Asian Spine Journal最新文献

Study design: Mendelian randomization (MR) and gene-level analysis.

Purpose: To investigate the relationship between gut microbiota (GM) and spinal canal stenosis (SCS).

Overview of literature: To date, no studies have demonstrated the relationship between GM and SCS or explored its racial differences.

Methods: This study utilized summary data from publicly available, large-scale genome-wide association studies to investigate the causal relationship between GM and SCS in interracial, European, and East Asian populations using a bidirectional two-sample MR approach. Reverse MR analysis was conducted to estimate the effect of SCS on GM taxa with significant associations. Additionally, genelevel analyses-including Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction network analysis-were performed to elucidate key biological processes and hub genes involved in both GM and SCS.

Results: In the interracial population, five bacterial taxa were identified as risk factors and four as protective factors for SCS. Among Europeans, three bacterial taxa were associated with increased risk and three with reduced risk. In the East Asian population, seven bacterial taxa demonstrated protective effects, while one taxon was associated with increased risk. Sensitivity analyses revealed no evidence of heterogeneity or horizontal pleiotropy. Cross-comparisons indicated significant differences in GM profiles between European and East Asian populations. Gene-level analysis identified key GO terms, enriched KEGG pathways, and hub genes potentially mediating the relationship between GM and SCS.

Conclusion: This study identified a potential causal relationship between GM and SCS, highlighting distinct microbial and genetic mechanisms in European and East Asian populations. The findings provide novel insights into the pathogenesis, prevention, and treatment of SCS. Gene-level analyses suggest potential molecular pathways underlying the GM-SCS association, providing a foundation for future mechanistic research.

Study design: Retrospective cohort study.

Purpose: To evaluate whether intraoperative changes in T1 tilt can predict the development of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).

Overview of literature: Multiple factors have been associated with PSI, but few studies have specifically investigated intraoperative radiographic predictors, such as changes in T1 tilt, in patients with Lenke type 2 AIS.

Methods: Fifty patients (45 females, five males) who underwent posterior corrective fusion surgery for Lenke type 2 AIS with at least 2 years of follow-up were included. Radiographic parameters and health-related quality of life were evaluated preoperatively, 1 week postoperatively, and at final follow-up. Intraoperative T1 tilt and upper instrumented vertebra (UIV) tilt were measured in the prone position before and after correction. PSI was defined as radiographic shoulder height (RSH) greater than 15 mm at 1 week postoperatively. Patients were classified into PSI and non-PSI groups. Intergroup comparisons were conducted using the Mann-Whitney U test or chisquare test. Correlations of intraoperative changes in T1 tilt (ΔT1) and UIV tilt (ΔUIV) with changes in RSH (ΔRSH) and clavicle angle (ΔCA) were analyzed.

Results: Twelve patients (24.0%) had PSI at 1 week postoperatively, which persisted in five patients (10.0%) at final follow-up. Intraoperative ΔT1 and ΔUIV were significantly correlated with ΔRSH (R =0.613, p <0.001; R =0.435, p =0.002) and ΔCA (R =0.453, p =0.002; R =0.383, p =0.007). In the PSI group, ΔRSH was strongly correlated with ΔT1 (R =0.678, p =0.015).

Conclusions: Minimizing intraoperative changes in T1 tilt may help reduce the risk of PSI in Lenke type 2 AIS.

Study design: Retrospective cohort study.

Purpose: This study aimed to document the presentation, treatment, and clinical outcomes of surgically managed de novo C5 palsies.

Overview of literature: De novo C5 motor palsy-occurring without prior cervical spine intervention or trauma-presents with a unique constellation of symptoms. Unlike typical multilevel cervical radiculopathy, patients with de novo C5 palsy primarily experience motor deficits, most notably affecting the deltoid and biceps. The etiology of their symptoms may be attributed to intrinsic spinal pathologies, including foraminal stenosis and spinal cord compression.

Methods: A total of 31 C5 motor palsies in 26 patients were included in this case series. Patients underwent 16 anterior cervical discectomy and fusions, six laminoplasties, and four laminectomies with fusion procedures. Visual Analog Scale (VAS) pain scores, Neck Disability Index (NDI), and strength scores were recorded during pre- and postoperative follow-up visits. Statistical analysis was conducted using Fisher's exact test and a paired t-test with analysis of variance.

Results: The mean preoperative motor strength grades for the deltoid and biceps were 2.1 and 3.2, respectively. At final follow-up, mean deltoid and bicep motor grades had significantly improved compared to preoperative values (p <0.0001, p <0.0001, respectively). Significant improvements were also observed in NDI scores (39.3 to 26.7, p <0.05) and VAS pain scores (4.42 to 2, p <0.05) at final follow-up.

Conclusions: This study is the first to report outcomes of surgical management for spontaneous, de novo C5 motor palsies. Following surgical intervention, patients experienced favorable recovery of deltoid and bicep motor strength. Both anterior and posterior approaches resulted in successful motor recovery when appropriately selected based on preoperative imaging and surgical planning.

Study design: retrospective study.

Purpose: This study aimed to develop an indicator of the compensatory capacity of hip joints in response to spinopelvic mismatch using standard radiographs.

Overview of literature: EOS imaging has enabled detailed analysis of hip and lower extremity compensation in sagittal malalignment. However, its high cost and limited availability hinder widespread clinical use. Currently, there are no established indicators to assess hip compensation for spinopelvic mismatch using standard radiographs.

Methods: A total of 209 patients with osteoporosis and 54 with adult spinal deformities were included. Patients were divided into two groups based on pelvic incidence-lumbar lordosis (PI-LL): <20° and ≥20° groups. The sagittal vertical axis (SVA), thoracic kyphosis, PI, pelvic tilt (PT), LL, sacral slope, and pelvic femoral angle (PFA) were measured. Health-related quality of life (HRQOL) was assessed in 86 patients using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A new index, PFA-(PI-LL), was defined as spinopelvic-hip mismatch. Correlation coefficients were calculated for each radiographic parameter, and the coefficient of determination (R2) for the relationship of each parameter with SVA was evaluated in both groups. The correlations between SVA, PT, PI-LL, PFA-(PI-LL), and JOABPEQ domain scores were also analyzed.

Results: PI-LL correlated with PFA in the PI-LL <20° group (r=0.56, p<0.001) but not in the PI-LL ≥20° group. Among all parameters, PFA-(PI-LL) demonstrated the strongest association with SVA, indicating its superior ability to explain variations in sagittal alignment in both groups and across all patients (all patients, R2=0.77). Significant correlations were observed between the radiographic parameters and JOABPEQ scores across all domains.

Conclusions: PFA-(PI-LL), which represented spinopelvic-hip mismatch, was a reliable indicator of hip compensatory function in terms of anterior trunk inclination and HRQOL.

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.