North American Spine Society Journal最新文献

{"title":"2. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020","authors":"Kentaro Yamada MD, PhD, Toshitaka Yoshii MD, Mikayo Toba MD, Satoru Egawa MD, Shingo Morishita MD, PhD, Yu Matsukura MD, Hiroyuki Inose MD, PhD, Kiyohide Fushimi MD, PhD","doi":"10.1016/j.xnsj.2024.100340","DOIUrl":"10.1016/j.xnsj.2024.100340","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Spinal metastasis can lead to pain, neurological deficit, and disruption of health-related quality of life, and sometimes needs surgical treatment. Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades.</p></div><div><h3>PURPOSE</h3><p>This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Analysis of nationwide administrative hospital discharge data.</p></div><div><h3>PATIENT SAMPLE</h3><p>This study included spinal surgery cases for metastatic spinal tumors including total en bloc spondylectomy, palliative fusion surgery, laminectomy, and vertebroplasty using the Diagnosis Procedure Combination (DPC) database: a national inpatient database in Japan, from 2012 to 2020.</p></div><div><h3>OUTCOME MEASURES</h3><p>Trends in the surgical treatment for spinal metastasis, patients’ demographics, and in-hospital outcomes were investigated using Jonckheere-Terpstra trend test and Cochran-Armitage test. The outcomes of this analysis were evaluated by (1) in-hospital mortality with the 30-day mortality, (2) length of stay, (3) the proportion of discharge to home, (4) postoperative complication, and (5) unfavorable ambulatory status.</p></div><div><h3>METHODS</h3><p>The number of patients who underwent spinal surgery for nonmetastatic spinal disorders at the institutions that have performed metastatic spine surgeries at least one case in the same year were also investigated. The postoperative unexpected ambulatory was defined as nonambulatory at discharge or a decrease in mobility score of Barthel Index between admission and discharge.</p></div><div><h3>RESULTS</h3><p>This study analyzed 10,321 eligible patients with spinal metastasis with 473,391 patients without spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 877 in 2012 to 1479 in 2020, especially in fusion surgery from 84% in 2012 to 87% in 2020, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2 %. Distributions of the primary site did not change whereas age was getting older. In-hospital death and length of stay decreased over time (9.9%–6.8%, p <0.001; 37 days–30 days, p <0.001). The postoperative complication retained stable (8.0%–8.5%, p=0.52). Postoperative unfavorable ambulatory slightly decreased (39%–36.9%, p=0.003).</p></div><div><h3>CONCLUSIONS</h3><p>During the last decade, surgical treatment for spinal metastasis has increased in Japan. Age at the time of surgery was getting older, whereas the distribution of the primary site of tumors and preoperative comorbidity did not change. In-hospital mortality and length of stay decreased ove","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100340"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000337/pdfft?md5=5b9a7d09e2eb507f932212e11dc1b43d&pid=1-s2.0-S2666548424000337-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849199","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":"63. Intraoperative blood pressure fluctuation is associated with postoperative C5 palsy in cervical spine surgery: a retrospective observational study","authors":"Toshiki Tsukui MD ,&nbsp;Eiji Takasawa MD, PhD ,&nbsp;Hirotaka Chikuda MD, PhD","doi":"10.1016/j.xnsj.2024.100401","DOIUrl":"10.1016/j.xnsj.2024.100401","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Postoperative C5 palsy is a well-recognized complication following cervical spine surgery. However, the precise pathophysiology remains debated given its multifactorial nature. We focused on intraoperative arterial blood pressure (IO-MAP) as a representation of systemic hemodynamic alterations during surgery. We hypothesized that IO-MAP changes may influence the incidence of postoperative C5 palsy.</p></div><div><h3>PURPOSE</h3><p>This study aimed to investigate the relationship between IO-MAP changes during cervical spine surgery and the occurrence of C5 palsy.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This was a retrospective single-center cohort study. Surgical records were reviewed to identify all patients undergoing cervical spine surgery at our institution from 2010 to 2022.</p></div><div><h3>PATIENT SAMPLE</h3><p>Our cohort included 74 patients with cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), or other cervical pathologies.