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Development and internal validation of machine-learning models for predicting survival in patients who underwent surgery for spinal metastases. 用于预测脊柱转移手术患者存活率的机器学习模型的开发和内部验证。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI: 10.31616/asj.2023.0314
Borriwat Santipas, Kanyakorn Veerakanjana, Piyalitt Ittichaiwong, Piya Chavalparit, Sirichai Wilartratsami, Panya Luksanapruksa

Study design: A retrospective study.

Purpose: This study aimed to develop machine-learning algorithms for predicting survival in patients who underwent surgery for spinal metastasis.

Overview of literature: This study develops machine-learning models to predict postoperative survival in spinal metastasis patients, filling the gaps of traditional prognostic systems. Utilizing data from 389 patients, the study highlights XGBoost and CatBoost algorithms̓ effectiveness for 90, 180, and 365-day survival predictions, with preoperative serum albumin as a key predictor. These models offer a promising approach for enhancing clinical decision-making and personalized patient care.

Methods: A registry of patients who underwent surgery (instrumentation, decompression, or fusion) for spinal metastases between 2004 and 2018 was used. The outcome measure was survival at postoperative days 90, 180, and 365. Preoperative variables were used to develop machine-learning algorithms to predict survival chance in each period. The performance of the algorithms was measured using the area under the receiver operating characteristic curve (AUC).

Results: A total of 389 patients were identified, with 90-, 180-, and 365-day mortality rates of 18%, 41%, and 45% postoperatively, respectively. The XGBoost algorithm showed the best performance for predicting 180-day and 365-day survival (AUCs of 0.744 and 0.693, respectively). The CatBoost algorithm demonstrated the best performance for predicting 90-day survival (AUC of 0.758). Serum albumin had the highest positive correlation with survival after surgery.

Conclusions: These machine-learning algorithms showed promising results in predicting survival in patients who underwent spinal palliative surgery for spinal metastasis, which may assist surgeons in choosing appropriate treatment and increasing awareness of mortality-related factors before surgery.

研究设计目的:本研究旨在开发预测脊柱转移手术患者生存率的机器学习算法:该研究开发了机器学习模型来预测脊柱转移瘤患者的术后生存率,填补了传统预后系统的空白。利用 389 例患者的数据,该研究强调了 XGBoost 和 CatBoost 算法̓ 对 90 天、180 天和 365 天生存率预测的有效性,术前血清白蛋白是关键的预测指标。这些模型为加强临床决策和个性化患者护理提供了一种很有前景的方法:对 2004 年至 2018 年期间因脊柱转移而接受手术(器械治疗、减压或融合)的患者进行登记。结果测量指标为术后 90 天、180 天和 365 天的存活率。术前变量用于开发机器学习算法,以预测每个时期的存活几率。算法的性能使用接收者操作特征曲线下面积(AUC)进行测量:共确定了 389 名患者,术后 90 天、180 天和 365 天的死亡率分别为 18%、41% 和 45%。XGBoost 算法在预测 180 天和 365 天生存率方面表现最佳(AUC 分别为 0.744 和 0.693)。CatBoost 算法在预测 90 天存活率方面表现最佳(AUC 为 0.758)。血清白蛋白与术后生存率的正相关性最高:这些机器学习算法在预测因脊柱转移而接受脊柱姑息手术的患者的生存率方面显示出了良好的效果,可帮助外科医生选择适当的治疗方法,并在手术前提高对死亡率相关因素的认识。
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引用次数: 0
Response to the Letter to the Editor: Comparison of efficacy between transforaminal epidural steroid injection technique without contrast versus with contrast in lumbar radiculopathy: a prospective longitudinal cohort study. 回应致编辑的信:腰椎病经椎间孔硬膜外类固醇注射技术无造影剂与有造影剂的疗效比较:一项前瞻性纵向队列研究。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2024-06-26 DOI: 10.31616/asj.2024.0177.r2
Waroot Pholsawatchai, Park Manakul, Warisara Lertcheewanan, Koopong Siribumrungwoung, Thongchai Suntharapa, Rattalerk Arunakul
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引用次数: 0
Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review. 腰椎椎间支架材料与设计的创新发展:综合叙述性综述。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2023-12-26 DOI: 10.31616/asj.2023.0407
Sam Yeol Chang, Dong-Ho Kang, Samuel K Cho

This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.

