Volume 35: Issue 3 (Sep 2021)
inJournal of Neurosurgery: Spine-
In Brief
The authors analyzed the adjacent-level mobility of single-level L3–4 cortical screw–rod (CSR) versus pedicle screw–rod (PSR) fixation with and without interbody support. The use of PSR versus CSR significantly affects mobility at the adjacent level, regardless of the type of interbody support. Biomechanical evaluations of adjacent-level mobility with different screw trajectories have not been previously reported. These findings provide useful insights for clinical decision-making based on cortical bone trajectories and outcomes, as well as for future investigations.
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In Brief
The incidence of adjacent-segment disease (ASD) necessitating reoperation has been well described following traditional posterior lumbar fusion techniques (2.5%–3.9% per year); however, the incidence of surgical ASD remains poorly characterized following the less invasive stand-alone lateral lumbar interbody fusion (LLIF). The objective of this study was to identify the incidence of ASD following LLIF for degenerative lumbar etiologies, which was noted to be 0.88% per year in this study cohort. Given this relatively lower rate of ASD, LLIF may be preferable for properly selected and appropriately indicated patients.
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In Brief
Researchers examined how a recent state-level opioid reform impacted postoperative opioid prescribing, patient-reported outcomes (PROs), and healthcare utilization following elective lumbar decompression surgery. In the year after the reform was introduced, patients received significantly less postoperative opioid medication compared with the year prior without having a change in PROs, emergency department visits, or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions may decrease opioid exposure to patients without negatively impacting patient outcomes.
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In Brief
The authors report their technique and early clinical experience with simultaneous posterior and lateral lumbar access utilizing a prone transpsoas lumbar corpectomy. They found that this approach is feasible for difficult clinical scenarios. To their knowledge, this paper is the first in the literature to report this technique.
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In Brief
Lateral lumbar interbody fusion (LLIF) has become a familiar, successful technique for minimally invasive spine surgeons. However, an increasing number of reported complications in the literature prompted the authors to investigate the feasibility of an endoscope-assisted LLIF to provide direct visualization of critical retroperitoneal structures (e.g., ureter, iliac vessels, genitofemoral nerve). The authors describe the endoscope-assisted LLIF with a step-by-step operative video and report favorable feasibility for clinical practice.
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In Brief
The authors compared patient characteristics associated with the utilization of a posterior lumbar interbody device between patients with degenerative spondylolisthesis and those with isthmic spondylolisthesis. Similar proportions of patients received a posterior interbody device and had similar postoperative outcomes. However, these cohorts showed significant variations in demographic and patient characteristics associated with the use of an interbody fusion device. These baseline differences should be considered when designing studies of lumbar spondylolisthesis and suggest that the two pathologies should be analyzed separately.
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In Brief
The authors aimed to identify associations between radiological parameters and neurological findings in degenerative cervical myelopathy. The spinal cord signal intensity on T2-weighted MR images was associated with a positive Hoffmann reflex, severe spinal cord compression during neck flexion was associated with a positive Babinski sign, and the position sense of the great toe was associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.
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In Brief
This study analyzed the biomechanical effects of adding a titanium triangular-shaped sacroiliac implant to a long-segment lumbopelvic construct with S2-alar-iliac screws. The analysis showed that the posteriorly placed device improved local stability of the sacroiliac joint without significantly affecting rod and screw strains at the lumbosacral junction. These findings were intended to help clinicians understand the in vitro biomechanical effects of supplementing adult deformity correction constructs with a sacroiliac fusion device.
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In Brief
L3 is most often selected as the lowest instrumented vertebra (LIV) to conserve mobile segments. This study aimed to know whether LIV selection as L3 for cases with the lowest end vertebra (LEV) at L4 could have a risk of coronal decompensation. The results showed that these cases showed postoperative main thoracic and thoracolumbar or lumbar curve progression, although no significant differences were observed in global alignment. Therefore, surgeons should pay attention to determining the LIV level as L3, especially for cases with the LEV at L4.
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In Brief
作者的影像学研究发现proximal junctional failures with late neurological deficits and clinical outcomes after revision surgery. Perioperative complications were common and neurological outcomes after surgery were not favorable. To the authors' knowledge, this is the first study demonstrating detailed radiographic findings of proximal junctional failures with late neurological deficits and clinical outcomes after revision surgery.
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In Brief
本研究比较了生物力学的概要文件dvanced surgical techniques in deformity reconstruction, including anterior column realignment and pedicle subtraction osteotomy. Both techniques are significantly destabilizing and prone to failure; however, with appropriate construct design, stability can be restored, with no significant difference between the two techniques. No prior rigorous biomechanical testing has been performed to compare these techniques; the results can help guide patient-specific surgical decision-making for spinal deformity surgeons in the future.
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In Brief
The authors retrospectively studied the effectiveness of systemic therapy on survival after surgery for renal cell spine metastases. Starting therapy was associated with a median survival benefit of 28 versus 12 months compared with surgery alone. This is the first paper demonstrating a survival advantage independent of sarcopenia and frailty. This may help surgeons adjudicate the role of surgery for patients with poor nutrition, limited survival, and an uncertain likelihood of starting or continuing systemic therapies.
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In Brief
The authors aimed to evaluate the role of perioperative antibiotic prophylaxis in noninstrumented spine surgery (NISS), both in postoperative infections and the impact on the selection of resistant bacteria. Results confirmed that a single dose of preoperative cefazolin was effective and mandatory in preventing surgical site infections in NISS. Single-dose antibiotic prophylaxis has an immediate impact on cutaneous flora by increasing cefazolin-resistant bacteria.
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In Brief
作者系统地回顾了文学on the management of instrumentation after surgical site infection. Studies were mostly low-quality and heterogeneous, and no clear consensus on whether to leave or remove instrumentation was identified. However, the most common findings supported retaining hardware in patients with early infection and potential removal for later infections. This review reinforces the need for higher-quality evidence from larger studies to determine optimal treatment of patients with instrumentation who experience wound infection.
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In Brief
Prior to embarking on a human trial, it is imperative to demonstrate that the surgical technique itself does not harm the individual. The data reported in this article provided the final demonstration of safety in a large-animal model comparable to the human spinal cord dimensions, thereby enabling proceeding with the first trial of administering stem cells in humans directly into the injured human spinal cord.
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