Approaching the debate of laminectomy versus fusion for grade 1 lumbar spondylolisthesis, the authors leveraged simulation to show how differences between the fusion groups of landmark randomized control trials (RCTs) led to seemingly divergent conclusions, and they offer insights into the design of future RCTs. Lami = laminectomy alone; SLIP = Spinal Laminectomy versus Instrumented Pedicle Screw. See the article in this issue by Meade et al. (pp 696–704). Reprinted with permission, Cleveland Clinic Foundation ©2023. All rights reserved.
In Brief
Researchers compared anterior cervical discectomy and fusion (ACDF) versus posterior decompression in multilevel degenerative cervical myelopathy without ossification of the posterior longitudinal ligament. The two techniques were similar in patient-reported outcomes at 1 year. Higher dysphagia and lower surgical site infection, C5 palsy, operative bleeding, and hospital stay were associated with the ACDF approach. Treatment decision-making should be individualized. Factors such as a narrower C4-5 foramen or higher infection risk factors favor an anterior approach, whereas baseline dysphagia would favor a posterior approach.
In Brief
To better understand postsurgical outcomes for degenerative cervical myelopathy (DCM), the authors identified and predicted outcome trajectories 2 years postsurgery. DCM patients followed distinct recovery trajectories in the first 2 years postoperatively, with most experiencing substantial improvement and a significant minority experiencing little improvement or worsening. The identification of DCM surgery recovery trajectories and their predictors may help clinicians with perioperative counseling and have a positive impact on treatment decision-making, especially for patients with mild DCM.
In Brief
This study compared postoperative cervical sagittal alignment and function in symptomatic cervical myelopathy patients with cervicothoracic junction (CTJ)-spanning versus C7-terminating multilevel posterior cervical fusion (PCF) constructs. Crossing the CTJ may provide greater correction but may not translate into improved function and may be associated with worse short-term patient-reported outcomes. This study provides evidence to assist surgeons in their decision-making for the lowest instrumented vertebra for multilevel PCF constructs in patients with cervical myelopathy.
In Brief
Researchers used finite element analysis to assess the biomechanical effect of semirigid spinal fixation techniques on developing mechanical complications. The analysis has shown that the semirigid fixation techniques increase mobility and therefore provide a more gradual transition in motion between the instrumented and healthy spinal segments. After successful biomechanical testing and clinical trials, the findings of this study could impact research strategies and clinical practice, given the high incidence of proximal junctional kyphosis.
In Brief
This study reports additional spinal growth and its effect on the spinal alignment after adolescent idiopathic scoliosis (AIS) surgery. The mean spinal height growth was 0.88 cm in this patient population. Age, sex, and Risser stage were significant predictors for growth. The LL tended to increase, the SVA tended to move backward, and the PT tended to decrease in patients with a spinal height increase < 1 cm. The study provides a reference for preoperative consultation and comprehending the pathophysiology of the spine after AIS surgery.
In Brief
Thirty-day readmission has become an increasingly important metric to optimize the value ratio of quality over cost. In this report, the authors examined the readmissions of 174 patients who underwent minimally invasive transforaminal lumbar interbody fusion and found that urinary retention, constipation, and persistent radicular symptoms were the leading causes of readmission. Addition of a bowel regimen, a more proactive urological algorithm, and bilateral decompression when necessary has decreased 30-day readmissions for this procedure at the authors' institution.
In Brief
Researchers examined degenerative changes at segments superjacent to the lumbosacral transitional vertebra in Bertolotti syndrome patients. Compared with controls, Bertolotti syndrome patients had a significantly greater pelvic incidence (PI) and were more likely to have adjacent-segment disease (ASD) (L4-5). However, after controlling for age and sex, PI and ASD did not have a significant association within the cohort of Bertolotti patients. The altered biomechanics and kinematics in this condition may be a causative factor in this degeneration, although proof of causation is not possible in this study. This association may warrant closer follow-up protocols for patients treated for Bertolotti syndrome.
