Asian Spine Journal最新文献

{"title":"Nonlaminotomy bilateral decompression: a novel approach in biportal endoscopic spine surgery for spinal stenosis.","authors":"Dae-Young Lee, Hee Soo Kim, Si-Young Park, Jun-Bum Lee","doi":"10.31616/asj.2024.0210","DOIUrl":"https://doi.org/10.31616/asj.2024.0210","url":null,"abstract":"<p><p>Biportal endoscopic spine surgery (BESS) is an emerging technique for lumbar spinal stenosis. Previous BESS techniques involve partial osteotomy for access to spinal canal such as partial laminotomy, partial facetectomy, and other forms to access the spinal canal for decompression. However, approaches that include osteotomy can cause bone bleeding intraoperatively, leading to obscured vision, and may be at risk of postoperative facet arthritis and segmental instability due to damage to the posterior stability structure. This study aimed to introduce a BESS technique, i.e., nonlaminotomy bilateral decompression (NLBD) that allows for decompression through the interlaminar space without damaging the posterior bony structures. For this, various sizes of curved curettes are mainly used than Kerrison rongeurs. The small tip of the curved curette allows it to reach any part of the spinal canal through the interlaminar space, and its rounded back reduces the risk of nerve damage during decompression. In addition, by changing the portals, decompression through the interlaminar space can be performed without osteotomy. Nine checkpoints were assessed for the complete decompression during surgery. In conclusion, NLBD is an alternative BESS approach that achieves adequate decompression while preserving the posterior structure as much as possible.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis.","authors":"Mahmoud Fouad Ibrahim, Ahmed Shawky Abdelgawaad, Essam Mohammed El-Morshidy, Amr Hatem, Mohamed El-Meshtawy, Mohammad El-Sharkawi","doi":"10.31616/asj.2024.0331","DOIUrl":"https://doi.org/10.31616/asj.2024.0331","url":null,"abstract":"<p><p>Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1-C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the visual body image classification in adolescent idiopathic scoliosis: a retrospective study.","authors":"Han Sol Kim, Jae Yoon Jeong, Yoon Jae Cho, Tae Sik Goh, Jung Sub Lee","doi":"10.31616/asj.2024.0201","DOIUrl":"https://doi.org/10.31616/asj.2024.0201","url":null,"abstract":"<p><strong>Study design: </strong>A prospective study.</p><p><strong>Purpose: </strong>To diagnose scoliosis, a visit to the hospital for radiography is typically necessary. In such cases, children with scoliosis are exposed to radiation, which may place their health at risk. Therefore, we sought to determine whether a classification method based on visual body images obtained through photography can be used to diagnose scoliosis.</p><p><strong>Overview of literature: </strong>Scoliosis can be diagnosed and classified into various types using radiographs. However, no studies have attempted to classify scoliosis based on visual body images.</p><p><strong>Methods: </strong>From January 1, 2019 to December 31, 2022, 136 patients newly diagnosed with Adolescent idiopathic scoliosis and 124 healthy candidates from our institution were enrolled. This study classified body images into five types based on visual confirmation of the positional relationship of the body. The accuracy of this classification method was identified by calculating its sensitivity, specificity, and reproducibility of this classification method within and between observers according to kappa value.</p><p><strong>Results: </strong>Overall, 136 patients and 124 control subjects who visited Pusan National University Hospital, Busan, Korea were photographed and compared by obtaining back images and X-ray radiographs. The sensitivity and specificity of the classification method showed a satisfactory-to-good degree of accuracy, although the degree varies depending on the visual body image type. The classification methods exhibited good intraobserver reliability (κ=0.855) and moderate interobserver reliability (κ=0.751).</p><p><strong>Conclusions: </strong>Our classification method showed a high degree of sensitivity and specificity (98.1% sensitivity, 98.9% specificity, and 98.4% accuracy) while exhibiting high reproducibility and ease of access. Based on our findings, we believe that our classification method can be used for scoliosis screening.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normative values of non-radiological surface measurement of the lumbar lordosis curvature in the standing position and its association with age, sex, and body mass index: a cross-sectional study of 2,500 healthy individuals from Iran.","authors":"Reza Rajabi, Magdalena Plandowska, Mohammad Bayattork","doi":"10.31616/asj.2024.0317","DOIUrl":"https://doi.org/10.31616/asj.2024.0317","url":null,"abstract":"<p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Purpose: </strong>This study aimed to define the normal values of the lumbar lordosis curve (LLC) and investigate its association with sex, age, and body mass index (BMI).