Spine Surgery and Related Research最新文献

{"title":"Does Sagittal Spinal Alignment Predict Future Fall-Related Fractures in Community-Dwelling Women with Osteoporosis?","authors":"Ryoma Asahi, Yutaka Nakamura, Masayoshi Kanai, Kohei Maruya, Satoshi Asano","doi":"10.22603/ssrr.2024-0248","DOIUrl":"10.22603/ssrr.2024-0248","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal alignment in women with osteoporosis tends to deteriorate with advancing age, and this misalignment may serve as an indicator of future fall-related fractures. Vertebral fractures, which commonly occur in patients with osteoporosis, have distinct characteristics compared with other fall-related fractures and should therefore be separately evaluated. This study aimed to investigate the association between future fall-related fractures and sagittal spinal alignment, excluding vertebral fractures.</p><p><strong>Methods: </strong>A total of 333 women with osteoporosis were recruited and followed up between November 2013 and July 2024. At baseline, information on medication status and bone mineral density in the lumbar spine and femoral neck was obtained from the patients' medical record. Furthermore, the locomotive syndrome (LOCOMO) stage was assessed via risk tests, and sagittal alignment parameters, including sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic incidence (PI), and lumbar lordosis (LL), were evaluated. In addition, Cox proportional hazards regression analysis was conducted to determine the risk of fall-related fractures based on all variables.</p><p><strong>Results: </strong>The mean follow-up period was 5.4 years. The final sample for assessing fall-related fracture incidence consisted of 214 participants. Fall-related fractures occurred in 31 of the 333 participants (9.3%). Cox proportional hazards regression analysis, adjusted for all variables, revealed that SVA (hazard ratio [HR]=1.011, 95% confidence interval [CI] 1.003-1.02), LL (HR=1.039, 95% CI 1.007-1.072), LOCOMO stage (HR=1.801, 95% CI 1.127-2.879), and presence of parathyroid hormone (HR=0.165, 95% CI 0.031-0.891) are independent risk factors for future fall-related fractures.</p><p><strong>Conclusions: </strong>Awareness of fall-related fracture risks can be increased by monitoring the SVA, LL, and LOCOMO stage as well as administering parathyroid hormone medications. While the deterioration of sagittal spinal alignment is a well-known factor in vertebral fractures, this study suggests that future fall-related fractures, excluding vertebral fractures, are influenced by sagittal spinal alignment.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"350-357"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275934","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":"Risk Factors and Consequences of Cage Subsidence after Single-level Posterior or Transforaminal Lumbar Interbody Fusion: A Retrospective Multicenter Study.","authors":"Hoai T P Dinh, Hiroki Ushirozako, Tomohiko Hasegawa, Shigeto Ebata, Tetsuro Ohba, Hiroki Oba, Keijiro Mukaiyama, Yu Yamato, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Toshiyuki Ojima, Jun Takahashi, Hirotaka Haro, Yukihiro Matsuyama","doi":"10.22603/ssrr.2024-0241","DOIUrl":"10.22603/ssrr.2024-0241","url":null,"abstract":"<p><strong>Introduction: </strong>Cage subsidence (CS) after posterior or transforaminal lumbar interbody fusion (PLIF or TLIF) is challenging; however, its impact on health-related quality of life (HRQOL) remains unclear. This study aimed to explore the impact of CS occurrence on HRQOL and identify the risk factors in patients following PLIF or TLIF.</p><p><strong>Methods: </strong>A total of 138 patients (mean age, 67 years; follow-up period, 12 months) who underwent single-level PLIF or TLIF were retrospectively analyzed. CS was defined as >1 mm sinking of the intervertebral cage evaluated via computed tomography. The patients were divided into the CS and nonsubsidence (NS) groups. HRQOL was assessed using the Oswestry Disability Index (ODI) scores.