Influence of decompression by laminotomy and percutaneous tansforaminal endoscopic surgery on postoperative wound healing, pain intensity, and lumbar function in elderly patients with lumbar spinal stenosis

PURPOSE

To compare the wound healing, pain intensity and lumbar function in elderly patients with lumbar spinal stenosis after laminectomy decompression or percutaneous transforaminal endoscopic surgery.

METHODS

A retrospective study was conducted on 65 patients who underwent laminotomy and 69 patients who underwent percutaneous transforaminal endoscopic spinal decompression surgery. clinical data analysis, including surgical parameters, complications, postoperative wound healing, pain intensity, lumbar function, and correlation analysis, was performed.

RESULTS

The operative time of percutaneous transforaminal endoscopic surgery was significantly shorter than that of laminotomy (70.78±6.80 min vs 128.97±4.70 min, p < 0.001), intraoperative blood loss was significantly reduced (94.22± 7.69ml vs 327.68± 6.44ml, p < 0.001), postoperative wound healing time and time to get out of bed were significantly shortened, pain was reduced by visual analog scale (3.48±1.11 vs 2.80±1.05, p = 0.007), the Japanese Orthopaedic Association (JOA) score was significantly increased, and the Oswestry Disability Index (ODI) score showed significantly decrease. The incidence of urinary tract infection and urinary retention was higher after laminotomy. Correlation analysis showed that operative time, intraoperative blood loss, and time to get out of bed were significantly related to prognosis in elderly patients.

CONCLUSION

Percutaneous transforaminal endoscopic surgery is significantly superior to conventional laminectomy decompression in the treatment of elderly lumbar spinal stenosis.

Anterior cervical discectomy and fusion in treating acute myelopathy caused by Brucella cervical spondylitis: a case series

BACKGROUND AND OBJECTIVES

Cervical disease caused by Brucella infection is rare, with acute spinal cord impairment due to myelitis being a severe complication. If untreated, it can lead to significant patient damage. This study aims to begin to investigate the clinical characteristics of acute cervical myelitis caused by Brucella infection and to evaluate the profile of clinical benefit of anterior cervical discectomy and fusion (ACDF) for this condition.

METHODS

This retrospective case series included 6 patients who underwent surgical treatment for acute cervical spinal cord impairment due to Brucella infection at our institution between January 1, 2013, and January 1, 2023. Clinical data such as age, gender, surgery duration, follow-up period, medication duration, time to bone fusion, ASIA classification, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI) score were collected both preoperatively and postoperatively. Statistical analysis was used to assess the clinical benefits of ACDF surgery.

RESULTS

Six patients (4 males, 2 females) underwent successful ACDF. The median age was 52.5 years. The median surgery duration was 130.0 min, and the median hospital stay was 13.5 days. The median follow-up period was 15.0 months, and the median duration of postoperative medication was 16.0 weeks. All patients achieved satisfactory bone graft fusion, with a median fusion time of 4.0 months. ASIA classifications improved in all patients. Three patients improved from grade C to grade E, two from grade B to grades D and E, and one from grade C to grade D. The median VAS score decreased from 6.0 preoperatively to 0.0 at follow-up. The median JOA score increased from 6.0 to 17.0, and the NDI score improved from 29.5 to 4.5. No recurrence of infection or neurological symptoms was observed during follow-up.

CONCLUSION

Acute cervical spinal cord impairment from Brucella infection is rare and challenging to diagnose early. However, early ACDF application effectively relieved spinal cord compression, improved neurological symptoms, and enhanced patient outcomes, demonstrating its efficacy for treating acute myelitis caused by Brucella infection.

Detrimental effects of advanced glycation end-products (AGEs) on a 3D skeletal muscle model in microphysiological system

Skeletal muscle is essential for maintaining body shape and supporting physiological processes. Musculoskeletal function is influenced by various factors, including nutrition, infection, injury or trauma, and advanced glycation end-products (AGEs), which are known to contribute in tissue degeneration, particularly in aging and diabetic populations. This study utilized a skeletal muscle-on-a-chip system to develop three-dimensional in vitro musculoskeletal tissue, enabling a detailed investigation of the effects of AGEs on muscle function and structure. AGEs-induced alterations on muscle were verified by assessments of musculoskeletal contractility, myotube growth, and apoptosis markers. Furthermore, metabolic changes such as modifications in collagen and NADH lifetime changes were observed using fluorescence-lifetime imaging microscopy (FLIM) in the AGEs-treated group. Our result demonstrated a significant reduction in musculoskeletal contractility and structural disruptions in response to AGEs exposure. Overall, these findings provide a robust in vitro model for elucidating the mechanisms by which AGEs impair muscle functionality and integrity, with potential implications for therapeutic strategies aimed at preserving muscle health and enhancing the quality of life in affected populations.

Acellular, bioresorbable, ultra-purified alginate gel implantation for intervertebral disc herniation: Phase 1/2, open-label, non-randomized clinical trials

Discectomy is the current surgical procedure for lumbar intervertebral disc (IVD) herniation. Discectomy was performed to remove the IVD material and relieve the pain inflicted by nerve root compression and axonotoxic effects, such as inflammatory cytokines in the IVD material; however, defects within the IVD caused by discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration. Given that viable cells with the capacity for IVD regeneration are scarce, discectomy alone is not conducive to tissue repair. Here, we report the use of an acellular, bioresorbable, ultra-purified alginate (UPAL) gel implantation system to prevent IVD degeneration after discectomy and demonstrate its feasibility and safety in phase 1/2, open-label, non-randomized clinical trials conducted at a double center. This study comprised two parts: a prospective study on UPAL gel implantation after discectomy in patients with lumbar disc herniation, and a subsequent prospective study on patients who underwent discectomy without UPAL implantation as a control group. The control group was recruited separately. The primary outcomes of this study were the feasibility and safety of UPAL implantation, and the secondary outcomes included physical function scores, self-report questionnaires (SRQs) evaluating pain and health-related quality of life and magnetic resonance imaging (MRI)-based measures of IVD tissues. The UPAL gel implantation demonstrated 100% feasibility and safety (n = 40). The physical function scores improved significantly postoperatively in both groups, with the UPAL group demonstrating greater improvements over time compared to the control group. The SRQ scores were significantly higher in the UPAL group than in the control group from the early postoperative period to 12 weeks. MRI revealed that the disc degeneration score was significantly lower in IVDs with UPAL implantation than in those that underwent discectomy alone. The findings of this study suggest that the UPAL gel is a novel therapeutic strategy after discectomy in cases of lumbar IVD herniation. Trial number: UMIN000034227, UMIN000042282.

Evaluating the Predictive Value of K-Line Conversion in Surgical Outcomes for K-Line Negative Cervical Ossification of the Posterior Longitudinal Ligament (OPLL): Laminectomy with Fusion versus Laminoplasty

BACKGROUND CONTEXT

Laminectomy with fusion (LF) and laminoplasty are common treatments for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL). However, the clinical significance of postoperative K-line conversion from negative to positive remains unclear.

PURPOSE

To determine whether converting a K-line from negative to positive improves surgical outcomes in patients with cervical OPLL by comparing LF and laminoplasty.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Patients with cervical myelopathy due to K-line negative OPLL who underwent LF or laminoplasty, with ≥1 year of follow-up.

OUTCOME MEASURES

Primary outcomes included neck and arm pain visual analog scale (VAS) scores, neck disability index (NDI), Japanese Orthopedic Association (JOA) score, JOA recovery rate, and radiographic parameters (C2-C7 lordosis, modified K-line interval).

METHODS

We compared radiographic and clinical outcomes between the two groups.

RESULTS

Among 85 patients with K-line-negative OPLL (39 LF, 46 laminoplasty), postoperative K-line conversion occurred significantly more frequently in the LF group (56.4% vs. 16.8%; p <0.001). Although laminoplasty better preserved cervical range of motion and reduced neck pain, LF provided superior neurologic outcomes, as indicated by higher final JOA scores and recovery rates. Patients who achieved K-line conversion had significantly higher rates of favorable clinical outcomes compared to those who did not (58.1% vs. 27.7%; p=0.019). Multivariate regression analyses further demonstrated that K-line conversion independently predicted favorable clinical outcomes (odds ratio [OR]: 3.900; p = 0.023), and LF was significantly associated with a higher likelihood of K-line conversion compared to laminoplasty (OR: 3.683; p = 0.033).

CONCLUSION

In patients with K-line-negative cervical OPLL, postoperative conversion to K-line-positive status is significantly associated with improved neurological outcomes. Although laminoplasty provides advantages regarding neck pain relief and motion preservation, LF more reliably facilitates K-line conversion and suppresses kyphosis, leading to superior clinical outcomes. Careful preoperative evaluation of cervical alignment, combined with surgical strategies aimed at promoting K-line conversion, may optimize surgical results.

LEVEL OF EVIDENCE

III.

Safety and Efficacy of Mirogabalin in Lumbar Spinal Stenosis Patients with Peripheral Neuropathic Pain on NSAIDs: Post Hoc Analysis of the MiroTAS Study

INTRODUCTION

The primary analysis of the MiroTAS study in patients with lumbar spinal stenosis (LSS) taking non-steroidal anti-inflammatory drugs showed that mirogabalin add-on therapy further improved pain and quality of life (QOL) without new safety concerns.

METHODS

This post hoc analysis of the MiroTAS study examined the timing of onset of mirogabalin-related adverse drug reactions (mrADRs) (composite of somnolence, dizziness, edema, and peripheral edema), factors affecting safety and efficacy, and the relationships between baseline numbness severity (by spine painDETECT questionnaire [SPDQ] score), EQ-5D-5L scores, leg pain improvement (by visual analogue scale [VAS]), and patient satisfaction (by Patient Global Impression of Change [PGIC] scores).

