Spine Journal最新文献

{"title":"Cervical facet joint degeneration, facet joint angle, and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4/5: a propensity score-matched study","authors":"Yuliang Wu MD , Jiajun Wu MD , Tianyu Qin MD , Bo Sun MD , Zhengqi Huang MD , Shun Han MD , Wanli Zheng MD , Mingxi Zhu MD , Bo Gao PhD , Wei Ye PhD","doi":"10.1016/j.spinee.2024.07.007","DOIUrl":"10.1016/j.spinee.2024.07.007","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Prior studies have hypothesized that degenerative cervical spondylolisthesis (DCS) may be influenced by loss of stability due to disc, facet joint or cervical alignment. Meanwhile, it is commonly believed that the facet joints and paraspinal muscles participate in maintaining cervical spine stability. However, the impact of paraspinal muscle morphology and detailed facet joint features on DCS requires further investigation.</div></div><div><h3>PURPOSE</h3><div>To compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Consecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited.</div></div><div><h3>OUTCOME MEASURES</h3><div>DCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated.</div></div><div><h3>METHODS</h3><div>Demographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated.</div></div><div><h3>RESULTS</h3><div>A total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊, and 37.1%, respectively.</div></div><div><h3>CONCLUSIONS</h3><div>This study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. An","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2232-2242"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectations in patients undergoing spine surgery are high and unmet","authors":"Ingrid Bergerud Grundnes ,&nbsp;Ole Kristian Alhaug MD, PhD ,&nbsp;Joao André Barroso Pereira Roque Dos Reis MD ,&nbsp;Rune Bruhn Jakobsen MD, PhD","doi":"10.1016/j.spinee.2024.09.004","DOIUrl":"10.1016/j.spinee.2024.09.004","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Defining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery.</div></div><div><h3>PURPOSE</h3><div>To examine patients’ expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself?</div></div><div><h3>STUDY DESIGN /SETTING</h3><div>Prospective single-center study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease.</div></div><div><h3>OUTCOME MEASURES</h3><div>Modified and standard version of ODI and NRS (back and leg pain).</div></div><div><h3>METHODS</h3><div>Preoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients’ expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics.</div></div><div><h3>RESULTS</h3><div>A total of 93 patients completed the preop questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2–42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81–6.88), and leg pain was 6.67 (6.08–7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5–13.5), mean (95%CI) NRS back pain of 2.5 (2.1–3.0), and NRS leg pain of 1.8 (1.5–2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0–26.5), NRS back pain of 3.4 (2.8–4.1), and leg pain of 2.8 (2.0–3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE.</div></div><div><h3>CONCLUSIONS</h3><div>Patients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2224-2231"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Oswestry Disability Index success criteria to assess the effect of consecutive surgeries on lumbar spinal stenosis","authors":"Ole Kristian Alhaug MD, PhD ,&nbsp;Filip C. Dolatowski MD, PhD","doi":"10.1016/j.spinee.2024.08.028","DOIUrl":"10.1016/j.spinee.2024.08.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Register studies have shown that chances of success after surgery for lumbar spinal stenosis (LSS) decrease with increasing numbers of previous operations. However, these studies presumed that success criteria remain constant with each consecutive spinal surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;We aimed to redefine success criteria specific for each consecutive surgery. Also, we assessed if fusion could be an effective procedure for LSS patients with previous decompression(s).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;We retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) from surgically treated LSS patients enrolled in The NORspine Register.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Patients operated for lumbar spinal stenosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;PROMs: Oswestry Disability Index (ODI) percentage (%) change and Global Perceived Effect (GPE).