这篇叙述性综述全面探讨了用于腰椎椎间融合术(LIF)的椎体间笼技术的发展和现状。该综述强调了脊柱手术从传统的静态椎体笼设计过渡到先进的可扩张变体所带来的生物力学和临床影响。综述首先探讨了椎体笼材料的早期发展,强调了钛和聚醚醚酮在推进 LIF 技术中的作用。文章讨论了这些材料的优势和局限性,从而对表面改性进行了创新,并引入了钽等新型材料作为替代材料。三维打印和表面改性技术的进步是本综述的重要组成部分,强调了这些技术在增强椎间笼的生物力学兼容性和骨结合方面的作用。本综述还探讨了生物可降解材料和复合材料(如聚乳酸和聚己内酯)的兴起,探讨了它们在减轻长期植入相关并发症方面的潜力。本综述对静态和可膨胀种植体进行了严格评估,包括它们各自的临床和放射学结果。静态固位体一直是 LIF 的主流,而可膨胀固位体则因其能够适应患者的解剖结构而备受关注,有可能减少固位体下沉等并发症。不过,本综述强调了目前的争论,并指出在临床效果方面,这两种保持架的优越性都缺乏确凿证据。最后,本综述提出了骨笼技术的未来发展方向,重点关注生物活性物质和多功能涂层的整合以及患者特异性植入物的开发。这些进步旨在进一步提高脊柱融合手术的疗效、安全性和个性化方法。这篇综述对 LIF 中脊柱骨架技术不断发展的状况有了细致入微的了解,并对脊柱手术的当前实践和未来可能性提供了深入的见解。
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引用次数: 0
Response to the Letter to the Editor: Lumbar transforaminal injection of steroids versus platelet-rich plasma for prolapse lumbar intervertebral disc with radiculopathy: a randomized double-blind controlled pilot study. 回应致编辑的信:腰椎经椎间孔注射类固醇与富血小板血浆治疗腰椎间盘突出伴根性病变:随机双盲对照试验研究。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2024-06-26 DOI: 10.31616/asj.2024.0109.r2
Anuj Gupta, Harvinder Singh Chhabra, Vishwajeet Singh, Daram Nagarjuna
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引用次数: 0
Artificial intelligence: a new cutting-edge tool in spine surgery. 人工智能:脊柱外科的新尖端工具。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2024-06-25 DOI: 10.31616/asj.2023.0382
Guna Pratheep Kalanjiyam, Thiyagarajan Chandramohan, Muthu Raman, Haritha Kalyanasundaram

The purpose of this narrative review was to comprehensively elaborate the various components of artificial intelligence (AI), their applications in spine surgery, practical concerns, and future directions. Over the years, spine surgery has been continuously transformed in various aspects, including diagnostic strategies, surgical approaches, procedures, and instrumentation, to provide better-quality patient care. Surgeons have also augmented their surgical expertise with rapidly growing technological advancements. AI is an advancing field that has the potential to revolutionize many aspects of spine surgery. We performed a comprehensive narrative review of the various aspects of AI and machine learning in spine surgery. To elaborate on the current role of AI in spine surgery, a review of the literature was performed using PubMed and Google Scholar databases for articles published in English in the last 20 years. The initial search using the keywords "artificial intelligence" AND "spine," "machine learning" AND "spine," and "deep learning" AND "spine" extracted a total of 78, 60, and 37 articles and 11,500, 4,610, and 2,270 articles on PubMed and Google Scholar. After the initial screening and exclusion of unrelated articles, duplicates, and non-English articles, 405 articles were identified. After the second stage of screening, 93 articles were included in the review. Studies have shown that AI can be used to analyze patient data and provide personalized treatment recommendations in spine care. It also provides valuable insights for planning surgeries and assisting with precise surgical maneuvers and decisionmaking during the procedures. As more data become available and with further advancements, AI is likely to improve patient outcomes.

