Asian Spine Journal最新文献

Study design: Retrospective cohort study.

Purpose: This study aimed to develop machine-learning algorithms to predict ambulation outcomes following surgery for spinal metastasis.

Overview of literature: Postoperative ambulation status following spinal metastasis surgery is currently difficult to predict. The improved ability to predict this important postoperative outcome would facilitate management decision-making and help in determining realistic treatment goals.

Methods: This retrospective study included patients who underwent spinal metastasis at a university-based medical center in Thailand between January 2009 and November 2021. Collected data included preoperative parameters and ambulatory status 90 and 180 days following surgery. Thirteen machine-learning algorithms, namely, artificial neural network, logistic regression, CatBoost classifier, linear discriminant analysis, extreme gradient boosting, extra trees classifier, random forest classifier, gradient boosting classifier, light gradient boosting machine, naïve Bayes, K-neighbor classifier, Ada boost classifier, and decision tree classifier were developed to predict ambulatory status 90 and 180 days following surgery. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1-score.

Results: In total, 167 patients were enrolled. The number of patients classified as ambulatory 90 and 180 days following surgery was 140 (81.9%) and 137 (82.0%), respectively. The extreme gradient boosting algorithm was found to most accurately predict 180-day ambulatory outcome (AUC, 0.85; F1-score, 0.90), and the decision tree algorithm most accurately predicted 90-day ambulatory outcome (AUC, 0.94; F1-score, 0.88).

Conclusions: Machine-learning algorithms were effective in predicting ambulatory status following surgery for spinal metastasis. Based on our data, the extreme gradient boosting and decision tree best predicted postoperative ambulatory status 180 and 90 days after spinal metastasis surgery, respectively.

Complex craniovertebral junction (CVJ) defects account for a considerable proportion of CVJ diseases. Given the heavily assimilated C1, an unfavorable C1-C2 joint orientation, an overriding C2 superior facet, a low-hanging occiput, and an abnormal vertebral artery course with a high-riding vertebral artery, placement of C1 lateral mass screws might be difficult. To address this, a novel technique for placing C1 lateral mass screws that avoid vertebral artery injury, low-hanging occiput, and overriding C2 superior facet was developed in this study. This approach enables firm fixation of C1-C2 even in difficult situations where the placement of the C1 lateral mass is challenging.

Study design: This experimental study was performed using human ligamentum flavum-derived cells (HFCs).

Purpose: To investigate the intracellular signaling mechanism of interleukin-6 (IL-6) secretion in transforming growth factor-β (TGF- β)-stimulated HFCs.

Overview of literature: Lumbar spinal stenosis (LSS) is a prevalent disease among the elderly, characterized by debilitating pain in the lower extremities. Although the number of patients with LSS has increased in recent years, the underlying pathomechanism remains unclear. Clinical examinations typically rely on magnetic resonance imaging to diagnose patients, revealing ligamentum flavum hypertrophy. Some studies have suggested an association between ligamentum flavum hypertrophy and inflammation/fibrosis, and expression of TGF-β and IL-6 has been observed in surgically obtained ligamentum flavum samples. However, direct evidence linking TGF-β and IL-6 expression in HFCs is lacking.

Methods: HFCs were obtained from patients with LSS who had undergone decompression surgery. The cells were stimulated with TGF-β and pretreated with either the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580 or the p44/42 MAP kinase inhibitor FR180204. IL-6 secretion in the cell culture medium and IL-6 messenger RNA (mRNA) expression levels were analyzed using an enzyme-linked immunoassay and real-time polymerase chain reaction, respectively.

Results: TGF-β administration resulted in a dose- and time-dependent stimulation of IL-6 release. Treatment with SB203580 and FR180204 markedly suppressed TGF-β-induced IL-6 secretion from HFCs. Moreover, these inhibitors suppressed IL-6 mRNA expression in response to TGF-β stimulation.