In Brief
investig研究人员创建了一个仿真模型ate the cause of divergent results between 2 landmark randomized controlled trials from the US and Sweden in 2016 investigating whether laminectomy or fusion is preferred in patients with grade 1 lumbar spondylolisthesis. Simulated results for fusion showed 2-4 times more treatment heterogeneity than for laminectomy alone predominantly explaining these divergent results. This emphasizes the need for future trials investigating which patients benefit most from surgical instrumentation for lumbar spondylolisthesis.
In Brief
Researchers used a novel vertebral bone quality (VBQ) score based on preoperative MR images to assess bone mineral density (BMD) in patients undergoing spine surgery. The VBQ score had a moderate negative correlation with the patient's BMD, and a VBQ score < 3.05 could initially exclude osteoporosis. The novel VBQ score provides an additional means and opportunity for BMD assessment and screening for osteoporosis.
In Brief
The objective of this study was to determine how the international AO Spine community conceptualizes and characterizes frailty in the context of spinal metastatic disease. Respondents from the community indicated that they commonly evaluate frailty based on general impressions rather than using frailty tools. The authors attained consensus regarding the association between numerous preoperative clinical variables and frailty. This study represents an important first step toward defining the multidimensional nature of frailty. The results will inform the development of an objective tool for evaluating frailty in the context of spinal metastatic disease.
In Brief
The objective of this study was to evaluate the capability of preoperative lymphopenia to predict postoperative outcomes in patients with metastatic spine disease. Lymphopenia was not associated with either 30-day mortality or 30-day major complications, contradicting prior research that had shown this relationship. Further research into reliable prognostic tools in this population is needed.
In Brief
The objective of this paper was to examine outcomes in elderly patients with spinal cord injury with the hope that the findings would guide clinicians in discussing the risks and benefits of aggressive surgical and ICU care. The key finding was that these patients have high complication rates, many of which are related to vasopressor use for mean arterial pressure goals. However, despite this, many patients do show improvement. These findings allow surgeons to have informed discussions about the expected outcomes and complications after spinal cord injury in the elderly.
In Brief
Researchers investigated the current epidemiologic landscape of spinal osteomyelitis and spondylodiscitis (SD) and analyzed cases requiring operative management. Results demonstrated that 45.5% of cases ofStaphylococcus aureusSD in the US are resistant to beta-lactam antibiotics. Cases of MRSA are more likely to be managed surgically and have higher rates of complications and reoperations as compared with MSSA. Early detection and prompt operative management are imperative to reduce risk of complications.
In Brief
本研究回顾了文献的患者spine tumors who underwent CF-PEEK instrumentation with a focus on implant-related complications and oncological outcomes. The authors found that while CF-PEEK implants may harbor similar biomechanical profiles to traditional titanium implants, it remains unclear whether they lead to benefits in local control, survival, and patient-reported outcomes. High-quality, direct comparative studies of CF-PEEK implants and their impact on outcomes in the spinal oncology setting are warranted.
In Brief
The authors aimed to compare the accuracy rates of pedicle screws placed with robotic assistance in the lateral decubitus position versus fluoroscopy, O-arm, or CT-based navigation. The results of the meta-analysis showed that robot-assisted placement is as accurate as the other methods and may offer additional benefits in dealing with the technical challenges of this position. These findings advocate for the use of single-position surgery with robotic technologies that can better facilitate the placement of pedicle screws.
OBJECTIVE
Vertebral body sliding osteotomy (VBSO) is a surgical technique that anteriorly translates the vertebral body with compressive lesions and achieves cord decompression through canal widening. However, data on the surgical complications of VBSO are lacking. Furthermore, it has not been known whether VBSO could be a viable alternative in the treatment of cervical myelopathy even when the preoperative canal-occupying ratio (COR) is large, which seems to frequently result in incomplete canal widening. This study aimed to describe the incidence of VBSO-associated surgical complications and to evaluate the incidence and risk factors of incomplete canal widening.
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A total of 109 patients who underwent VBSO to treat cervical myelopathy were retrospectively reviewed. Neck pain visual analog scale, Neck Disability Index, Japanese Orthopaedic Association (JOA) scores, and surgical complications were evaluated. For radiological evaluation, C2–7 lordosis, C2–7 sagittal vertical axis, and COR were measured. Patients with a preoperative COR < 50% (n = 60) and those with a COR ≥ 50% (n = 49) were compared and logistic regression analysis was performed to identify factors associated with incomplete canal widening.
