Clinical Spine Surgery最新文献

{"title":"The Use of Intraoperative Neuromonitoring in Anterior Cervical Spine Procedures for Myelopathy: Alert Incidence, Interventions, and Prognostic Value.","authors":"Sydney Rucker, Robert J Ferdon, Gabriella Rivas, Jessica Barley, Jeffrey Korte, John Glaser, Charles Reitman, James Lawrence, Robert Ravinsky","doi":"10.1097/BSD.0000000000001911","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001911","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>Examine the utility of intraoperative neuromonitoring (IONM) in anterior cervical spine procedures for myelopathy in informing intraoperative interventions.</p><p><strong>Summary of background data: </strong>The routine use of IONM in anterior cervical spine procedures for myelopathy remains controversial, with poorly defined indications and limited evidence validating protocols for managing intraoperative alerts.</p><p><strong>Methods: </strong>One hundred ninety-one anterior cervical spine cases with continuous IONM from 2021 to 2025 were included, excluding revisions and nondegenerative conditions. The incidence of IONM alert was recorded for both myelopathic (n=111) and non-myelopathy (n=80) groups. Alerts were characterized by associated surgical event, intraoperative interventions, duration and resolution, and correlation with new postoperative deficit. Patient demographic and procedural variables, including total monitoring time and blood pressure fluctuations, were assessed for confounding.</p><p><strong>Results: </strong>Intraoperative alerts occurred in 42 patients, with a higher incidence of alert in the myelopathic group (28, 25.2%) than the non-myelopathic group (14, 17.5%) (P = 0.220). The most common event at the time of alert was instrumentation (30%) followed by decompression (27%) and patient positioning (21%). Intraoperative interventions in response to alerts included increased stimulation parameters, anesthetic adjustment, patient repositioning, or reversal of last surgical maneuver. Alerts in the myelopathic group were more likely to remain unresolved at closing [P = 0.007159; OR = 5.718, 95% CI (1.369, 29.523)] and associated with a lower positive predictive value for new postoperative deficit (0.29 vs. 0.50). Total monitoring time was the only variable significantly associated with alert incidence (P = 0.0004).</p><p><strong>Conclusions: </strong>Myelopathic patients experienced a higher incidence of IONM alerts and were significantly more likely to have unresolved alerts at closure. However, alerts demonstrated limited predictive value for new postoperative deficits.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Back Pain Improve Following Lumbar Decompression Alone?","authors":"David J Mazur-Hart, Christian G Lopez Ramos, Joseph G Nugent, Brannan E O'Neill, Barry Cheaney, Hanne A Gehling, Jamila Godil, Brandi W Pang, Arilene Novak, James T Obayashi, Travis C Philipp, Clifford Lin, Jung U Yoo, Christina H Wright, James M Wright, Donald A Ross, Josiah N Orina, Won Hyung A Ryu","doi":"10.1097/BSD.0000000000001931","DOIUrl":"10.1097/BSD.0000000000001931","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of a prospectively collected database at an academic institution.</p><p><strong>Objective: </strong>(1) Evaluate if low back pain (LBP) improves following decompression for neurogenic claudication or radiculopathy, (2) use the least absolute shrinkage and selection operator (LASSO) methodology to identify preoperative predictors for improvement in LBP, and (3) develop a pilot nomogram to guide clinical planning and postoperative expectations.</p><p><strong>Summary of background data: </strong>LBP is a common complaint for patients with degenerative lumbar spine disease. Often, LBP is considered a contraindication to decompression. Anecdotally, patients with lumbar spinal stenosis (LSS) report improvements in LBP following decompression for neurogenic claudication or radiculopathy.</p><p><strong>Methods: </strong>Patients were analyzed that had decompressive surgery without fusion for LSS from 2017 to 2020. Patients were excluded with a tumor, infection, prior fusion, or incomplete questionnaires. Patient-reported outcome measures (PROMs), clinical variables, and radiographic variables were evaluated. Patients who achieved minimal clinically important difference (MCID) in LBP were compared with those who did not at 12-month follow-up. LASSO methodology was used to identify related predictive variables.</p><p><strong>Results: </strong>One hundred seventy-six patients were analyzed. The majority reached MCID for back pain (n=109, 61.9%). Baseline clinical and radiographic variables were comparable. Patients who achieved MCID in back pain had significantly higher preoperative pain and greater disability on PROMs. ML identified the related variables of age, BMI, VAS-B, ODI total tertile, EQ-5D, PROMIS-P, PROMIS-M, and CCI to accurately predict who will reach meaningful improvement at 12-months postoperatively (AUROC=0.832).</p><p><strong>Conclusions: </strong>The majority experienced significant improvements in LBP following decompression for LSS. Improvers had higher preoperative pain scores and measures of disability. Back pain should not be a contraindication to decompression without fusion. A pilot version of a predictive nomogram was developed to be used in the preoperative clinic visit that can guide clinical management and surgeon/patient expectations.