Spine Journal最新文献

{"title":"Does posterior longitudinal ligament resection during cervical artificial disc replacement affect the clinical or radiographic outcome?","authors":"Gumin Jeong, Dong-Ho Lee, Hyun Wook Gwak, Sehan Park, Chang Ju Hwang, Jae Hwan Cho","doi":"10.1016/j.spinee.2024.11.006","DOIUrl":"10.1016/j.spinee.2024.11.006","url":null,"abstract":"<p><strong>Background context: </strong>Much controversy exists about whether posterior longitudinal ligament (PLL) resection should be performed during cervical artificial disc replacement (ADR). The PLL can be resected or preserved during the ADR procedure based on the shape and location of the compressive pathology. However, unlike fusion operations, the outcomes of ADR may be affected by PLL resection since segmental motion is preserved with ADR and the PLL restricts flexion of the segment. Nevertheless, the effect of PLL removal during ADR in a clinical setting remains unclear.</p><p><strong>Purpose: </strong>To investigate the effect of PLL resection on the clinical or radiographic outcomes of ADR.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 113 patients who completed a minimum follow-up of 2 years after one-level ADR.</p><p><strong>Outcome measures: </strong>Global cervical sagittal parameters, including C2-7 range of motion, C2-7 flexion and extension capacity, segmental cervical sagittal parameters, including segmental range of motion, segmental flexion and extension capacity, adjacent segmental disease (ASD), and heterotopic ossification (HO) were assessed. Patient-reported outcome measures, including the neck pain visual analog scale (VAS), arm pain VAS, and neck disability index, were recorded.</p><p><strong>Methods: </strong>This study analyzed patients who underwent one-level ADR for soft disc herniation with or without PLL resection. ADR was performed for central or posterolateral soft disc herniation causing cervical radiculopathy or myelopathy, and a minimum 2-year follow-up. The results were compared between the PLL-preservation and -resection groups.</p><p><strong>Results: </strong>The PLL-preservation group included 55 of the 96 patients (57.3%), and the PLL-resection group contained the other 41 patients (42.7%). The baseline patient characteristics did not differ significantly between the two groups. Furthermore, global cervical radiologic parameters, segmental sagittal parameters, and the incidence of HO or ASD at the 2-year postoperative follow-up did not differ significantly between the two groups. The patient-reported outcome measures improved significantly after surgery in both groups, without significant intergroup differences at any time point.</p><p><strong>Conclusions: </strong>Resection of the PLL does not seem to have a significant effect on the range of motion or patient-reported symptoms. Therefore, the decision to resect the PLL during ADR should be based solely on whether it is needed for adequate decompression.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755635","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":"Value of metagenomic next-generation sequencing in the diagnosis of native pyogenic spinal infections: a multicenter, retrospective observational study.","authors":"Zhaohui Li, Qiang Zhang, Xiaofeng Lian, Chuqiang Yin, Yuhan Lin, Yuelei Wang, Zengshuai Han, Feng Shen, Yidan Xu, Huafeng Wang, Ting Wang","doi":"10.1016/j.spinee.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.11.004","url":null,"abstract":"<p><strong>Background context: </strong>The etiological diagnosis of pyogenic spinal infection is crucial for its precise antibiotic treatment. Traditional methods of detection are often slow and ineffective. In recent times, metagenomic next-generation sequencing (mNGS) has revolutionized pathogen detection, offering a more effective approach to disease management.</p><p><strong>Purpose: </strong>Comparing mNGS with microbial culture to comprehensively explore the diagnostic value of mNGS in pyogenic spinal infections.</p><p><strong>Design: </strong>A multicenter, retrospective observational study.</p><p><strong>Patient sample: </strong>In a multicenter retrospective observational study, we analyzed the data from 301 patients admitted in 4 selected hospitals with pyogenic spinal infections from December 2019 to February 2024.</p><p><strong>Outcome measures: </strong>Identification of pathogenic bacteria in patients.</p><p><strong>Methods: </strong>Obtain blood and lesion tissue or pus samples from the enrolled patients for microbial culture, serological and hematological laboratory tests, pathological examination, and mNGS analysis, followed by a comparative analysis of the results.