</p><p><strong>Results: </strong>Among the 138 patients, 30 (22%) developed CS following PLIF or TLIF. All cases with TLIF surgery (n=25) involved the use of one cage. A significant difference was observed in the use of two cages between the CS and NS groups (20.0% vs. 48.1%; <i>P</i>=0.006). The CS group had lower occupancy rate of autograft soon after the operation than the NS groups (<i>P</i>=0.002), and the occupancy rate of autograft tended to decrease in the CS group compared with the NS group over time. The ODI scores improved in both groups postoperatively; however, the NS group exhibited greater improvements in ODI scores from 4 months postoperatively. The CS group had a significantly lower proportion of patients with intervertebral osseous union at 6 and 12 months postoperatively compared with the NS group (<i>P</i>=0.003 and <i>P</i><0.001, respectively).</p><p><strong>Conclusions: </strong>The use of two intervertebral cages may enhance initial stability and reduce CS risk after PLIF. Initial intervertebral stability was crucial to preventing CS occurrence, as evidenced by the high occupancy rates of autograft in patients without CS. Surgical factors, including surgical strategy and intraoperative techniques, should be considered to prevent CS occurrence and to improve surgical outcomes and patient satisfaction.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"339-349"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275942","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":"Complete Resolution of Hematoma after Vertebroplasty in Epidural Hematoma Associated with Acute Osteoporotic Vertebral Fracture: A Case Report.","authors":"Jong-Pil Kim, Ho-Min Lee, Chan-In Seo","doi":"10.22603/ssrr.2024-0170","DOIUrl":"10.22603/ssrr.2024-0170","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"381-383"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275932","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":"\"Koshimagari Exercise\" for Adult Spinal Deformity in Older Adults: Assessment of Home-Based Exercise Outcomes in a Prospective Multicenter Study.","authors":"Hidetomi Terai, Shinji Takahashi, Masatoshi Hoshino, Hiroshi Taniwaki, Koji Tamai, Toshimitsu Ohmine, Tamotsu Nakatsuchi, Goya Shinbashi, Masatoshi Teraguchi, Masakazu Minetama, Kei Watanabe, Naritoshi Sato, Takuya Kitamura, Masaru Kanda, Tadao Tsujio, Yuichi Takeuchi, Tatsuki Mizouchi, Katsuhito Ishizu, Toshihito Ebina, Yasunari Muraoka, Tomonori Sodeyama, Hiroshi Mikami, Yuji Kasukawa, Takahiko Hyakumachi, Kazuhiro Ishida, Kazufumi Miyagishima, Yosuke Oishi, Kiyonori Yo, Ryota Kimura, Hiromichi Sato, Keiji Nagata, Yu Yamato, Ko Matsudaira, Naohisa Miyakoshi, Yukihiro Matsuyama, Hirotaka Haro, Hiroshi Hashizume, Hiroshi Yamada, Takashi Kaito","doi":"10.22603/ssrr.2024-0273","DOIUrl":"10.22603/ssrr.2024-0273","url":null,"abstract":"<p><strong>Introduction: </strong>Adult spinal deformity (ASD) is prevalent among older adults, considerably affecting their quality of life. Although surgical interventions are effective, they have high complication rates and medical costs. Furthermore, there is a lack of evidence supporting the effectiveness of nonsurgical treatments (e.g., physical therapy) in patients with ASD. This study aimed to investigate the impact of \"Koshimagari exercise,\" a specific home-based exercise regimen designed for patients with ASD, and to evaluate its effects on clinical outcomes in older adults.</p><p><strong>Methods: </strong>A total of 144 participants aged 50-80 years with chronic low back pain (LBP) due to spinal deformities were included in this multicenter prospective study. Qualified physiotherapists conducted intervention sessions at the hospital once a week, and self-exercise was performed at home three times a week. After 3 months, the frequency of self-exercise at home increased to four times a week. Clinical evaluations were conducted using the Oswestry Disability Index (ODI), five-level classification system of EuroQol-5 Dimensions (EQ-5D), Japanese edition of Scoliosis Research Society-22r (SRS-22r), and visual analog scale (VAS) for LBP at baseline and 3, 6, and 12 months. Radiographic evaluations were performed in standing and supine positions.</p><p><strong>Results: </strong>Of 130 participants who provided written informed consent, 98 completed the 6-month follow-up and were included in the analysis. Significant improvements observed in ODI, EQ-5D, and VAS scores were observed at 3 months, with SRS-22r scores improving throughout the study period. Radiographically, there were significant differences in the sagittal vertical axis and pelvic tilt at 12 months. Sufficient compliance with the self-exercise program was reported by 96%, 86%, and 73% of participants at 3, 6, and 12 months, respectively.