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentinoids in ERAS Protocols For Spine Surgery: A Systematic Review and Meta-Analysis.","authors":"Richard Wang, Avrohom Karp, Kevin Clare, Bridget Nolan, Eris Spirollari, Sabrina Zeller, Ilya Frid, Chirag D Gandhi, Merritt Kinon, Rachana Tyagi, John V Wainwright","doi":"10.1097/BSD.0000000000001877","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001877","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>This study aimed to estimate the safety and efficacy of gabapentinoid usage in ERAS protocols for spine surgery through a systematic review and meta-analysis.</p><p><strong>Summary of background data: </strong>Enhanced Recovery after Surgery (ERAS) is a perioperative strategy designed to improve surgical outcomes through multimodal protocols. These protocols often utilize gabapentinoids to reduce postoperative opioid usage while controlling patient pain. However, recent studies have implicated gabapentinoids in complications and even the death of patients when used in combination with opioids.</p><p><strong>Methods: </strong>The PubMed database was searched using 2 MeSH terms. An initial query aimed to identify studies that utilized ERAS spine protocols that include gabapentinoids. A secondary query targeted studies specifically investigating gabapentinoid complications in spine surgery and examined gabapentinoid side effects.</p><p><strong>Results: </strong>Three thousand forty-five patients were included in the selected ERAS comparison studies, and 417 patients were analyzed in the selected gabapentinoid-specific side effect comparison studies. Ten cohort studies were identified in the ERAS query. A meta-analysis of proportions revealed a decrease in the LOS for the ERAS cohorts compared with traditional treatment groups (P<0.05). No significant differences were found for the other measures. The second query identified thirteen RCTs for pregabalin and nine for gabapentin. Meta-analysis of proportions for complications at different dosages of pregabalin and gabapentin revealed a significant reduction in nausea and vomiting with 150 mg pregabalin as compared with control (P<0.05). No other significant differences in side effects were found with other doses of pregabalin or gabapentin as compared with placebo.</p><p><strong>Conclusions: </strong>ERAS spine surgery protocols, including gabapentinoids, may reduce hospital lengths of stay, with gabapentinoid analgesia having comparable or improved side effect profiles compared with placebo. Although adverse events involving the combination of gabapentinoids and opioids have been reported, these outcomes were not described in the literature examined for spine surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Physiology in Spine Disease: A Comparative Study of Cervical and Lumbar Patients.","authors":"Salim Yakdan, Jingwen Zhang, Kathleen Botterbush, Muhammad I Kaleem, Braeden Benedict, Ziqi Xu, Madelyn Frumkin, Saad Javeed, Justin K Zhang, John Ogunlade, Chenyang Lu, Brian Neuman, Michael Steinmetz, Wilson Z Ray, Munish Gupta, Jacob K Greenberg","doi":"10.1097/BSD.0000000000001926","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001926","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Objective: </strong>We aim to compare Fitbit-collected sleep metrics between patients with cervical and lumbar spine diseases and explore correlations between these metrics and patient-reported outcome measures (PROMs) and self-reported sleep.</p><p><strong>Summary of background data: </strong>Pain, fatigue, and postural problems often lead to sleep disturbances in patients with spine disease. However, it remains unclear whether such sleep disturbances impact patients with cervical and lumbar disease differently. Differentiating sleep physiology between cervical and lumbar patients may provide insights into sleep disturbance pathophysiology and highlight directions for future research and clinical care.</p><p><strong>Methods: </strong>Patients aged 21-85 years undergoing surgery for degenerative spine disease were included. Participants were passively monitored before surgery using Fitbit trackers. Raw Fitbit sleep data were extracted at the minute level and transformed into daily features, such as time taken to fall asleep, duration asleep, number of waking episodes, and others. Preoperative PROMs included PROMIS pain interference, physical function, and pain intensity. Self-reported sleep quality was assessed using sleep-related questions from the Oswestry Disability Index and Neck Disability Index. An Independent t test was used to test for differences in sleep metrics between cervical and lumbar patients, and Spearman correlation was carried out between sleep metrics and PROMs.</p><p><strong>Results: </strong>Our study included 155 patients, with a mean (SD) age of 59 (11.8) years, and 53% were female. Twenty-seven and 128 individuals were in cervical and lumbar cohorts, respectively. Cervical patients had greater self-reported sleep disturbances, though no significant differences were found in Fitbit sleep measures. Stronger correlations were found between sleep and pain measures in cervical patients.