RESULTS
The most frequent complication in the patients was mild dysphagia (7.3%). Dural tears were observed during posterior longitudinal ligament resection (n = 1) and foraminotomy (n = 1). Two patients underwent reoperation due to radiculopathy from adjacent-segment disease. Incomplete canal widening occurred in 49 patients. According to logistic regression analysis, high preoperative COR was the only factor associated with incomplete canal widening. The amount of canal widening and JOA recovery rate in the COR ≥ 50% group were significantly higher than in the COR < 50% group.
结论
轻度吞咽困难是最常见的并发症following VBSO. Although VBSO aims to decrease the complication rate of corpectomy, it was not free of dural tears. Special care would be required during the posterior longitudinal ligament resection. Incomplete canal widening occurred in 45.0% of patients, and high preoperative COR was the only risk factor for incomplete canal widening. However, high preoperative COR would not be a contraindication for VBSO, given that favorable clinical outcomes were presented in the COR ≥ 50% group.
In Brief
The objective of this paper was to examine the association of symptom duration with outcome in elective spine surgery. The key finding was that patients with symptoms for ≥ 1 year had poorer clinical outcomes compared with patients with a shorter symptom duration. With these findings, surgeons can help manage expectations for outcome based on the chronicity of symptoms.
读者:一个错误出现在article by Vargas et al. (
Because of a miscommunication during production of the article, the Spine Instability Neoplastic Score (SINS) was inadvertently removed from the title. As the scores indicate the specific patient group under consideration in our study, they have been included in the corrected title, which appears below.
In Brief
The authors investigated the longitudinal risk of tethering among adults with myelomeningocele who had escaped childhood without undergoing tethered cord release (TCR) and the factors that contributed to that risk. Female sex, prior Chiari decompression, and absent prior hydrocephalus treatment were independently correlated with TCR. The higher risk among adult females is striking, contrary to the authors′ prior findings that sex is not significantly correlated with TCR risk in childhood, and deserves further study….
In Brief
The clinical outcomes of patients with degenerative scoliosis undergoing decompression alone or short-segment fusion were compared using propensity score matching. For matched patients, a tradeoff was seen for reduced perioperative morbidity for decompression versus greater improvement in back pain, disability, and mental health 1 year after short-segment fusion. In the first propensity score–matched comparison of MISDEF2 (minimally invasive spinal deformity surgery revision 2) class I patients, future directions are provided to further refine treatment algorithms.
In Brief
The authors conducted a post hoc analysis of the Adult Symptomatic Lumbar Scoliosis (ASLS) trial examining factors related to crossover from nonoperative to operative treatment in ASLS. Enrollment in the randomized (vs observational) cohort, a lower baseline Scoliosis Research Society (SRS)–22 questionnaire subscore, and lower baseline lumbar lordosis were associated with crossover. These findings will help surgeons and patients understand the characteristics of those who are satisfied with nonoperative care and thereby assist with shared decision-making.
In Brief
The study aimed to investigate the feasibility of using a convolutional neural network (CNN)–based segmentation model to measure interspinous motion (ISM) in patients who had undergone single-level anterior cervical discectomy and fusion surgery. The research found that a CNN-based model designed to measure ISM agreed well with human raters. This study provides preliminary insights into an automated methodology that uses a CNN-based algorithm.
In Brief
Researchers investigated whether administration of radiotherapy after achieving gross-total resection to patients with spinal chordoma offered any improvement in overall survival. The authors found that administration of radiotherapy did not improve overall survival in this patient population to a value that achieved statistical significance when utilizing a multivariate model of 263 patients. This finding suggests that multicenter prospective studies may be needed to determine the true efficacy of radiotherapy in this patient population.