</p><p><strong>Overview of literature: </strong>The importance of the human spine's sagittal alignment, particularly in the lumbar region, has been argued from the physiological and pathophysiological points of view. The LLC size is an important predictor of lumbar pathologies. Lumbar curvature misalignment, particularly increased lumbar lordosis or hypolordosis, can, in the long term, lead to spinal instability and development of disorders such as low back pain and spondylolisthesis Therefore, knowledge about the normal LLC value and its association with age, sex, and BMI, appears crucial.</p><p><strong>Methods: </strong>The study recruited 2,497 asymptomatic volunteers (1,264 women and 1,233 men) aged 5-85 years. Participants were assigned to different groups based on their sex, age, and BMI. The LLC was measured using a Flexicurve.</p><p><strong>Results: </strong>Normal LLC values were established for different sexes, age, and BMI groups. Overall, normal LLC ranges from 10.2° to 74.9° with a mean of 42.34°±13° (male, 38.57°±11.44°; female, 46°±13.38°). LLC was generally higher by 7.5° in women than in men. A significant three-way interaction of sex, age, and BMI with LLC was found. The association of age and BMI with LLC was also significant.</p><p><strong>Conclusions: </strong>Our results can be used as a reference by physicians, healthcare, etc., when the LLC values in different ages and sexes are measured noninvasively. In other words, this information can be used as reference when determining whether the obtained LLC is within the normal range.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A magnetic resonance imaging-based morphometric analysis of bilateral L1-L5 oblique lumbar interbody fusion corridor: feasibility of safe surgical approach and influencing factors.","authors":"Archit Goyal, Mayukh Guha, Rajat Mahajan","doi":"10.31616/asj.2024.0193","DOIUrl":"https://doi.org/10.31616/asj.2024.0193","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Purpose: </strong>To investigate the size and local anatomy of the right and the left-sided oblique corridors between L1-L5 levels and identify the potential impact of increasing age and sex on corridor size.</p><p><strong>Overview of literature: </strong>The oblique lumbar interbody fusion (OLIF) was introduced by Silvestre and his colleagues as a solution to the approach-related complications associated with anterior lumbar interbody fusion and lateral lumbar interbody fusion. Limited data were available describing the local anatomy and morphology of this approach.</p><p><strong>Methods: </strong>Imaging data of 300 patients (150 males and 150 females) who underwent 1.5T magnetic resonance imaging (MRI) scans of the lumbar spine at Indian Spinal Injuries Centre, New Delhi, India between January 2023 and January 2024 were retrospectively reviewed. The cohort was stratified into six age groups (21-30, 31-40, 41-50, 51-60, 61-70, and >70 years) with 25 patients in each age group for both sexes. T2 weighted axial MRI images were analyzed from the L1-L5 level at the mid-disc level to calculate the corridor size. The local anatomical differences were recorded.</p><p><strong>Results: </strong>At L1-L2, L2-L3, L3-L4, and L4-L5 levels, the mean corridor sizes in males were 17.48, 15.50, 13.41, and 9.32 mm on the left side, and 11.48, 7.12, 4.34, and 1.64 mm on the right side, respectively. The corresponding mean corridor sizes in females were 10.34, 12.94, 12.64, and 7.22 mm on the left side and 2.66, 3.52, 3.69, and 1.64 mm on the right side, respectively. For both sides, the corridor size was significantly affected by sex, increased with age, and decreased at the lower lumbar disc levels.</p><p><strong>Conclusions: </strong>A left-sided OLIF approach is more feasible for both sexes. The right-sided approach is less likely to be performed effectively.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative complications in patients aged ≥85 years undergoing spinal surgery: a retrospective comparative study of pre-old and old patients in Japan.","authors":"Takahiro Mui, Hideki Shigematsu, Masaki Ikejiri, Sachiko Kawasaki, Yasuhito Tanaka","doi":"10.31616/asj.2024.0215","DOIUrl":"https://doi.org/10.31616/asj.2024.0215","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Purpose: </strong>To compare the characteristics of perioperative complications in patients aged ≥85 years with those of younger patients undergoing similar spine surgery and examine factors associated with perioperative complications and clinical outcomes among patients aged ≥85 years.