</p></div><div><h3>OUTCOME MEASURES</h3><p>Intraoperative hypotension was defined as ≥5 consecutive drops in IO-MAP to &lt;65 mmHg during surgery, which has been associated with adverse postoperative outcomes like myocardial infarction, acute kidney injury, and mortality. The IO-MAP amplitude was calculated as the difference between maximum and minimum IO-MAP values.</p></div><div><h3>METHODS</h3><p>Patients were divided into groups with or without C5 palsy (C5 palsy group vs age-matched control group). Demographics, diagnosis, surgical characteristics, and IO-MAP parameters were recorded. Multivariable logistic regression identified independent risk factors for postoperative C5 palsy.</p></div><div><h3>RESULTS</h3><p>Among 74 patients (mean age 70.5 years; 22 [30%] female), 13 (17.6%) developed postoperative C5 palsy. Age, sex, diagnosis (OPLL 23% vs 18%), spinal fusion rate (54% vs 33%), and intraoperative hypotension incidence (2.5 vs 3.1 episodes per surgery) were comparable between groups (P &gt; 0.05). However, patients with C5 palsy had greater IO-MAP amplitude versus controls (Δ92 vs Δ73 mmHg, P = 0.013). After adjusting for confounders, IO-MAP amplitude remained an independent risk factor for postoperative C5 palsy (odds ratio 1.03, 95% confidence interval 1.00-1.05, P = 0.03). ROC analysis found an IO-MAP amplitude cutoff of Δ67mmHg predicted C5 palsy with 85% sensitivity and 53% specificity (AUC 0.72, 95% CI 0.56-0.87).</p></div><div><h3>CONCLUSIONS</h3><p>Intraoperative MAP amplitude was closely associated with postoperative C5 palsy occurrence. Our findings emphasize the importance of optimal hemodynamic control to mitigate C5 palsy risk. The gap between maximum and minimum IO-MAP values should be maintained below 67 mmHg.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100401"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000945/pdfft?md5=df70b4d51700d60f27efc58375af5879&pid=1-s2.0-S2666548424000945-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849898","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":"32. The effect of transpedicular injection of rhBMP-2 injection on prevention of proximal junctional kyphosis","authors":"Joonhee Park MD ,&nbsp;Ho-Joong Kim MD, PhD","doi":"10.1016/j.xnsj.2024.100370","DOIUrl":"10.1016/j.xnsj.2024.100370","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Several studies have explored strategies to prevent proximal junctional kyphosis (PJK). Our study introduces a novel strategy to address the unresolved issue of PJK in ASD, utilizing recombinant human bone morphogenetic protein-2 (rhBMP-2).</p></div><div><h3>PURPOSE</h3><p>This study aimed to investigate the preventive effects of <strong>u</strong>pper instrumented vertebrae (UIV) rhBMP-2 injection on PJK and proximal junctional failure (PJF) and to determine whether UIV bone density significantly increases locally.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective and prospective case<strong>-</strong>control study.</p></div><div><h3>PATIENT SAMPLE</h3><p>The sample consists of <strong>154</strong> patients with ASD (<strong>a</strong>dult spine deformity)</p></div><div><h3>OUTCOME MEASURES</h3><p>Incidence of PJK and PJF and change in the Hounsfield unit of UIV after 1 year of follow-up</p></div><div><h3>METHODS</h3><p>All surgeries were performed with instrumentation and fusion from iliac to T10. In the experimental group, consisting of 25 patients with ASD, rhBMP-2 injection was administered to the vertebral body of UIV. To minimize performance bias, the control-1 group included 66 patients who had undergone ASD surgery by the same surgeon in the year preceding the commencement of the study. Control-2 consisted of 63 patients who had undergone ASD surgery by the same surgeon during the year following the end of the study for experimental group. Postoperatively, we evaluated the presence of PJK and PJF, change in the Hounsfield unit (HU) of UIV after 1 year of follow-up. The control-1 group was respectively collected data and the experimental group and control-2 group were prospectively collected data.</p></div><div><h3>RESULTS</h3><p>When comparing baseline characteristics with control groups, a significant difference was observed only in BMI with control-1 (p=0.006), control-total (control-1 + control-2, p=0.026) having a higher BMI than the study group. In the group that received rhBMP-2 at UIV, there were 3 cases (12.0%) of PJK, whereas the control-1 and control-2 had 26 cases (39.4%, BMI-adjusted p=0.010) and 20 cases (31.7%, BMI-adjusted p=0.078), respectively. In the control-total group (combining control-1 and control-2 groups), there were 46 cases (35.7%, BMI-adjusted p=0.025) of PJK. Regarding HU measurements, the UIV that received rhBMP-2 showed a statistically significant increase compared with the preoperative values <strong>one</strong> year after surgery (p=0.001).