In Brief
The authors' objective was to compare the impact of multirod constructs and dual-rod constructs on proximal junctional kyphosis (PJK) incidence in adult spinal deformity patients. Multirod constructs were more often used in revision surgery and long-segment reconstruction, as well as cases with 3-column osteotomies. The multirod cohort had equivalent incidence rates of postoperative PJK and revision surgery. PJK-free survival analysis demonstrated equivalent PJK-free survival in the multirod cohort.
In Brief
Efforts to reduce the occurrence of proximal junctional kyphosis (PJK) and failure (PJF) in patients with adult spinal deformity (ASD) have resulted in the development of novel prophylactic techniques and enhanced clinical and radiographic selection criteria. This study presents a validated model incorporating such techniques with a robust area under the curve of 92.3%, allowing for the prediction of clinically significant PJK and PJF. Thus, the model can assist surgeons and institutions in optimizing patient selection, enhancing intraoperative decision-making, and reducing postoperative complications in ASD surgery.
In Brief
Single-position prone transpsoas interbody fusion is gaining popularity, but its complication profile is poorly described. Researchers performed a systematic review and pooled analysis to understand the safety profile of this procedure. Intraoperative and postoperative complication rates were low and comparable to historical rates for lateral position transpsoas surgery. No vascular or visceral complications have been reported to date. Nonetheless, the quality of these published studies was low; further prospective studies are needed.
OBJECTIVE
Total disc arthroplasty (TDA) has been established as a safe and effective alternative to anterior cervical discectomy and fusion for the treatment of cervical spine pathology. However, there remains a paucity of studies in the literature regarding the amount of disc height distraction that can be tolerated, as well as its impact on kinematic and clinical outcomes.
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Patients who underwent 1- or 2-level cervical TDA with a minimum follow-up of 1 year with lateral flexion/extension and patient-reported outcome measures (PROMs) were included. Middle disc space height was measured on preoperative and 6-week postoperative lateral radiographs to quantify the magnitude of disc space distraction, and patients were grouped into < 2-mm distraction and > 2-mm distraction groups. Radiographic outcomes included operative segment lordosis, segmental range of motion (ROM) on flexion/extension, cervical (C2–7) ROM on flexion/extension, and heterotopic ossification (HO). General health and disease-specific PROMs were compared at the preoperative, 6-week, and final postoperative time points. The independent-samples t-test and chi-square test were used to compare outcomes between groups, while multivariate linear regression was used to adjust for baseline differences.
RESULTS
Fifty patients who underwent cervical TDA at 59 levels were included in the analysis. Distraction < 2 mm was seen at 30 levels (50.85%), while distraction > 2 mm was observed at 29 levels (49.15%). Radiographically, after adjustment for baseline differences, C2–7 ROM was significantly greater in the patients who underwent TDA with < 2-mm disc space distraction at final follow-up (51.35° ± 13.76° vs 39.19° ± 10.52°, p = 0.002), with a trend toward significance in the early postoperative period. There were no significant postoperative differences in segmental lordosis, segmental ROM, or HO grades. After the authors controlled for baseline differences, < 2-mm distraction of the disc space led to significantly greater improvement in visual analog scale (VAS)–neck scores at 6 weeks (−3.68 ± 3.12 vs −2.24 ± 2.70, p = 0.031) and final follow-up (−4.59 ± 2.74 vs −1.70 ± 3.03, p = 0.008).
结论
Patients with < 2-mm disc height difference had increased C2–7 ROM at final follow-up and significantly greater improvement in neck pain after controlling for baseline differences. Limiting differences in disc space height to < 2 mm affected C2–7 ROM but not segmental ROM, suggesting that less distraction may result in more harmonious kinematics between all cervical levels.
TO THE EDITOR: We read with great interest the study published by Meyer et al.,
Lumbar interbody fusion techniques ensure a 360° fixation and also address anterior pathology
In Brief
Researchers sought to discern whether patients with a cranial sagittal vertical axis to the hip (CrSVA-H) > 2 cm at 2 years postoperatively exhibited worse patient-reported outcomes (PROs) and clinical outcomes than patients with CrSVA-H < 2 cm. The authors' analysis found that patients with CrSVA-H > 2 cm had inferior PROs and higher reoperation rates than patients with CrSVA-H < 2 cm. This study provides additional support, validation, and clarification of the existing literature and further highlights the importance of the cranial position in relation to the spine.
