research.

Methods: This retrospective cohort study evaluated adult civilian patients (≥18 years) treated for spinal gunshot wounds at Latin American institutions between 2014 and 2022. Demographic, clinical, and injury characteristics, treatment approaches, and infectious complications were analyzed.

Results: After exclusions, 292 patients, primarily adult males (n=251, 86.0%) with a mean age of 32.6 years (standard deviation=11), were included. Most injuries affected the thoracic (n=135; 46.2%) and lumbosacral (n=95; 32.5%) spine. Infectious complications occurred in 20 patients (6.8%), including spinal infections (n=3; 1.0%), non-spinal infections (n=6; 2.1%), and wound infections (n=11; 3.8%). Most patients received prolonged antibiotic prophylaxis. The median duration of antibiotic administration was significantly increased in patients with dirty wounds (p<0.001) and high-velocity injuries (p=0.001). However, the duration of antibiotic administration did not influence spinal infection rates.

Conclusions: Our findings indicate a low incidence (1%) of spinal infections among patients with spinal gunshot wounds. Prolonged antibiotic use failed to reduce the risk of spinal infectious complications. Standardized guidelines for antibiotic prophylaxis in these injuries remain necessary to optimize care.

Study design: Retrospective cross-sectional analysis of 187 consecutive patients undergoing surgical treatment for cervical spondylotic myelopathy (CSM).

Purpose: To investigate sexual dimorphism in external occipital protuberance (EOP) hyperplasia morphology and elucidate its clinical correlation with ossification of the nuchal ligament (ONL) and cervical sagittal imbalance.

Overview of literature: Emerging evidence implicates EOP hyperplasia as potential biomarker of chronic neck strain, yet its relationship with ONL and cervical sagittal imbalance remains underexplored in surgical CSM cohorts.

Methods: Cervical radiographs were analyzed. EOP hyperplasia was classified into three subtypes with standardized length measurements. Variables encompassed demographics, ONL-related indices, and sagittal parameters. Subtype comparisons and multivariate regression analyses (with EOP length as dependent variable) were conducted.

Results: Analysis of 187 CSM patients (64.2% male) identified gender-specific patterns: males exhibited greater EOP length (9.4±6.8 mm vs. 4.6±3.4 mm, p<0.001). Type III EOP demonstrated male predominance (82.4% vs. type I 31.8%, type II 51.4%; p<0.001), with associated longer hyperplasia length (11.6±6.6 mm vs. type II 5.1±1.9 mm, p<0.001). Type III EOP was associated with higher ONL prevalence (type III 64.8% vs. type I 45.5%, type II 41.9%; p=0.010) and longer ONL osteophyte length (type III 18.8±9.8 mm vs. type I 14.2±8.1 mm, type II 14.2±9.4 mm; p=0.046). Multivariate regression confirmed male sex (β=-3.82, p=0.009), ONL osteophyte length (β=0.16, p=0.017), T1 slope (β=0.27, p=0.041), and spino-cranial angle (β=-0.19, p=0.009) as factors independently associated with EOP length (adjusted R²=0.382).

Conclusions: Severe EOP hyperplasia exhibits a male-predominant distribution pattern and demonstrates significant radiological associations with ONL and cervical sagittal imbalance in CSM patients. These findings advocate for EOP evaluation in clinical evaluations to identify high-risk biomechanical profiles.

This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration. A comprehensive literature search was conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses, using Review Manager, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic. The outcome measures were radiographic curve progression, percentage of patients with significant (>5°) progression, surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes. Thirteen studies involving 1,492 patients with AIS curves within 30°-45°, treated conservatively, with a minimum 10-year follow-up, were included. At 20+ years of follow-up (mean age, 34.5 years), curves worsened by an average of -5.69° (95% confidence interval [CI], -11.66 to 0.29). At 25+ years of follow-up (mean age, 49.8 years), curves worsened by an average of -14.32° (95% CI, -20.14 to -8.50). The incidence of significant progression was 35.68% (95% CI, 22.85 to 48.50). The surgery rate was 14.20% (95% CI, 0.87 to 27.53). Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. Back pain rate was 63.35% (95% CI, 38.36 to 88.34). These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients. A critical re-evaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.

Study design: Retrospective cohort study.

Purpose: To evaluate the effect of discrepancies between sacral and pelvic obliquity on postoperative disk wedging below the lower instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis (AIS).

Overview of literature: Previous studies have not fully explored the effect of discrepancies between sacral and pelvic obliquity on postoperative outcomes in patients with Lenke type 5 AIS.

Methods: Data from 35 patients with Lenke type 5 AIS (mean age, 14.7±1.8 years) followed for a minimum of 5 years were retrospectively analyzed. We investigated the effect of sacral coronal obliquity (S angle) and pelvic coronal obliquity (P angle) on postoperative coronal radiographic parameters. The angle between the S and P angles was defined as the sacral and pelvic (SP) angle. The patients were grouped by preoperative SP angle (<5°, n=23; ≥5°, n=12). Pre- and post-operative radiographic parameters were compared to determine whether the preoperative SP angle affected postoperative spinal alignment.