</p><p><strong>Results: </strong>In our cohort of 301 cases of clinically diagnosed pyogenic spinal infections, 242 yielded etiological evidence. The most common gram-positive bacterium was Staphylococcus aureus, and the most common gram-negative bacterium was Escherichia coli. mNGS showed a significantly higher rate of detection (77.9%) compared with microbial culture (27.2%) with a notable difference (X² = 140.17, P < 0.001). In culture-negative samples, mNGS could detect pathogens in 73.1% of cases, and in culture-positive samples, it could detect pathogens in 91.5% of cases with 94.7% genus-level concordance. mNGS provided faster results (24-48 h) compared with the culture method (2-7 days).</p><p><strong>Conclusions: </strong>mNGS serves as a valuable supplement to the culture method and shows potential in identifying the causative pathogen in native pyogenic spinal infections.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774087","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":"Finite element analysis of additive manufactured porous peek artificial vertebral bodies in lumbar total en bloc spondylectomy.","authors":"Bingjin Wang, Mingtao Liu, Wencan Ke, Wenbin Hua, Xianlin Zeng, Cao Yang","doi":"10.1016/j.spinee.2024.10.026","DOIUrl":"10.1016/j.spinee.2024.10.026","url":null,"abstract":"<p><strong>Background: </strong>Lumbar total en bloc spondylectomy and internal fixation allows the removal of spinal tumors and the reconstruction of spinal stability. However, postoperative internal fixation failure due to unmatched spinal biomechanics remains obscure.</p><p><strong>Purpose: </strong>This study aimed to assess the biomechanical characteristics of additive manufactured (AM) porous polyetheretherketone (PEEK) artificial vertebral body for total en bloc spondylectomy and internal fixation.</p><p><strong>Study design/setting: </strong>Comparative finite element (FE) study.</p><p><strong>Methods: </strong>We created porous artificial vertebral bodies using medical-grade PEEK filaments and fused deposition modeling (FDM) technology, and evaluated the mechanical properties of the solid and porous implants. A finite element model of intact L1-L5 was created to analyze biomechanical characteristics of 5 operative constructs for reconstructing the lumbar anterior column. The lumbar anterior column was reconstructed using a titanium alloy mesh and bone graft (Ti+B) and AM PEEK artificial vertebral bodies with solid or porous structures. The maximum von Mises stresses of implants and adjacent structures were analyzed and compared under physiological conditions.</p><p><strong>Results: </strong>AM PEEK artificial vertebral bodies reduced von Mises stress on the artificial vertebral body, adjacent vertebral bodies, and intervertebral discs. The AM porous PEEK artificial vertebral body (PEEK-500) exhibited the lowest von Mises stress of the artificial vertebral body, adjacent vertebral bodies, and intervertebral discs.</p><p><strong>Conclusions: </strong>Ti+B increased the maximum stress on adjacent vertebral bodies, suggesting that it has the potential for mesh subsidence. Moreover, PEEK-500 had minimal impact on the internal implants and adjacent structures. This indicated that the lumbar anterior column reconstructed with AM porous PEEK artificial vertebral bodies may decrease the risk of postoperative internal fixation failure and adjacent segment degeneration.</p><p><strong>Clinical significance: </strong>Manufactured porous PEEK artificial vertebral bodies demonstrated a minimal impact on both the internal implants and adjacent structures. This suggests that reconstructing the lumbar anterior column with AM porous PEEK artificial vertebral bodies can decrease the risk of postoperative internal fixation failure and adjacent segments degeneration.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774077","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":"Cervical disc arthroplasty is safe across various obesity levels.","authors":"Manjot Singh, Benjamin Chanes, Mariah Balmaceno-Criss, Alan H Daniels, Andrew S Zhang","doi":"10.1016/j.spinee.2024.11.008","DOIUrl":"10.1016/j.spinee.2024.11.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;As surgical indications for cervical disc arthroplasty (CDA) continue to expand, a growing patient population is now becoming indicated for this procedure. Little is known about whether CDA is safe in the overweight and obese populations, and how this procedure compares to anterior cervical discectomy and fusion (ACDF) in this particular demographic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the outcomes of CDA across varying levels of body mass indices and to compare these to ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 12,454 patients who underwent CDA and 45,513 patients who underwent ACDF between 2011 and 2020 were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The following data were observed for all cases: patient demographics, complications, revisions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PearlDiver database was queried to identify all adults who underwent single-level CDA. Patients were stratified by body mass index (BMI), defined as Healthy Weight (&lt;25kg/m2), Overweight (25-30kg/m2), Obese (30-40kg/m2), and Morbidly