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Letter to the Editor: "Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage? 致编辑的信:"成人脊柱畸形的不同病理(特发性腰椎侧弯症和新生腰椎侧弯症)会影响术前和术后的自我形象吗?
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2024-10-28 DOI: 10.31616/asj.2024.0349.r1
Shivani Bhatia, Priyanka Vij
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引用次数: 0
Optimizing preoperative bone health assessment for adult spinal deformity: a prospective correlation analysis of intraoperative pedicle screw insertion torque and imaging modalities in Japan. 优化成人脊柱畸形术前骨健康评估:日本椎弓根螺钉术中插入扭矩与成像模式的前瞻性关联分析。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-08 DOI: 10.31616/asj.2023.0443
Keishi Maruo, Fumihiro Arizumi, Tomoyuki Kusukawa, Masakazu Toi, Masaru Hatano, Tetsuto Yamaura, Kazuya Kishima, Toshiya Tachibana

Study design: Prospective cohort study.

Purpose: This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging.

Overview of literature: Existing data on optimal assessment tools for ASD surgery are limited.

Methods: The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups.

Results: Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group.

Conclusions: This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.

研究设计:前瞻性队列研究:目的:本研究旨在通过分析术中椎弓根螺钉(PS)插入扭矩与各种骨质量指标之间的相关性,确定成人脊柱畸形(ASD)手术的最佳术前骨健康评估方法,这些指标包括双能X射线吸收测量法(DEXA)评估的骨矿物质密度(BMD)、计算机断层扫描(CT)的霍恩斯菲尔德单位(HU)以及磁共振成像的椎体骨质量(VBQ)评分:有关 ASD 手术最佳评估工具的现有数据有限:研究对象包括年龄大于60岁、接受下胸椎至骨盆脊柱矫正融合手术的ASD患者。使用扭矩仪测量术中 PS 插入扭矩。计算了 PS 插入扭矩与 BMD、HU 和 VBQ 评分之间的皮尔逊相关系数。比较了近端连接失败(PJF)组与非 PJF 组的术前骨质情况:结果:分析了 31 名在 T10、T11 和 T12 位置有 177 个 PS 的患者。PS 插入扭矩与腰椎 BMD 呈中度正相关(r=0.59-0.69,p0.05)。值得注意的是,相同尺寸螺钉的 PS 插入扭矩与 HU 值之间存在很强的相关性(r=0.71 和 0.74,p 结论:本研究表明,下胸椎的 PS 插入扭矩和 HU 值之间存在正相关,与 BMD 存在中度相关,但与 VBQ 评分无关。使用 DEXA 和 CT 进行术前评估对于优化 ASD 手术中的骨健康管理至关重要。
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引用次数: 0
Risk factors for allogeneic red blood cell transfusion in adult spinal deformity surgery. 成人脊柱畸形手术中异体红细胞输血的风险因素。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-20 DOI: 10.31616/asj.2024.0080
Yasushi Iijima, Toshiaki Kotani, Tsuyoshi Sakuma, Tsutomu Akazawa, Shunji Kishida, Keisuke Ueno, Shohei Ise, Yosuke Ogata, Masaya Mizutani, Yasuhiro Shiga, Shohei Minami, Seiji Ohtori

Study design: Retrospective study.

Purpose: To investigate the risk factors for allogeneic red blood cell (RBC) transfusion in adult spinal deformity (ASD) surgery.

Overview of literature: Studies have not thoroughly explored the roles of intraoperative hypothermia, autologous blood donation, and hemostatic agent administration, which would provide a better understanding of the risk for perioperative RBC transfusion in ASD surgery.