In Brief
This study focused on the comparison of applied radiation doses of sliding gantry CT (SGCT)- and mobile cone-beam CT (CBCT)-based pedicle screw placement for spinal instrumentation. Results showed that the applied radiation doses are significantly lower using SGCT compared with CBCT for navigated pedicle screw placement in spinal instrumentation overall, and also per level. Such considerably high doses with even inferior image quality should be discussed for the future of CBCT.
In Brief
This study aimed to characterize upper-limb neurological recovery after high cervical spinal cord injury (SCI) and its association with functional independence. The recovery of the distal myotomes of the upper limb, including C7 (elbow-extension) and C8 (finger-flexion), substantially increased the degree of independence in performing functions related to tetraplegia. This information may provide important prognostic information to patients with high cervical SCI and inform design of research interventions focusing on restoration of distal myotomes.
In Brief
Researchers validated an up-and-coming smartphone-based accelerometry outcome-daily steps-for patients undergoing spine surgery using the current gold-standard patient-reported outcome measures (PROMs). The key finding of the study was that pain-related PROMs correlate with daily steps and that a postoperative increase in normalized daily steps by 0.613 standard deviation from baseline may signify the minimal clinically important difference. This study adds to spine literature by advancing the use of smartphone-based objective outcomes for understanding patient improvement following surgery.
In Brief
Researchers aimed to study if the duration of neurological deficit on presentation with spinal coccidiomycosis infection was associated with neurological recovery after surgical decompression. The study found that the duration of neurological deficit was not significantly associated with neurological improvement after surgery. These findings provide guidance to surgeons when confronted with this rare disease entity.
TO THE EDITOR: I read with interest the article by Chakravarthy et al.
I would suggest that readers consider the use of
In Brief
The purpose of this study was to introduce a modified posterior spinous process–splitting approach. This novel technique may be a useful alternative to the conventional posterior approach for transforaminal lumbar interbody fusion. The authors believe that this technique could be very valuable to the field.
In Brief
The goal of this study was to evaluate the efficacy of vertebral column decancellation and pedicle subtraction osteotomy in patients with ankylosing spondylitis with kyphotic deformity. Vertebral column decancellation was superior in terms of operative time and intraoperative blood loss. This study can give clinicians a better reference in the selection of surgical methods.
In Brief
This study reviewed the global literature to investigate the effects of surgery on patients with axial neck pain, focusing on those with predominant neck pain. The results show that patients with predominant neck pain experienced significant improvement, exceeding the minimal clinically important difference and achieving substantial clinical benefit. The study's importance lies in informing treatment guidelines and best practices for managing axial neck pain patients, addressing the current lack of consensus regarding surgical options.
In Brief
This study assessed agreement between surgeon-specified diagnostic indication and hospital-reported ICD-10 codes for lumbar spine surgery. Agreement was best for patients who underwent only decompression. Agreement was best for spondylolisthesis among fusion cases (76%), but poor for other fusion cases due to multiple diagnoses or lack of an ICD-10 code reflecting pathology. Standard ICD-10 codes may be inadequate to clearly define the indications for decompression or fusion in patients with lumbar degenerative disease.
In Brief
This study compared 1) subsidence and reoperation rates between polyetheretherketone (PEEK) and porous titanium (pTi) interbodies used in lateral lumbar interbody fusion, and 2) costs between devices. Subsidence rates were lower for pTi versus PEEK (8% vs 27%); subsidence-related reoperation rates were similar. pTi was economically superior to PEEK at a cost threshold of $1185.94. pTi had less subsidence compared to PEEK. The lower reoperation rate with pTi, although statistically similar to that of PEEK, justifies only a slightly higher cost for the pTi device.
TO THE EDITOR: We read with great interest the article by Beck et al.