RESULTS

Among 110 patients, there were no significant differences in the incidence rates of mrADRs by patient characteristics. The mrADRs occurred mainly after the first administration and uptitration period of mirogabalin. EQ-5D-5L scores significantly improved from baseline to week 12 in patients with mrADRs vs those without (difference 0.0767; p = 0.0304 by t test). The proportion of patients with PGIC scores ≤ 3 at week 12 was numerically higher in patients with mrADRs vs those without. There were no differences in the percentage of patients with reduced leg pain by VAS score (improvement ≥ 20 mm) at week 12 by patient characteristics except for spondylolysis/spondylolisthesis as a complication. Baseline SPDQ numbness scores were positively correlated with improvement in EQ-5D-5L at week 12 (Spearman's rank correlation coefficient 0.2811, p = 0.0092).

CONCLUSIONS

Mirogabalin was not related to specific patient characteristics regarding the onset of mrADRs and was effective for LSS regardless of patient characteristics. Caution is needed regarding the onset of mrADRs after first administration and uptitration of mirogabalin, but these may not reduce QOL or patient satisfaction. Patients with high numbness scores may be more likely to benefit from treatment with mirogabalin in terms of QOL.

TRIAL REGISTRATION

Japan Registry of Clinical Trials (jRCTs021200007).

Accuracy and Safety Assessment of Subaxial Cervical Pedicle Screw Instrumentation: A Systematic Review

BACKGROUND CONTEXT

Given increasing use of both cervical pedicle screw (CPS) fixation in the subaxial cervical spine (C3-C7) and emerging navigation technologies, a quantitative profile of safety and accuracy remains wanting. Compared with lateral mass instrumentation of this region, CPS fixation shows superior biomechanical properties but poses higher risk of complications because of the narrow cervical pedicle width and proximity to neurovascular structures.

PURPOSE

This systematic review quantifies the accuracy and safety of all types of subaxial CPS insertion, with or without navigation or template-based methods, to weigh the strengths and limitations of each technique.

STUDY DESIGN

Systematic review according to PRISMA guidelines.

PATIENT SAMPLE

Patients who underwent CPS instrumentation since its introduction.

OUTCOME MEASURES

Primary and secondary outcomes in our review included pedicle screw breach in the subaxial cervical spine determined on intra- or postoperative imaging, and screw-related operative complications, respectively.

METHODS

Following the PRISMA guidelines, our literature search of PubMed, Cochrane, and Scopus databases identified 3,312 clinical studies (1980-2024) using subaxial CPS that assessed for screw accuracy. After full-text analysis, data extracted included number of CPS, level of placement, number of patients, indications, insertion techniques, accuracy assessment method, classification of accuracy, breach rate, complication rate, and study origin.

RESULTS

The 73 studies included in final analysis from Asia (80%), Europe (12%) and North America (8%) yielded 14,118 CPS in 3,342 patients (1999-2024). Accuracy rates were 85.3% for 10,108 CPS placed with non-navigated techniques (free-hand and fluoroscopy), 82.7% for 3,067 with navigation techniques, and 96.3% for 943 CPS placed using 3D templates. Complication rates were 1.1%, 2.1%, and zero, respectively.

CONCLUSION

Our comprehensive review of more than 14,000 subaxial CPSs inserted found rates of high 84% overall accuracy and low 1.2% perioperative complications (i.e., attributed to a misplaced screw). With biomechanical advantages superior to lateral mass screws, our quantitative findings support consideration for CPS instrumentation in select patients by experienced surgeons.

Canadian Association of Radiologists Spine Imaging Referral Guideline

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

Association of lumbar disc herniation and paraspinal muscles changes in patients with chronic low back pain

BackgroundPatients with chronic low back pain (CLBP) exhibit changes in paraspinal muscles fat infiltration and cross-sectional area (CSA). However, the relationship between lumbar disc herniation (LDH) and paraspinal muscles changes in CLBP patients remains unclear.ObjectiveTo analyze the relationship between LDH, fat infiltration in paraspinal muscles, and their CSA in patients with CLBP.MethodsA total of 494 patients (201 males and 293 females) with an average age of 45.75 ± 12.93 years with CLBP were included in this study. Conventional magnetic resonance scanning sequences, inverted phase and Iterative Decomposition of water and fat with the Echo Asymmetry and Least-Square Estimation quantitation (IDEAL-IQ) sequences were used, and patients were assessed for pain on a visual analog scale (VAS). LDH was assessed based on T2 axial images at the L4-S1 level. Multifidus and erector spinae CSA and proton density fat fraction (PDFF) were measured bilaterally at the central level of the L4-S1 disc using the above-mentioned sequences and normalized by the square of height.ResultsPatients with LDH had a higher PDFF of the paraspinal muscles at the L4/5 level compared to those without LDH (p < 0.05). Additionally, the VAS score of patients with LDH was significantly higher than that of the control group (p < 0.05). However, there was no significant difference in the change of paraspinal muscles CSA between patients with CLBP with and without LDH.ConclusionIn patients with LDH, there is increased fatty infiltration in the paraspinal muscles, with no significant changes in CSA. Different types of LDH are not related to paraspinal muscles fatty infiltration and CSA.

Comparison of Clinical and Radiographic Outcomes Between Percutaneous Endoscopic Transforaminal Diskectomy and Unilateral Biportal Endoscopic Diskectomy for the Treatment of L4/5-Level MSU Size-3 Lumbar Disk Herniation: A 2-Year Retrospective Cohort Study

BACKGROUND AND OBJECTIVES

Percutaneous endoscopic transforaminal diskectomy (PETD) and unilateral biportal endoscopic diskectomy (UBED) have demonstrated favorable clinical outcomes in managing lumbar disk herniation (LDH). The surgical treatment of Michigan State University (MSU) Size-3 LDH remains technically challenging. The aim of this study was to compare the clinical and radiographic outcomes of PETD and UBED, specifically in the treatment of L4/5-level MSU Size-3 LDH.

METHODS

The study included 138 patients who underwent either PETD (75 cases) or UBED (63 cases). During a follow-up period of at least 2 years, clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, complication and recurrence rates, serum creatine phosphokinase (CPK) levels, and other surgical data. Radiographic parameters, including intraoperative bone loss, paraspinal muscle-disk ratio, and intervertebral height index, were also monitored.

RESULTS

Both VAS scores for low back and leg pain, as well as ODI scores, showed significant decreases in both groups postoperatively. At baseline, 3 months postoperation, and at the final follow-up, VAS and ODI scores showed no statistically significant differences between the 2 groups. Compared with the UBED group, the PETD group showed lower VAS scores for incision pain on the first day and third day after surgery ( P < .001). Although no significant differences were observed in modified MacNab criteria, complication rates, or LDH recurrence, PETD demonstrated advantages in operative time, incision length, intraoperative blood loss, postoperative length of stay, total hospitalization costs, serum CPK levels, and intraoperative bone loss volume ( P < .001). No statistically significant differences were observed in the intervertebral height index or paraspinal muscle-disk ratio.

CONCLUSION

Both PETD and UBED can achieve favorable clinical outcomes in the treatment of L4/5-level MSU Size-3 LDH. Compared with UBED, PETD performed under local anesthesia offers superior short-term postoperative incision pain relief, improved perioperative quality of life, and reduced surgical invasiveness.

Effects of Preoperative Cervical Range of Motion on Clinical Outcomes Following Posterior Decompression: A Multicenter Study of Patients With Cervical Ossification of the Posterior Longitudinal Ligament

Study DesignRetrospective multicenter study.ObjectivesTo investigate the impact of preoperative cervical range of motion (ROM) on clinical outcomes after posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL).MethodsWe analyzed data from 156 patients with cervical OPLL who underwent posterior decompression and were followed for at least 2 years. Patients were divided into two groups based on preoperative gap ROM, which was a novel indicator representing the difference between flexion and extension ROM: the gROM <0° and >0° groups, and their outcomes were compared.ResultsThere were no significant differences in patient demographics or surgical details between the gROM <0° and >0° groups. The gROM <0° group exhibited less lordosis in C2-7 angles before and after surgery compared to the gROM >0° group. Cervical ROM significantly decreased following posterior decompression regardless of whether preoperative gROM was <0° or >0°. Meanwhile, the incidence of perioperative complications was similar between the two groups. Furthermore, both groups showed significant improvement in Japanese Orthopaedic Association (JOA) scores postoperatively; however, there were no significant group differences in JOA scores, recovery rates, or visual analog scale for neck pain between the two groups at the preoperation and final follow-up.ConclusionsThe incidence of perioperative complications and postoperative clinical outcomes were comparable regardless of the magnitude of preoperative cervical gROM. Although cervical ROM decrease postoperatively, posterior decompression for cervical OPLL can offer favorable clinical outcomes irrespective of the preoperative cervical ROM magnitude, consequently.

MR Imaging Approach to Arthritides and Spondyloarthropathies

MR imaging is a valuable imaging tool in the assessment of spinal arthritides, allowing the radiologist to formulate a rational differential diagnosis and construct a meaningful radiologic report. Of this, spondyloarthritis has garnered the most attention over the years given its debilitating symptoms and disabling effect. MR imaging depicts both inflammatory and structural lesions in the spine and SI joints and a systematic anatomic approach in appraising these lesions can aid in proper diagnosis. Combined with careful correlation with clinical findings and biomarkers, MR imaging is an instrumental tool in the diagnosis and treatment planning of spinal arthritides, particularly spondyloarthritis.

Influence of Diabetes Mellitus on Neurological Recovery in Older Patients With Cervical Spinal Cord Injury Without Bone Injury: A Retrospective Multicenter Study

Study DesignRetrospective study.ObjectivesTo investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury.MethodsA retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis.ResultsPropensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = -0.34; 95% confidence interval [CI], -0.59 to -0.08; P = 0.01), dementia (B = -16.50; 95% CI, -24.99 to -8.01; P < 0.01), and baseline total AMS (B = -0.62; 95% CI, -0.72 to -0.51; P < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury.ConclusionsDiabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.