Conclusions: Our findings indicate that TGF-β induces IL-6 protein secretion and gene expression in HFCs through the activation of p38 or p44/42 MAP kinases. These results suggest a potential association between IL-6-mediated inflammatory response and tissue hypertrophy in LSS, and we provide insights into molecular targets for therapeutic interventions targeting LSS-related inflammation through our analysis of the MAP kinase pathway using HFCs.

Study design: Retrospective cohort study.

Purpose: This study aimed to determine whether the initiation of anti-calcitonin gene-related peptide (CGRP inhibitor) medication therapy for migraines was also associated with improvements in back/neck pain, mobility, and function in a patient population with comorbid degenerative spinal disease and migraine.

Overview of literature: CGRP upregulates pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-6, brain-derived neurotrophic factor, and nerve growth factor in spinal spondylotic disease, which results in disc degeneration and sensitization of nociceptive neurons. Although CGRP inhibitors can quell neurogenic inflammation in migraines, their off-site efficacy as a therapeutic target for discogenic back/neck pain conditions remains unknown.

Methods: All adult patients diagnosed with spinal spondylosis and migraine treated with CGRP inhibitors at a single academic institution between 2017 and 2020 were retrospectively identified. Patient demographic and medical data, follow-up duration, migraine severity and frequency, spinal pain, functional status, and mobility before and after the administration of CGRP inhibitors were collected. Paired univariate analysis was conducted to determine significant changes in spinal pain, headache severity, and headache frequency before and after the administration of CGRP inhibitors. The correlation between changes in the spinal pain score and functional or mobility improvement was assessed with Spearman's rho.

Results: In total, 56 patients were included. The mean follow-up time after the administration of CGRP inhibitors was 123 days for spinal pain visits and 129 days for migraine visits. Back/neck pain decreased significantly (p <0.001) from 6.30 to 4.36 after starting CGRP inhibitor therapy for migraine control. As recorded in the spine follow-up notes, 25% of patients experienced a functional improvement in the activities of daily living, and 17.5% experienced mobility improvement while taking CGRP inhibitors. Change in back/ neck pain moderately correlated (ρ=-0.430) with functional improvement but was not correlated with mobility improvement (ρ=-0.052).

Conclusions: Patients taking CGRP inhibitors for chronic migraines with comorbid degenerative spinal conditions experienced significant off-target reduction of back/neck pain.

Study design: Retrospective study.

Purpose: To investigate the clinical manifestations of a fragility fracture of the sacrum (FFS) and the factors that may contribute to a misdiagnosis.

Overview of literature: The number of patients diagnosed with FFS has increased because of extended life expectancy and osteoporosis. Patients with FFS may report nonspecific symptoms, such as back, buttock, groin, and/or leg pain, leading to a misdiagnosis and a delay in definitive diagnosis.

Methods: Fifty-six patients (13 males and 43 females) with an average age of 80.2±9.2 years admitted to the hospital for FFS between 2006 and 2021 were analyzed retrospectively. The following patient data were collected using medical records: pain regions, a history of trauma, initial diagnoses, and rates of fracture detection using radiography, computed tomography (CT), and magnetic resonance imaging (MRI).

Results: Forty-one patients presented with low back and/or buttock pain, nine presented with groin pain, and 17 presented with thigh or leg pain. There was no history of trauma in 18 patients (32%). At the initial visit, 27 patients (48%) were diagnosed with sacral or pelvic fragility fractures. In contrast, 29 patients (52%) were initially misdiagnosed with lumbar spine disease (23 patients), hip joint diseases (three patients), and buttock bruises (three patients). Fracture detection rates for FFS were 2% using radiography, 71% using CT, and 93% using MRI. FFS was diagnosed definitively using an MRI with a coronal short tau inversion recovery (STIR) sequence.

Conclusions: Some patients with FFS have leg pain with no history of trauma and are initially misdiagnosed as having lumbar spine disease, hip joint disease, or simple bruises. When these clinical symptoms are reported, we recommend considering FFS as one of the differential diagnoses and performing lumbar or pelvic MRIs, particularly coronal STIR images, to rule out FFS.