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;We categorized the LSS cohort by number of previous spine surgeries (none to ≥3). ROC analyses gave the most accurate cut-offs for ODI% change that corresponded to success, anchored by GPE, ie, “much improved” and “completely recovered”. Areas under the ROC curves (AUCs) indicated how well ODI discriminated between success and nonsuccess for each consecutive surgery: good (0.8–0.89) and excellent (0.9–0.99). We then calculated proportions of successfully treated patients by number of consecutive surgeries. We also analyzed whether fusion succeeded in patients with previous lumbar decompression(s).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;At 12 months, 8,919 (75%) responded; 6,961 (78%) had no previous LSS surgery, 1,338 (15%) had one, 417 (5%) had 2, and 203 (2%) had ≥3 previous surgeries. Preoperative ODI (95% CI) was 38.7 (38.2–39.1) for no previous surgery versus 49.4 (46.9–51.9) for patients with ≥3 previous surgeries. The postoperative ODIs (95% CI) were 21.9 (21.4–22.4) and 37.9 (34.9–40.8) for patients with no and ≥3 previous surgeries, respectively.&lt;/div&gt;&lt;div&gt;For patients with no previous surgeries, ODI% change of 37.6% most accurately defined success (AUC [95% CI]=0.909 [0.903–0.916]), and 57.1% reported success. For patients with ≥3 previous surgeries, success was an ODI% change of 25.0% (AUC [95%CI]=0.930 [0.890–0.971]), and 46.3% reported success.&lt;/div&gt;&lt;div&gt;Finally, 350 patients received fusion after previous decompression(s). ODI% change of 34.6% defined success (AUC [95% CI]=0.920 [0.890–0.949]). The proportion of successfully treated fusion patients was 47.7%, compared to 54.3% for the entire cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;We redefined ODI success criteria for patients with consecutive lumbar spinal stenosis surgeries. Our register study found the detrimental effect of consecutive surgeries on success rates to be less pessimistic than previously reported; fusion may be an effective option for LSS patients with previous decompression.&lt;/div&gt;&lt;/div","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2305-2313"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel subtype classification and corresponding surgical strategies for spinal dural cysts–a report of 104 cases","authors":"Guangjian He BA ,&nbsp;Xingsen Xue MA ,&nbsp;Xin Chen BA ,&nbsp;Xing Fang BA ,&nbsp;Hongyan Zhang MA ,&nbsp;Wanjiang Wu MA ,&nbsp;Jiantao Shi MD ,&nbsp;Rong Hu MD ,&nbsp;Jiangkai Lin MD ,&nbsp;Weihua Chu MD","doi":"10.1016/j.spinee.2024.08.005","DOIUrl":"10.1016/j.spinee.2024.08.005","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The nomenclature, classification, and surgical approaches for spinal dural cysts (SDCs) remain a subject of controversy.</div></div><div><h3>PURPOSE</h3><div>The present study proposes a novel subtype classification system and corresponding surgical strategies, with the aim of enhancing comprehension of this entity and standardizing surgical treatment.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective review.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 104 patients with SDCs underwent novel subtype classification and corresponding surgical strategies from January 2015 to December 2021. Fifty-four patients who underwent conventional surgery from January 2012 to December 2014 as the control group for preliminary validation.</div></div><div><h3>OUTCOME MEASURES</h3><div>The outcomes are categorized into 4 levels: excellent, good, unchanged, and deteriorated, based on neurological improvement and pain relief. Grades of excellent and good were identified as improvements. Follow-up magnetic resonance imaging and complications were also evaluated.</div></div><div><h3>METHODS</h3><div>Based on the shared pathogenic factor of dural defects, the dural-associated cysts in the spinal canal are uniformly referred to as SDCs. They are further classified into Type 1 (no nerve roots) and Type 2 (containing nerve roots), with 4 additional subtypes based on the shape of the leak and the flow of leakage. The fissure-shaped leak of Type 1a SDCs is directly sutured, whereas the aperture-shaped leak of Type 1b is repaired using a patch. Low-flow leakage of Type 2a is directly sealed using a combination of adipose tissue and fibrin glue, whereas high-flow Type 2b necessitates suturing at the end of the leak to attenuate cerebrospinal fluid flow prior to sealing.