Asian Spine Journal最新文献

Study design: A retrospective study.

Purpose: To compare the predictive utility between Hounsfield unit (HU) values and vertebral bone quality (VBQ) scores for adjacent vertebral fracture (AVF) risk after balloon kyphoplasty (BKP) and to identify the appropriate measurement site.

Overview of literature: HU and VBQ have emerged as novel bone strength assessment methods. However, no study has compared the efficacy of these methods for evaluating AVF risk.

Methods: This single-center study included 130 patients with osteoporotic vertebral fractures who underwent BKP and preoperative computed tomography and magnetic resonance imaging. After propensity score matching for age; sex; body mass index; fracture level; use of steroids, teriparatide, or osteoporosis medication; and previous AVF, patients were classified into the AVF (-) and AVF (+) groups, each of which included 34 patients. Bone strength was assessed using the L1 HU, L1-4 HU (mean HU of L1-L4), L1 VBQ, and L1-4 VBQ. Group differences were analyzed, and the predictive accuracy for AVF was evaluated using area under the receiver operating characteristic curve (AUC).

Results: L1 HU was significantly lower in the AVF (+) group than in the AVF (-) group (92.1±29.4 vs. 71.6±21.4, p =0.013). No significant differences between the groups were observed for L1-4 HU, L1 VBQ, and L1-4 VBQ. L1 HU had the highest AUC (0.657), compared with those for L1-4 HU (0.625), L1 VBQ (0.524), and L1-4 VBQ (0.523). The predictive accuracy of L1 was superior to that of L1-4 for both HU and VBQ scores.

Conclusions: HU was superior to VBQ in predicting AVF risk after BKP, with L1 HU being the most effective indicator of bone strength and AVF risk.

Study design: A retrospective cohort study.

Purpose: To determine whether the preoperative pars defect length predicts bone union following the modified smiley face rod (mSFR) technique for lumbar spondylolysis and to identify a threshold for clinical decision-making.

Overview of literature: Lumbar spondylolysis is a common cause of low back pain in young athletes, often leading to pseudarthrosis that requires surgical intervention. Various techniques, including mSFR, address pseudarthrosis; however, the effect of preoperative pars defect length on bone union remains unclear.

Methods: This study analyzed 75 pars defects in 38 patients treated with mSFR between 2014 and 2022. Pre- and postoperative pars defect lengths were measured using computed tomography (CT). Patients were categorized into bone union and nonunion groups based on CT findings up to 24 months postoperatively. Group comparisons of defect lengths were performed using the Mann-Whitney U test. Logistic regression was used to examine the association between preoperative defect length and nonunion. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal threshold for preoperative defect length.

Results: Bone union was achieved in 65 of 75 defects (87%). The preoperative pars defect length was significantly shorter in the bone union group than in the nonunion group (3.0 mm vs. 5.6 mm, p <0.001). A strong correlation was observed between pre- and postoperative pars defect lengths (Spearman's rho=0.76). Logistic regression analysis revealed a significant association between a longer preoperative defect and nonunion (odds ratio, 1.89; 95% confidence interval, 1.29-2.72; p =0.001). ROC analysis revealed a cut-off value of 3.8 mm (sensitivity, 89%; specificity, 75%; area under the curve=0.86).

Conclusions: Bone union following the mSFR technique may be influenced by the pars defect length, with larger preoperative defects potentially hindering bone union. The technique is most effective when the preoperative defect length is ≤3.8 mm.

Study design: Nationwide retrospective cohort study with propensity score matching (PSM) analysis.

Purpose: To investigate the impact of osteoporosis on perioperative complications in patients undergoing surgery for lumbar spinal stenosis (LSS).

Overview of literature: Progressive population aging has driven an increase in surgical procedures for degenerative spinal conditions such as LSS. While previous research has examined the impact of osteoporosis on implant-related complications, its specific impact on outcomes following LSS surgeries remains unclear.

Methods: This study analyzed 60,785 patients who underwent LSS surgery between April 2020 and March 2022, utilizing data from a nationwide Diagnosis Procedure Combination database. Perioperative complications, treatment costs, blood transfusion volume, and anesthesia time were compared between osteoporotic and non-osteoporotic patients. PSM was employed to account for confounding variables. Univariate and multivariate regression analyses were employed to identify risk factors for complications.

Results: The prevalence of osteoporosis in this cohort was 10.6%. On regression analyses, age, sex, body mass index, admission activities of daily living (ADL) score (Barthel index), hospital type, spinal fusion, Charlson comorbidity index score, and osteoporosis showed a significant association with perioperative complications. Before PSM, osteoporotic patients were older, predominantly female, and had lower body mass index and admission ADL scores, higher spinal fusion rates, and more complications. After PSM, osteoporotic patients exhibited significantly higher complication rates, increased costs, greater blood transfusion requirements, and longer anesthesia durations compared to non-osteoporotic patients.

Conclusions: This nationwide analysis identified osteoporosis as an independent risk factor for perioperative complications following LSS surgery. Our findings underline the need for careful perioperative management in this population.

Study design: A retrospective study.

Purpose: To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery.

Overview of literature: Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear.

Methods: We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups.

Results: ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group.

Conclusions: ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.

Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation has been reported in recent years for metastatic spine tumor surgery (MSTS). The benefits of CFR-PEEK include imaging artifact reduction, which enables more efficient follow-up and adjuvant radiotherapy (RT) planning compared with traditional titanium implants. Despite the increase in CFR-PEEK application in the literature, technical guides or considerations in terms of CFR-PEEK usage in MSTS are currently unavailable. This study aimed to highlight various important technical considerations and potential pitfalls for surgeons when applying CFR-PEEK instrumentation in MSTS. This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online, The Cochrane Library, and Scopus databases through December 31, 2024. This review included all studies related to CFR-PEEK instrumentation in MSTS. The vast personal experiences of the senior authors with the CFR-PEEK instrumentation circumstantiated the concepts emphasized in this paper. This review included 36 articles and discussed various considerations when planning for CFR-PEEK instrumentation in patients undergoing MSTS. Factors include preoperative construct planning, intraoperative CFR-PEEK system handling, and postoperative considerations such as the requirement for RT planning. This review is the first to highlight various considerations for MSTS surgeons when applying CFR-PEEK instrumentation. This serves as an important guide for surgeons performing MSTS, with the continuous evolution of our treatment capacity in metastatic spinal disease (Level of evidence: IV).