Methods: The medical records of 151 patients with ASD who underwent correction surgery between 2012 and 2021 were retrospectively reviewed. Estimated blood loss and perioperative allogeneic transfusion were examined. Patients were categorized into two groups based on whether they received perioperative allogeneic blood transfusion. Logistic regression analysis was employed to investigate the effect of age, sex, blood type, body mass index, American Society of Anesthesiologists' physical status, preoperative hemoglobin level, autologous blood donation, global spine alignment parameters, preoperative use of anticoagulants or antiplatelet medicine and nonsteroidal anti-inflammatory drugs, number of instrumented fusion levels, total operative duration, three-column osteotomy, lateral interbody fusion, pelvic fixation, intraoperative hypothermia, use of gelatin-thrombin based hemostatic agents, and intraoperative tranexamic acid (TXA) with simultaneous exposure by two attending surgeons.

Results: The estimated blood loss was 994.2±754.5 mL, and 71 patients (47.0%) received allogeneic blood transfusion. In the logistic regression analysis, the absence of intraoperative TXA use and simultaneous exposure (odds ratio [OR], 26.3; 95% confidence interval [CI], 7.6-90.9; p<0.001), lack of autologous blood donation (OR, 21.2; 95% CI, 4.4-100.0; p<0.001), and prolonged operative duration (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) were significant independent factors for perioperative allogeneic blood transfusion in ASD surgery.

Conclusions: Autologous blood storage, intraoperative TXA administration, and simultaneous exposure should be considered to minimize perioperative allogeneic blood transfusion in ASD surgery, particularly in patients with anticipated lengthy surgeries.

研究设计目的:调查成人脊柱畸形(ASD)手术中异体红细胞(RBC)输注的风险因素:研究尚未深入探讨术中低体温、自体献血和止血剂管理的作用,这将有助于更好地了解ASD手术围手术期输注RBC的风险:方法:回顾性分析 2012 年至 2021 年期间接受矫正手术的 151 例 ASD 患者的病历。对估计失血量和围手术期异体输血量进行了研究。根据患者是否接受围手术期异体输血将其分为两组。采用逻辑回归分析研究了年龄、性别、血型、体重指数、美国麻醉医师协会身体状况、术前血红蛋白水平、自体献血、脊柱整体排列参数、术前使用抗凝药物或抗血小板药物以及非甾体类抗炎药物的影响、器械融合层数、手术总时间、三柱截骨术、侧椎体间融合术、骨盆固定术、术中低体温、使用明胶-凝血酶原类止血剂、术中由两名主治医生同时暴露氨甲环酸(TXA)。手术结果估计失血量为 994.2±754.5 mL,71 名患者(47.0%)接受了异体输血。在逻辑回归分析中,术中未使用 TXA 和未同时暴露(几率比 [OR],26.3;95% 置信区间 [CI],7.6-90.9;pConclusions:在 ASD 手术中,尤其是预计手术时间较长的患者,应考虑自体血储存、术中使用 TXA 和同时暴露,以尽量减少围手术期异体输血。
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引用次数: 0
Magnetic resonance imaging phantom-based S1 vertebral scores are indicators of fat-water-like osteoporotic changes in postmenopausal women: a pilot study. 基于磁共振成像模型的 S1 椎体评分是绝经后妇女脂肪-水样骨质疏松变化的指标:一项试点研究。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-21 DOI: 10.31616/asj.2024.0116
Rahman Ud Din, Tahira Nishtar, Xiaoguang Cheng, Haisheng Yang

Study design: A prospective study.

Purpose: To assess fat-water-like tissue changes on the 1st sacral vertebra using novel magnetic resonance imaging (MRI) phantombased F- and W-scores and evaluate their diagnostic performances in osteoporosis detection.

Overview of literature: Using an uncommonly advanced MRI technique, previous studies have found that fat-water changes were consistent with osteoporosis. The role of routine MRI sequences can be extended in this regard. The S1 vertebra is considered a crucial anatomical site in spine surgeries because it seldom suffers from fractures. Thus, S1 could indicate osteoporotic fat-water changes.

