Asian Spine Journal最新文献

Screw loosening (SL) is a common complication following lumbar interbody fusion (LIF), particularly for degenerative lumbar disease. This study investigated the risk factors for SL following LIF for degenerative lumbar disease and examined the clinical relevance of SL. A PROSPERO-registered systematic search was conducted in the ScienceDirect, PubMed, Google Scholar, Epistemonikos, and Cochrane databases to identify longitudinal studies up to October 2024. Degenerative lumbar diseases included stenosis, spondylolisthesis, and disc herniation. Assessed risk factors were Cobb angle, lumbar lordosis (LL) angle, screw length, fixation to the sacrum, fused levels, and Hounsfield units (HU). Twenty-two studies involving 3,689 participants (56%±5% female; mean age, 61.95±9.55 years) and 17,722 lumbar screws were analyzed. Overall, 10%±2% of screws exhibited loosening in 29%±5% of patients, with 5%±2% undergoing revision surgery. Patients with SL (SL group) and those without SL (non-SL group) had similar sex distribution, body mass index, and comorbidities. The SL group had higher Visual Analog Scale scores for back pain (mean difference [MD], 0.75; 95% confidence interval [CI], 0.42-1.07; p<0.001) and Oswestry Disability Index scores (MD, 3.34; 95% CI, 0.49-6.20; p=0.02), indicating the clinical relevance of SL. The SL group exhibited significantly higher Cobb angle (MD, 2.42; 95% CI, 0.36-4.49; p=0.02), lower LL angle (MD, -3.67; 95% CI, -6.33 to -1.01; p=0.01), and shorter screw length (MD, -1.62; 95% CI, -2.78 to -0.45; p=0.01). Fixation to the sacrum, increased fused levels, and decreased HU were significant risk factors. The area under the curve for HU was 0.80 (0.77-0.84), with a sensitivity of 0.74 (0.67-0.81) and specificity of 0.76 (0.66-0.84), underscoring notable prognostic value. Patients with SL exhibited higher Cobb angles, lower LL angles, and shorter screws. Fixation to sacrum, increased fused levels, and decreased HU were significant risk factors for SL (PROSPERO ID: CRD42024563780).

Study design: Retrospective cohort study.

Purpose: To evaluate whether untreated foraminal stenosis (FS) at levels not included in anterior cervical discectomy and fusion (ACDF) impacts postoperative outcomes in patients with cervical radiculopathy and assess if residual FS increases the risk of adjacent segment disease (ASD).

Overview of literature: Level selection for ACDF for cervical radiculopathy is complex, considering variable patient anatomy and symptoms. It is unclear whether treating only potentially symptomatic levels could provide equivalent results to managing all pathologic levels.

Methods: This was a retrospective cohort study of 188 patients undergoing ACDF for degenerative cervical radiculopathy between 2014 and 2020. Patients were divided into two groups: those with all symptomatic levels decompressed (No-FS group, n=162) and those with untreated FS at levels not targeted in surgery (FS group, n=26). Postoperative outcomes, including neck pain, arm pain, and Neck Disability Index (NDI), were evaluated at 3 months and 2 years. Radiographic parameters and ASD incidence were also compared between groups.

Results: Both groups showed significant improvement in neck pain, arm pain, and NDI postoperatively, with no significant intergroup differences at 3 months and 2 years. C2-C7 lordosis and sagittal vertical axis showed similar improvement in both groups postoperatively. Rates of ASD and revision surgery did not differ significantly between No-FS and FS groups (5.6% vs. 7.7%, respectively; p=0.652). Logistic regression revealed no significant predictors of NDI improvement >50% among preoperative demographic or radiographic factors.

Conclusions: Untreated FS at levels outside the surgical target area did not adversely affect ACDF outcomes or increase ASD risk over a 2-year follow-up. These findings suggest that ACDF can be safely limited to levels directly associated with patient symptoms without compromising clinical outcomes, potentially reducing the surgical extent and associated risks.

Study design: Cadaveric experimental study.

Purpose: To evaluate the feasibility and accuracy of pedicle screw placement using a custom-developed augmented reality-assisted pedicle screw fixation (ARPSF) system in a porcine spine model.

Overview of literature: Conventional pedicle screw placement techniques face limitations including potential inaccuracy, radiation exposure, and workflow disruption. Augmented reality technology can overlay virtual surgical planning directly onto the operative field while maintaining the surgeon's focus on the patient.

Methods: Five porcine cadaveric lumbar spines were used in this study. A custom-developed head-mounted display system with optical tracking projected three-dimensional reconstructed spine models and planned screw trajectories into the surgeon's field of view. A single experienced spine surgeon placed 50 pedicle screws (4.5 mm diameter). Registration was performed using a point-pair matching technique with fifteen anatomical landmarks. Accuracy was assessed via postoperative computed tomography scan, measuring entry point deviation, trajectory deviation, and angular difference, and evaluated using the Gertzbein-Robbins classification.