Comparison of postoperative outcomes, satisfaction, and complications between bilateral 3-portal endoscopy and unilateral biportal endoscopy in patients with lumbar spinal stenosis: A multicenter, retrospective, cohort study

BACKGROUND

Bilateral 3-portal endoscopy is a novel minimally decompression surgery based on the modification of unilateral biportal endoscopy, which achieves complete decompression through a bilateral approach for patients with lumbar spinal stenosis. This study tested the hypothesis that bilateral 3-portal endoscopy could improve clinical outcomes and satisfaction versus unilateral biportal endoscopy in these patients.

METHODS

In this multicenter, retrospective, cohort study, 87 patients with lumbar spinal stenosis who received bilateral 3-portal endoscopy or unilateral biportal endoscopy were divided into bilateral 3-portal endoscopy (N = 35) and unilateral biportal endoscopy (N = 52) groups, respectively. Data on pain visual analog scale, Oswestry Disability Index, postoperative functional recovery by the Modified MacNab criteria, and patient self-reported satisfaction were retrieved. Complications were collected.

RESULTS

Back pain visual analog scale score (P = .111) and leg pain visual analog scale score (P = .178) at approximately 3 months of follow-up (3 months ± 2 weeks) tended to decrease in the bilateral 3-portal endoscopy group versus the unilateral biportal endoscopy group, although there was no statistical significance. Oswestry Disability Index at approximately 3 months of follow-up was reduced in the bilateral 3-portal endoscopy group versus the unilateral biportal endoscopy group (P = .047). The percentage of good to excellent postoperative functional recovery at approximately 3 months of follow-up showed an increasing trend in the bilateral 3-portal endoscopy group versus the unilateral biportal endoscopy group, but it did not reach statistical significance (P = .239). Patient self-reported satisfaction at approximately 3 months of follow-up tended to elevate in the bilateral 3-portal endoscopy group versus the unilateral biportal endoscopy group, although there was no statistical significance (P = .126). Moreover, the incidence of complications did not vary between groups (P > .999).

CONCLUSION

Bilateral 3-portal endoscopy yields relatively better postoperative outcomes and higher patient satisfaction with comparable complications versus unilateral biportal endoscopy in patients with lumbar spinal stenosis.

Trends in Cervical Laminoplasty Incidence in the United States: A Comparison of Commercial Insurance, Medicare, and Device Manufacturer Databases

STUDY DESIGN

Retrospective database study.

OBJECTIVE

To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).

SUMMARY OF BACKGROUND DATA

With purported benefits of motion preservation and lower complication rates than fusion, cervical laminoplasty is an important surgical technique. However, current commercial database studies suggest that laminoplasty adoption in the United States has been slow.

METHODS

The primary outcome was the total volume of laminoplasty procedures performed in the United States per year. Truven, a large commercial insurance claims database, was used to estimate laminoplasty volume from 2009 to 2019. Volume estimates for posterior cervical fusions were also generated as a comparator. Reimbursement data for laminoplasty adjusted for inflation were also generated. Trends in national procedural volumes and reimbursement over time were assessed with the Pearson correlation test. CMS Part B national summary statistics from 2000 to 2022 and market data from laminoplasty device manufacturers from 2017 to 2024 were qualitatively compared with volume estimates from Truven.

RESULTS

Truven volume of laminoplasty remained stable throughout the study period with an estimated annual volume of 944-1590 cases. Posterior cervical fusion volume was much higher, ranging from 7930 to 11,874 cases with increased trend. When compared qualitatively, Truven volume estimates were similar to those from CMS data, although industry volume estimates were comparatively higher (estimated total volume of 8352-11,428 cases). There was no statistically significant trend in Truven reimbursement values for laminoplasty from 2009 to 2019.

CONCLUSIONS

Industry market data suggest more laminoplasty procedures are being performed nationally than what is estimated by commercial/CMS databases. This suggests possible growth in laminoplasty usage, given purported advantages to fusion in the properly indicated patient, and possibly calls into question the epidemiological accuracy of commercial claims databases.

LEVEL OF EVIDENCE

IV-Retrospective study.

A look back at lumbar spinal stenosis cases in older adults during the COVID-19 pandemic

BACKGROUND

The management of elective surgeries during the COVID-19 pandemic was controversial, and the impact on lumbar spinal stenosis (LSS) surgery outcomes remains unclear. This study aimed to retrospectively analyze older adults who underwent LSS surgery during the pandemic and compare cases from its early and late phases.

METHODS

Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich Claudication Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively.

RESULTS

The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase. This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgery during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95 % CI = 0.5-0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively.

CONCLUSIONS

Poorer social life outcomes in the late-phase patients with LSS surgery may be attributed to worse preoperative ASA scores and changes in social life during different pandemic phases.

Impact of iatrogenic alterations on adjacent segment degeneration after lumbar fusion surgery: a systematic review

PURPOSE

Adjacent segment degeneration (ASDeg) and disease (ASDis) remain significant challenges following lumbar spinal fusion surgery, with reported incidences of 36% for ASDeg and 11% for ASDis within two to seven years post-operation. However, the mechanisms leading to the development of ASDeg are still poorly understood. This comprehensive review aims to elucidate the multifactorial etiology of ASDeg by examining important iatrogenic alterations associated with spinal fusion.

METHODS

A systematic review following PRISMA guidelines was conducted to identify clinical studies quantifying the occurrence of ASDeg and ASDis after lumbar fusion surgery. An EMBASE and citation search up to April 2023 yielded 378 articles. Data extracted encompassed study design, fusion type, sample size, patient age, and incidence of ASDeg and ASDis. A total of 87 publications were analyzed in the context of iatrogenic alterations caused by surgical access (muscle damage, ligament damage, facet joint damage) and instrumentation (fusion angle, immobilization).

RESULTS

Ligament damage emerged as the most impactful iatrogenic factor promoting ASDeg and ASDis development. Similarly, muscle damage had a significant impact on long-term musculoskeletal health, with muscle-sparing approaches potentially reducing ASDis rates. Immobilization led to compensatory increased motion at adjacent segments; however, the causal link to degeneration remains inconclusive. Fusion angle showed low evidence for a strong impact due to inconsistent findings across studies. Facet joint violations were likely contributing factors but not primary initiators of ASDeg.

CONCLUSION

Based on the analyzed literature, ligament and muscle damage are the most impactful iatrogenic factors contributing to ASDeg and ASDis development. Minimally invasive techniques, careful retractor placement, and ligament-preserving decompression may help mitigate these effects by reducing undue muscle and ligament trauma. Although it is not possible to definitively advocate for one or more techniques, the principle of selecting the most tissue-sparing approach needs to be scaled across surgical planning and execution. Further research is necessary to fully elucidate these mechanisms and inform surgical practices to mitigate ASDeg risk.

Optimal surgery sequence in the treatment of degenerative hip-spine syndrome: a propensity score-based inverse probability of treatment weighting analysis

BACKGROUND

The coexistence of spinal degenerative diseases and hip joint degeneration is common among middle-aged and elderly individuals, causing significant suffering and economic burden for patients. Total hip arthroplasty (THA) and lumbar fusion (LF) are primary treatment options for this combined condition, but the impact of the surgical sequence on patient outcomes remains unclear. Hence, this study aims to evaluate the effects of the surgical sequence of THA and LF on symptom recovery, changes in sagittal spine-pelvis parameters, and the incidence of long-term complications in patients.

METHODS

A retrospective analysis was conducted on 104 patients diagnosed with hip-spine syndrome (HSS) who underwent THA and LF at the Chinese PLA General Hospital. IPTW was implemented to control potential confounding factors. The impact of surgical sequence on clinical function scores, radiological parameters, and long-term complications was evaluated before and after conducting IPTW. Patients who underwent THA surgery first, followed by LF surgery, were categorized as the THA→LF group; conversely, those who underwent LF surgery first, followed by THA surgery, were categorized as the LF→THA group. Clinical function scores included the Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, and Harris Hip Score for both groups. Long-term complications assessed in this study included instances of Proximal Junctional Kyphosis (PJK), internal fixation loosening or failure, as well as hip prosthesis dislocation. Radiological parameters included Pelvic Tilt (PT), Pelvic Incidence (PI), Pelvic Incidence minus Lumbar Lordosis (PI-LL), Sacral Slope (SS), and Lumbar Lordosis (LL).

RESULTS

Before conducting IPTW, there were significant differences between the two groups across multiple variables, including age (P = 0.035), fixation stage (P = 0.042), preoperative PT (P = 0.005), preoperative PI-LL (P = 0.004), and preoperative LL (P = 0.040). After conducting IPTW, all baseline data variables had P-values greater than 0.50, indicating that the baseline characteristics between the two groups were comparable. Following IPTW, the study found significant improvements in postoperative ODI, JOA score, and Harris Hip Score for both groups (P < 0.001), indicating that both surgical sequences were effective in enhancing clinical functional activity. However, there were no significant differences between the groups. Additionally, there was no significant difference in the long-term complication rates between the two groups. Regarding radiological parameters, the PT in the THA→LF group was significantly lower than that in the LF→THA group (P = 0.043), while the SS was significantly higher (P = 0.028) at the last follow up after conducting IPTW.

CONCLUSION

Compared to preoperative assessments, both surgical sequences significantly improve postoperative clinical function scores and radiological parameters for patients. When comparing between the two groups, the surgical sequence exhibits equivalent effects on functional improvement and complication rates. The radiological outcomes indicate that the THA→LF group shows more pronounced effects on PT and SS, suggesting a more favorable impact on pelvic alignment in patients undergoing this sequence. The use of the IPTW method successfully eliminates differences in baseline characteristics, enhancing the reliability of the results. Future research is warranted to further explore these findings and their implications for surgical decision-making in HSS patients.

Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion

BACKGROUND CONTEXT

Laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF) are three techniques for posterior cervical decompression. LF can provide stability, but postoperative dural membrane adhesion and fusion failure can occur. LP can prevent postoperative dural membrane adhesion, but it can lead to kyphotic change. To address the disadvantages and further enhance the strengths of each, the LPF technique can be a good option.

PURPOSE

This study aimed to confirm whether LPF can overcome the disadvantages of LF and LP.

STUDY DESIGN

Single-center, retrospective cohort study PATIENT SAMPLE: Twenty patients for each technique were randomly selected.

OUTCOME MEASURES

Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, and fusion success rate were measured for radiologic outcomes. Preoperative and postoperative Japanese Orthopedic Association (JOA) scores and recovery rates (RRs) were measured for clinical outcomes.

METHODS

Patients who underwent LF, LP, or LPF between 2012 and 2023 were enrolled, and 20 patients for each technique were randomly selected. Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, fusion success rate, complications, operation time, blood loss, JOA scores, visual analog scale (VAS) scores, and RRs were measured.

RESULTS

Δ C2-7 Cobb's angle (LPF, -2.62 ± 5.0; LP, -6.43 ± 4.9; P = 0.020) and Δ C2-7 SVA (LPF, 6.48 ± 8.3; LP, 13.84 ± 9.9; P = 0.015) were significantly different between LPF and LP. No significant changes in Δ spinal canal length between LPF and LP were observed (LPF, 2.93 ± 1.3; LP, 3.05 ± 1.5; P = 0.780). The fusion success rate with LPF was higher than that with LF (LPF, 80.0%; LF, 45.0%; P = 0.027). The JOA RR was the highest with LPF (LPF, 49.96% ± 24.7; LF, 31.70% ± 27.8; LP, 29.31% ± 30.8, P = 0.045).

CONCLUSIONS

LPF can overcome the disadvantages of LF and LP while retaining their benefits.

Acute Spinal Problems in the Elderly

The human spine has two structural and one main physiological function. The first structural function is to maintain the erect posture to allow a bipedal stance and the second is to protect the neurological elements, namely the spinal cord and the derived nerve roots. Physiologically, the spine is responsible for the majority of haematopoiesis in the skeletally mature adult. Failure of the spine can be observed as a loss of these functions; spinal deformity and neurological deficit. Clinically "spine failure" manifests like many other non-spinal pathologies in the elderly such as reduced mobility, falls and loss of independence. The management of these problems poses a challenge in this population. It is anticipated that, with an ageing population, the incidence of these issues will increase across medical specialties and so awareness of their presentation and treatment is significant. In this review, we aim to provide an overview of the diagnosis and current treatment of the most prevalent spine issues in the elderly including osteoporotic fracture, C2 fractures, myelopathy, Metastatic Spinal Cord Compression (MSCC) and lumbar stenosis.

Anti-osteoporosis medication in patients with posterior spine fusion: a systematic review and meta-analysis

BACKGROUND CONTEXT

Osteoporosis and osteopenia are common among patients undergoing posterior spine fusion surgery, presenting challenges such as pseudarthrosis, screw loosening, and poor patient outcomes. While pharmacological interventions are available, no consensus exists regarding the optimal perioperative treatment for these patients. Furthermore, the effectiveness of various treatment options in improving fusion rates and minimizing complications remains uncertain.

PURPOSE

To compare the effects of teriparatide, bisphosphonates, denosumab, and romosozumab in patients with posterior spine fusion with low bone mineral density (BMD).

STUDY DESIGN

Systematic review and meta-analysis PATIENT SAMPLE: Adult patients with low BMD receiving osteoporosis medications and undergoing posterior spine fusion surgery OUTCOME MEASURES: Fusion rate, subsequent vertebral fracture (VF), screw loosening, cage subsidence, proximal junction kyphosis, and patient-reported outcomes (PROs), particularly the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).

METHODS

A systematic search was conducted using PubMed, EMBASE, and Cochrane Library. Two reviewers independently selected and assessed relevant studies. Four groups were analyzed to evaluate the comparative effectiveness of anti-osteoporosis medication on the outcome measures: Bisphosphonate vs. Control; Teriparatide vs. Control; Teriparatide vs. Bisphosphonate; and Denosumab vs. Control.

RESULTS

Bisphosphonate showed reduced subsequent VFs [Odds ratio (OR)=0.27, 95% Confidence interval (CI)=0.09-0.81] and cage subsidence [OR=0.29, 95% CI=0.11-0.75] and improved ODI scores at 12 months [Standardized mean difference (SMD) (95% CI)=-0.75 (-1.42, -0.08)] compared to the control. Teriparatide showed a higher fusion rate [OR=3.52, 95% CI=1.84-6.75], lower screw loosening [OR=0.23, 95% CI=0.09-0.60], and improved ODI scores at 24 months [SMD (95% CI)=-0.67 (-1.23, -0.11)] compared to the control. Moreover, teriparatide showed a higher fusion rate [OR=2.13, 95% CI=1.55-2.93], lower subsequent VF [OR=0.22, 95% CI=0.09-0.51], and improved VAS score for back pain (VASB) [mean difference (MD) (95% CI)=-0.39 (-0.64, -0.13)] and ODI [SMD (95% CI)=-0.39(-0.65, -0.13)] scores at 12 months compared to bisphosphonate. Denosumab showed no significant difference in fusion rate or other complications compared to control.

CONCLUSION

Our results indicated that teriparatide should be used as the first-line perioperative treatment for patients with poor bone quality scheduled for posterior spine fusion. Teriparatide exhibited better fusion rates and reduced complications than controls and bisphosphonates, resulting in improved PROs. Moreover, bisphosphonates can be utilized in patients with contraindications to teriparatide since the former prevents osteoporosis-related complications compared to controls, resulting in improved PROs. Further studies are warranted to evaluate the potential effects of denosumab and romosozumab.

A multimodal machine learning model integrating clinical and MRI data for predicting neurological outcomes following surgical treatment for cervical spinal cord injury

PURPOSE

Predicting the prognosis of cervical spinal cord injury (CSCI) is crucial for patients and healthcare providers, as it informs treatment decisions and rehabilitation planning. This study aimed to develop a multimodal machine learning model integrating clinical and MRI data to predict neurological outcomes in CSCI patients.

METHODS

We conducted a retrospective study of 247 patients with traumatic CSCI who underwent posterior decompression and fusion surgery at a specialized spinal cord injury center between April 2015 and June 2021. Clinical data, including demographics, comorbidities, laboratory data, and neurological findings, were collected. T2-weighted sagittal MRI images were analyzed using a convolutional neural network pre-trained on RadImageNet. Clinical and MRI features were integrated to construct a multimodal predictive model using the Light Gradient Boosting Machine algorithm, validated with 5-fold cross-validation. The primary outcome was defined as achieving American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade D or higher at 6 months post-injury. Shapley Additive Explanations identified key contributing factors in predicting these neurological outcomes.

RESULTS

The model achieved an accuracy of 0.90 and an AUC of 0.94 for predicting recovery to AIS grade D or higher at 6 months post-injury. Key predictors included lower extremity ASIA motor score (AMS), AIS grade at admission, upper extremity AMS, age, HbA1c, and MRI-derived features.

CONCLUSION

This multimodal model demonstrated superior predictive accuracy compared to previous monomodal approaches, emphasizing the value of combining clinical and MRI data. These findings highlight the potential of multimodal predictive models in improving clinical decision-making and outcomes for CSCI patients.

AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy

Study DesignLiterature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations.ObjectiveThis article summarizes several key current topics related to the management of DCM.MethodsRecent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional.ResultsArticle 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. Conditional recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. Conditional recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. Strong recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. Conditional recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients.ConclusionsDCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles.

A comparative study on clinical outcomes and safety of accurate anterior cervical ossified posterior longitudinal ligament en bloc resection versus piecemeal resection in patients with ossification of the cervical posterior longitudinal ligament: a propensity score-matching analysis

OBJECTIVE

The anterior approach for cervical ossification of posterior longitudinal ligament (OPLL) excision can improve long-term neurofunctional recovery by providing direct spinal cord decompression. The objective of the present study was to compare the clinical outcomes and complications between accurate anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) versus piecemeal resection (ACOP) using propensity score-matching analysis.

METHODS

Included in this study were 189 OPLL patients (65 female) who underwent anterior cervical surgery, with a mean age of 54.85 years. Of them, 105 patients (39 female) with a mean age of 55.69 years underwent ACOE, and the remaining 84 patients (26 female) with a mean age of 53.80 underwent ACOP. Of the 189 patients, 70 patients (37%) had a canal occupying ratio (COR) ≥ 50%, and therefore the patient data were stratified by COR with 50%. The clinical outcomes were compared between the two groups during a at least 27-month follow-up period.

RESULTS

The mean final follow-up JOA score in ACOE group was higher than that in ACOP group. The JOA recovery rate of patients with COR ≥ 50% was higher in ACOE group. The mean operative time and intraoperative blood loss were both lower in ACOE group. However, postoperative complications were not significantly different between the two groups.

CONCLUSION

This study demonstrated that the ACOE technique gained higher JOA recovery rates and better neurological recovery than ACOP for OPLL patients with COR ≥ 50%. In addition, ACOE offered a shorter operative time and less intraoperative blood loss as compared with ACOP. Therefore, the postoperative complications were not more common between two groups.

Duration of symptoms before diagnosis in degenerative cervical myelopathy: A systematic review and meta-analysis

Introduction

Degenerative cervical myelopathy (DCM), the commonest cause of spinal cord injury, can lead to progressive disability. Due to overlapping symptoms with other conditions and low awareness among healthcare professionals, many patients experience delayed diagnosis.

Research question

What is the typical duration of symptoms of DCM before diagnosis?