Methods: Forty-two female volunteers (aged 62.3±6.3 years) underwent spine examination with both MRI (including a phantom) and dual-energy X-ray absorptiometry (DXA) following ethical approval. MRI phantom-based F- and W-scoreS1 were defined by normalizing S1 vertebral signal intensities (SIs) by coconut oil and water SIs of the phantom on T1- and T2-weighted imaging, respectively. Using receiver operating characteristic analysis, the diagnostic performances of the new scores for evaluating osteoporosis and vertebral fractures were investigated against standard areal bone mineral density measured with DXA (DXA-aBMD).

Results: The F-scoreS1 and W-scoreS1 were greater (4.11 and 2.43, respectively) in patients with osteoporosis than those without osteoporosis (3.25 and 1.92, respectively) and achieved areas under the curve (AUCs) of 0.82 and 0.76 (p<0.05), respectively, for osteoporosis detection. Similarly, the mean F-scoreS1 and W-scoreS1 were higher (4.11 and 2.63, respectively) in patients with vertebral fractures than in those without fractures (3.30 and 1.82, respectively) and had greater AUCs (0.90 for W-scoreS1 and 0.74 for F-scoreS1) than DXA-aBMD (AUC, 0.26; p<0.03). In addition, the F- and W-scoreS1 demonstrated a strong correlation (r=0.65, p<0.001).

Conclusions: The new S1 vertebral-based MRI scores were developed to detect osteoporotic changes and demonstrated improvements over DXA-aBMD in differentiating patients with vertebral fractures.

研究设计目的:使用新型磁共振成像(MRI)幻影 F 值和 W 值评估第 1 骶椎的脂肪水样组织变化,并评估其在骨质疏松症检测中的诊断性能:以往的研究发现,脂肪-水变化与骨质疏松症一致。在这方面,常规 MRI 序列的作用可以得到扩展。S1 椎体被认为是脊柱手术中的关键解剖部位,因为它很少发生骨折。因此,S1 可显示骨质疏松性脂肪-水变化:42名女性志愿者(年龄为62.3±6.3岁)在获得伦理批准后接受了核磁共振成像(包括一个模型)和双能X射线吸收测量(DXA)的脊柱检查。在 T1 和 T2 加权成像中,通过将 S1 椎体信号强度(SI)分别与模型的椰子油和水 SI 进行归一化,定义了基于核磁共振成像模型的 F 值和 W 值S1。通过接收器操作特征分析,研究了新评分在评估骨质疏松症和椎体骨折方面与 DXA 测量的标准骨矿密度(DXA-aBMD)的诊断性能:结果:骨质疏松症患者的 F-scoreS1 和 W-scoreS1 分别为 4.11 和 2.43,高于非骨质疏松症患者(分别为 3.25 和 1.92),曲线下面积(AUC)分别为 0.82 和 0.76(pConclusions):新的基于S1椎体的磁共振成像评分是为检测骨质疏松性变化而开发的,在区分椎体骨折患者方面比DXA-aBMD有所改进。
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引用次数: 0
Effectiveness and safety of preoperative distraction using modified halo-pelvic Ilizarov distraction assembly in patients with severe kyphoscoliosis. 对重度脊柱后凸患者使用改良的 halo-pelvic Ilizarov 牵引组件进行术前牵引的有效性和安全性。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-09 DOI: 10.31616/asj.2024.0104
Muhammad Saad Ilyas, Abdullah Shah, Uruj Zehra, Muhammad Ismail, Haseeb Elahi, Amer Aziz

Study design: A 2-year follow-up study.

Purpose: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.

Overview of literature: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.

Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.

Results: Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).

Conclusions: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.

