Journal of spine surgery最新文献

{"title":"Analysis of antibiotic regimens and outcomes in spinal brucellosis: insights from a retrospective cohort study in Makkah, Saudi Arabia.","authors":"Abdulaziz S Aljuaid, Sara B Badirah, Rowaina I Abusaeed, Abdulrahman M Almalki, Murouj A Almaghrabi, Emad A Alzahrani, Khalid A Alhazmi, Ammar A Almaghrabi, Abdullmoin M AlQarni, Khalid M Alghamdi","doi":"10.21037/jss-23-104","DOIUrl":"10.21037/jss-23-104","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis is a zoonotic disease that is widely spread across the globe, with the number of cases increasing annually. Spinal brucellosis is known to affect about half of patients with brucellosis. Nevertheless, data on the optimal antibiotic regimens for spinal brucellosis are limited. Therefore, this study aims to compare antibiotic treatment regimens for spinal brucellosis at our center in Makkah, Saudi Arabia.</p><p><strong>Methods: </strong>This is a retrospective cohort study of an 11-year period from 2010 to 2021 conducted at a single center in Makkah, Saudi Arabia. All patients with spinal brucellosis were included. Patients were excluded if the duration of the received antibiotic regimen or follow-up was poorly documented. Data analysis was conducted using RStudio (R version 4.1.1). Categorical variables of each regimen used by the patients were presented as frequencies and percentages, while numerical variables were summarized using the median and interquartile range (IQR).</p><p><strong>Results: </strong>A total of 35 patients were included; the median (IQR) age of the patients was 58.0 (48.0 to 63.0) years. The most frequently reported symptoms upon admission included low back pain (83.3%). The most frequently administered regimen was the combination of streptomycin + doxycycline + rifampicin (SDR) (20 patients, 55.6%), followed by the combination of streptomycin + rifampicin + trimethoprim/sulfamethoxazole (SRT) (eight patients, 22.2%). Overall, out of the total 35 patients who received first-line treatment, only six patients experienced therapy failure. Out of the total six patients who experienced first-line treatment failure with SDR (five patients, 83%) and SDT (one patient, 17%), surgery was indicated for three patients. Surgical intervention was deemed necessary in 12 patients (34%). Three patients chose not to undergo surgical intervention but still showed complete improvement upon completing the treatment duration. One patient experienced a postoperative complication, resulting in paraplegia.</p><p><strong>Conclusions: </strong>In this study, we found that among 35 patients, treatment failure was observed only in six patients who received triple therapy. In addition, surgical intervention was indicated in 12 patients; however, three patients refused surgery and improved ultimately after changing or extending the duration of the antibiotic regimen.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"264-273"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmony between spinopelvic mismatch and sagittal hip alignment contributes to upright standing in females: a cross-sectional study.","authors":"Kazuyoshi Baba, Kohei Takahashi, Ko Hashimoto, Takahiro Onoki, Takashi Aki, Ryo Fujita, Keisuke Ishikawa, Toshimi Aizawa","doi":"10.21037/jss-23-145","DOIUrl":"10.21037/jss-23-145","url":null,"abstract":"<p><strong>Background: </strong>In upright standing, spinopelvic mismatch is compensated by hip extension. However, few studies have investigated the reciprocal relationship between the sagittal alignment of the hip joints and spinopelvic mismatch during upright standing in humans. Our study aims to investigate (I) the relationship between spinopelvic mismatch and hip extension and (II) whether insufficient hip extension against spinopelvic mismatch, i.e., pelvic incidence (PI)-lumbar lordosis (LL), affects trunk inclination in upright standing.</p><p><strong>Methods: </strong>This study was a retrospective cross-sectional study. We included 398 consecutive female patients treated for osteoporosis at our outpatient department between November 2017 and June 2022. Patients with any of the following were excluded from the study: (I) those whose plain whole-spine radiographs did not cover the femurs, (II) those with fractures in the vertebrae or lower extremities, (III) those with a history of surgery of the spine or of the lower extremities, (IV) those with scoliosis with a Cobb angle ≥10° in the anteroposterior radiograph, and (V) those with transitional vertebrae. Sixty-two patients were divided into normal and malalignment groups based on their sagittal spinal alignment. The patients underwent plain whole-spine radiography as a routine examination. A linear approximation between the pelvic femoral angle (PFA), representing hip extension, and PI-LL was obtained in both groups. The optimal PFA of each patient was obtained by substituting the PI-LL into the linear approximation of the normal group. The difference between the optimal and measured PFA was defined as the ΔPFA for each patient. The correlation between the ΔPFA and sagittal vertical axis (SVA) was evaluated in both groups.