</p><p><strong>Conclusion: </strong>Our study suggests that cervical and lumbar spine patients have similar objective sleep metrics, but cervical patients report greater sleep disturbances, more closely linked to pain than in the lumbar cohort. Further research is needed to clarify the relationship between sleep and spine pathology.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Evaluation of the TissueStat-A Novel Device for Minimally Invasive Spine Surgery Fascial Closure.","authors":"Jonathan Dalton, Alexander Crawford, Rachel Huang, Alec Giakas, Yulia Lee, Emily Berthiaume, Aditya Mazmudar, Ali Farooqi, Brandon Martinazzi, Rajkishen Narayanan","doi":"10.1097/BSD.0000000000001923","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001923","url":null,"abstract":"<p><strong>Study design: </strong>Pilot Evaluation Study.</p><p><strong>Objective: </strong>To assess the ease-of-use and performance of TissueStat, a novel minimally invasive spine surgery (MIS) fascial closure device, compared with conventional suturing techniques.</p><p><strong>Summary of background data: </strong>Wound issues in spine surgery can be a major source of morbidity and decreased patient satisfaction. A robust, multilayered closure can lead to decreased complications and need for revision surgery. However, the development of technology to assist in MIS fascial closures has lagged.</p><p><strong>Methods: </strong>Participants completed a fascial suturing trial using a benchtop model with both conventional suture and TissueStat. Time to completion and accuracy of each suture pass with were compared using the Student t test. After the trial, participants filled out a survey to quantify the ease of use and accuracy of conventional suture versus TissueStat. Survey responses were compared using descriptive statistics.</p><p><strong>Results: </strong>Eight participants were recruited (5 orthopaedic surgery residents and 3 orthopaedic spine surgery fellows). This group performed 16 attempts with the conventional suturing technique and 16 attempts with TissueStat. The average time to knot completion of the conventional suturing technique was slower than TissueStat [3 min and 22 s (range: 1:27-5:19) vs. 2 min and 1 s (range: 1:22-3:15), P=0.001]. The average distance from the suture location to the target dot was larger for the conventional suturing compared with TissueStat (1.25 vs. 0.22 mm, P=0.007). Participants reported a higher average ease of use score for TissueStat compared with conventional suture (9.4 vs. 3.9). Participants reported a higher average accuracy rating for TissueStat compared with the conventional suture (9.3 vs. 6.1). All participants answered that TissueStat offered the higher quality closure and allowed better suture targeting.</p><p><strong>Conclusion: </strong>TissueStat may be a useful tool to decrease operative time, improve closure accuracy/quality, and assist with meticulous fascial soft-tissue handling.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Repair of Delayed Esophageal Perforation Following Anterior Cervical Discectomy and Fusion.","authors":"Christopher Lucasti, Charles W Stube, Francesca Viola, Danielle E Chipman, Thomas J Ryan, Emily K Vallee, Maxwell M Scott, David Kowalski, Christopher L Hamill, Joseph L Muscarella","doi":"10.1097/BSD.0000000000001927","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001927","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical case series.</p><p><strong>Objective: </strong>The objective of our study was to analyze a series of patients with delayed esophageal perforations following anterior cervical discectomy and fusion (ACDF) and describe their presentation, causes, and the efficacy of primary esophageal repair.</p><p><strong>Summary of background data: </strong>Delayed esophageal perforation after ACDF is a rare but significant complication.</p><p><strong>Methods: </strong>Patients above 18 years with esophageal perforations presenting to a single otolaryngologist from 1998 to 2023 were reviewed. Seven patients met inclusion criteria. Patients were included if they had a delayed esophageal perforation with a prior ACDF. Demographics, comorbidities, length of stay, operative details, and postoperative test results were collected.</p><p><strong>Results: </strong>The average age was 63.6±10.0 years, and 4 (57%) were female. The average time between ACDF and esophageal perforation repair was 2.25 (IQR: 7) years. Patients presented with symptoms of dysphagia, dysphonia, neck abscesses, cutaneous fistula, and/or neck pain. Proposed reasons for esophageal perforation included exposed instrumentation on endoscopy (N=2), anterior displacement of instrumentation (N=2), instrumentation malposition (N=1), failure and infection of instrumentation (N=1), and adherence of plate to pharyngoesophageal segments causing perforation upon mobilization (N=1). All patients were successfully treated with instrumentation removal followed by primary closure of the esophageal defect. The average length of follow-up from esophageal repair surgery was 464.4±443.4 days. The median length of follow-up from prior ACDF was 4.25 (IQR: 6.75) years.