Obese (&gt;40kg/m2). Patient demographics and comorbidities were compared before matching, and medical and surgical complications were compared after matching for age, sex, and Charlson Comorbidity Index (CCI). Similar comparative analyses were performed on all obese patients (&gt;30kgm/2) who underwent single-level CDA and single-level ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 1907 Healthy Weight, 3295 Overweight, 5431 Obese, and 1821 Morbidly Obese patients were included. The mean age was between 45.43 and 47.41 years, 57.12% and 71.68% were female, and mean CCI was 1.16-1.73 across groups (all p&lt;.001). Mean CCI (Healthy Weight=1.16, Overweight=1.31, Obese=1.47, Morbidly Obese=1.63) and rate of comorbidities, such as diabetes (19.19%, 25.74%, 37.51%, 48.65%), hypertension (45.20%, 56.18%, 69.21%, 76.22%), and hyperlipidemia (49.34%, 60.61%, 65.33%, 64.96%), generally increased with increasing BMI (p&lt;.001). After matching, mean age was 44.59 years, 70.98% were female, and mean CCI was 1.07 for all groups. At 90 days postoperatively, medical complications, including infection, wound dehiscence, and readmissions, were comparable (p&gt;.05). At 2 years postoperatively, anterior revision was higher in Healthy Weight patients (30.27%, 28.11%, 24.71%, 24.96%, p=.005) but other surgical complications, including dysphagia, dysphonia, and implant failure, were otherwise comparable (p&gt;.05). Comparison of all obese patients across cervical procedures revealed higher rates of 90-day emergency department visits (ACDF=21.56% vs 16.65%, p&lt;.001) and 1-year hardware removal (1.49% vs 0.81%, p=.002), wound exploration (0.73% vs 0.35%, p=.018), and posterior fusion (1.14% vs 0.44%, p&lt;.001) and lower rates of anterior revision (18.82% vs 23.68%, p&lt;.001) in ACDF patients compared to CDA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755626","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":"Determining the normative reference values for acute-phase inflammatory markers 3 days after lumbar fusion surgery by using the e-norms method.","authors":"Shenyan Gu, Kaiwen Chen, Dongqing Zhu, Feizhou Lyu, Jianyuan Jiang, Xinlei Xia, Joe F Jabre, Chaojun Zheng","doi":"10.1016/j.spinee.2024.11.016","DOIUrl":"10.1016/j.spinee.2024.11.016","url":null,"abstract":"<p><strong>Background context: </strong>Surgical site infection (SSI) is a devastating complication that greatly increases the duration of hospital stays, health care costs and morbidity/mortality rates. Therefore, early diagnosis and treatment are also very important. Postoperative inflammatory markers are usually used to screen for SSI. However, the feasibility of these markers for the early detection of SSI remains unclear since it is not ideal to use a marker for which normative reference values do not exist.</p><p><strong>Purpose: </strong>To validate the use of the e-norms method for establishing a normative reference range for acute-phase inflammatory marker levels 3 days after lumbar fusion surgery for early screening of postoperative SSI.</p><p><strong>Study design: </strong>A retrospective analysis.</p><p><strong>Patient sample: </strong>This study included 907 patients who underwent lumbar fusion surgery (SSI vs. non-SSI: 28 vs. 879).</p><p><strong>Outcome measures: </strong>White blood cell (WBC) count, neutrophils count, lymphocyte count, C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR).</p><p><strong>Methods: </strong>We applied the e-norms method to calculate reference values for postoperative 3-day CRP, ESR, and differential WBC count in all 907 patients included in this study and compared these reference values with those calculated via conventional methods (data from non-SSI patients).</p><p><strong>Results: </strong>According to the e-norms method, the normal WBC count was 10.8±1.2 (x10^9/L), neutrophils count was 8.7±1.1 (x10^9/L), lymphocyte count was 1.6±0.3 (x10^9/L), CRP concentration was 31.2±10.8 mg/L, and ESR was 23.6±4.7 mm/h. The mean values obtained via the e-norms and conventional methods were almost identical, but the range of normative reference values obtained via the conventional methods was relatively wider. Importantly, the frequency of SSI patients with abnormal inflammatory markers identified by the e-norms method was higher than that of patients with abnormal inflammatory markers identified by the conventional methods (21/28, 75.0% vs. 6/28, 21.4%; p<.05).