</p></div><div><h3>CONCLUSIONS</h3><p>Injection of rhBMP-2 at the UIV effectively increased trabecular bone density at the UIV, thereby significantly contributing to the prevention of PJK.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100370"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000635/pdfft?md5=62b4287bf22f2eb161dcd0de6e71f4f7&pid=1-s2.0-S2666548424000635-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850089","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":"17. Comparison of clinical results between minimally invasive cervical foraminotomy and anterior cervical decompression and fusion for cervical radiculopathy","authors":"Akihito Minamide MD, PhD ,&nbsp;Shizumasa Murata MD ,&nbsp;Yasutsugu Yukawa MD, PhD ,&nbsp;Ryo Taiji MD ,&nbsp;Takuhei Kozaki MD, PhD ,&nbsp;Masanari Takami MD, PhD ,&nbsp;Shunji Tsutsui MD, PhD ,&nbsp;Yutaka Nohara MD ,&nbsp;Hiroshi Taneichi MD ,&nbsp;Hiroshi Yamada MD, PhD ,&nbsp;Andrew Simpson MD, MBA","doi":"10.1016/j.xnsj.2024.100355","DOIUrl":"10.1016/j.xnsj.2024.100355","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;As a surgical procedure for cervical radiculopathy, anterior cervical decompression and fusion (ACDF) or posterior foraminotomy is generally performed. Recently, the efficacy of minimally invasive cervical posterior foraminotomy has been reported. However, few studies have compared the postoperative clinical outcomes of minimally invasive cervical foraminotomy with those of ACDF. Nor have complications from their surgical procedure been compared.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;The purpose of this study was to clarify the efficacy of cervical microendoscopic foraminotomy (CMEF) compared with ACDF for the treatment of cervical disorders with radiculopathy.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;This study design is a retrospective subgroup analysis of a prospectively collected cohort analysis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;Consecutive patients with cervical radiculopathy who required surgical treatment were enrolled. The patients were diagnosed with cervical radiculopathy due to disc herniation or degenerative spondylosis on imaging including MRI and CT scan. Surgical treatment was selected when conservative treatment for more than 3 months was not effective. All enrolled patients (n = 79) underwent CMEF or ACDF.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;All patients were reviewed postoperatively for greater than 1 year. The preoperative and 1-year follow-up evaluations included neurological assessment. The primary outcome measure was the numeric rating scale (NRS) for neck and arm pain with a minimal clinically important difference defined as &gt;15%. Secondary outcomes were assessed with additional patient reported outcomes measures (PROMs).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Nominal variables were compared using the Chi-squared test, or Fisher's exact test if the sample was ≤10. The Mann – Whitney test was used to compare medians of ordinal variables and the independent-samples t-test was used to compare the means of continuous variables. The complication rate was analyzed using a matched-pairs t-test. To evaluate changes in the NRS score following each surgery a repeated-measures analysis of variance was used. A p-value ≤0.05 was defined, a-priori, as statistically significant.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;CMEF was performed in 55 patients and 24 patients underwent ACDF. The mean preoperative NRS for neck and arm pain was respectively 5.6 and 6.0 points in the CMEF group and 5.2 and 5.6 points in the ACDF group (p&gt;0.05). In both groups, their NRS improved significantly 1 year after surgery (p&lt;0.05), and there were no significant differences between the groups (p&gt;0.05). The VAS of surgical satisfaction was 82 mm in the CMEF group and 83 mm in the ACDF group (p&gt;0.05). There was no significant difference between the groups in SF-36. As for perioperative complications, in the CMEF group, 3 patients had temporary muscle weakness over MMT1 grade, and 2 patients had temporary progress","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100355"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000489/pdfft?md5=088a5e97774981d474fb24a0926419ad&pid=1-s2.0-S2666548424000489-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850889","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":"P15. Impact