Asian Spine Journal最新文献

{"title":"Computed tomography Hounsfield unit values as a treatment response indicator for spinal metastatic lesions in patients with non-small-cell lung cancer: a retrospective study in Japan.","authors":"Hiroshi Taniwaki, Sho Dohzono, Ryuichi Sasaoka, Kiyohito Takamatsu, Masatoshi Hoshino, Hiroaki Nakamura","doi":"10.31616/asj.2024.0334","DOIUrl":"10.31616/asj.2024.0334","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>This study aimed to determine the impact of increased Hounsfield unit (HU) values for metastatic spinal lesions measured via computed tomography on the overall survival of patients with non-small-cell lung cancer (NSCLC) and identify factors associated with increased HU values in metastatic spinal lesions.</p><p><strong>Overview of literature: </strong>Previous studies have underscored the utility of the HU as a marker of treatment response in metastatic bone lesions. However, no prior studies have explored the relationship between HU changes in response to treatment and overall survival in patients with NSCLC.</p><p><strong>Methods: </strong>This study included a total of 85 patients between 2016 and 2021. Nonsurgical treatments were provided by the respiratory medicine department. HU values for metastatic spinal lesions were evaluated upon diagnosis of spinal metastasis (baseline) and at 3, 6, and 12 months thereafter. Patients were then divided into two groups based on the median HU increase from baseline to 3 months. Overall survival was assessed using the Kaplan-Meier method.</p><p><strong>Results: </strong>Based on the median change in HU value (124), 42 and 43 patients were categorized into the HU responder and non-responder groups, respectively. The median overall survival was significantly longer in the HU responder group than in the HU non-responder group (13.7 months vs. 6.4 months, p <0.001). Multiple linear regression analysis revealed that the use of antiresorptive agents and molecularly targeted therapies were factors significantly associated with an increase in HU.</p><p><strong>Conclusions: </strong>An increase in HU values for metastatic spinal lesions after 3 months of treatment was correlated with a significantly longer overall survival in patients with NSCLC. Thus, HU measurements may not only serve as an easy and quantitative approach for evaluating treatment response in metastatic spinal lesions but also predict overall survival.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"46-53"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998948","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":"Endoscopic surgery for multilevel spinal stenosis: a comprehensive meta-analysis and subgroup analysis of uniportal and biportal approaches.","authors":"Manuel González-Murillo, Juan Castro-Toral, César Bonome-González, Juan Álvarez de Mon-Montoliú","doi":"10.31616/asj.2024.0171","DOIUrl":"10.31616/asj.2024.0171","url":null,"abstract":"<p><p>Minimally invasive spine surgery (MIS) has shown promising results, and endoscopic spine surgery has emerged as a less invasive approach. Although studies have examined the effectiveness of endoscopic surgery for spinal stenosis, no meta-analyses have focused on multilevel cases. This meta-analysis aimed to evaluate the efficacy and safety of uniportal and biportal endoscopy in patients with multilevel spinal stenosis. The patient, intervention, comparison, outcomes, and study criteria were established to guide study selection. Four databases were searched. The outcome measures included patient-reported outcome measures (PROMs), radiological and analytical data, complications, surgery time, length of hospital stay, and blood loss. Review Manager ver. 5.4 software (RevMan; Cochrane, UK) was used for the analysis. Heterogeneity was assessed using the chi-square and I2 tests. Ten studies (n=686) were included. PROMs showed significant improvements in Visual Analog Scale (VAS) scores for back pain (mean difference [MD], 4.07; 95% confidence intervals [CI], 3.72-4.42), leg pain (MD, 5.49; 95% CI, 5.17-5.80), and Oswestry Disability Index (MD, 35.97; 95% CI, 32.46-39.47). MacNab scale results were as follows: excellent (55.37%), good (34.93%), fair (7.58%), and poor (4.06%). C-reactive protein levels did not change significantly; however, hemoglobin levels decreased postoperatively (MD, 1.28; 95% CI, 0.91-1.65). Complications included dural tears (5.46%), hematoma (4.30%), incomplete decompression (3.12%), root injury (2.90%), reoperations/revisions (2.22%), conversion to open or microscopic surgery (1.97%), and transfusions (8.50%). Analysis by levels showed worse VAS leg pain in studies analyzing >30% multilevel stenosis (MD, 4.99; 95% CI, 4.47-5.51 vs. MD, 5.82; 95% CI, 5.63-6.01). Uniportal and biportal endoscopy had similar outcomes, except for a higher incidence of dural tears on biportal endoscopy (uniportal, 3.33%; biportal, 7.05%). This meta-analysis supports endoscopy as an effective and safe option for multilevel lumbar stenoses. It improves long-term pain and functionality, with no significant radiological changes or postoperative inflammation. Complications are few; however, dural tears are more common in biportal endoscopy. Higher multilevel stenosis rates were associated with increased leg pain and a lower likelihood of achieving incomplete decompression.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"133-147"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999023","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":"Transforaminal interbody debridement and fusion with antibiotic-impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: a comparative study in Asian population.","authors":"Chao-Chien Chang, Hsiao-Kang Chang, Meng-Ling Lu, Adam Wegner, Re-Wen Wu, Tsung-Cheng Yin","doi":"10.31616/asj.2024.0388","DOIUrl":"10.31616/asj.2024.0388","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether using antibiotic-impregnated bone graft (AIBG) enhances infection control and shortens the postoperative course of pyogenic discitis and vertebral osteomyelitis (PDVO).