This study consists of a retrospective cohort study, a systematic review, and a meta-analysis which were separately conducted. This study aimed to investigate the prevalence of atlas arch defects, generate an evidence-based synthesis, and propose a common classification system for the anterior and combined atlas arch defects. Atlas arch defects are well-corticated gaps in the anterior or posterior arch of the atlas. When both arches are involved, it is known as a combined arch defect. Awareness of these defects is essential for avoiding complications during surgical procedures on the upper spine. The prevalence of arch defects was investigated in an open-access OPC-Radiomics (Radiomic Biomarkers in Oropharyngeal Carcinoma) dataset comprising 606 head and neck computed tomography scans from oropharyngeal cancer patients. A systematic review and meta-analysis were performed to generate prevalence estimates of atlas arch defects and propose a classification system for the anterior and combined atlas arch defects. The posterior arch defect was found in 20 patients (3.3%) out of the 606 patients investigated. The anterior arch defect was not observed in any patient, while a combined arch defect was observed in one patient (0.2%). A meta-analysis of 13,539 participants from 14 studies, including the present study, yielded a pooled-posterior arch defect prevalence of 2.07% (95% confidence interval [CI], 1.22%-2.92%). The prevalences of anterior and combined arch defects were 0.00% (95% CI, 0.00%-0.10%) and 0.14% (95% CI, 0.04%-0.25%), respectively. The anterior and combined arch defects were classified into five subtypes based on their morphology and frequency. The present study showed that atlas arch defects were present in approximately 2% of the general population. For future studies, larger sample sizes should be used for studying arch defects to avoid the small-study effect and to predict the prevalence accurately.

Study design: Retrospective cohort study.

Purpose: The present study aimed to examine the characteristics of physical signs in elderly patients with cervical myelopathy (CM) and to compare the findings in three different age groups.

Overview of literature: As the global population ages, the incidence of CM in elderly patients is increasing.

Methods: We evaluated 100 consecutive surgical patients with CM and divided them into the following groups: 80s (34 patients; mean age, 83.9 years), 70s (33 patients; mean age, 73.9 years), and 69 or younger (33 patients; mean age, 60.9 years). The clinical symptoms and physical signs were evaluated and recorded.

Results: Although the recovery rate decreased with increasing age, all groups demonstrated a significant improvement in clinical symptoms relative to preoperative values. The Hoffman sign and hyperreflexia of the triceps tendon were, respectively, present in 82% and 88% of patients in the 80s group, 74% and 64% of those in the 70s group, and 69% and 82% of those in the 69 or younger group, with no significant difference among the groups. In contrast, the rates of hyperreflexia of the patellar and Achilles tendons were, respectively, 59% and 32% in the 80s group, 85% and 48% in the 70s group, and 91% and 70% in the 69 or younger group, with significant differences.

Conclusions: The positivity rate of the lower extremity hyperreflexia decreased significantly with increasing age in patients with CM. The absence of hyperreflexia, particularly lower extremity, is not uncommon in elderly patients with suspected CM.

Study design: Retrospective study.

Purpose: To introduce a simple technique to facilitate lumbar spondylolisthesis reduction during posterior lumbar interbody fusion (PLIF).

Overview of literature: Spondylolisthesis reduction has been conducted in various ways, but most of them require special complicated tools.

Methods: T-shaped levering tool was newly designed. This study included 23 patients who underwent PLIF for lumbar spondylolisthesis treatment using newly designed T-shaped tools and followed up for >2 years. Demographic, clinical, and surgical data, which had been routinely collected in a database, were analyzed. The degree of listhesis was measured on lateral radiographs by the Taillard method.

Results: The authors could achieve lumbar spondylolisthesis reduction without difficulty using newly designed T-shaped tools. Immediate postoperative lateral radiographs revealed a reduced preoperative slip of 36.9%±9.6% to 1.2%±1.9%, showing a correction rate of 96.7%. The final follow-up radiographs revealed the mean final slip of 2.6%±2.7%, showing a correction rate of 93.0%.

Conclusions: This technique allowed lumbar spondylolisthesis reduction without difficulty.