Materials and methods

We searched multiple databases for primary studies reporting duration of symptoms in people with confirmed diagnosis of DCM. Two independent reviewers screened titles, abstracts, full-text articles, extracted data and appraised study quality. We performed random-effects meta-analyses to pool duration of symptoms to presentation, diagnosis, and intervention.

Results

We identified 78 studies from 18 countries, with 12,450 participants. Time from symptom onset to first clinical presentation (two studies, n = 232 participants) was 3.3 (95 % confidence interval, -0.3-6.8) months. Time from symptom onset to diagnosis (five studies, n = 897) was 15.0 (5.0-25.0) months. In 29 studies (n = 3052) that measured from symptom onset to surgery/pre-operative assessment the duration was 14.5 (12.1-17.0) months. Thirty-seven studies had an undefined endpoint, in which when pooled, duration of symptoms was 15.2 (12.4-18.0) months. Most studies did not define the symptoms at onset, however when onset was defined as first occurrence of myelopathic (upper motor neurone) symptoms (five studies, n = 1006), time to surgery was 10.7 (2.3-18.5) months.

Discussion and conclusion

Most people with DCM experience symptoms for more than one year before diagnosis. These data may be useful to inform initiatives to promote early diagnosis. Standardised methodology would improve further research in this area.

Radiographic Phenotype-Driven Clustering in Lumbar Decompression: Comparative Study of Outcome and Reoperation Risk

BACKGROUND CONTEXT

Lumbar spinal canal stenosis (LSCS) presents with various radiographic findings, often including concurrent degenerative changes. Prior studies have investigated the effects of individual radiographic findings and parameters separately using conventional methods such as logistic regression. However, applying these independent effects to real-world patients remains challenging due to an unknown interaction effect among multiple degenerative radiographic findings.

PURPOSE

To identify distinct patient phenotypes based on preoperative radiographic findings using unsupervised clustering and to evaluate their associations with postoperative patient-reported outcomes and reoperation rates.

STUDY DESIGN

Retrospective cohort study PATIENT SAMPLE: Patients undergoing single-level lumbar decompression OUTCOME MEASURES: Oswestry Disability Index (ODI), Short Form-12 physical component scale (SF-12 PCS), reoperation rates METHODS: Unsupervised clustering was performed using preoperative radiographic data from standing X-ray imaging and magnetic resonance imaging (MRI). Variable selection was optimized through preliminary correlation analysis, causal assessment using a directed acyclic graph, and expert review. A multivariable mixed-effects model was used to assess the impact of cluster membership on postoperative outcomes. Reoperation rates were compared using Kaplan-Meier survival analysis and Cox proportional hazards models.

RESULTS

Unsupervised clustering identified four distinct clusters base on 10 radiographic variables: cluster 1 as "Young and Less Degenerative Spine" (cluster Y), cluster 2 as "Combined Coronal and Sagittal Spondylosis" (cluster CS), cluster 3 as "Coronal Spondylosis Characterized by Laterolisthesis" (cluster C), and cluster 4 as "Sagittal Spondylosis Characterized by Degenerative Spondylolisthesis" (cluster S). Multivariable regression analysis, adjusting for comorbidity, sex, and body mass index have revealed cluster C demonstrated slower improvement in ODI (β = 5.4, SE = 2.7, p = 0.043) and SF-12 PCS (β = -2.9, SE = 1.4, p = 0.045) compared to cluster Y. Regarding reoperation, cluster CS showed the highest hazard ratio (24.3%, HR = 4.18, 95% CI: 1.48-13.07, p = 0.007) compared to cluster S with the lowest reoperation rate (6.8%).

CONCLUSION

Unsupervised clustering based on preoperative radiographic findings identified four distinct degenerative phenotypes in LSCS. Patients with coronal spondylosis was associated with slower improvements in disability and function compared to those with minimal degeneration. Additionally, patients with combined sagittal and coronal degeneration exhibited the highest reoperation rates. These findings highlight the clinical relevance of coronal and sagittal degeneration in surgical decision-making.

Advancements in Degenerative Disc Disease Treatment: A Regenerative Medicine Approach

Regenerative medicine represents a transformative approach to treating nucleus pulposus degeneration and offers hope for patients suffering from chronic low back pain due to disc degeneration. By focusing on restoring the natural structure and function of the nucleus pulposus rather than merely alleviating symptoms, these innovative therapies hold the potential to significantly improve patient outcomes. As research continues to advance in this field, we may soon witness a paradigm shift in how we approach spinal health and degenerative disc disease. The main purpose of this review is to provide an overview of the various regenerative approaches that target the restoration of the nucleus pulposus, a primary site for initiation of intervertebral disc degeneration.

No Difference in Short-term Surgical Outcomes From Semaglutide Treatment for Type 2 Diabetes Mellitus After Cervical Decompression and Fusion: A Propensity Score-matched Analysis

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

To evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the risk of short-term (<6 mo) postoperative complications in patients undergoing primary cervical spine decompression and fusion (CSDF).

SUMMARY OF BACKGROUND DATA

Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c and obesity are linked to fewer positive results after undergoing spine surgery, particularly cervical decompression and fusion. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications, including surgical site infection, wound complications, and reoperation within 6 months, which were aggregated into a composite measure.

METHODS

The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM who underwent CSDF for degenerative pathology. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, using age, sex, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used to investigate the impact of semaglutide treatment on postoperative surgical complications.

RESULTS

The propensity score-matched cohort included 596 patients (semaglutide cohort: 298 and control cohort: 298). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index CSDF (OR 1.26, 95% CI 0.83-1.93, P =0.331). Similarly, both 30-day (OR 0.83, 95% CI 0.49-1.42, P =0.589) and 90-day readmission rate (OR 0.89, 95% CI 0.56-1.42, P =0.724) were similar between both cohorts.

CONCLUSIONS

This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of short-term adverse events after CSDF. The effect of semaglutide use on long-term outcomes remains unknown.

Impact of asymmetric L4-L5 facet joint degeneration on lumbar spine biomechanics using a finite element approach

This study investigated the effects of asymmetric facet joint degeneration on spinal behavior and adjacent structures using finite element analysis (FEA). Facet joints play a critical role in providing spinal stability and facilitating movement. Degenerative changes in these joints can lead to reduced spinal function and pain. Specifically, asymmetric degeneration occurs when one side deteriorates more rapidly due to alignment issues, subsequently impacting adjacent structures. In this study, facet joint degeneration grades (G00, G40, G42, and G44) were assigned to the L4-L5 segment to simulate spinal behavior during extension, left and right lateral bending, and left and right axial rotations. As degeneration progressed, the range of motion in the affected segment decreased, resulting in altered stress distribution across the intervertebral discs and posterior bone. The analysis showed that the posterior bending angle during extension decreased with increasing degeneration severity. Additionally, during lateral bending, the bending angle in the corresponding direction decreased, while the anterior bending angle increased. Maximum equivalent stress analysis of the intervertebral disc in the affected segment revealed a decreasing trend as degeneration worsened, a pattern also observed during extension, left lateral bending, and right axial rotation. In the G40 model, the maximum equivalent stress in the posterior bone of L4 and L5 exhibited a significant disparity between the left and right sides. These findings provide quantitative insights into the progression of spinal degeneration, enhancing our understanding of how asymmetric facet joint degeneration (FJD) affects spinal motion and adjacent structures.

Advancements in clinical practices of computed tomography imaging and its implications on surgical strategies for the management of cervical ossification of the posterior longitudinal ligament: A systematic review

Objectives

This systematic review examines advancements in computed tomography imaging-based classification systems and their implications for surgical decision-making in managing cervical ossification of the posterior longitudinal ligament.

Methods

This study is a systematic review. A comprehensive search of PubMed, MEDLINE, and Scopus databases identified relevant studies published from January 2010 to July 2024. The search utilized keywords including "ossification of the posterior longitudinal ligament," "cervical," "spine," "computed tomography," and "classification." Studies meeting predefined inclusion criteria focused on computed tomography imaging for diagnosing and surgically managing cervical ossification of the posterior longitudinal ligament. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the ROBINS-I tool was used for risk of bias assessment.

Results

Sixteen studies were included, demonstrating that computed tomography imaging enhances diagnostic precision and classification reliability for cervical ossification of the posterior longitudinal ligament. Comparative analysis across studies revealed consistent trends in computed tomography-based classification improving surgical decision-making, particularly influencing anterior approaches such as anterior controllable antedisplacement and fusion. However, moderate to severe risks of bias were identified in some studies, primarily due to confounding variables and deviations from intended interventions. Additionally, computed tomography imaging's role in prevalence studies has been expanded by incorporating, which highlights its epidemiological significance. The review also discusses the disadvantages of computed tomography, including radiation exposure and cost implications.

Conclusions

Computed tomography imaging is a crucial modality for diagnosing and managing cervical ossification of the posterior longitudinal ligament, offering superior lesion classification and guiding surgical decision-making. Future research should refine classification systems and integrate multimodal imaging approaches to enhance diagnostic and therapeutic precision.

Decomposing the genetic background of chronic back pain

Chronic back pain (CBP) is a disabling condition with a lifetime prevalence of 40% and a substantial socioeconomic burden. Because of the high heterogeneity of CBP, subphenotyping may help to improve prediction and support personalized treatment of CBP. To investigate CBP subphenotypes, we decomposed its genetic background into a shared one common to other chronic pain conditions (back, neck, hip, knee, stomach, and head pain) and unshared genetic background specific to CBP. We identified and replicated 18 genes with shared impact across different chronic pain conditions and two genes that were specific for CBP. Among people with CBP, we demonstrated that polygenic risk scores accounting for the shared and unshared genetic backgrounds of CBP may underpin different CBP subphenotypes. These subphenotypes are characterized by varying genetic predisposition to diverse medical conditions and interventions such as diabetes mellitus, myocardial infarction, diagnostic endoscopic procedures, and surgery involving muscles, bones, and joints.