of age on the occurrence of vascular complications in patients undergoing anterior lumbar approach surgery","authors":"Richard D. Guyer MD ,&nbsp;Jun-Young Ahn MD ,&nbsp;Emily Courtois MS ,&nbsp;Scott L Blumenthal MD ,&nbsp;Donna D. Ohnmeiss PhD","doi":"10.1016/j.xnsj.2024.100419","DOIUrl":"10.1016/j.xnsj.2024.100419","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;With increased longevity, the number of patients with symptomatic, degenerative spinal conditions is increasing. Anterior approach lumbar spinal surgery may facilitate use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of anterior approach lumbar spinal surgery, risks related to vascular injury in older patients have been described in the literature.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;The purpose of this study was to investigate the impact of age on the incidence of vascular complications in a large series of patients undergoing anterior lumbar approach surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;This was a retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;The study was based on 751 consecutive patients who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation, total disc replacement (TDR), or hybrid surgery (ALIF and TDR) for the treatment of degenerative spinal pathology. Patients with surgeries greater than 3 levels, or who underwent surgery for fracture, tumor, complex deformity, or involving a lateral approach were excluded.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;The primary outcome measures were the incidence of intraoperative vascular injuries and postoperative vascular complications (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Charts were reviewed to collect general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications. Rates of vascular complications were compared across age groups divided by decade of age. Data were also analyzed comparing the mean age of patients with no vascular complications to those in each of the vascular complication subgroups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The overall mean age was 50.4 years (range 20-83 years). The majority of patients (53.1%) underwent combined ALIF/posterior surgery, 31.7% underwent TDR, 11.3% underwent ALIF, and the remaining patients underwent hybrid surgery. With respect to the number of levels operated: 468 were 1-level, 253 were 2-level, and 30 were 3-level. Mean estimated blood loss was 91.3 mL (range 10-2800 ml). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins. The mean blood loss in these cases was 721 ml and all were successfully repaired intraoperatively. Postoperatively, 6 patients, 0.8%, developed DVT and/or PE (one patient had both intra and postoperative vascular complications). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates (all p&gt;.38). Additionally, there were no statistically significant differences in the mean ages of patients with vs those without vascular complications (all p&gt;.17","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001124/pdfft?md5=97e8be1e77766b23e7e64d67ac14d14d&pid=1-s2.0-S2666548424001124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852743","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":"P1. Comparison in the accuracy of thoraco-lumbo-sacral orthosis designed by a conventional contact casting technique with a plaster bandage versus by a new noncontact 3D digital scanning technique","authors":"Masao Ryu MD","doi":"10.1016/j.xnsj.2024.100405","DOIUrl":"10.1016/j.xnsj.2024.100405","url":null,"abstract":"<div><p>This abstract has been previously published as part of the ISSLS 2022 proceedings. For full access to the abstract, please visit the following URL: <span><span>http://issls-2022.m.issls.currinda.com/schedule/session/330/abstract/3098</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100405"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000982/pdfft?md5=7334060cbe8e824e6786f30066deaf2f&pid=1-s2.0-S2666548424000982-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853733","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":"60. Surgery for spinal stenosis in achondroplasia: causes of reoperation and reduction of risks","authors":"Arun Hariharan MD ,&nbsp;Hans K Nugraha MD ,&nbsp;Aaron Huser DO ,&nbsp;David Feldman MD","doi":"10.1016/j.xnsj.2024.100398","DOIUrl":"10.1016/j.xnsj.2024.100398","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;Individuals with achondroplasia are prone to symptomatic spinal stenosis requiring surgery. However, the optimal surgical management remains unknown. There is no data on the revision rate or causes of revision in patients with achondroplasia who have undergone previous spine surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;The purpose of this study was to review the patients with achondroplasia who have undergone surgery for spinal stenosis to determine the rate of revision, review the causes of revision and determine if spinal construct was related to the need for revision.