</p><p><strong>Overview of literature: </strong>Surgical treatment of PDVO is indicated for neurological deficit, instability, unknown pathogen, or poorly controlled infection. The posterior-only approach is effective but requires 4-6 weeks of antibiotic treatment postoperatively. We hypothesized that AIBG used in an all-posterior approach could enhance infection control and shorten the postoperative course of PDVO.</p><p><strong>Methods: </strong>Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups.</p><p><strong>Results: </strong>Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°.</p><p><strong>Conclusions: </strong>TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"38-45"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999031","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":"Dystrophinopathy in the paravertebral muscle of adolescent idiopathic scoliosis: a prospective case-control study in China.","authors":"Junyu Li, Danfeng Zheng, Zekun Li, Jiaxi Li, Zexi Yang, Xiang Zhang, Yingshuang Zhang, Miao Yu","doi":"10.31616/asj.2024.0299","DOIUrl":"10.31616/asj.2024.0299","url":null,"abstract":"<p><strong>Study design: </strong>A prospective case-control study.</p><p><strong>Purpose: </strong>This prospective case-control study aimed to analyze the paravertebral muscle changes in patients with adolescent idiopathic scoliosis (AIS) and determine paravertebral myopathological changes associated with the clinical progression of AIS.</p><p><strong>Overview of literature: </strong>The incidence of AIS is significant globally and worsens before bone maturation, causing a serious effect. Many studies have investigated its causes-such as genetic, epigenetic, and hormonal factors-but more research remains warranted.</p><p><strong>Methods: </strong>This study enrolled 40 patients with AIS, 20 patients with congenital scoliosis (CS), and 20 patients with spinal degenerative disease (SDD). All patients underwent open posterior surgery in our hospital, and a paravertebral muscle (multifidus muscle) biopsy was performed intraoperatively. This study included many indexes that describe muscle, especially dystrophin staining. The above pathological results were compared among the AIS, CS, and SDD groups. The correlation between the Cobb angle and Nash-Moe classification and the above pathological results was analyzed in patients with AIS.</p><p><strong>Results: </strong>Significant reductions in the dystrophin staining of dystrophin-1 (p<0.001), dystrophin-2 (p<0.001), and dystrophin-3 (p<0.001) were observed in the AIS group than in the CS and SDD groups. The higher the Nash-Moe classification in the AIS group, the more significant the loss of dystrophin-2 (p=0.042) in the convex paraspinal muscles. Additionally, a significantly positive correlation was observed between the reductions of dystrophin-2 on the concave side of the AIS group and Cobb angle (p=0.011).</p><p><strong>Conclusions: </strong>Dystrophin protein deficiency in the paraspinal muscles plays a crucial role in AIS formation and progression. The severity of scoliosis in patients with AIS is correlated with the extent of dystrophin loss in the paravertebral muscles. Therefore, dystrophin dysfunction may be relevant to AIS occurrence and development.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"64-73"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188042","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":"Magnetic resonance imaging of the lumbar spine: can we reach a consensus and have norms? A plea to colleagues in radiology India.","authors":"Arvind G Kulkarni, Abhijeet D Wadi, Shankargouda R Patil, Meet K Shah, Ponnam Ragha Midhun, Sunil S Chodavadiya","doi":"10.31616/asj.2024.0389","DOIUrl":"10.31616/asj.2024.0389","url":null,"abstract":"<p><strong>Study design: </strong>An analytical study.</p><p><strong>Purpose: </strong>To analyze the inadequacies of magnetic resonance imaging (MRI) films provided by diagnostic centers, leading to questionable and inconclusive diagnoses.</p><p><strong>Overview of literature: </strong>No literature is currently available on this subject.</p><p><strong>Methods: </strong>Lumbosacral MRI films of patients who visited the outpatient department between January 2023 and March 31, 2024, were evaluated to check for technical inadequacies.</p><p><strong>Results: </strong>A total of 1,150 lumbar MRI sets from 100 MRI centers were examined. Thirty-five percent did not include T1 axial images, and 8% did not include T1 sagittal images. Thirty-eight percent did not specify the sagittal image sequencing (right-to-left or left-to-right). Eighty-five percent of the sagittal images were profiled from right to left, and 15% were profiled from left to right. Macnab's recommendation was not followed in 970 sets. The axial sectioning of the scout films was nonparallel to the examined segment in 350 sets. The sacroiliac joint was not screened in 40% of the sets. The number of plates provided ranged from two to six films.</p><p><strong>Conclusions: </strong>Based on the results obtained, we strongly recommend that radiologists form structured guidelines to be followed by MRI centers to ensure uniformity, address inadequacies, and minimize the chance of errors in diagnosis and subsequent treatment.