</p><p><strong>Conclusions: </strong>The results of this study demonstrated that the reference values retrieved using e-norms were more effective for screening postoperative SSI than the reference values calculated using conventional methods. Thus, e-norms may be an alternative reliable and time-saving approach to establishing reference values for acute-phase inflammatory markers after spinal surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755633","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":"Sacroiliitis: current imaging modalities and future directions: a narrative review.","authors":"Meghana Bhimreddy, Carly Weber-Levine, Kelly Jiang, Smruti Mahapatra, Hendrick Francois, Atta Boateng, A Daniel Davidar, Louis Chang, Nicholas Theodore","doi":"10.1016/j.spinee.2024.11.011","DOIUrl":"10.1016/j.spinee.2024.11.011","url":null,"abstract":"<p><p>Sacroiliitis, or inflammation of one or both of the sacroiliac joints (SIJs), can be difficult to distinguish from other etiologies of lower back and buttock pain due to diverse patient presentations and a lack of highly sensitive and specific diagnostic modalities. Although physical examination, provocation tests, and an SIJ block test are informative, confirmatory imaging is often required to improve diagnostic accuracy. Radiography and magnetic resonance imaging (MRI) are the most popular imaging studies for this purpose, but other modalities such as computed tomography (CT), single-photon emission computed tomography (SPECT)/CT, positron emission tomography (PET)/CT, and ultrasonography are emerging as viable alternatives. This narrative review provides a comprehensive summary of the history, clinical use and limitations of each imaging modality in the diagnosis of sacroiliitis. Novel techniques in image acquisition and analysis, such as digital tomosynthesis (DT), volumetric interpolated breath-hold examination (VIBE) MRI and dual energy CT (DECT) are also discussed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755740","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":"Attitudes regarding barriers to entry and the learning curve associated with endoscopic decompression-only surgery: an international survey.","authors":"Murad Alostaz, Peter Derman, Patricia Lipson, Jerry Du, Raymond Gardocki, Christoph Hofstetter, Michael Wang, Sheeraz Qureshi, Philip K Louie","doi":"10.1016/j.spinee.2024.11.009","DOIUrl":"10.1016/j.spinee.2024.11.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Endoscopic spine decompression surgery (ESDS) offers numerous benefits, including reduced tissue damage, smaller incisions, shorter recovery times, and a lower risk of complications. However, its adoption among spine surgeons in the United States has been slow. The reluctance to adopt ESDS can be attributed to factors such as the learning curve, cost of equipment and training, and limited access to necessary resources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The primary objective of this study is to assess attitudes toward barriers to and reasons for not adopting ESDS. A secondary objective is to further identify the learning curves, challenges, and common concerns of surgeons considering ESDS adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;An international survey of fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery (SMISS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 171 fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery voluntarily and anonymously responded to our survey via the RedCap platform. Surgeons were located across the globe, representing six regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Data on current region of practice, specialty training, time in practice, practice type, and surgical volume was obtained for each surgeon who responded to the survey. Additionally, we obtained data on perceived benefits, barriers to entry, and the learning curve of endoscopic techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A survey was distributed to fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery, with questions focusing on perceived benefits, barriers to adoption, and the learning curve of endoscopic techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 171 surgeons responded to the survey, representing six regions: North America (48.0%), Asia Pacific (28.7%), and Europe (11.7%). Respondents were trained in Orthopaedic Surgery (59.1%) and Neurological Surgery (35.7%). Experience varied, with 35.9% having over 20 years in practice. Most respondents were in Private Practice (59.6%) or Academic/University settings (39.2%), with the majority practicing in urban areas (67.8%). Surgeons were categorized into the EG (50.3%) who used endoscopic techniques and the NEG (49.7%) who did not. There were no significant differences in training types or work settings between the groups. For the NEG, 23.5% were exposed to endoscopic techniques during training, and 50.6% received specific training in practice, mainly through formal industry courses (76.7%). The primary barriers to adopting ESDS were lack of training (55.3%), unavailability of equipment (50.6%), and financial concerns. EG surgeons cited minimizing tissue trauma, improved access to foraminal pathology, and minimizing recovery time as critical factors for using ESDS. Challenges included concerns for incomplete decompression and the duration of s","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755624","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":"Is cervical disc arthroplasty an