本综述旨在全面阐述人工智能(AI)的各个组成部分、其在脊柱外科中的应用、实际问题以及未来发展方向。多年来,脊柱外科在诊断策略、手术方法、程序和器械等各个方面不断变革,以提供更高质量的患者护理。外科医生也借助快速发展的技术进步来增强他们的外科专业知识。人工智能是一个不断进步的领域,有可能在脊柱外科的许多方面带来革命性的变化。我们对人工智能和机器学习在脊柱手术中的各个方面进行了全面的叙述性回顾。为了阐述人工智能目前在脊柱外科中的作用,我们使用 PubMed 和 Google Scholar 数据库对过去 20 年中发表的英文文章进行了文献综述。使用关键词 "人工智能 "和 "脊柱"、"机器学习 "和 "脊柱 "以及 "深度学习 "和 "脊柱 "进行初步检索,在 PubMed 和 Google Scholar 上分别提取了 78、60 和 37 篇文章,以及 11,500、4,610 和 2,270 篇文章。经过初步筛选并排除无关文章、重复文章和非英文文章后,共确定了 405 篇文章。经过第二阶段筛选,93 篇文章被纳入综述。研究表明,人工智能可用于分析患者数据,并在脊柱护理中提供个性化治疗建议。它还能为手术规划提供有价值的见解,并在手术过程中协助精确的手术操作和决策。随着更多数据的可用性和进一步的进步,人工智能很可能会改善患者的治疗效果。
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引用次数: 0
Letter to the Editor: Comparison of efficacy between transforaminal epidural steroid injection technique without contrast versus with contrast in lumbar radiculopathy: a prospective longitudinal cohort study. 致编辑的信:经椎间孔硬膜外类固醇注射技术在腰椎病中不使用造影剂与使用造影剂的疗效比较:一项前瞻性纵向队列研究。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-06-01 Epub Date: 2024-06-26 DOI: 10.31616/asj.2024.0177.r1
Rekib Sacaklidir
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引用次数: 0
Sagittal Section Hounsfield Units of the Upper Instrumented Vertebrae as a Predictor of Proximal Junctional Vertebral Fractures Following Adult Spinal Deformity Surgery. 成人脊柱畸形手术后上部器械椎体矢状切面 Hounsfield 单位作为近端交界处椎体骨折的预测指标。
IF 2.3 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.31616/asj.2023.0339
Koichi Murata, B. Otsuki, Takayoshi Shimizu, Takashi Sono, S. Fujibayashi, Shuichi Matsuda
Study DesignA retrospective observational study.PurposeThis study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs).Overview of LiteratureCT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear.MethodsThis retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative.ResultsPJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05).ConclusionsMeasurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.
研究设计回顾性观察研究目的本研究旨在确定一种准确、便捷的筛查方法,利用基于计算机断层扫描(CT)的霍斯菲尔德单位(HUs)测量方法预测成人脊柱畸形(ASD)手术后的近端交界处骨折(PJFr).文献综述基于计算机断层扫描的 HUs 测量方法是评估骨矿密度的一种替代工具。然而,使用 HUs 预测脊柱融合术后邻近椎体骨折的最佳方法仍不明确。方法这项回顾性观察研究纳入了 42 名接受 ASD 重建手术的患者。轴切面上的椭圆形感兴趣区(ROI)和矢状切面上的矩形感兴趣区分别位于上器械椎体(UIV)、UIV+1 和 UIV+2。此外,还以 L2 椎体的 HU 值为代表。从 L2、UIV、UIV+1 和 UIV+2 轴切面获得的 HU 值与 2 年内 PJFr 的发生率无显著相关性,但 L2 椎体下部区域的 ROI 值除外。然而,PJFr 组 UIV 前三分之一矢状切面的 HU 值明显低于非 PJFr 组(87.0 vs. 160.3,p =0.001)。结论矢状切面 UIV 前三分之一处的 HU 测量结果显示了 ASD 手术后对 PJFr 的预测能力。UIV HU 值小于 100 是 PJFr 的风险因素。
{"title":"Sagittal Section Hounsfield Units of the Upper Instrumented Vertebrae as a Predictor of Proximal Junctional Vertebral Fractures Following Adult Spinal Deformity Surgery.","authors":"Koichi Murata, B. Otsuki, Takayoshi Shimizu, Takashi Sono, S. Fujibayashi, Shuichi Matsuda","doi":"10.31616/asj.2023.0339","DOIUrl":"https://doi.org/10.31616/asj.2023.0339","url":null,"abstract":"Study Design\u0000A retrospective observational study.\u0000\u0000\u0000Purpose\u0000This study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs).\u0000\u0000\u0000Overview of Literature\u0000CT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear.\u0000\u0000\u0000Methods\u0000This retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative.\u0000\u0000\u0000Results\u0000PJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05).\u0000\u0000\u0000Conclusions\u0000Measurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"61 18","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140666821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characteristics of Lumbar Spondylolysis in Adolescent Baseball Players: Relationship between the Laterality of Lumbar Spondylolysis and the Throwing or Batting Side. 青少年棒球运动员腰椎骨质增生的特征:腰椎骨质增生的侧位与投球侧或击球侧的关系。
IF 2.3 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.31616/asj.2023.0360
Shotaro Teruya, T. Funayama, Masaki Tatsumura, Hisanori Gamada, Shun Okuwaki, Takeo Mammoto, Atsushi Hirano, Masashi Yamazaki
Study DesignA retrospective, cross-sectional study was conducted to analyze the implications of asymmetric baseball movements on the incidence of spondylolysis.PurposeThis study aimed to evaluate the relationship between asymmetric movements and the laterality of spondylolysis.Overview of LiteratureBaseball, characterized by its asymmetric throwing and batting, may disproportionately stress one side. Lumbar spondylolysis is a frequent cause of lower back pain in young athletes, particularly those involved in activities with consistent unilateral rotations such as baseball. However, whether a link exists between the laterality in spondylolysis and the dominant throwing/ batting side or whether disparities exist between pitchers and fielders remains unclear.MethodsThe study included 85 players. Participants were divided into two groups: pitchers and fielders. The association between the laterality of spondylolysis and the throwing/batting side in the overall cohort and between the two groups was evaluated.ResultsAmong pitchers, 16 lesions appeared on the throwing side and 32 on the nonthrowing side (p =0.029). For fielders, no notable difference was observed between the two sides (p =0.363). Furthermore, batting preference did not influence the laterality of spondylolysis in either group.ConclusionsAdolescent baseball players, particularly pitchers, exhibited a higher incidence of lumbar spondylolysis on the side opposite their throwing arm. The findings of this study highlight the significant effect of asymmetrical sporting activities on the development of spondylolysis, to which pitchers are particularly susceptible.
研究设计一项回顾性横断面研究,旨在分析不对称棒球运动对脊柱溶解症发病率的影响。文献综述棒球运动的特点是不对称投掷和击球,可能会对一侧造成不成比例的压力。腰椎骨质增生是年轻运动员腰痛的一个常见原因,尤其是那些从事棒球等持续单侧旋转活动的运动员。然而,脊柱侧弯症与投掷/击球优势侧之间是否存在联系,或者投手和外野手之间是否存在差异,目前仍不清楚。研究对象包括 85 名球员,分为投手和外野手两组。结果在投手中,16 例病变出现在投掷侧,32 例出现在非投掷侧(P =0.029)。至于外野手,两侧没有明显差异(P =0.363)。结论青少年棒球运动员,尤其是投球手,投球臂对侧腰椎骨质增生的发病率较高。这项研究结果突出表明,不对称的体育活动对脊柱溶解症的发生有显著影响,而投手尤其容易患上脊柱溶解症。
