Asian Spine Journal最新文献

Study design: A cross-sectional study.

Purpose: To evaluate the diagnostic performance of a novel 3-kg weight-lifting flexion radiograph for detecting lumbar instability.

Overview of literature: Conventional flexion-extension radiographs have limited sensitivity for detecting lumbar instability, while magnetic resonance imaging (MRI) is a reliable standard. This study compares the performance of a novel weight-lifting radiograph to conventional flexion radiographs, using MRI as the reference standard.

Methods: Forty-six patients with a diagnosis of lumbar instability were enrolled. Participants underwent lateral flexion, lateral extension, and 3-kg weight-lifting flexion lumbosacral spine radiographs. MRI was also performed on all participants. Diagnostic parameters, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios, were calculated for each lumbar level. Reliability was assessed using intraclass correlation coefficients (ICCs).

Results: The 3-kg weight-lifting flexion radiograph showed higher sensitivity for detecting spinal instability at the L3/4 and L4/5 levels (88% vs. 36% and 83.3% vs. 44.44%, respectively) but lower specificity (61.9% vs. 76.19% and 70% vs. 80%, respectively) compared to the conventional flexion radiograph. McNemar tests revealed no significant differences between the 3-kg weight-lifting flexion radiograph and MRI at these levels (p >0.05). Reliability assessments demonstrated excellent intra- and interobserver agreement (ICC ≥0.99). Furthermore, this technique was safe, with no adverse effects reported.

Conclusions: The 3-kg weight-lifting flexion radiograph enhances diagnostic sensitivity and accuracy for lumbar instability, particularly at the L3/4 and L4/5 levels, offering a reliable screening alternative.

Study design: A meta-analysis study.

Purpose: To compare the clinical efficacy and safety of combining full endoscopic lumbar discectomy (FELD) with platelet-rich plasma (PRP) administration versus FELD alone in treating lumbar disc herniation (LDH).

Overview of literature: FELD is effective for LDH, but PRP may enhance healing; evidence comparing both remains unclear.

Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data up to December 20, 2023. Primary outcomes included postoperative Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Secondary outcomes included disc height, complications, and Pfirrmann grade of disc degeneration.

Results: Six studies involving 433 patients were included (214 undergoing FELD combined with PRP and 219 undergoing FELD alone). Patients in the FELD+PRP group had significantly lower VAS scores for back pain after surgery compared to the FELD group (p <0.05). JOA and ODI scores showed significantly better improvement in the FELD+PRP group than in the FELD group (p <0.05). Compared to the FELD group, the FELD+PRP group had less disc height loss and a lower complication rate (p =0.0005). There was a significantly better improvement in disc degeneration (based on Pfirrmann grading) at final follow-up in the FELD+PRP group compared to the FELD group (p =0.002).

Conclusions: The combination of FELD and PRP offers superior outcomes compared to FELD alone in the treatment of LDH, including a more pronounced relief from back pain, significant functional improvement, and fewer postoperative complications. Additionally, it facilitates the repair of the annulus fibrosus of the intervertebral disc and reduces the loss of disc height.

Pelvic fixation has become increasingly important in treating spinal deformities that affect the lumbosacral junction. The sacral 2 alariliac screw (S2AI) and iliac screw (IS) fixations are two commonly used techniques. This meta-analysis aimed to systematically compare the clinical outcomes of S2AI and IS techniques in adult spinal deformity. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases, using combinations of keywords such as "S2-alar-iliac," "iliac screw," "spinopelvic fixation," "lumbosacral surgery," and "clinical outcomes." The search was restricted to articles published up to October 2024. Sixteen studies were included in the analysis. The S2AI cohort showed significant advantages in terms of reduced estimated blood loss (mean difference [MD], -140.70; p=0.006), shorter hospital stays (MD, -1.50; p=0.01), and improved ambulatory status (MD, 0.22; p=0.004). Additionally, the S2AI group had significantly lower incidence of complications, including screw prominence (odds ratios [OR], 0.08; p=0.001), wound infection (OR, 0.24; p=0.0001), wound dehiscence (OR, 0.14; p=0.0001), and reduced need for revision surgeries (OR, 0.32; p=0.0001). There were no significant differences between the S2AI and IS cohorts regarding the sagittal vertical axis (MD, 1.49; p=0.23), Visual Analog Scale pain scores (MD, 0.01; p=0.94), operation time (MD, -31.23; p=0.28), postoperative Oswestry Disability Index (ODI) (MD, 0.14; p=0.84), implant failure (OR, 0.74; p=0.23), pelvic tilt (MD, -0.44; p=0.65), sacral slope (MD, -0.82; p=0.46), lumbar lordosis (MD, -0.19; p=0.89), or pelvic incidence (MD, -0.38; p=0.78). This meta-analysis suggests that while both S2AI and IS fixations have similar outcomes in terms of implant failure, operation time, and postoperative ODI, S2AI may have better outcomes in terms of revision, screw prominence, and wound complications.

Study design: A single surgeon, retrospective case series.

Purpose: This study aimed to compare the radiological outcomes after using expandable versus static cages in oblique lumbar interbody fusion (OLIF).

Overview of literature: OLIF enables access to the spine while avoiding the anterior vessels and psoas muscles via a retroperitoneal corridor. Static cages have been used in this approach; however, they present with limitations, including repeated trialing, resulting in endplate violation and implant subsidence.

Methods: Patients who underwent OLIF (n=86) were divided into expandable (n=39) and static cage (n=47) groups. Radiographic data were then analyzed preoperatively and postoperatively, including immediate, 3 months, and the most recent follow-up.

