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Forbech Elmose, Signe; Oesterheden Andersen, Mikkel; Sigmundsson, Freyr G.; Yacat Carreon, Leah
doi: 10.1097/brs.0000000000004437pmid: 35877558
Study design: Retrospective cohort study. Objective: The aim was to investigate whether findings on magnetic resonance imaging (MRI) can be proxies (MRIPs) for segmental instability in patients with degenerative lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (LDS) L4/L5. Background: LDS has a heterogeneous nature. Some patients have a dynamic component of segmental instability associated with LDS. Studies have shown that MRI can show signs of instability. Methods: Patients with LSS or LDS at L4/L5 undergoing decompressive surgery±fusion from 2010 to 2017, with preoperative standing lateral spine radiographs and supine lumbar MRI and enrolled in Danish national spine surgical database, DaneSpine. Instability defined as slip of >3 mm on radiographs. Patients divided into two groups based upon presence of instability. Outcome measures: radiograph: sagittal slip (mm). MRIPs for instability: sagittal slip >3 mm, facet joint angle (°), facet joint effusion (mm), disk height index (%), and presence of vacuum phenomena. Optimal thresholds for MRIPs was determined by receiver operating characteristic (ROC) curves and area under the curve (AUC). Logistic regression to investigate association between instability and MRIPs. Results: Two hundred thirty-two patients: 47 stable group and 185 unstable group. The two groups were comparable with regard to baseline patient-reported outcome measures. Thresholds for MRIPs: bilateral facet joint angle ≥46°; bilateral facet effusion ≥1.5 mm and disk height index ≥13%. Logistic regression showed statistically significant association with MRIPs except vacuum phenomena, ROC curve AUC of 0.951. By absence of slip on MRI logistic regression showed statistically significant association between instability on radiograph and the remaining MRIPs, ROC curve AUC 0.757. Conclusion: Presence of MRIPs for instability showed statistically significant association with instability and excellent ability to predict instability on standing radiograph in LSS and LDS patients. Even in the absence of slip on MRI the MRIPs had a good ability to discriminate presence of instability.
Linden, Gabriel S.; Hresko, Michael T.; Cook, Danielle; Birch, Craig M.; Hedequist, Daniel J.; Hogue, Grant D.
doi: 10.1097/brs.0000000000004443pmid: 35913803
Study Design. Retrospective cohort study. Objective. To investigate the relationship between body mass index (BMI), spine flexibility index (FI), and their combined effects on adolescent idiopathic scoliosis (AIS) surgical outcomes. Background. BMI and FI are two factors considered during presurgical planning for AIS correction, but there is sparse research about their relationship. We hypothesize that AIS patients with increased BMI may be associated with decreased FI—a combination which could lead to worsened surgical outcomes. Materials and Methods. AIS patients ages 11 to 19 at surgery, who underwent posterior fusion at a single center from 2011 to 2017, were reviewed. Patients without proper radiographs to assess FI, or a previous spine surgical history, were excluded. FI was categorized as stiff (FI<50) or flexible (FI≥50), and patients were separated by major curve region. BMI was categorized as underweight (less than fifth percentile), healthy weight (fifth–85th percentile), overweight (85th–95th percentile), or obese (>95th percentile). Regression analysis was conducted to test BMI and FI’s effects on intraoperative, immediate postoperative, and two-year postoperative outcomes. Results. A total of 543 patients (82% female), with an average age of 14.9 years, were included. In all, 346 patients had available two-year data. A 10% increase in BMI was associated with a 1.3% decrease in FI for patients with major thoracolumbar/lumbar curves (P=0.01). Obese patients were most likely to have a postoperative complication (P=0.003) or a two-year complication (P=0.04). Revision surgery occurred after 58% of postoperative complications (15/26) and 80% of two-year complications (4/5). FI was negatively associated with initial curve magnitude (P<0.001), operative time (P=0.02), and blood loss (P=0.02). Overweight patients with flexible curves were 10.0 times more likely to sustain a postoperative complication than healthy weight patients with stiff curves (P=0.001). Conclusions. Elevated BMI was associated with decreased FI in patients with major thoracolumbar/lumbar curves. Patients with a high BMI and high FI were associated with the greatest risk of postoperative complication.
Shinn, Daniel; Mok, Jung Kee; Vaishnav, Avani S.; Louie, Philip K.; Sivaganesan, Ahilan; Shahi, Pratyush; Dalal, Sidhant; Song, Junho; Araghi, Kasra; Melissaridou, Dimitra; Sheha, Evan D.; Sandhu, Harvinder S.; Dowdell, James E.; Iyer, Sravisht; Qureshi, Sheeraz A.
