Asian Spine Journal最新文献

Study design: A double-blind randomized placebo-controlled trial.

Purpose: To evaluate the efficacy and safety of gabapentin (GBA) and pregabalin (PGB) versus placebo in managing neurogenic intermittent claudication (NIC), functional outcomes, and quality of life in patients with lumbar spinal stenosis (LSS).

Overview of literature: GBA and PGB are frequently prescribed for NIC associated with LSS. However, evidence supporting their efficacy, either in comparison with placebo or in direct comparison between the two gabapentinoids in LSS, remains limited.

Methods: LSS patients with predominant NIC symptoms for ≥3 months were randomized (1:1:1) to receive GBA (1,800 mg/day), PGB (300 mg/day), or placebo in addition to standard conservative management, including physical therapy and naproxen. GBA and PGB were both titrated to the effective dose over 14 days. The primary outcome was NIC pain measured by Visual Analog Scale (VAS). Secondary outcomes included the Swiss Spinal Stenosis Score (SSS), self-paced shuttle walk test (SPSWT; time to NIC symptoms and walking distance), Euro-QoL Group's 5-Dimension, 5-Level (EQ-5D-5L), and adverse effects. All outcomes were assessed monthly over 4 months.

Results: Ninety patients (mean age, 63.14 years; symptoms duration, 19.38 months) were included. All groups demonstrated significant improvements in VAS, SSS, SPSWT, and EQ-5D-5L at 4 months. At 1 and 2 months, PGB showed greater EQ-5D-5L improvement compared to GBA (mean differences: 0.07 [p=0.045] and 0.08 [p=0.001], respectively). No significant differences in other outcomes were observed between groups at any time point. Adverse effects, including dizziness and sedation, were more common in the GBA and PGB groups compared to placebo (p<0.001).

Conclusions: GBA and PGB did not demonstrate superior efficacy over placebo in reducing NIC and improving functional outcomes in LSS. Moreover, their use was associated with a higher incidence of adverse effects. These findings suggest limited utility for gabapentinoids as adjunctive treatments for LSS.

Study design: Longitudinal cohort study.

Purpose: To investigate factors associated with chronic pain (CP) development following vertebral fracture (VF).

Overview of literature: Factors contributing to CP development after VFs are not well characterized.

Methods: Hospitalized patients with acute VFs underwent assessment of vertebral morphology and paraspinal muscles. Two weeks post-admission, patients were evaluated for pain intensity (using the Verbal Rating Scale [VRS]), pain sensitivity (Pressure Pain Threshold [PPT] and Conditioned Pain Modulation), psychological factors, physical function, and activity levels. At 12 weeks, patients were categorized into CP and non-CP (NCP) groups based on VRS scores. Between-group comparisons and logistic regression analysis were performed to identify predictors of CP development.

Results: The CP group exhibited significantly lower remote PPT and reduced low-intensity physical activity time, but higher Pain Catastrophizing Scale rumination scores and prolonged 5-Times Sit-to-Stand Test (5SST) compared to the NCP group. Logistic regression identified prolonged 5SST and reduced low-intensity physical activity as independent predictors of CP development.

Conclusions: Prolonged 5SST and reduced low-intensity physical activity may predict CP development after VFs. Early assessment of these factors may facilitate CP risk screening in hospitalized patients with VFs.

Study design: Single-center, retrospective cohort study of patients undergoing adult spinal deformity (ASD) surgery between 2009 and 2021.

Purpose: To identify preoperative and intraoperative risk factors associated with increased estimated blood loss (EBL), operative time, and length of stay (LOS) in ASD surgery.

Overview of literature: Identifying risk factors associated with these outcomes may help improve surgical planning and outcomes in ASD surgery.

Methods: Inclusion criteria: ≥5-level fusion, sagittal/coronal deformity, and minimum 2-year follow-up. Primary outcomes were the highest quartile of EBL (mL), operative time (minutes), and LOS (days). EBL was calculated based on the hemoglobin drop. Bivariate analysis and multivariable logistic regression were performed, controlling for age, comorbidities, and preoperative radiographic parameters.