</p><p><strong>Conclusions: </strong>The \"Koshimagari Exercise\" program led to significant short-term improvements in health-related quality of life and pain among elderly patients with ASD. This home-based self-exercise program is an excellent nonsurgical treatment option for patients with ASD.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"358-367"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275928","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":"Severe Spinal Stenosis Secondary to a CREST Syndrome Related Calcific Deposit: A Case Report.","authors":"Henry Howard, Michael J Newman, Henry R Budd","doi":"10.22603/ssrr.2024-0232","DOIUrl":"10.22603/ssrr.2024-0232","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"384-387"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275943","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":"Efficacy of Airway Management Protocol for Cervical Anterior Surgery, Posterior Occipitocervical Fusion, and Intramedullary Tumor Resection.","authors":"Narihito Nagoshi, Kohei Matsubayashi, Osahiko Tsuji, Masahiro Ozaki, Satoshi Suzuki, Toshiki Okubo, Kazuki Takeda, Hiromasa Nagata, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.22603/ssrr.2024-0182","DOIUrl":"10.22603/ssrr.2024-0182","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical interventions for cervical spine and spinal cord diseases may lead to life-threatening postoperative airway obstruction, requiring urgent airway management. This study aimed to assess the feasibility and effectiveness of our respiratory management protocol for patients undergoing anterior cervical approaches, posterior occipitocervical fusion, and intramedullary tumor resection.</p><p><strong>Methods: </strong>This single-center retrospective study consisted of 497 patients who underwent cervical surgeries, including anterior fusion, posterior occipitocervical fusion, combined anterior and posterior fusions, and intramedullary tumor resection between January 2006 and June 2022. Our institution implemented a specific postoperative airway management protocol from September 2014 onward. The protocol involved continued intubation for at least the first postoperative night, followed by a spontaneous breathing trial with a cuff leak test and extubation one or more days after surgery. We compared the outcomes between the pre-protocol period (non-protocol group, n=234) and the protocol period (protocol group, n=263).</p><p><strong>Results: </strong>There were no significant between-group differences regarding demographic, clinical, or surgical details. In the non-protocol group, four subjects required reintubation because of postoperative airway complications (anterior fusion: 1 patient, posterior occipitocervical fusion: 1 patient, and intramedullary tumor resection: 2 patients). After the airway protocol implementation, the reintubation rate dropped to zero (<i>P</i>=0.048).</p><p><strong>Conclusions: </strong>Our airway management protocol substantially reduced the need for reintubation. These findings emphasize the importance of postoperative respiratory management after cervical spine surgeries and underscore the need for appropriate measures to prevent complications.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"300-306"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275935","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":"Impact of T1 Slope Visibility on Cervical Sagittal Alignment: A Comparative Study of Radiographic Parameters According to T1 Slope Visibility.","authors":"Hiroaki Nakashima, Akiyuki Matsumoto, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Yoshinori Morita, Shiro Imagama","doi":"10.22603/ssrr.2024-0253","DOIUrl":"10.22603/ssrr.2024-0253","url":null,"abstract":"<p><strong>Introduction: </strong>Proper cervical sagittal alignment is essential for maintaining overall spinal stability and function. A crucial measure of this alignment is the T1 slope, which is an important indicator. However, lateral cervical spine radiographs often fail to clearly show the T1 slope owing to several factors, such as shoulder anatomy or variations in body shape. In this study, we aimed to evaluate the differences in cervical alignment between individuals with visible and invisible T1 slopes.