effective treatment option for patients with cervical spondylotic myelopathy? A matched cohort analysis compared to anterior cervical discectomy and fusion.","authors":"George Abdelmalek, Harjot Uppal, Daniel Coban, Neil Patel, Stuart Changoor, Nikhil Sahai, Kumar Sinha, Ki Hwang, Arash Emami","doi":"10.1016/j.spinee.2024.11.003","DOIUrl":"10.1016/j.spinee.2024.11.003","url":null,"abstract":"<p><strong>Background context: </strong>Cervical spondylotic myelopathy (CSM) is a progressive condition characterized by spinal cord compression secondary to disc degeneration. While anterior cervical discectomy and fusion (ACDF) has long been considered the standard surgical treatment for CSM, loss of motion segments after this procedure may lead to sequelae, including adjacent segment disease (ASD), further propagating loss of function and the potential requirement for revision procedures. More recently, cervical disc arthroplasty (CDA) has been introduced as a motion-preserving alternative to ACDF in CSM.</p><p><strong>Purpose: </strong>This study compares ACDF to CDA in patients with preoperative CSM.</p><p><strong>Study design/setting: </strong>A matched cohort retrospective study.</p><p><strong>Patient sample: </strong>About 110 patients were included in the final analysis; 55 underwent ACDF, and 55 underwent CDA.</p><p><strong>Outcome measures: </strong>Complication rates, myelopathic severity measured by the Nurick scale, and patient-reported outcomes measured by VAS-neck, VAS-arm, and NDI scores METHODS: We examined patients who underwent either one or two-level ACDF or CDA with a minimum follow-up of 2 years. Patients were matched for age, sex, comorbid conditions, preoperative myelopathy severity, and the number of indicated operative levels. Demographics, perioperative data, and complication rates were compared between the two cohorts of patients. Patient-reported outcome measures were assessed at multiple follow-up intervals.</p><p><strong>Results: </strong>No significant differences were observed in demographics or perioperative data. Overall complication rates were similar between the two cohorts (p=.167). Rates of dysphagia (p=1.00), dysphonia (p=.157), infection (p=1.00), construct failure (p=.154), heterotopic ossification (p= .132), and ASD (p=.315) were similar between the two groups. Furthermore, revision rates were similar between the two groups (p=.315). No significant differences were observed in median postoperative Nurick scores between the two cohorts (p=1.00). NDI improvements were greater in the CDA cohort (p=.040).</p><p><strong>Conclusions: </strong>ACDF and CDA had statistically similar complication rates and improvements in myelopathic symptoms. However, patients who underwent CDA had superior PROMs to those who had undergone ACDF.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752023","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":"Effect of Industry Funding on Outcome Reporting in Cervical Disc Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Athan G Zavras, Jonathan R Acosta, Hareindra R Jeyamohan, Garrett M Breyer, Kyle J Holmberg, Boyle C Cheng, Daniel T Altman, Ryan D Sauber","doi":"10.1016/j.spinee.2024.11.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.11.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Cervical Disc Arthroplasty (CDA) has been shown to be an effective and safe alternative to Anterior Cervical Discectomy and Fusion (ACDF), with randomized controlled trials (RCTs) reporting non-inferior or even favorable outcomes to ACDF. However, the current literature of large RCTs reporting long-term outcomes of CDA primarily comprises of the industry sponsored Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials. As a result, CDA has yet to be universally accepted by surgeons due to concerns of bias in the current literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the outcomes of single-level CDA and ACDF by conducting a meta-analysis of RCTs, with a subgroup comparison of IDE and non-IDE trial results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;19 studies (9 IDE, 10 non-IDE) reporting the outcomes of 18 RCTs were included with a total of 3054 patients (1691 CDA and 1363 ACDF). Among CDA patients, 1229 (72.7%) were enrolled in an FDA IDE trial, while 462 (27.3%) were involved in RCTs that were not funded by industry. Minimum follow-up among the RCTs included ranged from 2-10 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Outcomes of interest included index and adjacent segment reoperation rates, postoperative disability as reported by the Neck Disability Index (NDI), and the Visual Analog Scale (VAS) for Neck and Arm pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A random effects meta-analysis was performed comparing CDA and ACDF by pooling the outcomes of all RCTs for each outcome of interest. A subgroup analysis was then performed comparing the pooled outcomes of the FDA IDE trials and non-IDE RCTs. Standardized mean