Asian Spine Journal最新文献

Study design: Retrospective cohort study.

Purpose: To compare rates of 30-day reoperation (RTOR), readmission, overall postoperative complication, non-home discharge, and length of stay (LOS); and investigate individual postoperative complication rates among patients with preoperative normoalbuminemia versus hypoalbuminemia.

Overview of literature: Evidence continues to accumulate associating poor preoperative nutritional status with inferior surgical outcomes in spinal deformity and oncology. These spinal subspecialities frequently require instrumentation and significant tissue disruption. However, the relationship between preoperative nutrition and shorter, less invasive spinal decompression remains poorly assessed.

Methods: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adult patients (>18 years) who underwent elective lumbar laminectomy for lumbar stenosis between 2015 and 2022. Univariate comparison and multivariate logistic regression analyses were conducted.

Results: This study identified 9,593 cases. Among primary outcomes, patients with hypoalbuminemia reported more 30-day readmission (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.17-1.2.82; p =0.008) and non-home discharge rates (OR, 2.08; 95% CI, 1.57-2.76; p <0.001) as well as longer LOS (3.7±4.5 days vs. 1.9±2.4 days, p <0.0005) in both univariate and multivariate analyses, whereas they demonstrated higher RTOR (5.3% vs. 2.7%, p =0.003) and postoperative complication rates (19.0% vs. 5.8%, p <0.001) in only univariate analysis compared with those having normoalbuminemia. Among secondary outcomes, patients with hypoalbuminemia reported statistically more wound and pulmonary complications in univariate analysis; however, they had higher risks of only venous thrombosis requiring anticoagulation and stroke in multivariate analysis.

Conclusions: Preoperative hypoalbuminemia is associated with higher rates of 30-day readmission, non-home discharge, and postoperative complications, as well as longer LOS after elective open lumbar laminectomy. These data indicate the importance of preoperative nutritional optimization even in shorter, more routine spinal surgery.

Study design: Retrospective cohort study.

Purpose: To compare thrombotic complication rates in thoracolumbar spine surgery patients before and after the coronavirus disease 2019 (COVID-19) pandemic.

Overview of literature: Thrombotic complications are a major cause of postoperative morbidity and mortality in spine surgery. Both COVID-19 infection and vaccination have been linked to hypercoagulability. However, data on pre- versus post-pandemic thrombotic risk in spine surgery are limited, and the influence of infection severity or vaccination status has not been examined.

Methods: Adult patients (≥18 years) undergoing primary thoracolumbar decompression with or without fusion were identified, excluding trauma and neoplastic cases. Patients were divided into "pre-COVID" and "post-COVID" cohorts. Outcomes included 90-day rates of postoperative deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and cerebrovascular accident (CVA). Cohorts were compared using Pearson's chi-square tests, and multivariable regression adjusted for demographics and comorbidities.

Results: A total of 784,498 patients were included. Post-COVID, rates of DVT (1.4% vs. 1.3%; risk ratio [RR], 1.11; p <0.001), PE (0.9% vs. 0.8%; RR, 1.14; p <0.001, and CVA (0.8% vs. 0.7%; RR, 1.17; p <0.001) were higher. Multivariable analysis demonstrated a 7% increase in odds of VTE post-COVID (odds ratios [OR], 1.07; p =0.002). Unvaccinated patients had a 6% higher odds of VTE (OR, 1.06; p =0.006), whereas vaccinated patients showed a nonsignificant increase (OR, 1.16; p =0.109). Patients with prior COVID-19 hospitalization had approximately double the odds of VTE (OR, 2.03; p =0.011).

Conclusions: Thrombotic complications modestly increased after the COVID-19 pandemic. Vaccination status showed no clear association, while prior hospitalization for COVID-19 was the strongest predictor of postoperative thrombotic risk.

Robotic-assisted laminectomy (RAL) is an emerging technique in spine surgery that can potentially improve precision, safety, and efficiency. While robotic-assisted pedicle screw placement is well established, RAL remains in early stages with varied methodologies and primarily pre-clinical validation. This narrative review evaluates current evidence on RAL, focusing on bone cutting tools, resection strategies, state recognition techniques for real-time identification of bone type and surgical endpoints, and clinical applications to inform future advancements. A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases with relevant keywords and operators to maximize sensitivity. Twenty-seven studies met predefined inclusion and exclusion criteria. Evaluated cutting tools included burrs, drills, and ultrasonic osteotomes. Burrs and drills provided superior state recognition feedback, while ultrasonic devices offered better force control and reduced thermal damage. Cyclic dorsal-ventral drilling was found to be superior to layer-by-layer resection for ultrasonic cutting. The only clinical study of RAL in a human patient is a case report demonstrating robotic-guided, surgeon-operated laminar bone removal. While RAL shows promise in improving surgical accuracy, the lack of in vivo data and standardized methodology remains a key barrier to clinical adoption. Future research should prioritize comparative evaluation of cutting modalities, clinical validation in human subjects, and long-term outcome studies to support the broader integration of RAL into spine surgery.