</p><p><strong>Methods: </strong>This study was a retrospective cohort analysis involving 60 patients diagnosed with cervical spine conditions and evaluated via radiographic imaging. The patients were categorized into two groups based on whether the T1 slope was clearly visible or not. Key radiographic measurements, such as the C2-C7 sagittal vertical axis (SVA) and C2-C7 Cobb angles in the neutral, flexion, and extension postures, were recorded and statistically analyzed.</p><p><strong>Results: </strong>Significant differences were observed in the C2-C7 SVA between the groups, particularly among men. Men in the invisible T1 slope group had an average SVA of 28.9 mm, whereas those in the visible group had a mean SVA of 16.0 mm (<i>P</i><0.05). Although no notable differences were observed in the Cobb angles for the neutral and flexion positions, a substantial reduction in the extension Cobb angle was noted in the invisible than in the visible group (24.4° vs. 37.6°, <i>P</i><0.05).</p><p><strong>Conclusions: </strong>Male patients with obscured T1 slopes exhibited unique radiographic features, including higher C2-C7 SVA and diminished extension capacity. This suggests that the visibility of the T1 slope plays a pivotal role in the evaluation of cervical alignment. Furthermore, the exclusion of patients with an invisible T1 slope from research studies could lead to biased results.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"307-312"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275937","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":"The Clinical Impact of Augmented Reality Surgical Navigation on Pedicle Screw Placement and its Effect on Perioperative Outcomes: A Systematic Review.","authors":"Charles Taylor, Chuck Lam, Nikhil Manoj, Omkaar Divekar","doi":"10.22603/ssrr.2024-0223","DOIUrl":"10.22603/ssrr.2024-0223","url":null,"abstract":"<p><strong>Background: </strong>Spinal fusion is a common form of orthopedic surgery, the most common of which involves pedicle screw placement (PSP). Despite well-documented benefits, pedicle screws are associated with several intraoperative complications. This area of surgery has subsequently been recipient to many surgical developments. Currently, augmented reality surgical navigation (ARSN) is at the forefront of surgical interest. This systematic review evaluates whether, when compared to freehand, fluoroscopic, and intraoperative image-guided navigation, ARSN results in superior screw accuracy and operative outcomes for patients undergoing PSP surgery.</p><p><strong>Methods: </strong>Data collection was performed on PubMed, Ovid MEDLINE, the Cochrane Library, Embase, and the Web of Science between January 7, 2023, and January 8, 2024. PRISMA guidelines were followed and the level of evidence was graded per the Centre for Evidence-Based Medicine's recommendations. Risk of bias was assessed per the ROBINS-I tool and the Cochrane guide for assessing study quality. A modified version of the Newcastle-Ottawa Scale was used to determine the certainty of the body of evidence.</p><p><strong>Results: </strong>A total of 521 papers were obtained from all bibliographical databases, 31 of which were included in the final review. ARSN resulted in a significantly greater number of screws placed as Gertzbein and Robbins grade 1 or 2 (93.33% vs 85.86%, p<0.000), significantly reduced intraoperative blood loss (470.32 vs 802.44 ml, p=0.050), comparative operative duration (281.6 vs 255.5 min, p=0.819), comparative time to place a screw (2.71 vs 3.1 min, p=0.703), and a nonsignificant reduction in hospital stay (5.4 vs 7.5 days, p=0.097). Maximum follow-up was more than 14 days.</p><p><strong>Conclusions: </strong>ARSN results in a significantly greater number of screws placed at Gertzbein-Robertson grade 1 or 2 than non-ARSN surgery. Therefore, ARSN can be considered as a safe and efficacious technical innovation within PSP surgery.