Karamian, Brian A.; Lambrechts, Mark J.; Sirch, Francis; Gupta, Sachin; D’Antonio, Nicholas D.; Levy, Hannah; Reiter, David; Dolhse, Nico; Qureshi, Mahir; Mao, Jennifer; Canseco, Jose A.; Woods, Barrett I.; Kaye, Ian David; Hilibrand, Alan; Kepler, Christopher K.;
Bovonratwet, Patawut; Samuel, Andre M.; Mok, Jung Kee; Vaishnav, Avani S.; Morse, Kyle W.; Song, Junho; Steinhaus, Michael E.; Jordan, Yusef J.; Gang, Catherine H.; Qureshi, Sheeraz A.
doi: 10.1097/brs.0000000000004432pmid:
Zhou, Yang; Hou, Juedong; Xiao, Ruipei; Zheng, Jintao; Zou, Xiaobao; Zhu, Yongjian; Yao, Ling; Chen, Jianting; Ma, Xiangyang; Yang, Jincheng
doi: 10.1097/brs.0000000000004423pmid: 35867616
Study Design. Retrospective study. Objective. To present a morphological map of cervical sagittal alignment in basilar invagination (BI), a congenital anomaly of the craniovertebral junction, and contribute to a comprehensive understanding of cervical sagittal alignment in congenital cervical deformities. Summary of Background Data. Ideal cervical sagittal alignment and surgical targets are debated by scholars. However, most of the literature focuses on the description of cervical sagittal alignment in acquired cervical diseases and normal subjects and few on congenital cervical spine deformities. Materials and Methods. This study analyzed cervical spine lateral radiographs of 87 BI patients and 98 asymptomatic subjects. They were analyzed for cranial, cervical spine, and thoracic inlet parameters. Results. Patients with BI manifested significantly larger values for the following parameters than asymptomatic subjects: cranial tilt, cranial incidence angle, sagittal vertical axis (SVA) CGH–C7, C2–C7 angle, cervical tilt, and significantly smaller values for the following parameters: cranial slope, C0–C2 angle, C0–C7 angle, SVA C2–C7, spine tilt, thoracic inlet angle, and neck tilt. In the BI group, SVA C2–C7 was the cervical parameter most strongly correlated with the cranial, cervical spine, and thoracic inlet parameters, and was smaller in BI patients with fusion (atlanto-occipital assimilation) than in those without. Conclusion. A significant difference was observed between BI patients and asymptomatic subjects. BI patients have craniums tilted forward and downward, smaller upper cervical lordosis, larger lower cervical lordosis, and smaller thoracic inlet angle. In BI patients, the SVA C2–C7 is an important parameter in cervical sagittal alignment. In both individuals with congenital anomalies of the craniovertebral junction and the asymptomatic population, cervical spine alignment is significantly associated with cranial alignment, particularly thoracic inlet alignment.
Odate, Seiichi; Fujibayashi, Shunsuke; Otsuki, Bungo; Shikata, Jitsuhiko; Tsubouchi, Naoya; Tsutsumi, Ryosuke; Ota, Masato; Yusuke, Kanba; Kimura, Hiroaki; Onishi, Eijiro; Tanida, Shimei; Ito, Hideo; Ishibe, Tatsuya; Matsuda, Shuichi
Ding, Weizhong; Hu, Shian; Wang, Pengju; Kang, Honglei; Peng, Renpeng; Dong, Yimin; Li, Feng
doi: 10.1097/brs.0000000000004417pmid: 35857624
Study Design. A retrospective cohort study. Objective. The authors aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) by location, sex, age, injury site and socio-demographic index (SDI) based on the data of the Global Burden of Disease Study (GBD) 2019. Summary of Background Data. GBD 2019 estimates the burden of 369 diseases and injuries worldwide in 2019 and the temporal trends in the past 30 years. SCI is estimated as a result of injury from various causes. Methods. A Bayesian meta-regression tool, DisMod-MR2.1, was used to produce the estimates. Estimated annual percentage change (EAPC) was calculated based on a linear regression mode of the age standardized rates and the calendar year to represent the temporal trends of the age standardized rates. Spearman rank order correlation was used to determine the correlation between SDI and the incidence and burden of SCI. Results. Globally, there were 0.9 [95% uncertainty interval (UI), 0.7 to 1.2] million incident cases, 20.6 (95% UI, 18.9–23.6) million prevalent cases and 6.2 (95% UI, 4.5–8.2) million YLDs of total SCI in 2019. The ASPR increased (EAPC, 0.1; 95% confidence interval, −0.01 to 0.2), while the age standardized incidence rate (ASIR) (EAPC, −0.08; 95% UI, −0.24 to 0.09) and age standardized YLD rate (ASYR) (EAPC, −0.08; 95% confidence interval, −0.24 to 0.09) decreased. Males had higher ASIR and ASYR, and the rate of incidence, prevalence and YLD increased with age. Spinal injuries at neck level caused higher ASYR than injuries below neck level. A positive correlation existed between SDI and ASIR (ρ=0.1626, P<0.05), while a negative correlation was observed between SDI and EAPC of ASYR (ρ=−0.2421, P<0.01). Conclusion. Conclusively, the incidence and burden of SCI has increased over the last 30 years. Males and the elderly were affected to a greater degree than females and younger individuals. Level of Evidence. Level III.