</div></div><div><h3>RESULTS</h3><div>The follow-up period averaged 23.8 months. Excellent or good outcomes were achieved in 100%, 88.9%, 100%, and 97.3% for the 4 subtypes respectively. The overall improvement rate of SDCs was 97.1%, which was significantly higher than that of the conventional surgery group (85.2%, p=.008). MRI follow-up showed a significant reduction in cyst size of 100%, 100%, 97.8%, and 97.3% for the 4 subtypes, respectively. The primary complications included pseudomeningocele in 4 cases (3.8%) and delayed wound healing in 5 cases (4.8%). The complication rate was also significantly lower than that of the control group (8.7% vs 24.1%, p=.008).</div></div><div><h3>CONCLUSIONS</h3><div>Subtyping SDCs based on the variation of leaks and leakage can enable more targeted surgical strategies, which are helpful for improving treatment effectiveness and reducing complications.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2322-2333"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic outcomes and complications of anterior column realignment (ACR): a systematic review","authors":"Gregory M. Mundis Jr MD ,&nbsp;Hazem Elsebaie MD ,&nbsp;Bahar Shahidi DPT, PhD ,&nbsp;Isaiah Love BS ,&nbsp;Pearce B. Haldeman BS ,&nbsp;Robert K. Eastlack MD ,&nbsp;Behrooz A. Akbarnia MD","doi":"10.1016/j.spinee.2024.08.003","DOIUrl":"10.1016/j.spinee.2024.08.003","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.</div></div><div><h3>PURPOSE</h3><div>To determine the efficacy and complications rates associated with ACR.</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review.</div></div><div><h3>METHODS</h3><div>We queried the MEDLINE, Google Scholar, and EMBASE databases for all literature related to ACR procedure with a publication cutoff start date of January 1, 2010. This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. nonEnglish, nonhuman, case reports and review article publications were excluded.</div></div><div><h3>RESULTS</h3><div>A total of 298 studies were identified. Following screening of title, abstract, and full text, 16 articles were included in the review with a total 756 patients. All the studies included in this systematic review were retrospective case series with a level of evidence IV. Ten studies reported ACR-related complications, with an average rate of 27.2%. The rate of reoperations was reported in 5 studies, for which the average reoperation rate was 9.5%. Cage Subsidence (CS) occurred in 13.7%, Proximal Junctional Kyphosis (PJK) in 12.2%, neurologic injury in 7.3%, and Proximal Junctional Failure (PJF) in 2.7%. The vascular injury rate was 0.5%, with bowel perforation and ureteric injury occurring in 0.2%. For the Patient Reported Outcome Measures (PROMs) and radiological outcome analysis we excluded studies with less than 12 months follow up leaving 8 studies eligible for the analysis. There was a significant improvement of both local Motion Segment Angle (MSA) and Intra Discal Angle (IDA) with a mean segmental correction of 20° lordosis in the 3 studies that reported these parameters.</div></div><div><h3>CONCLUSION</h3><div>Based on the limited data available in this systematic review, the ACR technique has significant ability to restore and, when needed, correct the local segmental intervertebral angulation and thereby influencing the overall regional and global sagittal alignment. The associated risk of vascular, bowel, and nerve injury did not seem to be significantly higher in this review than other alternative lumbar interbody fusion techniques. Additional higher quality studies, including a consensus for reporting complications is required to reach definitive conclusions regarding its possible associated risks.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2273-2284"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase 3, randomized, double-blind, sham-controlled trial of SI-6603 (condoliase) in patients with radicular leg pain associated with lumbar disc herniation","authors":"Kee D. Kim MD ,&nbsp;Farshad Ahadian MD ,&nbsp;Hamid Hassanzadeh MD ,&nbsp;Jose Rivera MD ,&nbsp;Kenneth Candido MD ,&nbsp;Steven Gershon MD ,&nbsp;Anand Patel MD ,&nbsp;Pragya B. Gupta MD ,&nbsp;Alan E. Miller MD ,&nbsp;Ferdinand J. Formoso DO ,&nbsp;Thomas Fuerst PhD ,&nbsp;Evan Zucker MS ,&nbsp;Takayuki Seo PhD ,&nbsp;Jun Watanabe RPh, EMBA, MSc ,&nbsp;Yukihiro Matsuyama MD ,&nbsp;Kazuhiro Chiba MD, PhD ,&nbsp;Kevin E. Macadaeg MD","doi":"10.1016/j.spinee.2024.08.006","DOIUrl":"10.1016/j.spinee.2024.08.