Results: Cage type predicted the incidence of subsidence, with expandable cages associated with 4.00 and 2.43 fewer instances of subsidence compared with static cages at the postoperative and most recent time points (p<0.05). Cage type was a significant predictor of the change in height in both the posterior disk and foraminal height (FH) models. Expandable cages were associated with improved posterior disk height (DH) expansion at all three time points (1.24 mm, 0.88 mm, and 1.85 mm, respectively; p<0.01), and with larger FH increases at the 3 months postoperatively and most recent follow-up (1.12 mm, 0.40 mm, and 1.28 mm, respectively; p=0.096, 0.016, and 0.030). The expandable cage type was associated with improvement (3.46°, 3.12°, and 3.36°; p<0.01, 0.05, and 0.08, respectively) at the postoperative and 3-month time points when predicting the change in segmental lordosis. No statistically significant differences were found between the groups in disk angle and lumbar lordosis measurements or baseline demographics.

Conclusions: The results of this study indicate that both static and expandable cages result in radiographic improvement in posterior DH, segmental lordosis, and FH when used in OLIF. Expandable cages may demonstrate certain advantages over static cages due to lower implant subsidence instances and the greater posterior disk and FH expansion, thereby providing preliminary evidence to support the superiority of expandable cages in OLIF procedures.

This study was the first comprehensive systematic review and meta-analysis to compare clinical outcomes between conventional open surgery and biportal endoscopy for decompression and fusion of lumbar degenerative disease. Although conventional open spine surgery has been the standard approach for decades, biportal endoscopy has gained attention as a minimally invasive alternative with potential surgical outcome benefits. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis including eight comparative studies on open and biportal endoscopic spine surgery. A comprehensive search of PubMed, Embase, and Scopus identified studies that reported outcomes, such as the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores for back and leg pain, complication rates, operative time, and hospital stay. Data were analyzed using a random effects model to evaluate the effect size between the two approaches. We analyzed 414 open and 383 biportal endoscopic lumbar surgical procedures. The open group had a mean age of 61.0 years and comprised 42.0% men, whereas the biportal group had a mean age of 59.8 years and comprised 46.7% men. Compared with open spine surgery, biportal surgery was associated with a significantly longer operative time but shorter length of hospital stay and similar preoperative VAS scores, ODI score, and postoperative outcomes at <1 month and >1 year. Fusion subgroup analysis showed significantly lower VAS score for back pain with biportal surgery than with open surgery, but the other measures were comparable. Despite its longer operative time, biportal endoscopy led to shorter hospital stay and similar long-term pain and disability outcomes, compared with open spine surgery. Given the significant improvement in short-term leg pain relief after fusion procedures, biportal endoscopic spine surgery is a potential minimally invasive alternative to open surgery that warrants further study.

Study design: A prospective randomized study.

Purpose: To investigate the impact of intermediate pedicle screw length on radiological and functional outcomes in unstable thoracolumbar burst fractures (TLF) treated with short-segment posterior fixation (SSPF).

Overview of literature: Although intermediate screws confer biomechanical advantages, there is no consensus on the ideal intermediate screw length.

Methods: Sixty-six patients with unstable TLF (Load Sharing Classification score ≥7) and normal neurology requiring SSPF were randomized into two groups. Group 1 (long intermediate screw [LIS]) underwent SSPF with a long intermediate screw (occupying >50% of the vertebral body, length ≥40 mm), while group 2 (short intermediate screw [SIS]) received a short intermediate screw (occupying <50% of the vertebral body, length ≤35 mm). Radiological parameters (restoration of anterior body height [ABH], posterior body height [PBH], ABH/PBH ratio, local kyphosis angle [LKA], and regional kyphosis angle [RKA]) and functional parameters (Visual Analog Scale score and Oswestry Disability Index) were evaluated.

Results: Demographic variables (age, sex), mode of injury, and fracture pattern were comparable between groups. The LIS group showed a significant improvement in RKA correction in the immediate postoperative period (p =0.019), but this difference was not sustained at the final follow-up (p =0.713). Other radiological and functional parameters were comparable between the two groups at the 2-year follow-up.

Conclusions: Although long intermediate pedicle screw provided better correction of regional kyphosis in the immediate postoperative period for unstable TLFs with LSC ≥7, the outcomes were comparable between both long and short intermediate pedicle screws at longterm follow-up.

Study design: Randomized controlled study.

Purpose: To investigate the immediate effect of posture correction taping on neck pain, neck range of motion (ROM), and scapulothoracic muscle activity in individuals with forward head posture (FHP) and mechanical neck pain (MNP).

Overview of literature: MNP is a common complaint among individuals with FHP. Poor posture is a major contributing factor to MNP. Taping is a treatment technique used to correct FHP with MNP, but its effectiveness in reducing neck pain, improving ROM, and altering muscle activity requires further investigation.

Methods: Forty-two patients with FHP and MNP were randomly assigned to either a taping group or a control group. Both groups received common treatments including mobilization of the hypomobile joints of cervicothoracic spine and ribcage joints, stretching of shortened muscles of the upper back and neck, and stabilization exercises for neck and scapular muscles. The taping group received additional posture correction taping. Pain intensity and neck ROM were assessed at baseline and 48 hours after the first treatment session. Electromyogram (EMG) activity of the scapulothoracic muscles was recorded before and immediately after taping.

Results: Both groups reported reduced pain intensity after 48 hours of intervention, with significantly lower pain intensity in the taping group. The taping group also demonstrated significant improvement in extension ROM compared with the baseline. There was no significant change in other neck ROM and no between-group difference in ROM 48 hours after intervention. EMG activity revealed reduced upper trapezius activity and increased middle trapezius and serratus anterior activity immediately after taping.

Conclusions: Posture correction taping may help reduce pain intensity, improve ROM, and alter scapulothoracic muscle activity in individuals with MNP and FHP. These results may be of interest for the development of posture correction interventions for this population.