</p><p><strong>Conclusions: </strong>This study demonstrates that delayed esophageal perforation is a significant postoperative complication of ACDFs but can be effectively treated through instrumentation removal and primary closure. Careful observation of symptoms post-ACDF and immediate evaluation upon present symptoms is paramount to managing esophageal perforations.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation in Ossification of the Posterior Longitudinal Ligament of the Cervical Spine: Monocytes and Proinflammatory Cytokines Increased Significantly.","authors":"Hao Wu, Cheng Ye, Longqing Wang, Qing Chen, Dong Xie, Qi Zhao, Mingliang Shi, Baocheng Niu, Lili Yang","doi":"10.1097/BSD.0000000000001929","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001929","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>The study aimed to explore the expression difference of inflammatory cells in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine and investigate the expression level of IL-6, IL-1β, MCP-1, TNF-α, RANTES, and IL-10 in patients with OPLL.</p><p><strong>Background: </strong>Ossification of the posterior longitudinal ligament (OPLL) is a disease that can seriously affect spinal cord and nerve function. Inflammation is thought to be an important source of the pathogenesis of ligament ossification.</p><p><strong>Materials and methods: </strong>A retrospective study was performed on 215 patients with OPLL and 184 patients without OPLL who were hospitalized in the Spine Surgery Department of Shanghai Changzheng Hospital. A case-control analysis of 147 OPLL patients and 147 demographically matched non-OPLL controls was performed by propensity score matching (PSM) to assess inflammatory cells in peripheral blood. The expression levels of IL-6, IL-1β, MCP-1, TNF-α, RANTES, and IL-10 in the peripheral blood of 53 patients with OPLL and 27 patients without OPLL were determined by the enzyme-linked immunosorbent assay (ELISA) method. The differences between groups were analyzed, and a P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>The peripheral blood monocytes in the OPLL group were significantly higher than those in the control group. The hs-CRP in the mixed type of COPLL group was significantly higher than that of the localized type of OPLL. ELISA showed that the expression levels of IL-1β, TNF-α, and MCP-1 in the peripheral blood of the OPLL group were significantly higher than those of the control group. The expression level of IL-10 in the peripheral blood of the OPLL group was significantly lower than that of the control group.</p><p><strong>Conclusion: </strong>The expression of monocytes and proinflammatory cytokines in the peripheral blood of OPLL patients was significantly increased, suggesting the existence of inflammation in these patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Nondisplaced Type II Odontoid Fractures in Elderly Patients: A Comparison of Military and Civilian Populations.","authors":"Sennay G Ghenbot, Matthew O'Hara, Cody D Schlaff, Conor McCarthy, Jeremy Tran, Richard C Lee, Alfred J Pisano, Donald J Fredericks, Scott C Wagner, Melvin D Helgeson","doi":"10.1097/BSD.0000000000001918","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001918","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to investigate patterns of surgical treatment of nondisplaced type II odontoid fractures.</p><p><strong>Summary of background data: </strong>Odontoid fractures represent ∼1/3 of all cervical spine fractures, resulting from low-energy mechanisms in the elderly. Type I and III odontoid fractures are typically treated nonoperatively with Aspen collar immobilization. Treatment of type II odontoid process fractures is of particular interest because of the risk of nonunion, secondary to the watershed blood supply to the base of the odontoid process. Though there is consistent agreement regarding the management of displaced type II fractures, there is marked heterogeneity in the clinical management of nondisplaced type II fractures.</p><p><strong>Methods: </strong>We queried the Military Health System Data Repository for the ICD-10 codes for nondisplaced type II odontoid fractures and CPT codes for surgical treatment, from 2015 to 2022. We excluded patients under the age of 65, polytraumatized patients, and patients with a diagnosis of displaced type II odontoid fracture during any clinical encounter.</p><p><strong>Results: </strong>Four hundred two patients were diagnosed with nondisplaced type II odontoid fractures. 90.3% of patients underwent nonoperative management. Of the 39 patients (9.70%) undergoing surgery, 56% underwent C1-C2 arthrodesis and 44% underwent anterior odontoid screw fixation. There was no significant difference between surgical rates in the military and nonmilitary population (P=0.46). No patient with an initially diagnosed nondisplaced fracture experienced late displacement. The nonunion prevalence was 3.2% and only occurred in patients managed nonoperatively. No patient with an isolated type II odontoid fracture nonunion underwent surgery.</p><p><strong>Conclusions: </strong>Nonoperative management of nondisplaced type II odontoid fractures is the preferred treatment modality in this cohort. C1-C2 fusion remains the most common surgical treatment modality. There is no evidence that late displacement is common or expected in patients undergoing nonoperative management. No patient with a diagnosed fracture nonunion underwent delayed surgical intervention.