</p><p><strong>Results: </strong>The PFA and PI-LL were correlated in both groups. The malalignment group had a significantly greater ΔPFA than the normal group. ΔPFA was correlated with SVA only in the malalignment group.</p><p><strong>Conclusions: </strong>The magnitude of the ΔPFA indicated insufficient hip extension to compensate for the spinopelvic mismatch during upright standing.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"244-254"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous lumbar interbody fusion results in less perioperative opioid usage compared to minimally invasive transforaminal lumbar interbody fusion: a single institution, multi-surgeon retrospective study.","authors":"Chidyaonga Shalita, Timothy Wang, Christopher F Dibble, Shawn W Adams, Amanda Nelli, David Sykes, Troy Tabarestani, Subasish Bhowmik, Beiyu Liu, Sin-Ho Jung, Padma Gulur, Peter Grossi, Clifford Crutcher, Muhammad M Abd-El-Barr","doi":"10.21037/jss-23-132","DOIUrl":"10.21037/jss-23-132","url":null,"abstract":"<p><strong>Background: </strong>Ultra-minimally invasive percutaneous lumbar interbody fusion (percLIF) has been demonstrated to further minimize tissue trauma and has been associated with improved clinical outcomes including decreased blood loss, post-operative pain and length of stay when compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. A single-institution retrospective study was conducted to investigate whether 1-level percLIF is associated with decreased narcotic consumption compared to 1-level MIS-TLIF in the first 24-hour following surgery.</p><p><strong>Methods: </strong>A retrospective study of patients undergoing either single-level percLIF or MIS-TLIF from January 2018 to December 2021. Opioid consumption in the 24-hour following surgery was converted into total morphine milligram equivalents (MME). The primary outcome used univariate and multivariate regression analysis to compare MME consumption between the MIS-TLIF and percLIF groups. Secondary outcome variables included, estimated blood loss, total intraoperative MME, MME at discharge, MME at 30 days post-op, exiting nerve root injury, post-anesthesia care unit (PACU) visual analogue scale (VAS) score at handoff, time to first ambulation, distance ambulated post-operative day one and hospital length of stay.</p><p><strong>Results: </strong>A total of 51 patients (21 percLIF <i>vs.</i> 30 MIS-TLIF) were included in the study. Univariate regression analysis revealed that on average patients who underwent percLIF had a 24-hour postoperative MME -50.8 mg (95% CI: -91.6, -10) lower than those who had MIS-TLIF (P=0.02). On multivariable analysis, after adjusting for sex and age, 24-hour postoperative MME closely failed to meet statistical significance (P=0.06) with an average of -40.8 mg (95% CI: -83.2, 1.6) MME in percLIF patients compared to MIS-TLIF. There was no statistically significant difference in MME between MIS-TLIF and percLIF at the time of discharge and at 30 days post-op.</p><p><strong>Conclusions: </strong>In the setting of the current opioid epidemic in the United States and increased numbers of patients undergoing lumbar interbody fusion, spine surgeons must continue to do their part helping reduce the need for opioid prescriptions for postoperative pain management. New \"ultra-MIS\" techniques such as percLIF allow surgeons to further decrease tissue trauma, which should lead to reduced need for post-operative narcotic requirements.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"190-203"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of endoscopic spine surgery: history, indications, uses, and future directions.","authors":"Christopher L Antonacci, Francine R Zeng, Brian Ford, Ian Wellington, Cameron Kia, Hanbing Zhou","doi":"10.21037/jss-23-112","DOIUrl":"10.21037/jss-23-112","url":null,"abstract":"<p><strong>Background and objective: </strong>The concept of endoscopic surgery began in the 1930s and has since undergone numerous advancements in both technology and surgical indications. Its main benefit is providing the opportunity to perform surgery while minimizing disruption to surrounding structures. The purpose of this review is to summarize the history, uses, and future directions for spine endoscopic surgery.</p><p><strong>Methods: </strong>A review of national databases was performing using key terms \"endoscopic\", \"spine\" and \"surgery\" for literature from 1900 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded.</p><p><strong>Key content and findings: </strong>This review includes a brief overview of the history of endoscopic surgery and its current two main approaches, transforaminal and interlaminar approaches. It then summarizes the main indications and utilization of endoscopic surgery in the lumbar, cervical and thoracic spine, as well as expansion in managing spine tumors, infections, and outpatient surgical cases.