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 3","pages":"269-282"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275944","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":"Effects of Physiotherapeutic Scoliosis-Specific Exercise for Adolescent Idiopathic Scoliosis Cobb Angle: A Systematic Review.","authors":"Hiroki Oba, Kei Watanabe, Tomoyuki Asada, Akira Matsumura, Ryo Sugawara, Shinji Takahashi, Haruki Ueda, Satoshi Suzuki, Toru Doi, Takumi Takeuchi, Hideyuki Arima, Yu Yamato, Satoru Demura, Naobumi Hosogane","doi":"10.22603/ssrr.2024-0191","DOIUrl":"https://doi.org/10.22603/ssrr.2024-0191","url":null,"abstract":"<p><strong>Background: </strong>The study of physiotherapeutic scoliosis-specific exercise (PSSE) for adolescent idiopathic scoliosis (AIS) is rapidly progressing. However, there are limited reports on the medium- to long-term effects of PSSE on scoliosis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis feasibility study were conducted according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In our exhaustive search, we employed nine search formulas and four search databases according to a preregistered protocol. Identification, screening, eligibility, inclusion, and meta-analysis were performed through repeated meetings involving all coauthors. Each process was conducted by three or more authors.</p><p><strong>Results: </strong>A total of 1,518 studies were identified in the initial search. After manually reviewing abstracts and full texts, 11 studies were chosen for evaluation and reporting. The overall risk-of-bias was high in approximately half of the studies and moderate in the other half, with none found to have a low risk-of-bias. Only two randomized controlled trials (RCTs) specifically evaluated the therapeutic effect of PSSE on over a 1-year clinical course and the preventive ability of PSSE on surgery. One RCT reported that Cobb angle was substantially smaller in the PSSE group than in the control group at the final follow up, whereas the other found no significant difference between the groups. The methods of exercise intervention, control group selection, and timing of outcome assessments were not standardized in the selected studies. Thus, conducting a meta-analysis of the literature was deemed unfeasible at this time.</p><p><strong>Conclusions: </strong>The certainty of the evidence that PSSE reduces the progression of Cobb angle in patients with AIS in the short and long term was extremely low. Accordingly, healthcare providers should carefully examine the current evidence when explaining and applying PSSE in such patients. High-quality studies addressing the long-term changes in Cobb angle and Cobb angle at bone maturity as primary outcomes are warranted.</p><p><strong>Level of evidence: </strong>Level 1.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 2","pages":"120-129"},"PeriodicalIF":1.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038966","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":"Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.","authors":"Hideki Shigematsu, Go Yoshida, Hiroki Ushirozako, Kenta Kurosu, Nobuaki Tadokoro, Masahiro Funaba, Shigenori Kawabata, Jun Hashimoto, Muneharu Ando, Shinichirou Taniguchi, Masahito Takahashi, Naoki Segi, Hiroaki Nakashima, Shiro Imagama, Shinji Morito, Kei Yamada, Tsunenori Takatani, Tsukasa Kanchiku, Yasushi Fujiwara, Hiroshi Iwasaki, Kanichiro Wada, Naoya Yamamoto, Kazuyoshi Kobayashi, Akimasa Yasuda, Kazuyoshi Nakanishi, Yasuhito Tanaka, Yukihiro Matsuyama, Katsushi Takeshita","doi":"10.22603/ssrr.2024-0229","DOIUrl":"https://doi.org/10.22603/ssrr.2024-0229","url":null,"abstract":"<p><strong>Introduction: </strong>Multimodal intraoperative neurophysiological monitoring (IONM)-such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve-is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm.</p><p><strong>Methods: </strong>We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm.</p><p><strong>Results: </strong>All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type.</p><p><strong>Conclusions: </strong>Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"9 2","pages":"173-178"},"PeriodicalIF":1.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048808","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}