Showing 1 to 10 of 10 Articles
doi: 10.1097/brs.0000000000004399pmid: 35867600
Study Design. Single-center, multisurgeon, retrospective review. Objective. To evaluate the timing of return to commonly performed activities following minimally invasive spine surgery. Identify preoperative factors associated with these outcomes. Summary of Background Data. Studies have reported return to activities with open techniques, but the precise timing of when patients return to these activities after minimally invasive surgery remains uncertain. Materials and Methods. Patients who underwent either minimally invasive lumbar laminectomy (MI-L) or minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) were included. Patient-reported outcome measures, return to drive, return to work, and discontinuation of opioids data were reviewed. Regression was conducted to identify factors associated with return to driving by 15 days, return to work by 30 days, and for discontinuing opioids by 15 days. A composite group analysis was also performed for patients who returned to all three activities by 30 days. Results. In total, 123 MI-L patients and 107 MI-TLIF patients were included. Overall, 88.8% of MI-L patients and 96.4% of MI-TLIF patients returned to driving in 11 and 18.5 days, respectively. In all, 91.9% of MI-L patients and 85.7% of MI-TLIF patients returned to work in 14 and 25 days. In all, 88.7% of MI-L patients and 92.6% of MI-TLIF patients discontinued opioids in a median of seven and 11 days. Overall, 96.2% of MI-L patients and 100% of MI-TLIF patients returned to all three activities, with a median of 27 and 31 days, respectively. Male sex [odds ratio (OR)=3.57] and preoperative 12-Item Short Form Physical Component Score (OR=1.08) are associated with return to driving by 15 days. Male sex (OR=3.23) and preoperative 12-Item Short Form Physical Component Score (OR=1.07) are associated with return to work by 30 days. Preoperative Visual Analog Scale back was associated with decreased odds of discontinuing opioids by 15 days (OR=0.84). Conclusion. Most patients return to activity following MI-L and MI-TLIF. These findings serve as an important compass for preoperative counseling.
doi: 10.1097/brs.0000000000004405pmid: 35867579
Study Design. This is a retrospective cohort study. Objective. The aim was to evaluate differences in readmission rates, number of debridements, and length of antibiotic therapy when comparing bacterial gram type following lumbar spinal fusion infections. Summary of Background Data. Surgical site infections (SSIs) after spinal fusion serve as a significant source of patient morbidity. It remains to be elucidated how bacterial classification of the infecting organism affects the management of postoperative spinal SSI. Methods. Patients who underwent spinal fusion with a subsequent diagnosis of SSI between 2013 and 2019 were retrospectively identified. Patients were grouped based on bacterial infection type (gram-positive, gram-negative, or mixed infections). Poisson regressions analyzed the relationship between the type of bacterial infection and the number of irrigation and debridement (I&D) reoperations, and the duration of intravenous (IV) antibiotic therapy. Significance was set at P<0.05 Results. Of 190 patients, 92 had gram-positive (G+) infections, 57 had gram-negative (G−) infections, and 33 had mixed (M) infections. There was no difference in 30 or 90-day readmissions for infection between groups (both P=0.051). Patients in the M group had longer durations of IV antibiotic treatment (G+: 46.4 vs. G−: 41.0 vs. M: 55.9 d, P=0.002). Regression analysis demonstrated mixed infections were 46% more likely to require a greater number of debridements (P=0.001) and 18% more likely to require an increased duration of IV antibiotic therapy (P<0.001), while gram-negative infections were 10% less likely to require an increased duration of IV antibiotic therapy (P<0.001) when compared with G− infections. Conclusion. Spinal SSI due to a mixed bacterial gram type results in an increased number of debridements and a longer duration of IV antibiotics required to resolve the infection compared with gram-negative or gram-positive infections. Level of Evidence. Level III.