</p><p><strong>Conclusions: </strong>There are many rising indications and uses for endoscopic spine surgery in nearly every aspect of the spine. Compared to conventional spine surgery, there is early evidence showing endoscopic surgery is associated with less post-operative pain, shorter hospital stays, and possibly quicker recovery times. As current trends in spine surgery move towards minimally invasive techniques, it is anticipated that the use of endoscopic surgery will continue to expand.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"295-304"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical prediction for surgical versus nonsurgical interventions in patients with vertebral osteomyelitis and discitis.","authors":"Jennifer Lee, Miguel A Ruiz-Cardozo, Rujvee P Patel, Saad Javeed, Raj Swaroop Lavadi, Catherine Newsom-Stewart, Anton Alyakin, Camilo A Molina, Nitin Agarwal, Wilson Z Ray, Michele Santacatterina, Brenton H Pennicooke","doi":"10.21037/jss-23-111","DOIUrl":"10.21037/jss-23-111","url":null,"abstract":"<p><strong>Background: </strong>Vertebral osteomyelitis and discitis (VOD), an infection of intervertebral discs, often requires spine surgical intervention and timely management to prevent adverse outcomes. Our study aims to develop a machine learning (ML) model to predict the indication for surgical intervention (during the same hospital stay) versus nonsurgical management in patients with VOD.</p><p><strong>Methods: </strong>This retrospective study included adult patients (≥18 years) with VOD (ICD-10 diagnosis codes M46.2,3,4,5) treated at a single institution between 01/01/2015 and 12/31/2019. The primary outcome studied was surgery. Candidate predictors were age, sex, race, Elixhauser comorbidity index, first-recorded lab values, first-recorded vital signs, and admit diagnosis. After splitting the dataset, XGBoost, logistic regression, and K-neighbor classifier algorithms were trained and tested for model development.</p><p><strong>Results: </strong>A total of 1,111 patients were included in this study, among which 30% (n=339) of patients underwent surgical intervention. Age and sex did not significantly differ between the two groups; however, race did significantly differ (P<0.0001), with the surgical group having a higher percentage of white patients. The top ten model features for the best-performing model (XGBoost) were as follows (in descending order of importance): admit diagnosis of fever, negative culture, <i>Staphylococcus aureus</i> culture, partial pressure of arterial oxygen to fractional inspired oxygen ratio (PaO₂:FiO₂), admit diagnosis of intraspinal abscess and granuloma, admit diagnosis of sepsis, race, troponin I, acid-fast bacillus culture, and alveolar-arterial gradient (A-a gradient). XGBoost model metrics were as follows: accuracy =0.7534, sensitivity =0.7436, specificity =0.7586, and area under the curve (AUC) =0.8210.</p><p><strong>Conclusions: </strong>The XGBoost model reliably predicts the indication for surgical intervention based on several readily available patient demographic information and clinical features. The interpretability of a supervised ML model provides robust insight into patient outcomes. Furthermore, it paves the way for the development of an efficient hospital resource allocation instrument, designed to guide clinical suggestions.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"204-213"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted spine surgery-a narrative review.","authors":"Christopher L Antonacci, Francine Zeng, Andrew Block, Annabelle Davey, Heeren Makanji","doi":"10.21037/jss-23-40","DOIUrl":"10.21037/jss-23-40","url":null,"abstract":"<p><strong>Background and objective: </strong>Emerging technologies have increasingly been adopted in spine surgery in the attempt to increase precision and improve outcomes. Robotic assistance is an area of significant interest, with proposed benefits including increased accuracy, decreased complication rates, and decreased radiation exposure. The purpose of this review is to provide an overview of the currently available robotic assistance systems and their associated outcomes and limitations.</p><p><strong>Methods: </strong>A review of national databases was performed using key terms \"robotic\", \"spine\", and \"surgery\" for literature from 2014 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded.</p><p><strong>Key content and findings: </strong>This review includes a brief overview of the history of robotic spine surgery as well as its clinical outcomes, limitations, and future directions.</p><p><strong>Conclusions: </strong>Robotic-assisted spine surgery has seen increasing use in the attempt to increase precision and improve outcomes and has been associated with increased accuracy in pedicle screw placement and decreased complication rates. Barriers to its adoption include a significant learning curve, possibly longer operative cases, and significant associated costs. As robotic assistance continues to become increasingly popular in spine surgery, it is critical for surgeons to understand the technology available and the associated outcomes to make informed decisions when considering which system to incorporate into their practice.