In Brief
Cohorts of patients with high pelvic incidence were studied to examine mechanical complications and patient-reported outcomes after spinal fusion. Neither proximal junctional kyphosis nor pseudarthrosis rates were different between those fixed with appropriate lordosis and those with high pelvic tilt (Roussouly false type 2). Patient-reported outcomes were not different. In some patients, less surgery to allow for retroversion and horizontal gaze may be appropriate and durable.
In Brief
This study aimed to investigate the rates and indications of unplanned reoperation after pedicle subtraction osteotomy (PSO) for correction of kyphotic deformity in patients with advanced ankylosing spondylitis (AS). Although PSO may be the most effective surgical procedure for correcting thoracolumbar kyphosis, 15.9% of patients required an unplanned reoperation. The longer the follow-up period, the more unplanned reoperations due to mechanical complications were performed. Despite abundant surgical experience, many unplanned minor or major reoperations should be performed after PSO.
OBJECTIVE
Bone morphogenetic proteins (BMPs) are part of the transforming growth factor–beta superfamily and are involved in bone formation and repair. In spine surgery, recombinant human BMP (rhBMP) is used as an alternative to autografts for spinal fusions. This study aimed to evaluate bibliometric parameters and citations of the literature on BMPs to provide an overview of how the field has evolved.
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A comprehensive search of the literature was conducted using Elsevier’s Scopus database to capture all the published and indexed studies relevant to BMPs from 1955 to the present. A discrete set of validated bibliometric parameters was extracted and analyzed. All statistical analyses were performed using R 4.1.1.
RESULTS
The 100 most cited articles were published between 1994 and 2018 by 472 unique authors in 40 sources (e.g., journals and books). On average, there were 279 citations per publication and 17.69 citations per publication per year. The United States had the publications with the most citations (n = 23,761), followed by Hong Kong (n = 580) and the United Kingdom (n = 490). The three institutions in the United States with the greatest number of publications in the field were Emory University (n = 14), Hughston Clinic (n = 9), Hospital for Special Surgery (n = 6), and University of California (n = 6).
结论
The authors evaluated and characterized the 100 most cited articles about BMP. Most of the publications were clinical in nature and focused on BMP’s application in spine surgery. While early scientific efforts focused on basic science research to advance the understanding of BMP’s mechanism of action in promoting bone formation, the majority of the more recent publications are clinically focused. It will be beneficial to conduct more controlled clinical trials to compare the outcomes of BMP use with other methods.
In Brief
The authors compared functional status after surgery and radiation in patients with potentially unstable spines (Spine Instability Neoplastic Score values 7-12) without spinal cord compression. Compared to patients who underwent radiation therapy, patients who underwent surgery had greater improvement in Karnofsky Performance Status scores, but not in Eastern Cooperative Oncology Group scores. These findings suggest that patients with potentially unstable spines may benefit from surgical stabilization even in the absence of spinal cord compression.
读者:一个错误出现在article by Sait et al. (
An affiliation for Azad Sait was omitted. The authors are listed below, followed by the corrected affiliations. The numbering used reflects that used for the affiliations in the now updated article.
In Brief
This study examined the effect of increasing interbody cage angles in patients undergoing stand-alone single-level anterior lumbar interbody fusion (ALIF). Stand-alone ALIF cages < 15° showed improved average foraminal and disc height without sacrificing improvements in sagittal parameters or increasing risk of subsidence when compared with hyperlordotic cages > 15°, which did not provide spinal lordosis commensurate with the lordotic angle of the cage and had a greater risk of subsidence. The authors' findings support the judicious use of hyperlordotic cages in stand-alone ALIF.
OBJECTIVE
Odontoid fractures can be managed surgically when indicated. The most common approaches are anterior dens screw (ADS) fixation and posterior C1–C2 arthrodesis (PA). Each approach has theoretical advantages, but the optimal surgical approach remains controversial. The goal in this study was to systematically review the literature and synthesize outcomes including fusion rates, technical failures, reoperation, and 30-day mortality associated with ADS versus PA for odontoid fractures.
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A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching the PubMed, EMBASE, and Cochrane databases. A random-effects meta-analysis was performed and the I2statistic was used to assess heterogeneity.