</p><p><strong>Overview of literature: </strong>The risk factors for perioperative complications and their effect on outcomes in patients aged ≥85 years remain unclear. Furthermore, no study has compared younger patients with similar surgeries and condition with those aged ≥85 years.</p><p><strong>Methods: </strong>The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75-84, and 65-74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications.</p><p><strong>Results: </strong>The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048).</p><p><strong>Conclusions: </strong>Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors related to surgical site infection in spinal instrumentation surgery: a retrospective study in Japan.","authors":"Kazumasa Konishi, Hideto Sano, Yosuke Kawano, Takehiko Moroi, Takumi Takeuchi, Masahito Takahashi, Naobumi Hosogane","doi":"10.31616/asj.2024.0274","DOIUrl":"https://doi.org/10.31616/asj.2024.0274","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>To identify factors involved in surgical site infections (SSIs) after spinal instrumentation surgery performed at a single institution.</p><p><strong>Overview of literature: </strong>SSIs after spinal instrumentation surgery are a serious complication. Despite reports on risk factors for SSIs in spine surgery, limited studies are related to spinal instrumentation surgery.</p><p><strong>Methods: </strong>In total, 828 patients (338 males and 490 females; mean age, 65.0 years) who underwent spinal instrumentation surgery from 2013 to 2021 in Kyorin University School of Medicinewere retrospectively investigated. Patients were divided into the SSI (group I) and non-SSI (group N) groups. Patient characteristics, comorbidity, laboratory, and surgical factors were investigated. Univariate analysis was performed for each item, and multivariate logistic regression analysis was performed for items with significant differences.</p><p><strong>Results: </strong>Fifteen patients (1.85%) had SSIs. Univariate analysis revealed significant differences between groups I and N in history of steroid use, serum albumin, C-reactive protein, number of fixed vertebrae, and perioperative blood transfusion. Multivariate logistic regression analysis showed that a history of steroid use (odds ratio [OR], 5.38; 95% confidence interval [CI], 1.41-20.49; p=0.014), serum albumin (OR, 0.34; 95% CI, 0.13-0.84; p=0.020), and perioperative blood transfusion (OR, 5.85; 95% CI, 1.46-23.50; p=0.013) were independent risk factors for SSIs.</p><p><strong>Conclusions: </strong>The results of this study indicate that preoperative nutritional intervention, appropriate management of anemia, and intraoperative and postoperative bleeding control may decrease the incidence of SSIs. However, this study has several limitations, including its retrospective design, analysis of a few SSI cases, and inclusion of various surgical approaches and disease types. Future studies that address these limitations are desirable.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel pedicle screw design to maximize screw-bone interface strength using finite element analysis and design of experiment techniques.","authors":"Arvind Kumar Prajapati, Parimanathukovilakom Ramavarma Harikrishna Varma, Gurunathan Saravana Kumar, Chirathody Vayalappil Muraleedharan, Ganesh Divakar","doi":"10.31616/asj.2024.0220","DOIUrl":"https://doi.org/10.31616/asj.2024.0220","url":null,"abstract":"<p><strong>Study design: </strong>Basic study.</p><p><strong>Purpose: </strong>This study aimed to utilize finite element (FE) analysis and design of experiment (DoE) techniques to propose and optimize a novel pedicle screw design and compare its pull-out force with that of a control device.</p><p><strong>Overview of literature: </strong>Pedicle screw-based fixation is the gold-standard treatment for spine diseases, particularly in fusion procedures. However, pedicle screw loosening and breakage still occur in osteoporotic and non-osteoporotic patients. This research investigates screw design modifications to enhance screw-bone interface strength and reduce the likelihood of loosening.</p><p><strong>Methods: </strong>We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation.</p><p><strong>Results: </strong>FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device.</p><p><strong>Conclusions: </strong>The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative advantages of activities with lumbosacral preservation for adult spinal deformity surgery: a retrospective Japanese cohort study.","authors":"Yoshinori Ishikawa, Takashi Kobayashi, Eiji Abe, Ryo Shoji, Naohisa Miyakoshi","doi":"10.31616/asj.2024.0217","DOIUrl":"10.31616/asj.2024.0217","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to demonstrate the advantages of preservation of the lumbosacral segment (LSS) in adult spinal deformity (ASD) surgery.