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"21-27"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188045","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":"Effect of core stabilization exercises on cervical sagittal balance parameters in patients with forward head posture: a randomized controlled trial in Egypt.","authors":"Ahmed Mahmoud Mohamed Shabana, Abeer Farag Hanafy, Ahmad Salamah Yamany, Reda Sayed Ashour","doi":"10.31616/asj.2024.0328","DOIUrl":"10.31616/asj.2024.0328","url":null,"abstract":"<p><strong>Study design: </strong>A randomized controlled trial using a pretest-posttest control group design.</p><p><strong>Purpose: </strong>This study investigated the effects of core stabilization exercises (CSEs) on cervical sagittal vertical alignment (cSVA), Cobb's angle, and Neck Disability Index (NDI) scores in patients with forward head posture (FHP).</p><p><strong>Overview of literature: </strong>FHP is a local poor neck posture. However, it is frequently caused by sagittal lumbopelvic malalignment. Therefore, an alternative view by which we can begin proximal neuromuscular control is necessary.</p><p><strong>Methods: </strong>This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI.</p><p><strong>Results: </strong>Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups.</p><p><strong>Conclusions: </strong>Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"85-93"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999005","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":"Clinical outcome of vertebroplasty alone versus short-segment posterior instrumentation with vertebroplasty in osteoporotic vertebral fracture: a propensity-score-matched analysis.","authors":"Borriwat Santipas, Nath Adulkasem, Korawish Mekariya, Ekkapoj Korwutthikulrangsri, Monchai Ruangchainikom, Werasak Sutipornplalangkul","doi":"10.31616/asj.2024.0231","DOIUrl":"10.31616/asj.2024.0231","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study with propensity-score-matched analysis.</p><p><strong>Purpose: </strong>To compare the efficacy of vertebroplasty (VP) versus short-segment posterior instrumentation (SS) with VP in patients with osteoporotic vertebral fractures (OVFs).</p><p><strong>Overview of literature: </strong>OVFs significantly affect the aging population, causing pain, reduced mobility, and increased dependence. Treatment guidelines vary, and a consensus on the most effective approach remains unclear. To the best of our knowledge, no previous report focused on the efficacy comparison of VP alone versus SS with VP.</p><p><strong>Methods: </strong>The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics.</p><p><strong>Results: </strong>This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups.</p><p><strong>Conclusions: </strong>SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"28-37"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188041","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":"Letter to the Editor: Optimizing deformity correction: a retrospective comparative analysis of two techniques in high-magnitude curves in adolescent idiopathic scoliosis.","authors":"Anmol Mall, Reema Rasotra","doi":"10.31616/asj.2025.0052.r1","DOIUrl":"10.31616/asj.2025.0052.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 1","pages":"160-161"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555782","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":"A new classification of atlas fracture based on computed tomography: reliability, reproducibility, and preliminary clinical significance.","authors":"Yun-Lin Chen, Wei-Yu Jiang, Wen-Jie Lu, Xu-Dong Hu, Yang Wang, Wei-Hu Ma","doi":"10.31616/asj.2024.0162","DOIUrl":"10.31616/asj.2024.0162","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>This study aimed to observe the computed tomography (CT) characteristics of atlas fracture and propose a new CT classification system, evaluate its reliability and repeatability, and discuss its clinical significance.</p><p><strong>Overview of literature: </strong>The treatment and classification of atlas fracture remain controversial. At present, no classification method has been standardized for atlas fracture. Injury to the transverse atlantal ligament (TAL) and lateral mass displacement is still controversial.</p><p><strong>Methods: </strong>Seventy-five patients with atlas fracture were included from January 2015 to December 2020. Based on the anatomy of the fracture line, atlas fractures were divided into three types. Each type was divided into two subtypes according to the fracture displacement. Unweighted Cohen kappa coefficients were applied to evaluate the reliability and reproducibility.</p><p><strong>Results: </strong>According to the new classification, 17 cases of type A1, 12 of type A2, seven of type B1, 13 of type B2, 12 of type C1, and 14 of type C2 were identified. The K-values of the interobserver and intraobserver reliability were 0.846 and 0.912, respectively, for the new classification. The K-values of interobserver reliability for types A, B, and C were 0.843, 0.799, and 0.898, respectively. The K-values of intraobserver reliability for types A, B, and C were 0.888, 0.910, and 0.935, respectively. The mean K-values of the interobserver and intraobserver reliability for subtypes were 0.687 and 0.829, respectively.</p><p><strong>Conclusions: </strong>The new classification of atlas fractures can cover nearly all atlas fractures. This system is the first to evaluate the severity of fractures based on the C1 articular facet and fracture displacement and strengthen the anatomy ring of the atlas. It is concise, easy to remember, reliable, and reproducible.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 1","pages":"3-9"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555737","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":"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":"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":"889-902"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799307","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}