研究设计目的:评估改良晕盆伊利扎罗夫牵引组件在治疗严重脊柱侧凸患者中的有效性:严重而僵硬的脊柱侧弯一直是外科医生面临的挑战。通过光环骨盆装置进行术前矫正可成功地将脊柱侧弯的严重程度降至最低,但也有报道称使用该装置会产生繁琐的并发症。对这些病例而言,改良装配可能是安全的:方法:对冠状面 Cobb 角大于 90° 的严重脊柱后凸患者,在术前使用改良的半身-骨盆 Ilizarov 牵张装置。改良组件由骨盆组件和光环组成,以每天 2-3 毫米的速度牵引 6-12 周。在使用该组件之前和两年的随访期间,对患者进行了全面的临床评估和肺功能测试,并对脊柱侧凸系列 X 光图像进行了冠状面和矢状面 Cobb 角以及其他脊柱骨盆参数的评估:共纳入 34 名患者(年龄为 9-27 岁,男女比例为 18:16)。冠状角和矢状角分别为116°±16.2°和84°±28.3°。通过改良光环-骨盆组件获得的矫正率为:冠状角近52%(P=0.001),矢状角40%(P=0.001),高度也有所改善(P=0.001)。椎体顶端平移和冠状面平衡也有明显改善(p=0.001)。最终手术后,所有参数都得到了进一步改善,1秒用力呼气容积(p=0.002)和用力生命容量(p=0.001)也得到了改善:结论:我们的改良晕盆Ilizarov牵引组件可对严重脊柱畸形进行良好矫正,且不会对神经系统造成重大风险,并发症较少,患者依从性良好。
{"title":"Effectiveness and safety of preoperative distraction using modified halo-pelvic Ilizarov distraction assembly in patients with severe kyphoscoliosis.","authors":"Muhammad Saad Ilyas, Abdullah Shah, Uruj Zehra, Muhammad Ismail, Haseeb Elahi, Amer Aziz","doi":"10.31616/asj.2024.0104","DOIUrl":"10.31616/asj.2024.0104","url":null,"abstract":"<p><strong>Study design: </strong>A 2-year follow-up study.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.</p><p><strong>Overview of literature: </strong>Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.</p><p><strong>Methods: </strong>Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.</p><p><strong>Results: </strong>Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).</p><p><strong>Conclusions: </strong>Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"522-531"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biportal endoscopic en bloc removal of the ligamentum flavum for spinal stenosis: nuances for the "butterfly" technique. 双腔内窥镜黄韧带整体切除术治疗椎管狭窄症:"蝴蝶 "技术的细微差别。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-20 DOI: 10.31616/asj.2024.0057
Cheol Wung Park, Jacob Yoong-Leong Oh

The introduction of endoscopic spine surgery has led to a paradigm shift in the treatment of spinal disorders. In particular, biportal endoscopic surgery has gained traction for its wider visual field and improved the maneuverability of instruments, familiar anatomy, and costeffectiveness. In this study, we describe our en bloc removal of the ligamentum flavum using a "butterfly" technique. This approach had several advantages: (1) The flavum serves as a protective barrier for the dura during drilling. (2) There is less epidural bleeding, which provides (3) better visualization. (4) In an inadvertent durotomy, this usually occurs later in the procedure, which is more manageable than the early stages of decompression. Biportal decompression for spinal stenosis can be performed using an en bloc ligamentum flavum removal technique that is safe, reproducible, and efficient. A systematic approach will help early adopters overcome the steep learning curve.

内窥镜脊柱手术的引入带来了脊柱疾病治疗模式的转变。尤其是双入口内窥镜手术,因其视野更宽阔、器械可操作性更强、解剖结构更熟悉、成本效益更高而备受青睐。在本研究中,我们介绍了使用 "蝴蝶 "技术整体切除黄韧带的方法。这种方法有几个优点:(1)黄韧带在钻孔过程中起到保护硬膜的作用。(2) 硬膜外出血较少,因此 (3) 视野更好。(4)如果不慎造成硬膜切开,通常发生在手术的后期,比减压的早期阶段更容易处理。双腔减压术治疗椎管狭窄可采用整体黄韧带切除技术,该技术安全、可重复且高效。系统化的方法将帮助早期采用者克服陡峭的学习曲线。
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引用次数: 0
The insert and revolve technique: a novel approach for inserting cages during unilateral biportal endoscopic assisted fusion surgery for effective spinal alignment restoration. 插入和旋转技术:在单侧双侧内窥镜辅助融合手术中插入保持架以有效恢复脊柱排列的新方法。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-21 DOI: 10.31616/asj.2024.0066
Ji Soo Ha, Shreenidhi Kulkarni, Do-Hyoung Kim, Chang-Wook Kim, Rajendra Sakhrekar, Hee-Don Han

Study design: Retrospective study.