Predicting genes associated with ossification of the posterior longitudinal ligament using graph attention network

Ossification of the posterior longitudinal ligament is a degenerative disease that severely impacts the spine, with a complex pathogenesis involving the interplay of multiple genes. This study utilizes a combination of graph neural networks and deep neural networks to systematically analyze genes associated with OPLL, leveraging genomics and bioinformatics techniques. By integrating gene data from the DisGeNET and HumanNetV2 databases, we constructed a GNN model to identify potential pathogenic genes for OPLL and validated the expression characteristics and mechanisms of these genes in different cell types. The findings indicate that the GNN model achieves remarkable accuracy and reliability in predicting genes associated with OPLL. Additionally, cellular trajectory analysis and immune cell infiltration studies uncovered distinct cellular environments and immune features in OPLL patients, emphasizing the significant roles of fibroblasts and mesenchymal stem cells in the disease's progression. Drug sensitivity analysis also sheds light on future personalized treatment options. This study not only enhances the understanding of OPLL's molecular mechanisms but also suggests new avenues for diagnostic and targeted therapy development.

Effect of vertebral rotation on adjacent segment degeneration after the early stage of lumbar fusion surgery

OBJECTIVE

Related studies have shown that the torsional vertebral after fused significantly increase adjacent disc stress and accelerate degeneration. This suggests that vertebral rotation (VR) may accelerate adjacent segment degeneration (ASD). To investigate: (1) the correlation between VR and radiographic adjacent segment degeneration (rASD) after the early stage of lumbar fusion (2), the incidence of rASD with different VR degrees (3), whether the incidence of rASD can be reduced by surgically reducing instrumented vertebrae (IV) rotation.

METHODS

A retrospective analysis was conducted on the cases of 195 patients with lumbar degenerative disease (LDD) who were selected based on inclusion and exclusion criteria. The grade and angle of VR were measured for accurate analysis. The final follow-up evaluated the clinical improvement of the patients and the rASD. The impact of various factors on rASD was observed using univariate and multivariate logistic regression analyses. With different VR grades, Kaplan-Meier survival analysis was used to describe the incidence of rASD at various follow-up intervals.

RESULTS

The results indicate that preoperative adjacent vertebrae (AV) rotation (OR = 1.852, 95% CI = 1.064-3.224, P = 0.029) and IV rotation at final follow-up (OR = 2.748, 95% CI = 1.458-5.177, P = 0.002) are the independent risk factors for rASD. The results of the Kaplan-Meier analysis showed that with different VR grades, the follow-up period was different when the cumulative incidence of rASD reached 50%. The AV rotation decreased in the patients whose IV rotation decreased after the operation (P < 0.001), and the incidence of rASD was also lower (P = 0.004), especial in the fused to S1 group.

CONCLUSIONS

VR is a risk factor for rASD at the early stage of lumbar fusion surgery. Reducing VR during surgery can alleviate the speed of ASD and reduce the incidence of rASD in fused to S1.

Validation of a novel scoring system (Cervical Surgical Score) for the management of degenerative cervical myelopathy

Background

Degenerative Cervical Myelopathy (DCM) is the leading cause of spinal cord dysfunction globally. Surgical intervention is often recommended for moderate to severe cases, but the optimal surgical approach remains debated.

Objective

This study aims to validate the novel Cervical Surgical Score (CSS) for managing DCM, aiding surgical decision-making.

Methods

A prospective study was conducted in Carlo Besta institute (Milan) from a consecutive series, enrolling 113 patients undergoing surgery for DCM from January 2022 to February 2023. This cohort was compared with 106 patients from a retrospective cohort treated between 2019 and 2021.

Results

A total 219 patients (113 prospective, 106 retrospective) were included. The prospective group had an average age of 59.6 years (61 % males), and the retrospective group, 60.7 years (69 % males). The mean CSS score (calculated based on age, level of cervical pathologies, level of myelopathy, extension, site and type of compression, cervical alignment and mJOA) was 12.3 for prospective and 13.18 for retrospective groups. Most prospective cases used an anterior approach compared to retrospective group (88,5 % vs 48.1 %). At two years, neurological recovery (last follow-up mJOA-preoperative mJOA)/(18-preoperative mJOA × 100) was higher in prospective group (68 % vs. 54 %). CSS concordance linked to better recovery rates at one and two years (45 % and 66 % vs. 29 % and 47 %; p < 0,001). High-expertise surgeons (defined based on case-load evaluation scale) achieved higher CSS concordance (64 %) than medium (31 %) and low-expertise surgeons (0 %).

Conclusion

The CSS is a reliable tool for optimizing surgical strategies for DCM, enhancing decision-making, and improving patient outcomes.

Lumbosacral anatomy is unique in pediatric spondylolysis

PURPOSE

To determine whether patients with L5 spondylolysis have different lumbosacral anatomy compared to patients without L5 spondylolysis.

METHODS

Computed tomography (CT) scans of pediatric patients with isolated L5 spondylolysis were identified and matched 1:4 (age, sex, BMI) to patients without spondylolysis. Sagittal parameters assessed included sacral slope angle, sacral table angle, L4-S1 and L5-S1 Cobb angles, the horizontal angle of the L5 pars interarticularis, the distances between the L4 inferior articular process (IAP) and the S1 superior articular process (SAP) and their respective individual distances to the L5 pars. Coronal parameters assessed included the percent subluxation of L4 IAP below the facet joint.

RESULTS

1084 CT scans were reviewed. 32 patients with isolated L5 spondylolysis were identified and matched to 122 patients without spondylolysis. The horizontal angle of the L5 pars was greater in spondylolysis patients (142.5 ± 10.2 vs. 119.9 ± 5.9, p < 0.05). There was less distance (mm) between L4 IAP and S1 SAP (11.3 ± 3.9 vs. 14.7 ± 2.9, p < 0.05) and less distance (mm) from both L4 IAP (2.6 ± 1.7 vs. 5.4 ± 2.2, p < 0.05) and S1 SAP (0.7 ± 0.4 vs. 1.5 ± 0.7, p < 0.05), respectively, to the L5 pars in the spondylolysis group. Pearson's analyses revealed that a larger horizontal angle of the L5 pars was strongly associated with spondylolysis (0.59).

CONCLUSION

Pediatric patients with L5 spondylolysis have a significantly more horizontal L5 pars that is closer to both the L4 IAP and S1 SAP.

Cervical pedicle screw placement with patient-specific 3D-printed guides: accuracy and safety in a clinical experience

PURPOSE

Cervical pedicle screw (CPS) instrumentation offers significant biomechanical advantages compared to lateral mass or transarticular fixation. Nonetheless, malpositioning complications constitute a relevant concern. Customized patient-specific 3D-printed templates have been developed to improve CPS placement accuracy and safety. The aim of this study is to present our experience with this surgical technique and its accuracy and safety in a clinical setting.

METHODS

This single-center retrospective observational study of prospectively collected data included patients undergoing CPS fixation surgery using a patient-specific 3D template guide system. All patients underwent a 3D-volumetric high-resolution CT scan of the cervical spine for preoperative surgical planning. Postoperative CT scans were used to evaluate pedicle perforation, CPS trajectories, and deviations between the planned and the actual screw position.

RESULTS

A total of 115 CPS were implanted in 25 patients, with 107 (93.1%) of the screws completely placed inside the pedicle. Cortical breach within 2 mm was observed in 8 (6.9%) cases, with no cases of more severe pedicle infractions or perioperative neurovascular complication. No differences of CPS accuracies were found between each metameric fusion level, and between monolateral or bilateral templates. Mean total deviations were 0.75 mm vertically and 0.51 mm horizontally at the screw entry point, and 0.72 mm vertically and horizontally at the narrowest pedicle point. Mean total sagittal and transverse angular deviations were 2.94° and 3.04°, respectively.

CONCLUSION

Cervical pedicle screw placement using patient-specific guides is safe and accurate, supporting the feasibility of this technique in posterior cervical spine fusion surgery.

2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances

Classification systems for Adolescent Idiopathic Scoliosis (AIS) play an important role in guiding both surgical planning and conservative treatments. Traditional 2D classification systems, such as the Lenke, King and Lehnert-Schroth classifications, have been widely used for the clinical diagnosis and treatment of scoliosis. However, with the growing understanding of the three-dimensional nature of scoliosis and advancements in 3D reconstruction technologies, 3D classification systems are gaining increasing attention. This paper reviews the current applications, advantages, and limitations of different 2D and 3D classification systems, focusing on their clinical significance in treatment planning. While 3D classification systems offer clear advantages in capturing the complexity of spinal deformities, their clinical implementation faces challenges such as high costs and technical complexity. Additionally, studies show that computer-assisted technologies, artificial intelligence can significantly improve the accuracy and consistency of classification systems, reducing human errors. The paper also explores the future directions of classification system development, emphasizing the potential of combining 2D and 3D technologies and the impact of these advancements on personalized scoliosis treatment.

Comparison of 3-Dimensional Correction and Clinical Outcomes of Lenke 1A Curves with the Stable Vertebra (SV) or SV-1 Selected as the Lowest Instrumented Vertebra

Backgroud

Lowest instrumented vertebra (LIV) selection is controversial in Lenke 1A curves. Alignment of the LIV in coronal, sagittal, and transverse planes is important for correction of overall scoliosis, as well as the alignment of uninstrumented lumbar curve. In this study, we aimed to evaluate the 3-dimensional correction and clinical outcomes of Lenke 1A curves, corrected with rod derotation (RD) maneuver, according to the LIV level.