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;SI-6603 (condoliase) is a chemonucleolytic agent approved in Japan in 2018 for the treatment of lumbar disc herniation (LDH) associated with radicular leg pain. Condoliase, a mucopolysaccharidase with high substrate specificity for glycosaminoglycans (GAGs), offers a unique mechanism of action through the degradation of GAGs in the nucleus pulposus. As LDH management is currently limited to conservative approaches and surgical intervention, condoliase could offer a less invasive treatment option than surgery for patients with LDH.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The Discovery 6603 study (NCT03607838) evaluated the efficacy and safety of a single-dose injection of SI-6603 (condoliase) vs sham for the treatment of radicular leg pain associated with LDH.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A randomized, double-blind, sham-controlled, phase 3 study conducted across 41 sites in the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Male and female participants (N=352; aged 30–70 years) with contained posterolateral LDH and unilateral radiculopathy/radicular leg pain for greater than 6 weeks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary endpoint was the change from baseline (CFB) in average worst leg pain score at 13 weeks, assessed using the 100-mm visual analogue scale. Key secondary endpoints were CFB in average worst leg pain score at 52 weeks, herniation volume at 13 weeks, and Oswestry Disability Index (ODI) score at 13 weeks. Safety evaluations included adverse events (AEs) and imaging findings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Participants were randomized 1:1 to receive a single intradiscal injection of condoliase (1.25 units) or sham injection followed by 52 weeks of observation. The primary and key secondary endpoints were assessed using a mixed model for repeated measures (MMRM) analysis and a protocol-specified multiple imputation (MI) sensitivity analysis on the modified intention-to-treat (mITT) population. A prespecified serial gatekeeping algorithm was used for multiple comparisons. Safety endpoints included AEs, laboratory tests, vital signs, imaging (by X-ray and magnetic resonance imaging [MRI]), and occurrence of posttreatment lumbar surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of the 352 randomized participants, 341 constituted the mITT population (condoliase n=169; sham n=172) and the safety population (condoliase n=167; sham n=174). For the primary endpoint, the condoliase group showed significantly greater improvement in CFB in worst leg pain at Week 13 (least squares mean [LSM] CFB: −41.7) compared with sham injection (−34.2; LSM difference: −7.5; 95% confidence interval [CI]: −14.1, −0.9; p=.0263) based on the MMRM analysis. CFB in worst leg pain at Week 52 favored condoliase vs sham, but the difference was not statistically significant (p=.0558), which halted the serial gatekeeping testing algorithm and dictated that the CFB in herniation volume","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2285-2296"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric proof-of-concept study","authors":"Miguel A. Ruiz-Cardozo MD, MPH ,&nbsp;Karma Barot BA, MA ,&nbsp;Samuel Brehm BS ,&nbsp;Tim Bui BS ,&nbsp;Karan Joseph BS ,&nbsp;Michael Ryan Kann BE ,&nbsp;Gabriel Trevino PhD ,&nbsp;Michael Olufawo MBA ,&nbsp;Som Singh MD ,&nbsp;Alexander T. Yahanda MD ,&nbsp;Alexander Perdomo-Pantoja MD ,&nbsp;Julio J. Jauregui MD ,&nbsp;Magalie Cadieux MD, MMSc ,&nbsp;Brian J. Ipsen MD ,&nbsp;Ripul Panchal DO ,&nbsp;Kornelis Poelstra MD, PhD ,&nbsp;Michael Y. Wang MD ,&nbsp;Timothy F. Witham MD ,&nbsp;Camilo A. Molina MD","doi":"10.1016/j.spinee.2024.08.012","DOIUrl":"10.1016/j.spinee.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>The accurate and safe positioning of cervical pedicle screws is crucial. While augmented reality (AR) use in spine surgery has previously demonstrated clinical utility in the thoracolumbar spine, its technical feasibility in the cervical spine remains less explored.</div></div><div><h3>Purpose</h3><div>The objective of this study was to assess the precision and safety of AR-assisted pedicle screw placement in the cervical spine.</div></div><div><h3>Study Design</h3><div>In this experimental study, 5 cadaveric cervical spine models were instrumented from C3 to C7 by 5 different spine surgeons. The navigation accuracy and clinical screw accuracy were evaluated.