Purpose: This study aimed to propose a method of performing unilateral biportal endoscopy (UBE)-assisted interbody cage insertion for fusion using the "insert and revolve" technique and analyze the clinico-radiological outcomes.

Overview of literature: UBE-assisted lumbar interbody fusion (ULIF) is a rapidly evolving technique combining the advantages of minimally invasive technique with ease of learning. The limited size of cages was a result of the narrow insertion channel. We propose a technique in which large extreme lateral interbody fusion cages can be inserted through the same opening.

Methods: This study included 104 patients who underwent ULIF using the "insert and revolve technique" between July 2019 and September 2022. The patients were followed up for at least 12 months postoperatively. The clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI), and modified McNab's criteria. Changes in segmental lordosis (SL), intervertebral disc height (IVDH), segmental coronal alignment (SCA), cage subsidence, and fusion grade were evaluated at 6- and 12-month follow-up.

Results: The VAS scores for leg and back pain and ODI score showed significant improvement. Based on the Macnab's criteria, 97 patients showed excellent outcomes and seven demonstrated good outcomes at 12 months. The mean IVDH increased from 6.3±2 to 10±2.1 mm immediately after surgery and 10±1.1 mm at 6 months. SL improved from 9.3°±11.5° to 17.78°±8.1°, while SCA improved from 7.7°±2.1° to 3.4°±1.2° at 1 year. Moreover, 92 and 11 patients showed grade 1 and 2 fusion, respectively, according to the Bridwell grading at 1 year.

Conclusions: The "insert and revolve technique" facilitates the successful insertion of large cages, contributing to the restoration of disc height and coronal and sagittal spinal correction with favorable fusion rates.

研究设计目的:本研究旨在提出一种使用 "插入和旋转 "技术进行单侧双侧内窥镜(UBE)辅助椎间笼插入融合术的方法,并分析其临床放射学结果:UBE辅助腰椎椎间融合术(ULIF)是一项发展迅速的技术,它结合了微创技术和易学易用的优点。由于插入通道狭窄,椎体套管的尺寸受到限制。我们提出了一种可通过同一开口插入大型极外侧椎间融合器的技术:本研究纳入了在 2019 年 7 月至 2022 年 9 月期间使用 "插入和旋转技术 "接受 ULIF 的 104 例患者。术后对患者进行了至少 12 个月的随访。临床结果采用腿痛和背痛视觉模拟量表(VAS)、Oswestry 失能指数(ODI)和改良 McNab 标准进行评估。在6个月和12个月的随访中评估了节段前凸(SL)、椎间盘高度(IVDH)、节段冠状对位(SCA)、椎笼下沉和融合等级的变化:腿部和背部疼痛的 VAS 评分以及 ODI 评分均有显著改善。根据 Macnab 的标准,在 12 个月的随访中,97 名患者的疗效为 "优",7 名患者的疗效为 "良"。术后IVDH平均值从6.3±2毫米增加到10±2.1毫米,6个月时为10±1.1毫米。SL从9.3°±11.5°改善到17.78°±8.1°,而SCA在1年时从7.7°±2.1°改善到3.4°±1.2°。此外,根据 Bridwell 分级,分别有 92 名和 11 名患者在 1 年后出现 1 级和 2 级融合:结论:"插入和旋转技术 "有助于成功插入大型椎体保持架,有助于恢复椎间盘高度以及冠状面和矢状面脊柱矫正,融合率良好。
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引用次数: 0
Outcome of intradiscal condoliase injection therapy for patients with recurrent lumbar disc herniation. 对复发性腰椎间盘突出症患者进行椎间盘内髁状突注射治疗的效果。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-08 DOI: 10.31616/asj.2024.0042
Noritaka Suzuki, Yawara Eguchi, Takashi Hirai, Takuya Takahashi, Yohei Takahashi, Kota Watanabe, Tomohiro Banno, Kyohei Sakaki, Satoshi Maki, Yuuichi Takano, Yuki Taniguchi, Yasuchika Aoki, Takamitsu Konishi, Yutaka Hiraizumi, Masatsune Yamagata, Akihiro Hirakawa, Seiji Ohtori

Study design: Retrospective cohort study.