Methods

Prospectively collected data of 46 consecutive idiopathic scoliosis surgery patients with Lenke 1A scoliosis who had been treated with posterior instrumentation and fusion were retrospectively evaluated. Patients were divided into 2 groups according to the LIV level: stable vertebra (SV) group (25 patients) and 1 level proximal to SV (SV-1) group (21 patients). Patients were compared pre- and postoperatively according to radiographic and clinical outcomes. Measured parameters in coronal plane were Cobb angle of thoracic curve, shoulder balance, coronal balance, LIV translation, and LIV tilt; in sagittal plane, thoracic kyphosis, lumbar lordosis, sagittal balance, and distal junctional angle. Transverse plane analysis included rotational measurement of apical vertebra (AV), LIV, and LIV+1 with computerized tomography. Clinical outcomes were evaluated with Scoliosis Research Society (SRS)-22 questionnaire. Surgical times were noted.

Results

There were no statistically significant differences between the 2 groups in terms of preoperative radiographic values. In both groups, Cobb angle of thoracic curve, shoulder balance, LIV translation, and LIV tilt improved significantly after the surgery. Postoperatively, AV rotation decreased in both groups significantly. No significant change was observed in rotations of LIV and LIV+1 after the surgery. Clinical outcomes and surgical times were similar between the groups.

Conclusions

Selection of the LIV as SV or SV-1 in Lenke 1A patients led to similar results in terms of coronal and sagittal plane reconstruction, as well as AV and LIV rotation. With RD maneuver, an acceptable amount of rotation could be achieved at LIV and LIV+1. Radiologic and functional outcomes were satisfactory in both LIV levels. To save 1 more mobile segment, it seems reasonable to select SV-1 as the LIV if possible in order to obtain a well-aligned LIV in all 3 planes.

Research Progress on the Posterior Midline Lumbar Spinous Process-Splitting Approach

The traditional posterior median approach laminectomy is widely used for lumbar decompression. However, the bilateral dissection of paraspinal muscles during this procedure often leads to postoperative muscle atrophy, chronic low back pain, and other complications. The posterior midline spinous process-splitting approach (SPSA) offers a significant advantage over the traditional approach by minimizing damage to the paraspinal muscles. SPSA reduces the incidence of muscle atrophy and chronic low back pain while maintaining the integrity of the posterior spinal structures. The technique involves longitudinal splitting of the spinous process, which allows for adequate access to the lamina for decompression without detaching the paraspinal muscles. As a result, it provides a clearer surgical field and facilitates muscle preservation, which reduces the risk of postoperative complications. Additionally, SPSA requires only standard surgical instruments, making it accessible in most surgical settings. This paper reviews the anatomical considerations, surgical techniques, and clinical applications of the SPSA, highlighting its effectiveness in reducing muscle atrophy and improving recovery outcomes. The paper also discusses its potential in treating conditions such as lumbar spinal stenosis, disc herniation, and spondylolisthesis. Furthermore, it emphasizes the need for future research to establish the long-term benefits of SPSA and refine surgical techniques. The results suggest that SPSA is a promising alternative to traditional approaches, with better outcomes in terms of muscle preservation and overall recovery.

Wide-Awake Local Anesthesia No Tourniquet Surgery for Zone VII Extensor Tendon Reconstruction: Stages in Active Range of Motion From Intraoperative to Final Recovery

PURPOSE

We investigated chronological changes in active range of motion (ROM) of the metacarpophalangeal (MCP) joint after zone VII extensor tendon reconstruction with wide-awake local anesthesia no tourniquet (WALANT) surgery.

METHODS

Reconstruction of the extensor tendons ruptured in zone VII of 82 fingers in 40 patients was performed using WALANT techniques. The mean patient age was 71.3 years. During surgery, we evaluated passive stretch distance and active contraction distance of the ruptured musculocutaneous unit. The sum of passive stretch distance and active contraction distance was defined as total excursion. In cases with total excursion ≥30 mm, we selected bridge tendon grafting for tendon reconstruction. In cases with total excursion <30 mm, end-to-side tendon transfer was performed. Active ROM of the MCP joint was measured before surgery; during surgery; 1, 3, and 5 months after surgery, and at the final follow-up.

RESULTS

Extension lag of the MCP joint was 49.2° before surgery, improving to 2.9° during surgery, deteriorating to 18.7° at 1-month, and improving again to 15.6° at 3-months, 13.6° at 5-months, and 10.5° at the final follow-up. Meanwhile, the active flexion angle of the MCP was 87.9° before surgery, 87.3° during surgery, 67.6° at 1-month, 76.0° at 3-months, 79.7° at 5-months, and 81.0° at the final follow-up. Extension and flexion angles at each time point remained nearly constant regardless of whether tendon grafting or tendon transfer was used.

CONCLUSIONS

Extensor tendon reconstruction using WALANT surgery allowed intraoperative measurement of active ROM, confirming near-complete extension and flexion after reconstruction. The changes in ROM of the MCP joint during follow-up are an approximate indication of the progression of postoperative recovery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic Ⅳ.

Integration of small needle knife in treating inflammatory factors, Th17 cell function, and magnetic resonance imaging evaluation in osteoporosis complicated by compression fractures in elderly patients

OBJECTIVE

The incidence of osteoporosis complicated by vertebral compression fractures (OVCF) has been increasing annually, and percutaneous vertebroplasty (PVP) is the main surgical approach for it. It was to evaluate the use of a small needle knife (SNF) in conjunction with PVP to assess changes in inflammatory response, Th17 cell function, and magnetic resonance imaging (MRI) parameters in OVCF patients.

METHODS

A retrospective analysis was conducted using the clinical data of 138 patients with OVCF, who were categorized into PVP group (n = 65) and PVP + SNF group (n = 73). MRI was employed to evaluate changes in lumbar spine anatomy and paraspinal muscle parameters. The postoperative thoracic and intercostal pain and joint function recovery were assessed. Blood samples were collected to measure inflammatory factors, Th17 cell proportions, and related cytokine levels.

RESULTS

PVP + SNF group showed decreased visual analogue scale (VAS) scores at 3 days, 7 days, and 1 month postoperatively versus PVP group (P < 0.05). MRI examination indicated significant improvements in anterior vertebral height, posterior vertebra height, multifidus cross-sectional area, and erector spinae cross-sectional area, along with a decrease in steatosis proportion in the PVP + SNF group (P < 0.05).

CONCLUSION

SNF in combination with PVP reduced postoperative pain and improved lumbar spine function in OVCF patients. Furthermore, it can lower inflammatory responses by enhancing Th17 cell function. MRI examinations can serve as valuable tools for predicting and assessing postoperative outcomes in OVCF patients.

A non-inferiority analysis of surgical outcomes following outpatient laminoplasty for cervical spondylosis

OBJECTIVE

A trend of outpatient spinal procedures has recently been observed due to evidence of less hospital-associated risks and better value-based care. We aimed to assess non-inferiority in surgical outcomes of outpatient and inpatient laminoplasty for cervical spondylosis.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing cervical laminoplasty for spinal spondylosis. Patients with a hospital stay longer than 48 hours were excluded to increase baseline comparability between groups. Patients undergoing other spinal procedures during the same hospital stay were also excluded. The outcomes of interest were postoperative complications, readmissions, and reoperations within 30 days postoperatively. The non-inferiority of outpatient compared to inpatient surgery was defined as a risk difference of < 10.0 % at a one-sided 97.5 % confidence interval.

RESULTS

Total 808 cervical laminoplasty surgeries were identified. The study cohorts consisted of 107 and 701 patients in outpatient and inpatient groups, respectively. Baseline characteristics, except age (58.3 ± 10.6 vs. 61.4 ± 11.5 years, p = 0.01), were similar between groups. The incidences of postoperative complications were 2.8 % and 3.4 % for the outpatient and inpatient groups, respectively, while both groups had a 30-day readmission rate of 3.7 %. The 30-day reoperation rates were 2.8 % and 1.4 % for the outpatient and inpatient groups, respectively. Noninferiority of outpatient surgery was documented at a risk difference of 10 % for postoperative complications, readmissions, and reoperations.

CONCLUSIONS

Outpatient cervical laminoplasty demonstrated similar early postoperative outcomes to inpatient surgery, with non-inferiority documented in surgical outcomes. Therefore, outpatient laminoplasty can be safely offered in carefully selected patients with minimal perioperative risk factors. Future research should further refine patient selection criteria for outpatient procedures to optimize surgical decision-making.

One-stage posterior debridement approach combined with autogenous bone grafting and internal fixation for the treatment of adult thoracic or lumbar suppurative spondylitis via the multifidus and longissimus interspaces

BACKGROUND

Surgical treatment of suppurative spondylitis requires focus debridement, spinal stability, and deformity correction. Different approaches face challenges like complex anatomical structures and greater trauma. The aim is to evaluate the clinical efficacy of One-stage debridement approach combined with autogenous bone grafting and internal fixation for the treatment of adult thoracic or lumbar suppurative spondylitis via the multifidus and longissimus interspaces.

METHODS

From July 2018 to July 2021, 91 patients (65 male, 26 female) with single - level thoracic or lumbar suppurative spondylitis underwent the one-stage posterior procedure. Operative details and hospital stay were recorded. ESR, CRP, and PCT levels were analyzed at specific times. Pain was rated by VAS, Using ODI score to evaluate the improvement of lumbar activity, and neurological function was assessed by ASIA scale. Cobb angles were measured for deformity evaluation. Bony fusion was evaluated by radiography and computed tomography.

RESULTS

The mean operative duration was 195.6 ± 15.4 min, blood loss was 575.9 ± 90.1 ml, and hospital stay was 19.9 ± 2.2 days. ESR, CRP, and PCT levels significantly decreased before discharge (ESR: 80.2 ± 14.6 mm/h vs. 30.2 ± 8.9 mm/h, CRP: 58.5 ± 13.6 mg/L vs. 15.1 ± 7.4 mg/L, PCT: 0.8 ± 0.2 ng/ml vs. 0.1 ± 0.1 ng/ml, P < 0.05). All patients had pain relief. VAS scores improved (preoperative 7.7 ± 1.1, before discharge 2.8 ± 0.6, final follow-up 1.3 ± 0.6). The lumbar activity of all patients was significantly improved compared with preoperative(preoperative 41.36 ± 3.20, final follow-up 6.18 ± 1.33). Neurologically impaired patients improved in ASIA grade. The mean preoperative Cobb angle was 19.6 ± 1.6°, reduced to 6.2 ± 1.5° before discharge and 9.4 ± 1.0° at final follow-up. The mean angle correction was 13.4 ± 0.6°, correction rate 68.7% ± 5.4% (P < 0.05), with a final loss angle of 3.2 ± 0.7° and loss rate 24.1% ± 4.8%. All grafts achieved complete fusion.