</div></div><div><h3>Methods</h3><div>Postprocedural CT scans were evaluated for clinical accuracy by 2 independent neuroradiologists using the Gertzbein-Robbins scale. Technical precision was assessed by calculating the angular trajectory (°) and linear screw tip (mm) deviations in the axial and sagittal planes from the virtual pedicle screw position as recorded by the AR-guided platform during the procedure compared to the actual pedicle screw position derived from postprocedural imaging.</div></div><div><h3>Results</h3><div>A total of forty-one pedicle screws were placed in 5 cervical cadavers, with each of the 5 surgeons navigating at least 7 screws. Gertzbein-Robbins grade of A or B was achieved in 100% of cases. The mean values for tip and trajectory errors in the axial and sagittal planes between the virtual versus actual position of the screws was less than 3 mm and 30°, respectively (p&lt;.05). None of the cervical screws violated the cortex by more than 2 mm or displaced neurovascular structures.</div></div><div><h3>Conclusions</h3><div>AR-assisted cervical pedicle screw placement in cadavers demonstrated clinical accuracy comparable to existing literature values for image-guided navigation methods for the cervical spine.</div></div><div><h3>Clinical Significance</h3><div>This study provides technical and clinical accuracy data that supports clinical trialing of AR-assisted subaxial cervical pedicle screw placement.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2417-2427"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy","authors":"Sehan Park MD ,&nbsp;Gumin Jeong BA, MA ,&nbsp;Chang Ju Hwang MD, PhD,&nbsp;Jae Hwan Cho MD, PhD,&nbsp;Dong-Ho Lee MD, PhD","doi":"10.1016/j.spinee.2024.08.027","DOIUrl":"10.1016/j.spinee.2024.08.027","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Anterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR).</div></div><div><h3>PURPOSE</h3><div>To compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Propensity score-matched retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients with CMR who underwent ACDF or LPF and were followed up for at least 2 years.</div></div><div><h3>OUTCOME MEASURES</h3><div>C2–C7 lordosis, C2–C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed.</div></div><div><h3>METHODS</h3><div>The radiographic and clinical outcomes of the 2 groups were compared.</div></div><div><h3>RESULTS</h3><div>Eighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2–C7 lordosis (p&lt;.001) and ROM (p&lt;.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2 to C7 lordosis (p&lt;.001), while ACDF caused a significant decrease in cervical ROM (p&lt;.001). ACDF effectively improved neck pain VAS (p&lt;.001) and NDI (p&lt;.001), while neck pain did not significantly improve after LPF (p=.103). Furthermore, neck pain VAS (p=.026) and NDI (p=.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=.502; NDI, p=.085). Arm pain VAS and JOA score both significantly improved after LPF (p=.003 and 0.043, respectively) or ACDF (p&lt;.001 and 0.039, respectively), and postoperative results were not significantly different between the 2 groups.</div></div><div><h3>CONCLUSION</h3><div>LPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR.</div></div><div><h3>LEVEL Of EVIDENCE</h3><div>III.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2253-2263"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year patient reported outcomes after single-level lumbar fusion at orthopedic specialty hospital compared to tertiary referral center","authors":"Rajkishen Narayanan MD,&nbsp;Teeto Ezeonu BA,&nbsp;Jeremy C. Heard BS,&nbsp;Yunsoo Lee MD,&nbsp;Azra Dees,&nbsp;Goutham Yalla BS,&nbsp;Jose A. Canseco MD, PhD,&nbsp;Mark F. Kurd MD,&nbsp;Ian David Kaye MD,&nbsp;Barrett I. Woods MD,&nbsp;Alan S. Hilibrand MD,&nbsp;Alexander R. Vaccaro MD, PhD, MBA,&nbsp;Gregory D. Schroeder MD,&nbsp;Christopher K. Kepler MD, MBA","doi":"10.1016/j.spinee.2024.08.024","DOIUrl":"10.1016/j.spinee.2024.08.024","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The objectives of this study were (1) to determine if changes in patient reported outcome measures (PROMs) after elective lumbar spinal fusion surgery differ between patients who undergo surgery at an orthopedic specialty hospital (OSH) and those who undergo surgery at a tertiary referral center (TRC) and (2) to characterize differences in short-term outcomes between hospitals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Adult patients (≥18 years old) who underwent primary, elective single-level posterior lumbar decompression and fusion between January 2014 and December 2021 at a tertiary referral center or an orthopaedic specialty hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;PROMs: Oswestry Disability Index (ODI), Short-form 12 (SF12) Mental Component Summary (MCS); SF12 Physical Component Summary (PCS); Visual Analogue Back and Leg (VAS Back/Leg).