RESULTS
总共22个研究包括963例(广告527, PA 436) were included. The average age of the patients ranged from 28 to 81.2 years across the included studies. The majority of the odontoid fractures were type II based on the Anderson-D’Alonzo classification. The ADS group was associated with statistically significantly lower odds to achieve bony fusion at last follow-up compared to the PA group (ADS 84.1%; PA 92.3%; OR 0.46; 95% CI 0.23–0.91; I242.6%). The ADS group was associated with statistically significantly higher odds of reoperation compared to the PA group (ADS 12.4%; PA 5.2%; OR 2.56; 95% CI 1.50–4.35; I20%). The rates of technical failure (ADS 2.3%; PA 1.1%; OR 1.11; 95% CI 0.52–2.37; I20%) and all-cause mortality (ADS 6%; PA 4.8%; OR 1.35; 95% CI 0.67–2.74; I20%) were similar between the two groups. In the subgroup analysis of patients > 60 years old, the ADS was associated with statistically significantly lower odds of fusion compared to the PA group (ADS 72.4%; PA 89.9%; OR 0.24; 95% CI 0.06–0.91; I258.7%).
结论
ADS fixation is associated with statistically significantly lower odds of fusion at last follow-up and higher odds of reoperation compared to PA. No differences were identified in the rates of technical failure and all-cause mortality. Patients receiving ADS fixation at > 60 years old had significantly higher and lower odds of reoperation and fusion, respectively, compared to the PA group. PA is preferred to ADS fixation for odontoid fractures, with a stronger effect size for patients > 60 years old.
In Brief
This study introduces the application of 2 intraoperative targets for coronal alignment (central sacral pelvic line [CSPL] and intraoperative central sacral vertical line [iCSVL]) based on 4 distinct groups of patients, who were categorized on the basis of pelvic obliquity (PO), leg length discrepancy, and lower-extremity compensation in the coronal plane. This study's findings demonstrated that CSPL and iCSVL, when used appropriately, can predict postoperative coronal vertical axis with high accuracy up to 2 years of follow-up.
In Brief
The authors aimed to investigate how representative the American Spine Registry (ASR) is of the national spinal surgery practice by comparing it to the National Inpatient Sample (NIS). They found that the ASR includes highly similar patient populations and surgical approaches among cervical and lumbar arthrodeses compared to the NIS, with the ASR's representativeness of the national practice increasing yearly. This analysis provides evidence of the ASR's external validity, which is important in the database's role as a quality assessment instrument and a data source for future research endeavors.
In Brief
Despite the increasing prevalence of combination therapy of SBRT and immune checkpoint inhibitors in the treatment of metastatic spinal tumors, practices combining these two therapies vary. This study, one of the first to characterize this clinical scenario, found low rates of esophageal, bowel, and spinal cord toxicity and no difference in safety by immunotherapy sequence with respect to SBRT. Prospective studies are needed to characterize the optimal timing of immunotherapy to maximize local and distal control.
In Brief
The objective of this study was to evaluate the impact of an Enhanced Recovery After Surgery (ERAS) protocol on the postoperative outcomes of patients undergoing posterior cervical decompression surgery. The key finding was that implementing an ERAS protocol significantly improved length of stay, return of physiological function, home discharge, complications, and maximum pain score after posterior cervical surgery. This study adds value to the field by demonstrating the effectiveness of the ERAS protocol in improving outcomes for patients undergoing posterior cervical decompression surgery, an area that has not been previously studied in the context of ERAS.
In Brief
The authors sought to develop and validate the clinical validity and accuracy of a risk prediction model (nomogram) for recompression of augmented vertebrae (RCAV) after percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral fractures. In patients at high risk of RCAV, the findings demonstrated that the target puncture technique, vitamin D supplementation, and antiosteoporotic therapies would be essential to prevent deterioration of their clinical course.
In Brief
Understanding the differences between adverse event (AE) systems is fundamental for accurately identifying AEs that drive quality improvement. This study demonstrates that the Spine Adverse Events Severity System, a disease-specific, prospective, point-of-care database, captures a greater incidence of spine-specific AEs, while the National Surgical Quality Improvement Program, a generic, chart-abstracted, retrospective database, captures a greater incidence of AEs beyond 30 days without additional database indexing. This study highlights that an institution's contextual and aim-specific needs should guide the choice and implementation of an AE system.