differences (SMD) and log relative risk (RR) were used to analyze continuous and categorical variables with corresponding 95% confidence intervals (CI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among all RCTs, there was a significantly lower risk for all secondary surgical interventions with CDA relative to ACDF (RR: 0.91, 95% CI: 0.55 - 1.28; p &lt; 0.0001) in addition to lower risk for adjacent segment surgery (RR: 1.06, 95% CI: 0.66 - 1.45; p &lt; 0.0001), and index segment reoperation (RR: 0.48, 95% CI: 0.005 - 0.96; p = 0.048). No significant differences in NDI, VAS Neck, or VAS Arm were found in the analyses comparing ACDF and CDA (p &gt; 0.05). When comparing between the IDE and non-IDE trial subgroups, there were no significant differences noted in any assessed outcome (p &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Cervical disc arthroplasty appears to be equivalent to ACDF in reducing postoperative pain and disability, while also potentially decreasing the risk for subsequent surgical intervention, as demonstrated by the FDA IDE trials and non-IDE RCTs without industry ties. While a large number of high-quality trials for CDA do pose a risk for bias due to industry sponsorship, the current literature of h","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755638","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":"Spinal cord blood flow elevation with systemic vasopressor noradrenaline is partly mediated by vasodilation of spinal arteries due to reduced expression of alpha adrenoreceptors.","authors":"Seyar Entezari, Mathias Møller Thygesen, Christian Staehr, Elizaveta Melnikova, Mathias Skov, Rajkumar Rajanathan, Mads Rasmussen, Mikkel Mylius Rasmussen, Vladimir V Matchkov","doi":"10.1016/j.spinee.2024.11.010","DOIUrl":"10.1016/j.spinee.2024.11.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Elevation of mean arterial blood pressure (MAP) has been proposed to raise spinal cord blood flow (SCBF) after traumatic spinal cord injury (TSCI). Current clinical guidelines for cervical TSCI suggest maintaining MAP 85-90 mmHg for 5-7 days using vasopressors, eg, noradrenaline. However, it remains unknown whether these interventions that promote an increased systemic MAP result in improved perfusion in the spinal cord. The local effect of vasopressors on the spinal cord arteries also remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of this study was to investigate whether the increased systemic MAP results in increased SCBF, and secondly, to examine the mechanism behind noradrenaline (NA) action in spinal cord arteries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;An experimental animal study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study included nine 38-42 kg landrace pigs. In six pigs, MAP was gradually elevated using NA and continuous SCBF was recorded by laser doppler flowmetry. Spinal cord samples from these 6 pigs were excised for isolation of spinal cord arteries that were used for ex-vivo vascular function assessment in isometric myograph. Segments of mesentery from another 3 pigs were used to dissect mesenteric small arteries that were also studied in myograph, as control peripheral arteries. Other spinal cord and mesenteric arterial segments from the same biopsies were dissected and snap-frozen for the following expression analysis. Adrenoceptor's expression in arteries of all included animals was assessed with quantitative PCR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The controlled mixed model found that SCBF was lower at MAP below 50 mmHg and that SCBF increased significantly in the MAP range of 50-100 mmHg (p=.02). Further increase of MAP did not significantly affect SCBF (at MAP range of 100-150 mmHg, p=.15; at 150-200 mmHg, p=.51). However, SCBF significantly increased over the study time-course (at 80 min, p=.002; at 100 min, p&lt;.001), which was dependent on the experimental duration being a confounder of increased exposure to large doses of NA. Isolated spinal arteries did not contract to NA ex-vivo and even showed a tendency for vasorelaxation. This relaxation was abolished by β-adrenoceptor inhibitor, propranolol. In contrast, mesenteric arteries were contracted by NA and propranolol potentiated this contraction. Mesenteric arteries showed a higher expression of α1A adrenoceptors than spinal arteries, while no significant difference was found in other adrenoceptor isoforms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We found SCBF reduced at MAP below 50 mmHg and that the SCBF increased significantly in MAP range between 50 and 100 mmHg. Elevating MAP above 100 mmHg was not associated with a further increase in SCBF. We also showed that NA increases SCBF in-vivo and relaxes spinal arteries ex-vivo. This effect was associated with a low arterial expression of α adrenoceptors over β adrenoceptors in the spin","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755742","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}