Study design: Randomized controlled trial (RCT).

Purpose: This study aimed to determine the impact of mechanical bowel preparation (MBP) before surgery on postoperative ileus (POI) after elective lumbar spine procedures conducted via a posterior approach.

Overview of literature: Postoperative Ileus occurs in 5%-12% of spine surgeries. The data relating to spine surgeries is sparse. Previous studies have not shown a significant effect of MBP. However, most of these studies have been conducted on patients undergoing spine surgeries through anterior approaches.

Methods: This RCT included 60 patients (30 in control and 30 in intervention) between 18 and 80 years old, scheduled for elective single or double-level lumbar spine surgeries through the posterior approach. Intervention group (MBP) received PEGLEC, tablet Metronidazole 400 mg twice daily (BD), tablet Cefuroxime 500 mg BD, and probiotic (Bacillus clausii ) on pre-operation day, whereas the control (non-MBP) had no specific bowel preparation but received only a placebo. Outcome parameters included time to first flatus, bowel sound, and first defecation, which were compared between the two groups.

Results: Demographic data such as age, sex, body mass index, level of surgery, and intraoperative data such as duration of surgery and blood loss were similar without significant differences. The time to first flatus, bowel sounds, and first defecation was not statistically significant, but POI was seen in 6.67% of patients, all belonging to the MBP group. No correlation observed between the duration of the ileus and the intraoperative blood loss and duration of surgery.

Conclusions: Bowel preparation may not be necessary for patients undergoing posterior lumbar spine surgery involving a maximum of two levels.

Study design: Comparative study.

Purpose: To evaluate the concurrent validity, test-retest reliability, and inter-rater reliability of Cobb measurement in the coronal plane via dual-energy X-ray absorptiometry (DEXA) images and plain radiographs in female patients with idiopathic scoliosis (IS).

Overview of literature: IS, which affects primarily females, is commonly monitored at least biannually with spine radiographs according to the Cobb method. DEXA is a safer imaging method because it involves less radiation exposure. Although DEXA has potential for assessing spinal alignment, its validity and reliability in measuring Cobb angles require further verification.

Methods: A repeated-measures design was used to evaluate the test-retest reliability of measuring spinal alignment with DEXA. Eighty-six women aged 18-20 years with a diagnosis of IS, who had undergone spinal radiography within the previous 3 months, underwent two DEXA scans (DEXA1 and DEXA2) 1 week apart. Cobb angles were measured on radiographs, DEXA1, and DEXA2 by two independent assessors. Intraclass correlation coefficients (ICCs) were calculated to assess test-retest reliability and inter-rater reliability. Concurrent validity was examined using Pearson's correlation coefficients between Cobb angles obtained from radiographs and those from DEXA1 and DEXA2 images.

Results: Cobb angle measurements from DEXA images had excellent test-retest and nter-rater reliability (ICC>0.90) and very strong concurrent validity with radiographs (r >0.90, p <0.001). The mean difference in Cobb angles between radiographs and DEXA images ranged from 2.37° to 2.91°, whereby the curves were less severe on DEXA images.

Conclusions: DEXA has consistent reliability and validity for evaluating spinal alignment and is potentially useful in monitoring curve progression in young populations.

Study design: Retrospective observational study.

Purpose: To evaluate the effectiveness of the inlet view in detecting anterior deviations of the S2 alar iliac (S2AI) screw during spinopelvic surgery and to assess the utility of the obturator inlet (OI) and iliac oblique (IO) views as alternative imaging methods.

Overview of literature: S2AI screws are increasingly utilized in spinopelvic fixation due to their biomechanical advantages. However, malpositioning of screws can lead to neurovascular complications. While inlet views in fluoroscopic techniques are generally effective for identifying screw deviations, there are instances where deviations go unnoticed.

Methods: We analyzed data from 101 patients who underwent spinopelvic surgery involving 202 S2AI screws. Postoperative computed tomography (CT) images were reviewed to identify screw deviations. The reconstructed fluoroscopic views from CT, including the inlet, OI, and IO views, were assessed for their effectiveness in detecting deviations. An experimental study using pelvic bone models simulated scenarios where deviations were undetectable in the inlet view but visible in the OI view.

Results: Screw deviations were identified in 12 cases (11.9%) and 13 screws (6.4%), including six screws (3.0%) with anterior deviations and seven screws (3.5%) with posterior deviations. The accurate inlet view detected anterior deviations in three of the five cases analyzed with reconstructed images. However, two cases of anterior deviation were missed due to an insufficient inlet view caused by a 30° caudal tilting angle. In contrast, the OI view successfully identified all cases of both anterior and posterior deviations. In particular, deviations above the arcuate line of the pelvic brim were not detectable in the inlet view.

Conclusions: The inlet view alone is inadequate for detecting anterior deviations, especially those located above the arcuate line of the pelvis. The OI and IO views demonstrated greater effectiveness in identifying deviations, thereby enhancing the accuracy and safety of S2AI screw placement.