CONCLUSIONS

This one-stage posterior approach is effective and feasible for adult single - level thoracic or lumbar suppurative spondylitis, protecting paravertebral muscles and posterior ligament complexes. However, further studies with larger samples and longer follow-up are needed.

Proteomic analysis and effects on osteogenic differentiation of exosomes from patients with ossification of the spinal ligament

Ossification of the spinal ligament (OSL), including ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum (OLF), is a multifactorial disease that includes genetic predisposition. The association between the rate of ossification in the spinal canal and the severity of myelopathy symptoms is well known, but the degree of progression varies widely among patients. Although many candidate genes and biomarkers have been reported, there are no definitive and quantitative conclusions to date, probably because of low reproducibility due to individual differences. In this study, we focused on exosomes secreted by ossified spinal ligament cells. Exosomes are crucial for intercellular communication during development and progression of disease. In a co-culture study of non-OLF cells with OLF cells, there was increased osteogenic differentiation, including Runx2 and Wnt3a expression, with use of exosome-penetrating filters (1.2 μm) compared to exosome-non-penetrating filters (0.03 μm). Dose-dependent increases in alkaline phosphatase activity and mineral deposition were observed in non-OLF cells treated with OLF-derived exosomes. These results support the hypothesis that OLF-derived exosomes are involved in regulation of osteogenic differentiation. In comparative proteomics analysis, 32 factors were increased and 40 were decreased in OLF-derived exosomes compared to non-OLF-derived exosomes. Molecular network analysis of these 72 factors indicated 10 significant pathways, including the matrix metalloproteinase (MMP) signaling, mTOR signaling, Wnt signaling and VDR-associated pathways. Among the upregulated exosomal membrane proteins in OLF samples, COL IV, FMNL3, mTORC2, and PIP4K showed increased expression with greater ossification, suggesting they may serve as biomarkers of disease activity and therapeutic targets. These factors are involved in the PI3K/Akt/mTOR signaling pathway, and particularly mTOR is known to regulate osteogenic and chondrogenic differentiation. In contrast, fatty acid-binding protein 5, several KRT family proteins, S100A8, SERPINB3, and transglutaminase, were significantly downregulated in OLF-derived exosomes. These findings provide novel insights into the molecular mechanisms underlying OSL pathogenesis.

Comparison of Surgical Outcomes After Posterior Decompression by Junior or Senior Surgeons for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: Results From Retrospective Multicenter Cohort Study

Study DesignRetrospective multicenter study.ObjectivesTo investigate surgical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) when performed by board-certified spine (BCS) or non-BCS (NBCS) surgeons.MethodsWe included 203 patients with cervical OPLL who were followed for a minimum of 1 year after surgery. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed preoperatively and at the final follow-up using the Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) for the neck. We compared outcomes between BCS surgeons, who must meet several requirements, including experience in more than 300 spinal surgeries, and NBCS surgeons.ResultsBCS surgeons performed 124 out of 203 cases, while NBCS surgeons were primary in 79 cases, with 73.4% were directly supervised by a BCS surgeon. There was no statistically significant difference in surgical duration, estimated blood loss, and perioperative complication rates between the BCS and NBCS groups. Moreover, no statistically significant group differences were observed in each position of the C2-7 angle and cervical range of motion at preoperation and the final follow-up. Preoperative and final follow-up JOA scores, VAS for the neck, and JOA score recovery rate were comparable between the two groups.ConclusionsSurgical outcomes, including functional recovery, complication rates, and cervical dynamics, were comparable between the BCS and NBCS groups. Consequently, posterior decompression for cervical OPLL is considered safe and effective when conducted by junior surgeons who have undergone training and supervision by experienced spine surgeons.

Impact of hypertension in diabetes on surgical outcomes after cervical laminoplasty - a retrospective, multi-institutional study of 1002 patients

PURPOSE

This study aimed to elucidate the association between comorbid hypertension (HT) and diabetes mellitus (DM) (HT in DM) and clinical outcomes after cervical laminoplasty.

METHODS

This retrospective multi-institutional study enrolled patients who underwent laminoplasty between 2008 and 2017. The primary outcome was the recovery rate of JOA score. The secondary outcome was in-hospital all-cause postoperative complications.

RESULTS

This study included 1002 patients (mean age, 66 years; 30% women) who were divided into 4 groups based on the presence of medically-treated HT and/or DM. The overall incidence of DM was 17%, and the prevalence of HT was 47% in diabetic patients. Patients with HT in DM showed similar preoperative JOA scores compared to those without both HT and DM. However, patients with HT in DM showed poorer postoperative JOA scores and worse JOA-RR (non-HT/DM, 48%; DM, 43%; HT, 37%; HT in DM, 28%; p < 0.05). Patients with HT in DM tended to have a higher risk of postoperative complications (2.5%, 5.4%, 3.0%, and 7.4%; p = 0.09), especially C5 palsy (0.8%, 3.0%, 1.7%, and 4.9%; p = 0.04). After adjusting confounders, the presence of HT in DM was an independent risk factor for failure to achieve the JOA-RR MCID (JOA-RR < 42%) (OR = 3.6).

CONCLUSIONS

Approximately half of patients with DM had HT. HT in DM was closely associated with unfavorable surgical outcomes, including an increased incidence of in-hospital postoperative complications and an elevated risk of C5 palsy. In contrast, patients with DM alone demonstrated relatively favorable outcomes.

The TLR-M-CSF axis is implicated in increased bone turnover and curve progression in adolescent idiopathic scoliosis

BACKGROUND

Facet joint osteoarthritis (OA) is prevalent in patients with adolescent idiopathic scoliosis (AIS). The most pronounced OA presents above and below the curve's apex where the intervertebral rotation is the greatest. This indicates that facet joint OA is implicated and potentially contributes to AIS progression. OA impacts both cartilage and bone and we have previously demonstrated an association between lower bone quality and more severe OA in AIS facet joints. This study aimed to further investigate the molecular mechanisms underlying cartilage-bone crosstalk in the facet joints of patients with AIS.

METHODS

Unbiased deep RNA sequencing was performed to compare gene expression in facet joint chondrocytes of age-matched AIS patients and non-scoliotic individuals. Differentially expressed genes of interest were validated through qPCR and ELISA in a larger sample cohort. Key regulatory pathways involved in cartilage-bone crosstalk were identified through bioinformatic analysis. Functional studies were conducted by treating chondrocytes with TLR2 and TLR4 agonists, collecting conditioned media, and administering it to an in vitro osteoclastogenesis model. The expression of M-CSF, a key regulatory factor influencing osteoclast proliferation, was measured in individual facet joint cartilage samples at different spinal levels and correlated with cartilage morphological grade and 3D structural parameters extracted from spine reconstruction.

RESULTS

One thousand four hundred twenty six upregulated genes were detected, and gene ontology analysis revealed a significant enrichment of the TLR pathway, and bone-regulating biological processes in AIS chondrocytes. TLR activation of AIS chondrocytes induced expression of bone-regulating factors, including M-CSF, a key regulator of osteoclast proliferation. Furthermore, secreted factors from AIS chondrocytes enhanced osteoclast proliferation and maturation, with a stronger effect observed following TLR pre-activation. Clinically, M-CSF expression was found to correlate strongly with increased OA severity and a greater degree of intervertebral axial rotation.

CONCLUSIONS

Together, our findings suggest that the TLR-M-CSF axis is implicated in osteoclastogenesis, resulting in increased bone turnover and may contribute to curve progression in AIS patients.

Techniques of Deformity Correction in Adolescent Idiopathic Scoliosis-A Narrative Review of the Existing Literature

Surgical management of adolescent idiopathic scoliosis [AIS] is a complex undertaking with the primary goals to correct the deformity, maintain sagittal balance, preserve pulmonary function, maximize postoperative function, and improve or at least not harm the function of the lumbar spine. The evolution of surgical techniques for AIS has been remarkable, transitioning from rudimentary methods of spinal correction to highly refined, biomechanically sound procedures. Modern techniques incorporate advanced three-dimensional correction strategies, often leveraging pedicle screw constructs, which provide superior rotational control of the vertebral column. A number of surgical techniques have been described in the literature, each having its own pros and cons. This narrative review provides a detailed analysis of the contemporary surgical techniques used in the treatment of patients with AIS.

Development of a YOLOv3-Based Model for Automated Detection of Thoracic Ossification of the Posterior Longitudinal Ligament and the Ligamentum Flavum on Plain Radiographs

Background/Objectives: This study aims to develop and validate a YOLOv3-based deep learning model for detecting ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) on lateral thoracic radiographs, improving early diagnosis and screening accessibility. Methods: A retrospective dataset of 356 lateral thoracic radiographs, including 176 with OPLL or OLF and 180 controls, was annotated by spine surgeons. The YOLOv3 model was trained using data augmentation and evaluated via five-fold cross-validation, with accuracy, precision, recall, and F1-score compared to two spine surgeons. Results: The model achieved 80.6% accuracy, 70.3% precision, 92.6% recall, and 79.9% F1-score, surpassing spine surgeons in accuracy and recall, especially for combined OPLL and OLF cases. Detection accuracy was 81.1% for OPLL, 53.3% for OLF, and 86.3% for combined cases. Conclusions: The YOLOv3-based model provides high accuracy and robust detection of OPLL and OLF on plain radiographs, offering an efficient and accessible screening tool.