Volume 38: Issue 1 (Jan 2023)
inJournal of Neurosurgery: SpineIllustration from Beck et al. (pp 147–152). © Department of Neurosurgery, Freiburg Medical Center; published with permission.
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In Brief
Postoperative kyphotic deformity (KD) following cervical laminoplasty is a common complication. Several studies have investigated predictors for this event, but the findings remain highly inconsistent. The authors sought to resolve this issue by performing a meta-analysis. Patient age, BMI, and four preoperative radiographic measurements were identified as predictors for KD. The findings from this study will be valuable to those developing a risk scoring system that can accurately predict KD in the clinical setting.
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In Brief
作者试图识别c的补充linical and radiologic factors that best predicts neurologic improvement after surgery for degenerative cervical myelopathy. Preoperative cervical kyphosis, number of levels with bidirectional compression, and intramedullary lesion length demonstrated the highest predictive power for nonresponse in a multivariate model. A risk factor point system predictive of failure of improvement based on standard-of-care imaging studies was derived that can guide patient counseling, surgical decision-making, and stratification in clinical trials.
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In Brief
The authors evaluated the clinical significance of C2 slope (C2S) in patients who underwent multilevel cervical spine fusion. Increased C2S correlated with worse neck pain, Neck Disability Index, and Japanese Orthopaedic Association scale scores after surgery, and its cutoff values were determined. C2 slope may be a simple yet effective parameter that can be utilized to determine cervical sagittal alignment.
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In Brief
The recently proposed AO Spine Upper Cervical Injury Classification System underwent an international validation with relatively equal participation from orthopedic spine surgeons and neurosurgeons. Both groups of surgeons had similar accuracy and reliability when interpreting upper cervical spine injury films. This indicates that the classification may be used by either surgical subspecialty without significant differences between their accuracy and reliability.
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In Brief
For patients with cervical spondylotic myelopathy (CSM) with severe neck pain (visual analog scale score > 6), it is unclear if an anterior or posterior approach is superior. Comparing 3- and 4-level ACDF and posterior cervical laminectomy and fusion (PCLF), researchers observed no statistically significant difference in neck pain at 24 months postoperatively. This suggests that musculoligamentous insult during posterior approaches may not contribute substantially to long-term postoperative neck pain in patients receiving PCLF for CSM with severe neck pain.
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In Brief
The authors described the 24-month postoperative trajectories of arm pain, neck pain, and pain-related disability in patients undergoing anterior cervical discectomy and fusion, and they identified the predictors of poor outcome. Outcome trajectories were variable, with 15.5%–23.5% of patients experiencing a poor result. Demographic, health, clinical, and surgery-related prognostic factors predicted outcomes. This information informs future research and may assist surgeons with patient selection and in setting realistic expectations with patients.
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In Brief
In this study the authors sought to determine whether patients who underwent multiple revision surgeries following adult spinal deformity (ASD) correction would exhibit lower self-reported satisfaction scores. Important findings were that among patients undergoing primary ASD surgery, revision surgery is associated with decreased satisfaction, and multiple revisions are associated with additive detriment to satisfaction. These findings have direct implications for preoperative patient counseling and establishment of postoperative expectations.
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In Brief
This study highlights the treatment of a unique population of young adult patients requiring surgical treatment of idiopathic scoliosis for pain, deformity progression, and/or unsatisfactory appearance. While most patients who make it to adulthood without surgery do well, this multi-institutional experience demonstrates that a portion of patients still require scoliosis surgery. Operations in this population have a relatively low risk relative to adult spinal deformity correction for older patients with degenerative conditions.
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In Brief
Given the paucity of existing data on early failures with pelvic fixation, researchers determined the incidence of this underreported complication, compared the findings with current literature, and shared potential protective strategies. The acute pelvic fixation failure rate was exceedingly low in adult spine surgery. This rate may be the result of multiple factors including the preference for multirod (> 2), closed-headed pelvic screw constructs in which large-diameter, long screws are used. Increasing the number of rods and screws at the lumbopelvic junction may be important factors to consider.
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In Brief
The authors sought to determine if a previously identified mechanism and rate of pelvic fixation failure occurred at other institutions. Failures occurred in 37 (5%) of 779 pelvic fixation cases across 13 academic centers. Failures involved large-magnitude surgical corrections and likely resulted from high mechanical strain on the pelvic instrumentation. Large corrections may benefit from anterior structural support at the most caudal motion segment and multiple rods connecting to more than two pelvic fixation points.
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In Brief
The authors report on a novel technique regarding lumbosacral junction augmentation using additional S1 alar screws, with no need for extending instrumentation to the pelvis in some cases. The biomechanical characteristics detected by this study indicated that this technique can be an excellent alternative to sacropelvic fixation for lumbosacral disorders. This strategy should be applied in advanced lumbosacral fixation, and the risk of violating the sacroiliac joints can be avoided.
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In Brief
This investigational device exemption study compared the safety and efficacy of a posterior lumbar motion-preserving device with standard transforaminal interbody fusion (TLIF) in the treatment of stenosis due to degenerative spondylolisthesis. The key finding was that posterior lumbar facet arthroplasty was statistically superior compared with TLIF on the composite measure of success. This study demonstrated that posterior lumbar facet replacement may represent a viable alternative to fusion for the treatment of degenerative lumbar spondylolisthesis.
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In Brief
本研究的目的是确定incidence and independent risk factors of dural ossification in patients with thoracic ossification of the ligamentum flavum. The incidence of dural ossification was 35%. The tuberous type according to the Sato classification and large supine local kyphosis angle (≥ 9°) were independent risk factors. These findings are beneficial to predicting the existence of dural ossification preoperatively and investigating the underlying mechanisms.
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In Brief
Researchers sought to investigate differences in outcomes between dural attachment location subgroups in spinal meningioma patients who underwent a posterior-based resection. Posterior-based approaches for resection of spinal meningiomas are safe and effective, regardless of dural attachment location, with similar surgical, oncologic, and neurologic outcomes. In addition, strong oncologic outcomes were had with Simpson grade II resections of spinal meningiomas.
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In Brief
Researchers describe their technique, results, and complications of minimal invasive surgery by means of tubular nonexpandable retractors in patients with spinal CSF leaks and spontaneous intracranial hypotension. Primary sealing was achieved in 96.6% of patients, with up to 90% of patients reporting improvement after surgery. Permanent neurological deficits occurred in 1.7% of patients. Minimally invasive surgery with tubular retractors for the treatment of spinal CSF leaks is safe and effective and should be performed in specialized centers.
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