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Outcomes of Functional Balance Stability in Patients With Cervical Compressive Myelopathy.","authors":"Shotaro Nishikawa, Takashi Fujishiro, Yuki Yamamoto, Hiromichi Hirai, Takuya Obo, Sachio Hayama, Shuhei Otsuki","doi":"10.1097/BSD.0000000000001901","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001901","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To investigate the surgical outcomes of functional balance stability in patients with cervical compressive myelopathy (CCM) using the patient-reported outcome measure (PROM) of the Falls Efficacy Scale-International (FES-I) together with an objective evaluation using the stabilometric test.</p><p><strong>Summary of background data: </strong>Impaired functional balance, including standing and gait instability, is a common symptom in patients with CCM. However, studies evaluating the surgical outcomes of this symptomatology using PROMs are lacking.</p><p><strong>Methods: </strong>Data of patients who underwent decompressive surgery for CCM were retrospectively reviewed. Functional balance stability was evaluated subjectively using the FES-I instrument and objectively using a stabilometric test. Changes in these measures from baseline to 1 year postoperatively were analyzed. In addition, subgroup analyses were conducted, categorizing patients into the M (baseline FES-I score of 20-27 points) and H groups (baseline FES-I score ≥28 points).</p><p><strong>Results: </strong>A total of 133 patients (mean age: 65.1 y; males: 55.6%) were included in the analysis, with 43 and 90 patients assigned to the M and H groups, respectively. For the entire study population, the FES-I score significantly improved at 1 year postoperatively compared with that at baseline. Subgroup analysis showed that the 1-year postoperative FES score in the H group demonstrated a significant improvement compared with the baseline score; however, the score was still inferior to that of the M group. Regarding objective measures, significant improvements in stabilometric parameters were observed after surgery compared with those at baseline, with changes closely mirroring those of the FES-I score.</p><p><strong>Conclusions: </strong>Surgery can enhance functional balance stability in the daily activities of patients with CCM. However, patients with impaired functional balance stability before surgery are likely to experience greater residual symptoms postoperatively. Therefore, to minimize postoperative sequelae, early surgical intervention is recommended when the symptoms are still mild.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Effect of Chinese Manual Therapy for Cervical Spondylotic Radiculopathy After Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy: A Finite Element Study.","authors":"Zhongxiang Yu, Zhen Deng, Hanxi Chen, Linling Zhang, Yongfang Zhao, Hongsheng Zhan, Maohua Lin, Frank Vrionis, Huihao Wang","doi":"10.1097/BSD.0000000000001920","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001920","url":null,"abstract":"<p><strong>Study design: </strong>Finite element (FE) comparative study.</p><p><strong>Objective: </strong>This study aims to assess the biomechanical effects of Chinese manual therapy (CMT) on the cervical spine following percutaneous endoscopic cervical foraminotomy and diskectomy (PECFD).</p><p><strong>Summary of background data: </strong>Cervical spondylotic radiculopathy (CSR) is a challenging condition that often recurs after cervical spine surgery, sparking interest in alternative treatment modalities such as CMT.</p><p><strong>Methods: </strong>We developed a validated 3-dimensional finite element model of the cervical spine from C2 to T1. Three additional models (M1-M3) were created to simulate different extents of disc resection following PECFD. These models were evaluated alongside an intact model (M0) under conditions simulating CMT and physiological movements. Key biomechanical parameters, including maximum displacement (MD), rotation angle (RA), annulus fibrosus stress, intervertebral disc pressure (IDP), and facet ligament strain, were measured for both the operated and adjacent segments.</p><p><strong>Results: </strong>The analysis revealed that load 1 produced greater maximum displacement compared with other loads. Model M3 exhibited decreased rotation angle during right bending and rotation, but showed increased extension. The stress on the annulus fibrosus escalated with the extent of disc resection. While intervertebral disc pressure remained relatively stable across most segments, it was notably higher in the operated C5-C6 segment of the PECFD models. Facet ligament stress in these models was significantly greater than in the intact model, especially in M3.</p><p><strong>Conclusions: </strong>The findings suggest that while the removal of the annulus fibrosus has a limited effect on overall stability, CMT may contribute to reherniation and instability in areas where the nucleus pulposus has been resected. This indicates a need for caution when recommending CMT following PECFD.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}