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;A retrospective review was conducted over an 8-year period of all patients with achondroplasia at a single institution that serves as a large referral center for patients with skeletal dysplasias.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;Thirty-three surgeries from 130 patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;Type of surgery was placed into four categories: decompression only without fusion, decompression with a short fusion (T10 or distal for the upper instrumented vertebra [UIV])(short fusion) decompression with a long fusion (T9 or proximal as the UIV) (long fusion) and decompression with a long fusion and interbody caudally (interbody). Need for revision (binary), cause of the revision (proximal junctional kyphosis, pseudarthrosis and symptomatic stenosis/recurrence of stenosis) and previous revision (binary) were also documented&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Patient demographics, surgical dates, indications for surgery and type of surgery were recorded. Descriptive statistics were calculated. Statistical analysis was performed using R (R Core Team 2022, Vienna, Austria.). Fisher's exact test was used to determine if an association existed between construct type and need for revision as well as revision causes. Pairwise comparisons were again performed using Fisher's Exact test but with a Bonferroni correction. Multivariate logistic regression was performed to determine if any of the construct types could predict the need for revision and/or cause of revision. Odds ratios were calculated based on significant findings in the Fisher's Exact test and logistic regression coefficients. Significance was set at p &lt; 0.05.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;Thirty-three of the 130 (21.5%) patients with achondroplasia required spinal stenosis surgery. Twenty-four individuals who met the criteria were selected for analysis. The initial spine surgery was at an average age of 18.7 years (SD 10.1 years). Nine patients (37.5%) required revision surgeries, 3 required multiple revisions. Five of 9 (55.6%) of the revisions had primary surgery at an outside institution. Revision surgeries were due to caudal pseudarthrosis (8), proximal junctional kyphosis (PJK) (7), and new neurological symptoms (7). Short fusions (T10 or distal) had a significantly higher likelihood of developing proximal junctional kyp","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100398"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266654842400091X/pdfft?md5=aa7e915c8b1e4fb4cabb74d578a7bb41&pid=1-s2.0-S266654842400091X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838875","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":"6. Predictive factors for bladder function recovery following OPLL surgery: a comprehensive analysis","authors":"Yusuke Setojima MD ,&nbsp;Kengo Fujii MD, PhD ,&nbsp;Toru Funayama MD, PhD ,&nbsp;Masashi Yamazaki MD, PhD ,&nbsp;Masao Koda MD, PhD","doi":"10.1016/j.xnsj.2024.100344","DOIUrl":"10.1016/j.xnsj.2024.100344","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;Neurogenic bladder dysfunction poses a significant challenge in patients with ossification of posterior longitudinal ligaments (OPLL), affecting both bladder storage and voiding function. Predicting postsurgery bladder function outcomes in OPLL patients is essential for counselling, rehabilitation planning, and discharge. However, no valid prediction rule is currently available for bladder outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;This study aims to discover the independent factors for predicting the recovery of bowel function one year after surgery for OPLL patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;A total of 477 patients treated surgically for OPLL at various departments between 2014 and 2018 were reviewed. The treatment modalities included anterior and posterior surgical approaches and combined both, involving procedures such as corpectomy, discectomy, laminoplasty, laminectomy, and fusion. Exclusion criteria