Purpose: This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH.

Overview of literature: Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery.

Methods: The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment.

Results: Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4).

Conclusions: Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

研究设计回顾性队列研究.目的:本研究旨在比较接受椎间盘内髁突酶(硫酸软骨素ABC内溶解酶)注射治疗原发性腰椎间盘突出症(LDH)和复发性LDH患者的数据.文献综述:椎间盘内溶解酶治疗LDH是一种效果相对较好、安全性较高的治疗方法,但很少有研究报道LDH术后复发的情况:研究对象为9家参与机构的249名接受椎间盘内髁突酶注射治疗LDH的患者,其中包括241名初次LDH患者(C组)和8名复发LDH患者(R组)。对患者的年龄、性别、体重指数、病程、椎间盘 LDH 水平、吸烟史和糖尿病史等特征进行了评估。腰痛/腿痛数字评定量表(NRS)评分和Oswestry残疾指数(ODI)用于评估治疗前、治疗后6个月和1年的临床症状:C组的腰痛NRS评分(治疗前、治疗后6个月和1年时分别为4.9 → 2.6 → 1.8)在治疗1年后有明显改善。虽然 R 组(3.5 → 2.8 → 2.2)有改善趋势,但无明显差异。治疗后,C 组(6.6 → 2.4 → 1.4)和 R 组(7.0 → 3.1 → 3.2)的腿部疼痛 NRS 评分有明显改善。C组(41.4 → 19.5 → 13.7)的ODI在治疗一年后有明显改善;但R组(35.7 → 31.7 → 26.4)无明显差异:结论:虽然椎间盘内髁状突注射对 LDH 复发的疗效不如初发病例,但它对改善腿部疼痛很有帮助,可视为一种微创、安全的治疗方法。
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引用次数: 0
Latest knowledge on a comprehensive understanding of cervical deformity and selection of effective treatment methods using recent classification systems: a narrative review. 利用最新分类系统全面了解颈椎畸形和选择有效治疗方法的最新知识:叙述性综述。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-08 DOI: 10.31616/asj.2024.0071
Seok Woo Kim

Surgical treatment for patients with cervical spine deformities is challenging for both patients and doctors. For successful surgical treatment, mastery of processes is important to objectively evaluate and classify the degree of deformity. Recently, efforts have been increasing to systematically understand, evaluate, and effectively treat complex cervical spine deformities. Various parameters are being developed to quantify and objectively evaluate the degree of cervical spine deformity, and classification methods are being introduced to help establish the treatment scope by categorizing it according to the degree of deformity. However, a comprehensive and systematic understanding of complex deformities using only the currently introduced classification methods and related knowledge is not easy. Through this review, we aimed to introduce various classification methods and their pros and cons to evaluate cervical deformities, analyze their meaning, and provide a basic understanding of the evaluation and classification of patients with cervical spine deformities. This review also aimed to aid in the decision-making process for the treatment of cervical spine deformities by presenting a structured treatment algorithm based on recently known classification systems and lay the foundation for efficient treatment.