Results: Of the 50 pedicle screws placed, 47 (94%) achieved grade A accuracy with complete containment within the pedicle. The remaining three screws (6%) were classified as grade B, with minor breaches less than 2 mm. No unsafe placements (grades C-E) occurred. The mean entry point deviation was 0.55 mm (standard deviation [SD]=0.33 mm), and the mean deviation at the screw tip was 0.71 mm (SD=0.32 mm). The mean axial angular deviation was 2.04° (SD=0.58°). The average placement time was 2.2 minutes per screw.

Conclusions: The custom-developed ARPSF system demonstrated high accuracy for pedicle screw placement in a porcine model, achieving submillimeter precision and minimal angular deviation. This experimental study shows the potential of augmented reality technology to enhance spine instrumentation precision.

Despite the favorable postoperative prognosis of C5 palsy (C5P), a certain proportion of these patients have less satisfactory outcomes. The current systematic review and meta-analysis thus aimed to comprehensively evaluate existing literature and identify the onset, recovery patterns, and outcomes of C5P following diverse surgical approaches. Five different databases (Google Scholar, Embase, PubMed, Web of Science, and Cochrane Library) were thoroughly searched for relevant literature on October 15, 2024. Studies reporting on incidences of C5P following surgery for degenerative cervical conditions with recovery data published until 2024 were scrutinized. Narrative or systematic reviews, opinions, letters to the editor, and manuscripts published in non-English languages were excluded. A total of 30 articles involving 8,116 patients who underwent undergoing surgery for degenerative cervical myelopathy with 748 reported C5P cases were included for analysis. The overall time to palsy reported in the included studies was 3 days (95% confidence interval [CI], 2.56-3.60). Palsy occurred earliest with anterior cervical decompression and fusion (ACDF) at 2 days (95% CI, 0.35-4.54), followed by laminoplasty (LP) at 3.2 days (95% CI, 2.02-4.34) and posterior cervical decompression and fusion (PCDF) at 3.6 days (95% CI, 2.81-4.37). Patients with palsy showed improved recovery with time. At the 1-year follow-up, the reported recovery rates were 100%, 52.9%, and 50% for ACDF, LP, and PCDF, respectively. C5P demonstrated a delayed presentation, with mean onset of 3 days after surgery, which can range from 2 days for ACDF to 3.6 days for PDCF. Recovery improved progressively with time and varied for different surgical procedures, with ACDF showing the best recovery and PDCF for cervical myelopathy showing the poorest recovery.

Obesity is an escalating health problem that has been increasingly associated with surgical complications. In general, open surgical techniques worsen these complications, because they are more tissue-destructive and associated with a relatively long recovery period. Minimally invasive techniques, such as endoscopic spine surgery, appear to be good substitutes, because they reduce tissue iatrogenic injury and hasten recovery. However, the effect of obesity on the performance of endoscopic spine surgery remains uncertain. This metaanalysis was designed to evaluate the safety and efficacy of endoscopic spine surgery in patients with obesity compared with those without obesity. This study adhered to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We conducted a thorough search using PubMed, Scopus, and Virtual Health Library. Methodological quality was assessed using the MINORS (Methodological Index for Non-randomized Studies) criteria. Mean differences (MD) and standardized mean differences with 95% confidence intervals (CI) were calculated. Statistical analyses were conducted using Review manager ver. 5.4.1. Seven studies involving 659 participants were analyzed. The obese and nonobese groups had no significant differences in operative time (MD, 9.86 minutes; 95% CI, -4.93 to 24.65); Visual Analog Scale (VAS) scores for back pain at 3 months (MD, 0.26; 95% CI, -0.11 to 0.63), 6 months (MD, 0.26; 95% CI, -0.05 to 0.56), and 12 months (MD, -0.54; 95% CI, -1.70 to 0.62); VAS leg pain scores at 3 months (MD, 0.17; 95% CI, -0.06 to 0.41), 6 months (MD, 0.23; 95% CI, -0.13 to 0.59), and 12 months (MD, 0.18; 95% CI, -0.10 to 0.45); Oswestry Disability Index scores at 3 months (MD, 1.02; 95% CI, -0.14 to 2.18) and 12 months (MD, 0.10; 95% CI, -1.14 to 1.33); and reherniation rate (odds ratio, 1.35; 95% CI, 0.73 to 2.49). Endoscopic surgery demonstrated no significant differences in outcomes between obese and nonobese patients and was safe and effective for this patient population.

Study design: Retrospective cohort study.

Purpose: To compare rates of 30-day reoperation (RTOR), readmission, overall postoperative complication, non-home discharge, and length of stay (LOS); and investigate individual postoperative complication rates among patients with preoperative normoalbuminemia versus hypoalbuminemia.