Study design: Observational cadaveric anatomical study.

Purpose: To investigate the anatomical relationship between the segmental vessels and the diaphragmatic crus, aiming to reduce the risk of segmental vessel injury.

Overview of literature: Total en bloc spondylectomy and lateral lumbar interbody fusion are advanced surgical procedures associated with segmental vessel injury. Previous research suggests these injuries may arise from anatomical variations where segmental vessels intersect intervertebral discs. At upper lumbar levels, the diaphragmatic crus lies adjacent to the vertebral bodies, and its relationship with segmental vessels may increase vascular risk. Although this proximity has been noted, no study has specifically examined the detailed anatomy of the crus in relation to segmental vessels. Clarifying this relationship is critical for surgical planning and safety.

Methods: Fifteen Thiel-embalmed human cadavers (three males, 12 females; mean age 90.1 years) were dissected. Segmental arteries and veins from L1 to L5 and both crura were identified and measured. Crus origin, width, and distance from the vertebral midline were assessed. Data were analyzed using paired t-tests and Wilcoxon signed-rank tests.

Results: The right crus was broader, originated more caudally, and was positioned closer to the vertebral midline along the ventral surface of the vertebral body than the left crus, especially at L1-L3. Segmental arteries and the left segmental vein coursed between the crus and vertebral bodies, whereas the right segmental vein consistently passed ventral to the crus.

Conclusions: The diaphragmatic crus shows laterality in origin, width, and position, with distinct relationships to segmental vessels. Recognizing these anatomical features may help surgeons minimize vascular injury and improve safety during lumbar spinal surgery.

Endoscopic transforaminal lumbar interbody fusion (TLIF) offers substantial advantages in the management of degenerative spinal diseases, including accelerated postoperative recovery. However, its technical complexity and steep learning curve pose risks for nerve root injury. Optimizing nerve root protection in full-endoscopic facet-sparing TLIF (FE fs-TLIF) and full-endoscopic facet-resecting TLIF (FE fr-TLIF) is essential for enhancing surgical safety. This study aimed to improve the nerve root protection in FE fs-TLIF and FE fr-TLIF by optimizing cage glider selection and insertion techniques based on the specific cage shape-banana-shaped or bullet-shaped. The goal was to ensure safe cage positioning and mitigate nerve root injury during discectomy, endplate preparation, and cage insertion. These strategies were validated through cadaveric simulations and clinical implementation. In FE fr-TLIF utilizing bullet-shaped (straight) cages, one-tip and two-tip cage gliders effectively protected the traversing nerve root by facilitating medial cage entry, thereby minimizing irritation of the exiting nerve root. Conversely, in FE fr-TLIF with banana-shaped cages, the lateral tilt of the cage holder during implantation required the use of a two-tip cage glider to protect the traversing and exiting nerve roots, thereby mitigating the potential risk of nerve irritation. In FE fs-TLIF, a one-tip cage glider is preferred for safeguarding the exiting nerve root, while the traversing root is inherently protected by the medial wall of the facet joint. The use of a two-tip cage glider in FE fs-TLIF can cause injury to the nerve root during glider insertion. In addition to the selection of cage gliders, improper cage insertion steps can also contribute to postoperative neurapraxia. The appropriate selection of cage gliders with corresponding insertion techniques is critical for nerve root protection in endoscopic TLIF. Tailoring these choices to the specific approach (FE fs-TLIF or FE fr-TLIF) and cage type (banana or bullet) enhances surgical safety and clinical outcomes.

Study design: Prospective observational radiographic study.

Purpose: To evaluate how different car seat recline angles affect global spinal alignment and lap belt positioning in healthy adults, and to assess the influence of demographic factors on these changes.

Overview of literature: Seated posture alters global spinal alignment and may contribute to spinal symptoms, especially in individuals with adult spinal deformity (ASD) or following spine surgery. However, radiographic data on reclined seated postures and their impact on spinal alignment and restraint safety remain limited.

Methods: Lateral radiographs were obtained from 100 healthy adults in standing and seated postures at 25°, 35°, and 45° recline angles. Spinal parameters (cervical lordosis, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and T1 spinopelvic inclination) and seat belt metrics (X-value, Z-value, and lap belt angle) were measured. Multivariate regression was used to assess associations with sex, age, height, and body mass index (BMI).

Results: Reclining reduced cervical/lumbar lordosis and sacral slope, while thoracic kyphosis and pelvic tilt increased. Higher BMI was associated with a cranially shifted and more horizontal lap belt. Taller individuals showed greater T1 spinopelvic inclination and pelvic parameters. Females exhibited more pronounced thoracic kyphosis and pelvic retroversion across reclining angles.

Conclusions: Car seat recline significantly alters spinal alignment and seat belt positioning, with changes influenced by age, height, and BMI. These findings support ergonomic improvements in seat design and may inform surgical planning for ASD.