Results: Among 238 patients (mean age, 63.4±17.4 years), the highest EBL quartile (2,594.0±1,550.5 mL) had more three-column osteotomies (3CO) (30.5% vs. 14.8%, p=0.008). Multivariable predictors of highest EBL were older age (odds ratio [OR], 1.03; p=0.039) and 3CO (OR, 3.60; p=0.007). The highest operative time quartile (618.9±99.4 minutes) had more 3CO (27.1% vs. 15.3%, p=0.041) and higher rod fracture rates (30.5% vs. 15.8%, p=0.014). Multivariable predictors of the highest operative time were higher total instrumented levels (TIL) (OR, 1.26; p<0.001) and older age (OR, 1.05; p=0.003). The highest LOS quartile (14.5±18.5 days) had more 3CO (27.3% vs. 14.3%, p=0.045). The multivariable predictor of highest LOS was higher TIL (OR, 1.23; p<0.001).

Conclusions: Three-column osteotomy was the strongest predictor of perioperative morbidity in ASD surgery, consistently associated with higher blood loss, longer operative times, and prolonged hospital stays. Recognizing its impact can inform surgical strategies to improve patient outcomes.

This study aimed to preliminarily evaluate the efficacy of posterior debridement and corpectomy via the spinal canal's lateral wall approach (PDC-SCLWA) for spinal infection after vertebral augmentation (SIAVA). The procedure is characterized as "lateral wall resection for access, anterior lesion removal for debridement, and posterior wall preservation for bone graft fusion." This distinguishes it from conventional 360° decompression that involves extensive lamina and facet joint resection. Eight patients who underwent PDC-SCLWA were included. The mean surgical duration was 290.6±59.2 minutes, with an average intraoperative blood loss of 775.0±389.7 mL. Intraoperative dural laceration occurred in two patients. All patients' symptoms were alleviated, and no recurrent infection was observed during follow-up. Seven patients received double titanium meshes, and one received an iliac bone graft. At 3 months postoperatively, the fusion rates of intervertebral bodies and posterolateral laminae were 93.8% (15/16) and 100% (7/7), respectively. SIAVA is a severe postoperative complication, especially in elderly patients with multiple comorbidities. PDC-SCLWA is a safe and effective surgical technique. It provides advantages through posterior wall preservation that minimize spinal cord disruption, maintains mechanical stability, and optimizes the bone graft bed for fusion.

This systematic review and meta-analysis aimed to assess the effectiveness of chemical prophylaxis in preventing venous thromboembolism (VTE) and spinal epidural hematoma (SEH) following degenerative spine surgery. The effectiveness of chemical prophylaxis in preventing VTE and SEH following degenerative spine surgery remains controversial, with variability in protocols and a lack of comprehensive, high-quality studies guiding optimal prophylaxis strategies. An electronic search across five databases, including Medline, Embase, Cochrane Library, Scopus, and Web of Science, was performed on February 2, 2024 to identify studies comparing chemical with nonchemical prophylaxis for VTE among degenerative spine surgery patients. Studies reporting on VTE (deep vein thrombosis and pulmonary embolism) and SEH were included. Patients under 18 years of age and those with trauma, tumors, infections, congenital deformities, and adolescent idiopathic scoliosis were excluded. Data on study characteristics, clinical details, and outcomes were collected. Metaanalyses were conducted to compare patients received chemical and non-chemical prophylaxis for VTE. Subgroup analyses according to the type of medication used for the chemical prophylaxis, study design, dosage regimen, and study quality were also performed. A total of 17 studies involving 5,383 patients satisfied our eligibility criteria. No significant difference in VTE incidence was observed between patients receiving chemical and non-chemical prophylaxis (risk ratio, 1.09; 95% confidence interval, 0.82 to 1.46; p=0.988). Subgroup analyses also showed consistent results (p>0.05). SEH incidence was reported in five studies (29.4%) involving five cases, among whom three and two were in the control and chemoprophylaxis groups, respectively. Perioperative chemoprophylaxis may not significantly alter VTE or SEH rates following degenerative spine surgery. This study highlights the need for further high-quality studies to establish better recommendations for VTE prophylaxis after degenerative spine surgeries (PROSPERO registration no., CRD42024585493).