Results: The discrepancy between SP obliquity was reduced by correction surgery 5 years postoperatively. The mean lumbar Cobb angle correction rate in the ≥5° group was significantly lower than that in the <5° group (52.1%±17.8% vs. 65.5%±12.7%), and the mean wedge angle below the lower instrumented vertebra (LIV) in the ≥5° group was significantly larger than that in the <5° group (9.0°±2.6° vs. 4.7°±3.4°) 5 years postoperatively. No significant between-group differences were observed in age, Risser grade, thoracic Cobb angle correction rate, LIV-central sacral vertical line (CSVL), and C7-CSVL. The Scoliosis Research Society-22 outcomes were comparable between the two groups.

Conclusions: The ≥5° group exhibited a larger wedge angle below the LIV and lower lumbar Cobb angle correction rate than the <5° group 5 years postoperatively. Preoperative discrepancies between SP obliquity should be considered when planning corrective surgery for patients with Lenke type 5 AIS.

Study design: Single-center retrospective cohort analysis.

Purpose: To compare surgical outcomes between the unilateral biportal endoscopic (UBE) and open microdiscectomy for the treatment of single-level lumbar disc herniation (LDH).

Overview of literature: Open microdiscectomy remains the gold standard for LDH, while UBE has emerged as a minimally invasive alternative. However, comparative evidence on efficacy, safety, and recovery profiles remains limited.

Methods: This was a single-center retrospective analysis of 46 patients with single-level LDH who underwent either the UBE surgery (n=22) or open microdiscectomy (n=24) between January 2020 and December 2022. Demographic information, perioperative data, and radiographic measurements were reviewed. Pain intensity, patient satisfaction, and quality of life were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) at 1-week, 3-month, and 12-month follow-ups.

Results: The mean operative time in the UBE group (86.1±11.4 minutes) was significantly longer than in the open microdiscectomy group (72.3±8.0 minutes, p=0.032). UBE was associated with significantly lower estimated blood loss (54.1±13.7 mL vs. 92.5±11.6 mL, p=0.001) and shorter hospital stay (3.7±1.2 days vs. 6.6±1.4 days, p=0.001). The mean VAS score for back pain at 1 week was significantly better in the UBE group (1.88±0.60 vs. 3.59±0.72, p=0.004). However, both surgical techniques showed similar long-term results regarding disc height, disc angle changes, and patient-reported outcomes.

Conclusions: Despite the longer operative time, UBE is associated with reduced estimated blood loss and shorter hospital stays, offering a minimally invasive alternative with early postoperative pain relief. Conversely, open microdiscectomy, the conventional treatment approach, demonstrates comparable efficacy in long-term clinical outcomes despite its more invasive nature. Both methods show similar rates of complications and recurrent disc herniation. UBE is a viable alternative to open microdiscectomy, depending on individual patient considerations and surgical preferences.

Study design: Retrospective cohort study.

Purpose: This study aimed to investigate trends in postoperative complications for posterior cervical fusions from 2012 to 2022.

Overview of literature: Previous studies analyzing the longitudinal outcomes of posterior cervical fusion from 2003 to 2013 have demonstrated relatively improved postoperative outcomes despite the increasing volume, complexity, and age of the patient population. However, few studies have evaluated these outcomes since 2013.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing posterior cervical fusion between 2006 and 2022. Patients aged >18 years with current procedural terminology code 22600 for posterior cervical fusion were included. Patient demographics and comorbidities were recorded, including age, race, body mass index, diabetes mellitus, and hypertension. Annual 30-day complication rates were reported, including wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions, and mortality.

Results: In total, 25,537 patients undergoing posterior cervical fusion from 2012 to 2022 were included. Variations in the rates of urinary tract infection, deep vein thrombosis, sepsis, reoperation, and mortality were not significant. Wound infection rates increased from 2.4% in 2012 to 4.0% in 2022 (p=0.003). Pneumonia rates increased from 1.2% in 2012 to 1.6% in 2022 (p=0.011). Intraoperative blood transfusion rates decreased consistently from 5.6% in 2012 to 2.8% in 2022 (p<0.001). Readmission rates increased from 6.4% in 2012 to 6.7% in 2022 (p<0.001). The average length of stay decreased from 4.18 days in 2012 to 3.97 days in 2019, before increasing between 2020 and 2022 to 4.17 days in 2022.

Conclusions: Rates of comorbidities including age, diabetes mellitus, and hypertension have increased among patients undergoing posterior cervical fusion between 2012 and 2022, whereas complication rates have remained relatively similar. The length of stay has shortened despite the higher medical complexity of the patients who underwent surgery.