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"305-312"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral interbody fusion for adjacent segment disease: a narrative review.","authors":"Christopher L Antonacci, Francine Zeng, Casey Jackson, Ian J Wellington, Seema M Patel, Sean M Esmende","doi":"10.21037/jss-23-16","DOIUrl":"10.21037/jss-23-16","url":null,"abstract":"<p><strong>Background and objective: </strong>Adjacent segment disease (ASD) is a late complication of lumbar fusion characterized by persistent symptoms correlating to radiographic changes in the levels immediately above or below the prior fusion. Lateral interbody fusion (LIF) through a direct lateral approach is a minimally invasive and effective surgical treatment for ASD. Biomechanically, LIF for ASD provides significantly decreased motion in multiple planes. While hardware failure and injury to the lumbar plexus are potential complications, these risks may be outweighed by decreased blood loss, shorter operating room (OR) times, and possibly superior patient reported visual analog scale (VAS) scores compared to traditional posterior spinal fusion (PSF) alone. The purpose of this review is to summarize the history, uses, outcomes, and future directions of LIF for ASD.</p><p><strong>Methods: </strong>A review of national databases (PubMed and SCOPUS) was performed using literature from 1900 to 2022. Keywords included terms \"LATERAL\" and \"LUMBAR\" and \"INTERBODY\" and \"FUSION\" and \"ADJACENT\" and \"SEGMENT\" and \"DISEASE\". Studies that aimed to describe the biomechanical, clinical course and complications, radiological outcomes, biomechanical aspects, need for revision surgery, and/or patient reported outcomes of the XLIF/LIF technique were included.</p><p><strong>Key content and findings: </strong>This review includes a brief overview of the natural history of ASD and current approaches to address it. It then summarizes the main indications and utilization of LIF to address ASD, summarizing reported outcomes in regard to biomechanical, clinical, and radiographic outcomes.</p><p><strong>Conclusions: </strong>LIF has emerged as a minimally invasive and effective surgical treatment for ASD. This mini-review suggests that LIF provides a solid foundational biomechanical construct that has been paired with good patient-reported, clinical, and radiographic outcomes. While further research is required, current literature suggests that LIF for ASD results in fewer complications, decreased morbidity, and decreased need for subsequent surgery compared to other commonly utilized techniques.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"286-294"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar disk herniation in pregnancy: its incidence, presentation and management: a systematic review.","authors":"Nanette Y Chan, Michael Le, Sophie Reinecker, Morgan Prince, Geoffrey T Murphy","doi":"10.21037/jss-24-3","DOIUrl":"10.21037/jss-24-3","url":null,"abstract":"<p><strong>Background: </strong>Back pain in pregnancy is common, but pain from lumbar disk herniations in pregnancy is rare. This systematic review aims to comprehensively analyse literature on lumbar disk herniation in pregnancy, focusing on risk factors, incidence, clinical presentation, and management.</p><p><strong>Methods: </strong>We conducted a literature review using PubMed and Web of Science databases, including studies from January 1, 1950, to August 1, 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case-control studies were utilised to assess risk of bias. The review protocol was not previously published.</p><p><strong>Results: </strong>A total of 41 studies were reviewed, with 6 addressing incidence and risk factors and 35 focusing on clinical presentation and management. Symptomatic lumbar disk herniation during pregnancy was found to be uncommon, with no significant predisposition noted during pregnancy as per magnetic resonance imaging (MRI) findings. However, patients with MRI-detected herniations were more likely to report back pain. Non-surgical management resulted in higher rates of complete symptom resolution (69% <i>vs.</i> 50%) and lower rates of cesarean section (57% <i>vs.</i> 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).</p><p><strong>Conclusions: </strong>While pregnancy does not inherently increase the risk of herniated lumbar disks, the presence of a prolapsed disk can predispose to back pain during pregnancy. There is poor quality evidence that should be interpreted cautiously. Non-surgical management, in the absence of red-flag symptoms including bowel and bladder dysfunction may be trialled and yield comparatively better symptom resolution. Additionally, surgical management if necessitated has no clear link to pregnancy complications within the scope of this study.