Overview of literature: Evidence continues to accumulate associating poor preoperative nutritional status with inferior surgical outcomes in spinal deformity and oncology. These spinal subspecialities frequently require instrumentation and significant tissue disruption. However, the relationship between preoperative nutrition and shorter, less invasive spinal decompression remains poorly assessed.

Methods: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adult patients (>18 years) who underwent elective lumbar laminectomy for lumbar stenosis between 2015 and 2022. Univariate comparison and multivariate logistic regression analyses were conducted.

Results: This study identified 9,593 cases. Among primary outcomes, patients with hypoalbuminemia reported more 30-day readmission (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.17-1.2.82; p =0.008) and non-home discharge rates (OR, 2.08; 95% CI, 1.57-2.76; p <0.001) as well as longer LOS (3.7±4.5 days vs. 1.9±2.4 days, p <0.0005) in both univariate and multivariate analyses, whereas they demonstrated higher RTOR (5.3% vs. 2.7%, p =0.003) and postoperative complication rates (19.0% vs. 5.8%, p <0.001) in only univariate analysis compared with those having normoalbuminemia. Among secondary outcomes, patients with hypoalbuminemia reported statistically more wound and pulmonary complications in univariate analysis; however, they had higher risks of only venous thrombosis requiring anticoagulation and stroke in multivariate analysis.

Conclusions: Preoperative hypoalbuminemia is associated with higher rates of 30-day readmission, non-home discharge, and postoperative complications, as well as longer LOS after elective open lumbar laminectomy. These data indicate the importance of preoperative nutritional optimization even in shorter, more routine spinal surgery.

Study design: Retrospective cohort study.

Purpose: To compare thrombotic complication rates in thoracolumbar spine surgery patients before and after the coronavirus disease 2019 (COVID-19) pandemic.

Overview of literature: Thrombotic complications are a major cause of postoperative morbidity and mortality in spine surgery. Both COVID-19 infection and vaccination have been linked to hypercoagulability. However, data on pre- versus post-pandemic thrombotic risk in spine surgery are limited, and the influence of infection severity or vaccination status has not been examined.

Methods: Adult patients (≥18 years) undergoing primary thoracolumbar decompression with or without fusion were identified, excluding trauma and neoplastic cases. Patients were divided into "pre-COVID" and "post-COVID" cohorts. Outcomes included 90-day rates of postoperative deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and cerebrovascular accident (CVA). Cohorts were compared using Pearson's chi-square tests, and multivariable regression adjusted for demographics and comorbidities.

Results: A total of 784,498 patients were included. Post-COVID, rates of DVT (1.4% vs. 1.3%; risk ratio [RR], 1.11; p <0.001), PE (0.9% vs. 0.8%; RR, 1.14; p <0.001, and CVA (0.8% vs. 0.7%; RR, 1.17; p <0.001) were higher. Multivariable analysis demonstrated a 7% increase in odds of VTE post-COVID (odds ratios [OR], 1.07; p =0.002). Unvaccinated patients had a 6% higher odds of VTE (OR, 1.06; p =0.006), whereas vaccinated patients showed a nonsignificant increase (OR, 1.16; p =0.109). Patients with prior COVID-19 hospitalization had approximately double the odds of VTE (OR, 2.03; p =0.011).

Conclusions: Thrombotic complications modestly increased after the COVID-19 pandemic. Vaccination status showed no clear association, while prior hospitalization for COVID-19 was the strongest predictor of postoperative thrombotic risk.

Robotic-assisted laminectomy (RAL) is an emerging technique in spine surgery that can potentially improve precision, safety, and efficiency. While robotic-assisted pedicle screw placement is well established, RAL remains in early stages with varied methodologies and primarily pre-clinical validation. This narrative review evaluates current evidence on RAL, focusing on bone cutting tools, resection strategies, state recognition techniques for real-time identification of bone type and surgical endpoints, and clinical applications to inform future advancements. A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases with relevant keywords and operators to maximize sensitivity. Twenty-seven studies met predefined inclusion and exclusion criteria. Evaluated cutting tools included burrs, drills, and ultrasonic osteotomes. Burrs and drills provided superior state recognition feedback, while ultrasonic devices offered better force control and reduced thermal damage. Cyclic dorsal-ventral drilling was found to be superior to layer-by-layer resection for ultrasonic cutting. The only clinical study of RAL in a human patient is a case report demonstrating robotic-guided, surgeon-operated laminar bone removal. While RAL shows promise in improving surgical accuracy, the lack of in vivo data and standardized methodology remains a key barrier to clinical adoption. Future research should prioritize comparative evaluation of cutting modalities, clinical validation in human subjects, and long-term outcome studies to support the broader integration of RAL into spine surgery.