{"title":"Characteristics of Lumbar Spondylolysis in Adolescent Baseball Players: Relationship between the Laterality of Lumbar Spondylolysis and the Throwing or Batting Side.","authors":"Shotaro Teruya, T. Funayama, Masaki Tatsumura, Hisanori Gamada, Shun Okuwaki, Takeo Mammoto, Atsushi Hirano, Masashi Yamazaki","doi":"10.31616/asj.2023.0360","DOIUrl":"https://doi.org/10.31616/asj.2023.0360","url":null,"abstract":"Study Design\u0000A retrospective, cross-sectional study was conducted to analyze the implications of asymmetric baseball movements on the incidence of spondylolysis.\u0000\u0000\u0000Purpose\u0000This study aimed to evaluate the relationship between asymmetric movements and the laterality of spondylolysis.\u0000\u0000\u0000Overview of Literature\u0000Baseball, characterized by its asymmetric throwing and batting, may disproportionately stress one side. Lumbar spondylolysis is a frequent cause of lower back pain in young athletes, particularly those involved in activities with consistent unilateral rotations such as baseball. However, whether a link exists between the laterality in spondylolysis and the dominant throwing/ batting side or whether disparities exist between pitchers and fielders remains unclear.\u0000\u0000\u0000Methods\u0000The study included 85 players. Participants were divided into two groups: pitchers and fielders. The association between the laterality of spondylolysis and the throwing/batting side in the overall cohort and between the two groups was evaluated.\u0000\u0000\u0000Results\u0000Among pitchers, 16 lesions appeared on the throwing side and 32 on the nonthrowing side (p =0.029). For fielders, no notable difference was observed between the two sides (p =0.363). Furthermore, batting preference did not influence the laterality of spondylolysis in either group.\u0000\u0000\u0000Conclusions\u0000Adolescent baseball players, particularly pitchers, exhibited a higher incidence of lumbar spondylolysis on the side opposite their throwing arm. The findings of this study highlight the significant effect of asymmetrical sporting activities on the development of spondylolysis, to which pitchers are particularly susceptible.","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"139 34","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Value of Spinal Infection Treatment Evaluation Score, Pola Classification, and Brighton Spondylodiscitis Score from Decision to Surgery in Patients with Spondylodiscitis: A Receiver-Operating Characteristic Curve Analysis. 脊柱盘炎患者从决定到手术的脊柱感染治疗评估评分、Pola 分级和 Brighton 脊柱盘炎评分的价值:受体操作特征曲线分析》。
IF 2.3 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.31616/asj.2023.0317
Majid Rezvani, Ali Ahmadvand, Taravat Yazdanian, P. Azimi, Navid Askariardehjani
Study DesignThis was a retrospective study.PurposeThis study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis.Overview of LiteratureSpondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process.MethodsAll case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients' satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation.ResultsIn all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z =2.1, p =0.037); SITE score vs. Pola classification, 0.05 (Z =0.82, p =0.412); and Pola classification vs. BSDS, 0.08 (Z =1.22, p =0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients' satisfaction was observed.ConclusionsThe findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.