for the study were: (i) patients with a preoperative JOA score of 3 points in bladder function and (ii) patients with less than one year of follow-up after surgery. Among the remaining 192 patients analyzed, consisting of 145 men and 47 women with a mean age of 68 (standard deviation [SD]: 11.0), 2 groups were formed: the improved group (n=125) with a postoperative JOA score increase of 3 points in bladder function, and the unimproved group (n=67) with a postoperative JOA score under 2 points. JOA score consists of 6 domains: motor function in the upper extremities (MU), motor function in the lower extremities (ML), sensory function in the upper extremities (SU), sensory function in the trunk (ST), sensory function in the lower extremities (SL), and bladder function, with a minimum total score of 0 and maximum of 17. Univariable and multivariable analyses were executed using the Cox proportional hazards regression model. This study investigates factors at the initial visit, including age, sex, BMI, comorbidities, preoperative JOA score, OPLL occupation ratio, and K-line.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;The improved group comprised 94 men and 31 women, with a mean age of 65 (standard deviation: 10.8) years. The unimproved group included 51 men and 16 women, with a mean age of 70 (standard deviation [SD]: 10.4) years. Among the improved group, 106 patients (84%) had comorbidities, and 42 patients (34%) had diabetes. The mean OPLL occupation ratio was 44.7 (SD: 16), and the mean preoperative JOA MU score was 2.41 (SD: 0.81), ML 2.05 (SD: 0.4), SU 1 (SD: 0.92), ST 1.66 (SD: 0.53), SL 1.34 (SD: 0.58), and total score of 9.98 (SD: 2.27). In the unimproved group, 56 patients (83%) had comorbidities and 23 patients (34%) had diabetes. The mean OPLL occupation ratio was 45.7 (15.7), and the mean preoperative JOA MU score was 1.93 (SD: 1.13), ML 1.3 (SD: 0.92), SU 0.88 (SD:","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000374/pdfft?md5=73f6939943be0e80ea692e2648e94584&pid=1-s2.0-S2666548424000374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839109","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":"56. Effects of cecompression surgery and erythropoietin combination on a rat model of compressive myelopathy","authors":"Yuki Shiratani MD ,&nbsp;Takeo Furuya MD, PhD ,&nbsp;Satoshi Maki MD, PhD ,&nbsp;Juntaro Maruyama MD ,&nbsp;Kyota Kitagawa MD ,&nbsp;Seiji Ohtori MD, PhD","doi":"10.1016/j.xnsj.2024.100394","DOIUrl":"10.1016/j.xnsj.2024.100394","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;In clinical practice, treatment options for severe myelopathy are currently limited, primarily involving surgical interventions such as decompression surgery. Although decompression surgery is an established treatment in terms of efficacy and safety, the degree of postoperative symptom recovery and the time required for recovery vary among individuals. Therefore, it is worthwhile to explore additional treatment methods that can enhance postoperative outcomes. Erythropoietin (EPO) is a medication known for its hematopoietic effects; however, it has also attracted attention for its neuroprotective and remyelination properties.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;The objective of this study is to investigate the effects of combining EPO administration with decompression surgery in a rat model of cervical compressive myelopathy.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;Eight-week-old female SD rats were used. After removing the C6 lamina, a hydroexpansive sheet (3 × 5 × 0.7mm) was inserted under the C4/5 lamina to create a chronic spinal cord compression model. Following sheet insertion, weekly behavioral evaluations (Basso, Beattie and Bresnahan score: BBB score, Grid runway test) were conducted, and rats with BBB scores of 13 or lower between weeks 4 and 8 were considered to have developed myelopathy. The BBB score serves as an assessment scale for evaluating the function of a rat's hindlimbs. In the Grid runway test, rats are made to walk on a wire mesh, and the number of times their hindlimbs fall through the grid is measured. To evaluate spinal canal occupancy of sheets, we used micro-CT. Rats with myelopathy were divided into three groups: Control group (sham surgery and subcutaneous saline injection), Decompression group (laminectomy, sheet removal, and subcutaneous saline injection), and Decompression-EPO group (laminectomy, sheet removal, and subcutaneous EPO injection). Behavioral evaluations were conducted for 8 weeks after the onset of myelopathy. Blood samples were collected from the tail vein every 2 weeks, and the administration of EPO was monitored by measuring Hb levels. After 8 weeks, spinal cords were harvested for Luxol fast blue (LFB) staining and immunohistochemical staining (Myeline Basic Protein: MBP, Growth Associated Protein 43: GAP-43, and stuff).