颈椎畸形患者的手术治疗对患者和医生来说都具有挑战性。要想成功进行手术治疗,必须掌握客观评估和分类畸形程度的流程。最近,人们越来越致力于系统地了解、评估和有效治疗复杂的颈椎畸形。目前正在开发各种参数来量化和客观评估颈椎畸形的程度,并引入分类方法,根据畸形程度进行分类,以帮助确定治疗范围。然而,仅凭目前引入的分类方法和相关知识来全面系统地了解复杂畸形并非易事。通过本综述,我们旨在介绍评估颈椎畸形的各种分类方法及其利弊,分析其意义,为颈椎畸形患者的评估和分类提供一个基本的认识。本综述还旨在通过介绍基于最新已知分类系统的结构化治疗算法,为治疗颈椎畸形的决策过程提供帮助,并为高效治疗奠定基础。
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引用次数: 0
A machine learning-based approach for individualized prediction of short-term outcomes after anterior cervical corpectomy. 基于机器学习的颈椎前路切除术后短期疗效个性化预测方法。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-08-01 Epub Date: 2024-08-08 DOI: 10.31616/asj.2024.0048
Mert Karabacak, Alexander Schupper, Matthew Carr, Konstantinos Margetis

Study design: A retrospective machine learning (ML) classification study for prognostic modeling after anterior cervical corpectomy (ACC).

Purpose: To evaluate the effectiveness of ML in predicting ACC outcomes and develop an accessible, user-friendly tool for this purpose.

Overview of literature: Based on our literature review, no study has examined the capability of ML algorithms to predict major shortterm ACC outcomes, such as prolonged length of hospital stay (LOS), non-home discharge, and major complications.

Methods: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent ACC. Prolonged LOS, non-home discharges, and major complications were assessed as the outcomes of interest. ML models were developed with the TabPFN algorithm and integrated into an open-access website to predict these outcomes.

Results: The models for predicting prolonged LOS, non-home discharges, and major complications demonstrated mean areas under the receiver operating characteristic curve (AUROC) of 0.802, 0.816, and 0.702, respectively. These findings highlight the discriminatory capacities of the models: fair (AUROC >0.7) for differentiating patients with major complications from those without, and good (AUROC >0.8) for distinguishing between those with and without prolonged LOS and non-home discharges. According to the SHapley Additive Explanations analysis, single- versus multiple-level surgery, age, body mass index, preoperative hematocrit, and American Society of Anesthesiologists physical status repetitively emerged as the most important variables for each outcome.

Conclusions: This study has considerably enhanced the prediction of postoperative results after ACC surgery by implementing advanced ML techniques. A major contribution is the creation of an accessible web application, highlighting the practical value of the developed models. Our findings imply that ML can serve as an invaluable supplementary tool to stratify patient risk for this procedure and can predict diverse postoperative adverse outcomes.

研究设计:目的:评估机器学习(ML)在预测颈椎前路椎体切除术(ACC)预后建模方面的有效性,并为此开发一种便于使用的用户友好型工具:根据我们的文献综述,还没有研究考察过 ML 算法预测 ACC 主要短期预后的能力,如住院时间(LOS)延长、非居家出院和主要并发症:方法: 使用美国外科学院的国家外科质量改进计划数据库来识别接受 ACC 的患者。延长的住院时间、非家庭出院和主要并发症被评估为相关结果。使用 TabPFN 算法开发了 ML 模型,并将其集成到一个开放访问的网站中,以预测这些结果:结果:预测住院时间延长、非居家出院和主要并发症的模型的接收者操作特征曲线下的平均面积(AUROC)分别为 0.802、0.816 和 0.702。这些结果凸显了这些模型的鉴别能力:在区分有重大并发症和无重大并发症的患者方面尚可(AUROC >0.7),在区分有无延长 LOS 和非家庭出院的患者方面良好(AUROC >0.8)。根据 SHapley Additive Explanations 分析,单层次手术与多层次手术、年龄、体重指数、术前血细胞比容和美国麻醉医师协会身体状况重复出现,是对每种结果最重要的变量:本研究通过采用先进的多变量模型技术,大大提高了对 ACC 手术术后结果的预测能力。其主要贡献在于创建了一个可访问的网络应用程序,突出了所开发模型的实用价值。我们的研究结果表明,ML 可以作为一种宝贵的辅助工具,对患者进行手术风险分层,并能预测各种术后不良后果。
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引用次数: 0
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Asian Spine Journal
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