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;PROMs were collected preoperatively, 6 months after surgery, and 1 year after surgery. Six-month and 1-year delta PROM values were calculated by subtracting the preoperative PROM score from the 6-month or 1-year score, respectively. Multivariable linear regression analyses were conducted to assess the independent effect of hospital location on postoperative PROM scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 288 patients were identified as part of the study cohort including 205 patients who underwent surgery at the tertiary hospital and 83 patients who underwent surgery at the OSH. OSH patients had shorter length of stay (1.57±0.72 vs 3.28±1.32, p&lt;.001), however there was no difference in discharge disposition or 90-day readmission rates between hospitals (p&gt;.05). At 6 months, having surgery at the specialty hospital was associated with higher PCS (estimate=2.96, confidence interval: 0.21–5.71, p=.035). At 1-year postoperatively, the location of surgery no longer demonstrated significant associations with PROM scores. Preoperative PROM scores demonstrated significant associations with 6-month and 1-year scores for each PROM (p&lt;.05) except VAS leg at 6 months postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;To our knowledge, this is one of the largest studies investigating PROMs at OSH versus TRCs for single-lev","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2297-2304"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term reoperation after decompression with versus without fusion among patients with degenerative lumbar spinal stenosis: a systematic review and meta-analysis.","authors":"Fon-Yih Tsuang, Yu-Lun Hsu, Tzu-Yi Chou, Chung Liang Chai","doi":"10.1016/j.spinee.2024.11.015","DOIUrl":"10.1016/j.spinee.2024.11.015","url":null,"abstract":"<p><strong>Background: </strong>The debate over adding fusion after decompression in lumbar spinal stenosis patients without spondylolisthesis is due to the \"absence of evidence\" in its benefits, particularly in reoperation. However, this \"absence of evidence\" does not indicate \"evidence of absence.\"</p><p><strong>Purpose: </strong>To investigate the reoperation rates following the addition of fusion after decompression in patients with lumbar spinal stenosis without spondylolisthesis.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched Medline, Embase, Web of Science, and Google Scholar databases on December 12, 2021, with an updated search conducted on April 06, 2023. Inclusion criteria were adult patients with lumbar spinal stenosis. Exclusions comprised cases of spondylolisthesis and instabilities. The occurrence of reoperation was summarized using odds ratios (OR), while other outcomes were presented as mean differences. We employed a Cox-based shared-frailty model with random effects for the time-to-event analysis of reoperation. Additionally, we used a 2-stage method to validate our estimates. Heterogeneity variance within the random-effects model was estimated using the Hartung-Knapp-Sidik-Jonkman method.</p><p><strong>Results: </strong>A total of 1973 studies were identified and screened, of which 48 met selection criteria, and 17 were included in the meta-analysis. Comparison between fusion and non-fusion groups in patients with lumbar stenosis and neurological claudication revealed no significant difference in reoperation rates (odds ratio: 1.13 [95% CI: 0.88 to 1.46]; 8016 participants; 14 studies; I² = 0%). Bayesian analysis indicated an 8.9-fold likelihood of similar reoperation rates. Time-to-reoperation analysis revealed a 16.46 months delay in the fusion group, though not statistically significant (mean difference: 16.46 [95% CI: -3.13-36.04]; 83 participants; 3 studies; I² = 46%). Consistently, ODI, back pain, and leg pain VAS showed no significant differences. The certainty of the evidence was low for odds of reoperation and leg pain VAS, and very low for the remaining outcomes.</p><p><strong>Conclusion: </strong>In lumbar spinal stenosis patients without spondylolisthesis, the addition of fusion after decompression showed limited benefits in terms of reoperation rates, ODI, and leg pain.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}