Facet joint violation (FJV) is a known complication of pedicle screw fixation that may contribute to adjacent segment disease (ASD) by altering spinal biomechanics and increasing loading of the cranial facet joints. However, the prevalence, biomechanical effects, and longterm consequences of FJV remain unclear. A scoping review was conducted using the PubMed, Embase, and Scopus databases. Clinical studies reporting the number of FJVs in relation to screws placed during lumbar fusion or assessing the frequency of ASD in patients with FJV were included. Biomechanical studies evaluating segmental kinematics and loading after FJV were also included. Data regarding study characteristics, surgical techniques, FJV rates, severity grading, and outcomes were extracted. Bayesian statistical models were applied for pooled prevalence estimates. Fifty studies met the inclusion criteria (39 clinical and 11 biomechanical studies). The prevalence of FJV varied, with robotic-assisted percutaneous placement associated with the lowest risk (4.79%; 95% credible interval [CrI], 3.88-5.79), and freehand percutaneous placement associated with the highest risk (19.45%; 95% CrI, 18.15-20.73). FJV rates were highest at L2 (14.5%; 95% CrI, 10.4%-19.0%) compared to lower levels. Biomechanical studies indicate that minor FJV may destabilize the superior segment by disrupting the facet capsule, while severe FJV involving full joint traversal might stabilize the segment due to the screw's interaction with both articulating processes. Limited evidence suggests an association between FJV and ASD, though methodological limitations, selection bias, and reporting errors limit conclusions. FJV is common during lumbar fusion, especially with percutaneous screw placement. While biomechanical evidence suggests differing grades of FJV may variably alter segmental stability, its role in ASD development remains uncertain. Given its prevalence, biomechanical implications, and potential mitigation through navigation or robotics, determining whether FJV is a clinically significant driver of ASD is a key research imperative.

Study design: Retrospective cohort study.

Purpose: We assessed the predisposition to type II odontoid fractures (T2OFs) in elderly people by comparing patients who had T2OFs with those who had sub-axial fractures.

Overview of literature: T2OFs are common among elderly people; osteoporosis and degenerative changes in the upper cervical spine are major risk factors. However, the role of spinal ankylosis remains unclear.

Methods: We analyzed data from 45 patients with T2OFs and 79 with sub-axial fractures, all aged ≥75 years. Hounsfield unit (HU) values at C2-C4, the prevalence of ankylosis, and degenerative changes were assessed via computed tomography. We performed sex-specific analysis and logistic regression to identify factors associated with T2OF. In addition, we used the Swedish Fracture Registry (SFR) to analyze the prevalence of spinal ankylosis among Swedish patients with T2OFs and sub-axial fractures.

Results: Among patients with T2OFs, in comparison with those with sub-axial fractures, spinal ankylosis was less prevalent (2.2% vs. 31.6%, p<0.001), HU values were lower (p<0.05), atlanto-occipital degeneration was less prevalent (p=0.009), and facet joint degeneration was more prevalent (p=0.03). Logistic regression revealed that atlanto-occipital degeneration (odds ratio, 0.33; p=0.02) and spinal ankylosis (odds ratio, 0.06; p=0.01) were negative predictors of T2OF. Sex-specific analysis revealed that HU values were lower for women with T2OFs (p<0.05) and ankylosis was less prevalent among men with T2OFs (p<0.001) than among sex-matched patients with subaxial fractures. The SFR confirmed that ankylosis was less prevalent among patients with T2OFs (3.3%) than among those with sub-axial fractures (28.3%, p<0.0001).

Conclusions: Spinal ankylosis and atlanto-occipital degeneration are significant risk factors for T2OF. According to sex-specific analysis, spinal ankylosis was less prevalent among men with T2OFs than among those with sub-axial fractures, whereas C2-C4 HU values were significantly lower in among women with T2OFs.