Study Design. A retrospective cohort comparison study. Objective. To compare perioperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs) between minimally invasive unilateral laminotomy with bilateral decompression (MIS-ULBD) versus MIS transforaminal lumbar interbody fusion (MIS-TLIF) for treatment of low-grade lumbar degenerative spondylolisthesis. Summary of Background Data. While lumbar degenerative spondylolisthesis is a common condition, optimal surgical treatment remains controversial. Newer MIS techniques, which preserve bone, paraspinal musculature, and posterior midline stabilizers, are thought to reduce the risk of iatrogenic instability and may obviate the need for fusion. However, few comparative studies of MIS techniques for low-grade lumbar degenerative spondylolisthesis currently exist. Materials and Methods. Consecutive patients with low-grade (Meyerding grade I or II) lumbar degenerative spondylolisthesis treated with single-level MIS-ULBD or MIS-TLIF were identified retrospectively from a prospectively collected spine surgery registry from April 2017 to November 2021. Perioperative outcomes, radiographic data, and PROMs were assessed. Results. A total of 188 patients underwent either MIS-ULBD or MIS-TLIF (79 MIS-ULBD and 109 MIS-TLIF). Patients who underwent MIS-ULBD tended to be older, had higher Charlson Comorbidity Index, lower mean percentage back pain, higher percentage of L4/L5 pathology, shorter operative time, lower estimated blood loss, and lower postoperative pain (P<0.05). In both groups, there were statistically significant improvements at one year for five of the six PROMs studied: Oswestry Disability Index (ODI), visual analog scale (VAS)-back pain, VAS-leg pain, Short Form 12 Physical Component Score (SF12-PCS), and Patient-Reported Outcomes Measurement Information System (PROMIS) (P<0.05). On multivariate analysis controlling for confounders, there were no associations between procedure type and achieving minimal clinically important difference at one year in any of the PROMs studied. Conclusions. The current study suggests that both MIS-ULBD and MIS-TLIF result in significant improvements in pain and physical function for patients with low-grade lumbar degenerative spondylolisthesis. Level of Evidences: 3
doi: 10.1097/brs.0000000000004398pmid: 35797598
Study Design. A multicenter retrospective analysis. Objective. This study aims to investigate reoperation of misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF), focusing on neurological complications. Summary of Background Data. The management strategy for MPSs and the clinical results after reoperation are poorly defined. Materials and Methods. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. Results. The rate of reoperation for screw misplacement per screw was 0.17%. A total of 69 patients (mean age, 67.4±16.5 yr) underwent reoperation because of 82 MPS. Reasons for reoperation were neurological symptoms (58 patients), contact with vessels (5), suboptimal bone purchase (4), and misplacement recognized during operation (2). Neurological symptoms were the major reason for reoperation in cervical (5/5 screws, 100%) and lumbo-sacral (60/67 screws, 89.6%) regions. Contact with vessels was the major reason for reoperation in the thoracic spine (6/10 screws, 60.0%). We further evaluated 60 MPSs in the lumbo-sacrum necessitating reoperation because of neurological symptoms. The majority of MPSs necessitating reoperation were placed in the lower lumbar spine (43/60 screws, 71.7%). The mean pedicle breach tended to be larger in the incomplete recovery group than in the complete recovery group (6.8±2.4 vs. 5.9±2.2 mm, P=0.146), and the cutoff value resulting in incomplete resolution was 5.0 mm. Multivariate analysis revealed that medial-caudal breaches (vs. medial breach, odds ratio: 25.8, 95% confidence interval: 2.58–258, P=0.0057) and sensory and motor disturbances (vs. sensory only, odds ratio: 8.57, 95% confidence interval: 1.30–56.6, P=0.026) were significant factors for incomplete resolution of neurological symptoms. Conclusions. After reoperation, 70.1% of the patients achieved complete resolution of neurological symptoms. Factors associated with residual neurological symptoms included sensory and motor disturbance, medial-caudal breach, and larger pedicle breach (>5 mm).