Asian Spine Journal最新文献

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.

Study design: A prospective cohort study.

Purpose: To determine the age-specific normative values of the prognostic nutritional index (PNI) among elderly residents in Japan and explore the relationship between malnutrition and spinal alignment.

Overview of literature: Nutritional status affects postoperative recovery, with malnourished patients often experiencing severe postoperative complications. PNI is a known nutritional indicator based on serological value; however, there is a dearth of age-specific normative values for PNI, with even less research on the impact of malnutrition on spinal alignment.

Methods: We included 237 participants from a 2-yearly resident health checkup conducted in Toei, Aichi, Japan. Participants underwent blood tests and whole-spine standing radiography, and were stratified based on age (60s, 70s, and 80s) and sex to determine age-specific normative PNI values. Additionally, participants were categorized into a lower PNI (PNI <50) or higher PNI (PNI ≥50) group to compare spinal alignment.

Results: The average PNI values for different age groups were: 60s: males (n=13): 50.7, females (n=31): 50.9; 70s: males (n=55): 50.3, females (n=57): 50.1; 80s: males (n=28): 49.1, females (n=53): 48.3. For females, the radiographic spinal alignment parameters were comparable between the lower and higher PNI groups; however, in males, significant differences were noted for pelvic tilt (20° vs. 16°, p=0.020), lumbar lordosis (35° vs. 44°, p<0.001), and pelvic incidence minus lumbar lordosis (10° vs. 4°, p=0.013).

Conclusions: Malnutrition in males negatively impacts their lumbar-pelvic alignment. While the normative PNI value decreases with age, the two variables show a very weak correlation.

Study design: Animal study.

Purpose: To investigate the effects of Lycium barbarum polysaccharide (LBP) on functional recovery following decompressive surgery in a rat model of cervical spondylotic myelopathy (CSM).

Overview of literature: Surgical decompression halts the progression of CSM, but may leave residual neurologic deficits. LBP, derived from wolfberry, has been shown to modulate macrophage polarization and exert neuroprotective effects in acute spinal cord injury. We hypothesized that LBP would enhance functional recovery after surgical decompression in a rat model of CSM.

Methods: Female Sprague-Dawley rats with induced chronic cervical spinal cord compression were randomly assigned to the following groups: (1) LBP alone; (2) decompression alone; (3) decompression+LBP; (4) no treatment; and (5) sham surgery. Decompression was performed 4 weeks after compression. Outcomes were assessed using neurobehavioral tests, electrophysiology, and histological/immunohistochemical analyses.

Results: Baseline spinal cord injury severity was comparable across groups, as confirmed by electrophysiological studies. At 8 weeks postsurgery, rats in the decompression+LBP group showed significantly greater recovery of hindlimb function compared with rats in the decompression alone group. Improvements in somatosensory evoked potential and motor evoked potential latency and amplitude were also more pronounced in the decompression+LBP group. Histological analyses demonstrated reduced myelin vacuolation and increased myelin density with LBP treatment.

Conclusions: This study provides the first evidence that LBP derived from Chinese herbal medicine enhances neurological and functional recovery when combined with decompression in a rat model of CSM. These findings support further clinical investigation of LBP as an adjunctive therapy in patients with CSM.

Study design: Retrospective analysis.

Purpose: To evaluate preoperative bone mineral density (BMD), as quantified by computerized tomography (CT)-derived Hounsfield unit (HU) values, in patients who underwent lumbar fusion and to examine the link between BMD and failed back surgery syndrome (FBSS).

Overview of literature: FBSS is a serious complication affecting 10%-40% of patients undergoing lumbosacral spinal surgery. Given the detrimental impact of FBSS on the psychological and physiological wellbeing of patients, preoperative identification of those at risk for developing FBSS and the implementation of targeted interventions to minimize this complication are highly important.

Methods: Preoperatively, all 115 patients underwent BMD assessments using both CT-derived HUs and dual-energy X-ray absorptiometry and were administered multiple questionnaires, including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI). Both pain intensity and pain-related disability were assessed before and after lumbar fusion surgery.

Results: Postoperatively, 14 patients (14/115, 12.2%) experienced FBSS. Multivariate logistic regression was used to examine all preoperative covariates with significant differences between the patients with and without FBSS. The numeric rating pain scale score at rest, BAI score, PCS score, and HU value were found to be independently associated with FBSS (p<0.05).

Conclusions: This study revealed that preoperative BMD, as quantified by CT-derived HU values, may be associated with FBSS. Preoperative assessments of CT-derived HU values might provide additional details for identifying patients susceptible to FBSS, which could help prevent this complication.

Study design: A cross-sectional study.

Purpose: This study aimed to investigate temporal patterns, seasonal variations, and geographic differences in the US public interest in lumbar decompression and fusion surgery.

Overview of literature: The number of lumbar decompression and fusion surgery procedures for various surgical indications has significantly increased in the United States over the past few decades. As the prevalence of these procedures increases, patients are increasingly seeking online information on these procedures.

Methods: This study analyzed US public interest in lumbar decompression and fusion surgery using Google Trends data from January 1, 2015 to December 31, 2024. The relative search volume (RSV) was used to measure public interest. Temporal trends were assessed using linear regression analysis, whereas seasonal and geographic variations were evaluated using analysis of variance and Tukey's post hoc tests. Statistical significance was set at p<0.05.

Results: Public interest in lumbar decompression and fusion surgery showed a statistically significant upward trend from 2015 to 2024 (p<0.05), with R2 ranging from 0.0141 to 0.6748 across search terms. Monthly analysis revealed that the average search volume was highest in October (78.8%) and lowest in December (68.7%). No significant differences were observed among seasons (p=0.102). Geographically, the highest mean RSV was in the Northeast (43.3%), followed by the West (19.5%), Midwest (12.6%), South (11.1%), and Southwest (10.2%), with significant differences among these regions (p<0.001).

Conclusions: Public interest in lumbar decompression and fusion surgery has shown a consistent and statistically significant upward trend over the past decade. Although seasonal variation was not significant, notable geographic differences in search volume were observed, with the northeast showing the highest level of interest. These findings highlighted regional disparities in public engagement and may serve as a basis for future healthcare resource planning and patient education strategies.