研究设计这是一项回顾性研究。目的本研究旨在评估脊柱感染治疗评估(SITE)评分、布莱顿脊柱盘炎评分(BSDS)和波拉分类在预测脊柱盘炎患者是否需要手术干预方面的价值。方法评估所有病例记录,提取手术前后美国脊柱损伤协会(ASIA)、视觉模拟量表(VAS)和日本骨科协会背痛评估问卷(JOABPEQ)的评分信息。记录了 SITE 评分、Pola 分级和 BSDS。应用接收者操作特征(ROC)曲线分析和曲线下面积(AUC)来估计评分系统的预测能力。采用 VAS、ASIA、JOABPEQ 和 Likert 量表评估患者对手术结果的满意度。患者的平均年龄为(54.6±14.7)岁。其中 112 名患者接受了手术治疗。SITE 评分、BSDS 和 Pola 分类的 AUC 分别为 0.86、0.81 和 0.73。在 ROC 曲线 AUC 的比较中,SITE 评分与 BSDS 相比,AUC 明显更高,为 0.13(Z =2.1,P =0.037);SITE 评分与 Pola 分级相比,AUC 为 0.05(Z =0.82,P =0.412);Pola 分级与 BSDS 相比,AUC 为 0.08(Z =1.22,P =0.219)。在决定是否手术时,SITE 评分的最佳临界值为 8.5(灵敏度为 80.6%;特异度为 81.2%),BSDS 的最佳临界值为 9.5(灵敏度为 52.8%;特异度为 83.0%)。VAS 背痛和 JOABPEQ 分量表与术前评分相比有显著差异。根据 ASIA 分级,没有一名患者出现神经功能恶化。结论研究结果表明,SITE 评分是一种有用的测量方法,有助于临床医生对脊柱盘炎患者做出正确的临床决定。
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引用次数: 0
The Transaxillary Approach as a Direct Route in the Management of Upper Thoracic Spine Pathology: A Technical Note with Case Series. 经腋窝入路是治疗胸椎上部病变的直接途径:附病例系列的技术说明。
IF 2.3 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.31616/asj.2023.0175
S. Ifthekar, Ju-Wan Seuk, Ui Dong Hwang, Hyung-Chang Lee, Sang-Ho Lee, J. Bae
This retrospective case series of prospective data aims to describe the transaxillary approach for the treatment of upper thoracic spine pathology. Various surgical techniques and approaches have been reported across the literature to address upper thoracic spine pathology, including the cervicothoracic approach, anterior transsternal approach, posterolateral approach, supraclavicular approach, and lateral parascapular approaches. These techniques are invasive. A minimally invasive, less morbid, and direct access approach to the pathology of the upper thoracic spine has not been reported in the literature. Patients with pathology affecting the first thoracic vertebra up to the sixth thoracic vertebra were classified into the upper thoracic spine group. Patients with pathology below the sixth thoracic vertebra were excluded. Patients not having a minimum follow-up of 12 months were also excluded. The study analyzed 18 patients. The mean preoperative modified Japanese Orthopedic Association score was 7.2±1.44, which improved to 10.16±1.2 (p<0.05). The majority (14/18) of the patients had an excellent outcome. Three patients had good outcomes, and one patient had a fair outcome. Five cases of intraoperative dural leak were recorded, and one patient had postoperative neurological deficit. The transaxillary approach is a safe, viable, muscle-sparing, and minimally invasive approach for ventral pathologies of the upper thoracic spine.
这组回顾性病例系列的前瞻性数据旨在描述经腋窝入路治疗上胸椎病变的方法。文献报道了各种治疗上胸椎病变的手术技术和方法,包括颈胸椎入路、经胸骨前入路、后外侧入路、锁骨上入路和肩胛旁外侧入路。这些技术都是侵入性的。文献中还没有报道过一种微创、发病率较低、直接进入上胸椎的病理学方法。病变影响第一胸椎至第六胸椎的患者被归入上胸椎组。病变在第六胸椎以下的患者被排除在外。随访时间不足 12 个月的患者也被排除在外。研究分析了 18 名患者。术前平均改良日本骨科协会评分为(7.2±1.44)分,术后评分提高到(10.16±1.2)分(P<0.05)。大多数患者(14/18)的疗效极佳。3名患者疗效良好,1名患者疗效一般。5例患者术中出现硬脑膜渗漏,1例患者术后出现神经功能缺损。经腋窝入路是治疗上胸椎腹侧病变的一种安全、可行、不伤肌肉的微创入路。
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引用次数: 0
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Asian Spine Journal
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