</p><p><strong>Overview of literature: </strong>Sacroiliac foundation enables sufficient restoration in ASD surgery; however, it could result in poor mobility. Thus, whether LSS provides better activities is still unknown.</p><p><strong>Methods: </strong>Among 399 patients who underwent ASD surgery, 62 (≥5 levels fused, >2-year follow-up) underwent fusion from T9-10 to L5 (group L, n=21) or to S2-alar-iliac (group S, n=41). Spinal alignments, Scoliosis Research Society (SRS)-22 scores, performance of activities (clipping toenail, wiping buttock, and wearing socks), proximal and distal junctional failure (PJF+DJF), rod fractures (RFs), and overall revision rates (RRs) were compared between the groups.</p><p><strong>Results: </strong>Group L included younger patients and had longer follow-ups when compared with group S. Although the preoperative pelvic incidence and SRS sagittal modifiers were better in group L, postoperative spinal restorations were nonpathological in both groups. Both groups showed similar deformity progression at the 2-year follow-up; however, group L had lower SRS-22 pain scores. Although \"wiping buttocks\" did not differ between the groups, the performance of \"clipping toenails\" and \"wearing socks\" was poorer in group S at 2 years (possible, group S; 40% vs. group L; 85%-90%). The RRs did not differ between the groups; however, the PJF+DJF rate was higher in group L. DJF was not observed in group S, but occurrence of RFs was noted.</p><p><strong>Conclusions: </strong>Although poorer SRS-22 pain scores might be related to lumbosacral mobility, sufficient restoration, equivalent deformity progression, and similar RRs with better activity imply that lumbosacral preservation should be considered in younger patients with moderate deformities.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"699-705"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456894","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":"Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States.","authors":"Tyler Kade Williamson, Oluwatobi O Onafowokan, Ankita Das, Jamshaid Mahmood Mir, Oscar Krol, Peter Tretiakov, Rachel Joujon-Roche, Bailey Imbo, Salman Ahmad, Stephane Owusu-Sarpong, Jordan Lebovic, Shaleen Vira, Andrew J Schoenfeld, Muhammad Burhan Janjua, Bassel Diebo, Renaud Lafage, Virginie Lafage, Peter Gust Passias","doi":"10.31616/asj.2023.0388","DOIUrl":"10.31616/asj.2023.0388","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.</p><p><strong>Overview of literature: </strong>3COs are often required to correct severe, rigid ASD presentations. However, controversy remains on the utility of 3COs, particularly in primary surgery.</p><p><strong>Methods: </strong>Patients ASD having 2-year data were included and divided into 3CO and non-3CO (remaining ASD cohort) groups. For the subanalysis, patients were stratified based on whether they were undergoing primary (P3CO) or revision (R3CO) surgery. Multivariate analysis controlling for age, Charlson comorbidity index, body mass index, baseline pelvic incidence-lumbar lordosis, and fused levels evaluated the complication rates and radiographic and patient-reported outcomes between the 3CO and non-3CO groups.</p><p><strong>Results: </strong>Of the 436 patients included, 20% had 3COs. 3COs were performed in 16% of P3COs and 51% of R3COs. Both 3CO groups had greater severity in deformity and disability at baseline; however, only R3COs improved more than non-3COs. Despite greater segmental correction, 3COs had much lower rates of aligning in the lumbar distribution index (LDI), higher mechanical complications, and more reoperations when performed below L3. When comparing P3COs and R3COs, baseline lumbopelvic and global alignments, as well as disability, were different. The R3CO group had greater clinical improvements and global correction (both p<0.04), although the P3CO group achieved alignment in LDI more often (odds ratio, 3.9; 95% confidence interval, 1.3-6.2; p=0.006). The P3CO group had more neurological complications (30% vs. 13%, p=0.042), whereas the R3CO tended to have higher mechanical complication rates (25% vs. 15%, p=0.2).</p><p><strong>Conclusions: </strong>3COs showed greater improvements in realignment while failing to demonstrate the same clinical improvement as primaries without a 3CO. Overall, when suitably indicated, a 3CO offers superior utility for achieving optimal realignment across primary and revision surgeries for ASD correction.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"673-680"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456896","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}