TO THE EDITOR: With great interest, we read the article by Malone et al.
In Brief
The objective of this study was to discern factors that differentiate patients who experience postoperative lower-extremity motor function decline in the early postoperative period. Multivariate logistic regression demonstrated that the presence of intraoperative neurophysiological monitoring changes and each degree of negative change in the T1 pelvic angle (T1PA) conferred a 3.71 and 1.09 greater odds of postoperative lower-extremity motor score deterioration, respectively, which has implications for surgical planning, patient counseling, and clinical research.
In Brief
作者试图检查如果圆周minimally invasive surgery (cMIS) for patients with adult spinal deformity (ASD) provided incrementally increasing benefit to patients with escalating frailty. Relative to propensity score-matched patients who underwent surgery via an open technique, cMIS patients with increasing frailty had greater relative reductions in perioperative complications and mitigation of catastrophic outcomes. These findings demonstrate that cMIS may offer acceptable outcomes and increased operative safety in increasingly frail patients with ASD who may not be candidates for traditional open surgery.
In Brief
The main objective of this study was to compare the time to revision surgery between elective single-level cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF). The data showed no significant difference in protective benefit against adjacent-segment disease based on the time to revision surgery between cohorts. This study adds value to the current literature by reporting on the real-world use and revision care of ACDF versus CDR technologies in a large, diverse cohort.
In Brief
By comparing the natural history progression of adult spinal deformity with the progression of patients with suboptimal outcomes after surgical correction, this study found that those who had suboptimal outcomes after surgical correction were more likely to achieve favorable minimal clinically important difference in health-related quality of life measures compared with those who did not undergo surgical correction.
In Brief
Novel endoscopic spine surgery is defying the need for traditional in-person postoperative care, counseling, and follow-up. In this study, the authors demonstrate the safety and feasibility of virtual postoperative care and outcome collection in this patient population using a novel smartphone app. The patients expressed a high rate of satisfaction with app-based virtual postoperative care, and more than 75% of patients provided postoperative patient-reported outcomes at 3 months after surgery. App-based patient follow-up provides a highly flexible platform to power multicenter research endeavors. Importantly, implementation eases the burden of postoperative care and elevates the patient's postoperative experience.
In Brief
This study analyzes risk factors for sacral fracture following partial sacral amputation for en bloc chordoma resection. The authors found S1–2 sacral amputation, a combined anterior-posterior surgical approach, low superior S1 Hounsfield units, and partial sacroiliac joint resection to be independent predictors of sacral fracture. This study can help guide which patients may benefit from upfront spinopelvic instrumentation at the index procedure, and is important for patient optimization, surgical planning, and counseling.
OBJECTIVE
Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK.
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A systematic literature search was performed using PubMed and Web of Science keywords of "Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]" AND "Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score.
RESULTS
A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of −0.69 (95% CI −0.88 to −0.50; I2= 63.9%, p < 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference −32.35, 95% CI −46.05 to −18.65; I2= 28.7%, p < 0.001).
结论
This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.
In Brief
This large study of nearly 300,000 spine surgery patients in the American College of Surgeons National Surgical Quality Improvement Program database (2015-2019) compares the discriminative threshold of the retrospective Risk Analysis Index (RAI) with the 5-factor modified frailty index (mFI-5) for predicting postoperative mortality. The RAI demonstrated superior discrimination compared with the mFI-5 in predicting postoperative mortality (C-statistic 0.80) in the overall cohort and in the trauma and infection cohorts. The RAI is preferred to the mFI-5 for frailty screening in spine surgery patients.
In Brief
The objective of this study was to use a patient-specific finite element model to compare changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty. Spinal cord stress and strain were lowest after laminectomy with fusion compared with motion-preserving approaches such as laminoplasty and laminectomy. This study highlights the potential utility of patient-specific finite element modeling of the spinal cord to predict postsurgical spinal cord stress/strain using simulated surgical interventions.
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