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;Starting at 4 weeks postintervention, Hb levels in the decompression-EPO group were significantly higher than those in the other two groups. No significant differences were observed in spinal canal occupancy among the three groups at the onset of myelopathy. At 8 weeks postintervention, BBB scores were 12.1(±0.8), 13.4(±1.0), and 14.1(±1.4) for the Control, Decompression, and Decompression-EPO groups, respectively, with a significant difference observed between Decompression-EPO and Cont","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000878/pdfft?md5=562339b0b0648a40a38a01b607688a37&pid=1-s2.0-S2666548424000878-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839652","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":"3. Risk factors and frequency of occurrence of lumbar spine disease in young male American football players - A 6-year cohort study using lumbar spine MRI and X-rays","authors":"Tsuyoshi Iida MD, PhD,&nbsp;Morito Takano MD, PhD,&nbsp;Tomohiro Hikata MD, PhD","doi":"10.1016/j.xnsj.2024.100341","DOIUrl":"10.1016/j.xnsj.2024.100341","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;It is known from experience that the risk of lumbar spine disorders such as lumbar disc herniation and lumbar spondylolysis is increased in American football players. However, no large-scale prospective study has been conducted, and the risk factors and frequency are not clear. The purpose of this study is to investigate the risk factors and frequency of occurrence of lumbar spine disease among young male American football players.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;We enrolled 306 subjects, who gave consent to participate in this study, between 2005 and 2017. All subjects were male, aged 15-16 years (first-year of high school students in Japan). We evaluated subjects’ demographic data (height, weight, BMI, and position in American football), lumbar spine MRI and X-rays which were taken at the start of competition, 3 years, and 6 years later.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;Of the 306 subjects, 103 (33.7%) could be successfully followed up to the last observation. The subjects with Pfirrmann classification grade IV or higher disc degeneration as assessed by MRI, significantly increased from 8.8% at the start of competition, to 33.3% at 3 years later and 48.0% at 6 years later (p&lt;0.001). The progression of disc degeneration on MRI was frequently observed in L4/5 and L5/S levels at final follow up (L1/2; 1.0%, L2/3; 1.0%, L3/4; 4.9%, L4/5; 25.5%, L5/S1; 32.4%). The position of lineman was the only risk factor for the progression of disc degeneration (p=0.049). The subjects with herniated discs protruding more than 5 mm from the posterior wall of the vertebral body, significantly increased from 3.9% at the start of competition, to 23.5% at 3 years later and 33.3% at 6 years later (p&lt;0.001). The prevalence of lumbar disc herniation on MRI at final follow up were L1/2; 1.0%, L2/3; 0%, L3/4; 0%, L4/5; 25.5%, and L5/S1; 32.4%. Lineman, weight, and BMI were risk factors for disc herniation (p=0.015, 0.013, 0.019 each), but the results of differential analysis by each position showed that neither weight nor BMI differed significantly in any position (p&lt;0.05). X-ray findings revealed that the rate of lumbar spondylolysis was 3.9% at the start of competition, compared to 7.8% at 3 years later and 9.8% at 6 years later, but this change was not statistically significant (p = 0.17).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;p&gt;From this study, it was found that American football competition was a risk for the progression of disc degeneration and herniation in lower lumbar. Especially, the position of lineman seemed to be involved with significant risk factors, and body weight and BMI were confounding factors. Previous reports have shown differences in disc degeneration and herniation occurrences in lower lumbar depending on the athletic competition typ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100341"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000349/pdfft?md5=0412f1bb400733e1dad588a369bf5f21&pid=1-s2.0-S2666548424000349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839985","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}