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"274-285"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cervical hybrid constructs reduce superior adjacent segment burden compared to multilevel anterior cervical discectomy and fusion.","authors":"Fenil R Bhatt, Lindsay D Orosz, Kirsten A Schuler, Brandon J Allen, Rita T Roy, Julia N Grigorian, Thomas C Schuler, Christopher R Good, Ehsan Jazini, Colin M Haines","doi":"10.21037/jss-23-135","DOIUrl":"10.21037/jss-23-135","url":null,"abstract":"<p><strong>Background: </strong>Traditional surgical treatment for symptomatic cervical degenerative disc disease is anterior cervical discectomy and fusion (ACDF), yet the increased risk of adjacent segment degeneration (ASD) requiring additional surgery exists and may result in limiting long-term surgical success when it occurs. Disc arthroplasty can preserve or restore physiologic range of motion (ROM), decreasing adjacent level stress and subsequent surgery. For patients with multilevel pathology requiring at least a 1-level fusion, interest is growing in anterior cervical hybrid (ACH) surgery as a partial motion-preserving procedure to decrease the adjacent level burden. This radiographic study compares postoperative superior adjacent segment motion between ACH and ACDF. Secondarily, total global motion, construct motion, inferior adjacent segment motion, and sagittal alignment parameters were compared.</p><p><strong>Methods: </strong>This is a single-center, multi-surgeon, retrospective cohort study of 2- and 3-level ACH and ACDF cases between 2013 and 2021. Degrees of motion were analyzed on flexion/extension views using Cobb angles to measure global (C2-C7) construct and adjacent segment lordosis. Neutral lateral X-rays were analyzed for alignment parameters, including global lordosis, cervical sagittal vertical axis (cSVA), and T1 slope (T1S). Differences were determined by independent t-test and Fisher's exact test.</p><p><strong>Results: </strong>Of 100 patients, 38% were 2-level cases (47% ACH, 53% ACDF) and 62% were 3-level cases: (52% ACH, 48% ACDF). Postoperatively, superior adjacent segment motion increased with ACDF and decreased with ACH (-1.3°±5.3° ACH, 1.6°±4.6° ACDF, P=0.005). Postoperatively, the ACH group had greater ROM across the construct (16.3°±8.7° ACH, 4.7°±3.3° ACDF, P<0.001) and total global ROM (38.0°±12.8° ACH, 28.0°±11.1° ACDF, P<0.001). ACH resulted in a significant reduction of motion loss across the construct (-10.0°±11.7° ACH, -18.1°±10.8° ACDF, P<0.001). Postoperative alignment restoration was similar between both cohorts (-2.61°±8.36° ACH, 0.04°±12.24° ACDF, P=0.21).</p><p><strong>Conclusions: </strong>Compared to ACDF, hybrid constructs partially preserved motion across operative levels and had greater postoperative global ROM without increasing superior adjacent segment mobility or sacrificing alignment restoration. This supports the consideration of ACH in patients with multilevel degenerative cervical pathology requiring at least a 1-level fusion and suggests a propensity for long-term success by reducing the superior adjacent segment burden.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"165-176"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study.","authors":"Yuya Kanie, Shota Takenaka, Takayuki Kitahara, Masayuki Furuya, Yuichiro Ukon, Takahito Fujimori, Seiji Okada, Takashi Kaito","doi":"10.21037/jss-23-138","DOIUrl":"10.21037/jss-23-138","url":null,"abstract":"<p><strong>Background: </strong>Although pelvic obliquity (PO) is a risk factor for postoperative coronal decompensation in corrective surgery in adolescent idiopathic scoliosis (AIS), especially Lenke 5C, methods of measuring PO are controversial. This study aimed to establish an appropriate measurement method using multiplanar reconstructed computed tomography (MPR-CT) images instead of standing posteroanterior (PA) whole-spine radiographs to evaluate PO in patients with Lenke 5C AIS.</p><p><strong>Methods: </strong>This study was a retrospective cross-sectional study. Twenty-five patients who underwent corrective surgery for AIS in Osaka University Hospital from August 2014 to February 2023 were included. Cobb angle, L5 tilt, C7 plumb line to center sacral vertebral line (C7PL-CSVL), and leg length discrepancy (LLD) were measured on standing PA whole-spine radiographs preoperatively. Sacral obliquity (SO), the slope of the upper endplate of S1, and iliac obliquity (IO), the tilt of the line connecting the iliac crests, were measured on standing PA whole-spine radiographs and MPR-CT (SO/IO-X-ray, SO/IO-CT, respectively). S1 angle and S2 angle were measured on CT.</p><p><strong>Results: </strong>The mean age of the patients was 18.7±3.9 years and all of them were females. SO-X-ray and SO-CT were larger than IO-X-ray and IO-CT, respectively. SO-X-ray was highly correlated with SO-CT (r=0.838, P<0.001). L5 tilt had higher correlation with SO-CT (r=0.884, P<0.001) than with SO-X-ray (r=0.726, P=0.001) and IO-CT (r=0.550, P=0.22). L5 tilt was correlated poorly with IO-X-ray (r=0.104, P=0.69). The S1 angle was 4.5±3.5° meanwhile the S2 angle was 1.2±2.1°, the sacral deformity was mainly due to the S1 vertebral wedging.</p><p><strong>Conclusions: </strong>Given the asymmetric sacral morphology, SO is more appropriate pelvic parameter than IO to represent the sacral tilt of Lenke 5C AIS, especially when measured using CT images to overcome the poor visibility on PA whole-spine radiographs.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 2","pages":"255-263"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}