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Sousa CS, Monteiro A, Salgado AJ, Silva NA. Combinatorial therapies for spinal cord injury repair. Neural Regen Res 2025; 20:1293-1308. [PMID: 38845223 DOI: 10.4103/nrr.nrr-d-24-00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 07/31/2024] Open
Abstract
Spinal cord injuries have profound detrimental effects on individuals, regardless of whether they are caused by trauma or non-traumatic events. The compromised regeneration of the spinal cord is primarily attributed to damaged neurons, inhibitory molecules, dysfunctional immune response, and glial scarring. Unfortunately, currently, there are no effective treatments available that can fully repair the spinal cord and improve functional outcomes. Nevertheless, numerous pre-clinical approaches have been studied for spinal cord injury recovery, including using biomaterials, cells, drugs, or technological-based strategies. Combinatorial treatments, which target various aspects of spinal cord injury pathophysiology, have been extensively tested in the last decade. These approaches aim to synergistically enhance repair processes by addressing various obstacles faced during spinal cord regeneration. Thus, this review intends to provide scientists and clinicians with an overview of pre-clinical combinatorial approaches that have been developed toward the solution of spinal cord regeneration as well as update the current knowledge about spinal cord injury pathophysiology with an emphasis on the current clinical management.
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Affiliation(s)
- Carla S Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar - gualtar, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Lab, Campus de Gualtar - gualtar, Braga, Portugal
| | - Andreia Monteiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar - gualtar, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Lab, Campus de Gualtar - gualtar, Braga, Portugal
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar - gualtar, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Lab, Campus de Gualtar - gualtar, Braga, Portugal
| | - Nuno A Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar - gualtar, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Lab, Campus de Gualtar - gualtar, Braga, Portugal
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2
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Chen J, Zeng X, Wang L, Zhang W, Li G, Cheng X, Su P, Wan Y, Li X. Mutual regulation of microglia and astrocytes after Gas6 inhibits spinal cord injury. Neural Regen Res 2025; 20:557-573. [PMID: 38819067 PMCID: PMC11317951 DOI: 10.4103/nrr.nrr-d-23-01130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 06/01/2024] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202502000-00032/figure1/v/2024-05-28T214302Z/r/image-tiff Invasive inflammation and excessive scar formation are the main reasons for the difficulty in repairing nervous tissue after spinal cord injury. Microglia and astrocytes play key roles in the spinal cord injury micro-environment and share a close interaction. However, the mechanisms involved remain unclear. In this study, we found that after spinal cord injury, resting microglia (M0) were polarized into pro-inflammatory phenotypes (MG1 and MG3), while resting astrocytes were polarized into reactive and scar-forming phenotypes. The expression of growth arrest-specific 6 (Gas6) and its receptor Axl were significantly down-regulated in microglia and astrocytes after spinal cord injury. In vitro experiments showed that Gas6 had negative effects on the polarization of reactive astrocytes and pro-inflammatory microglia, and even inhibited the cross-regulation between them. We further demonstrated that Gas6 can inhibit the polarization of reactive astrocytes by suppressing the activation of the Yes-associated protein signaling pathway. This, in turn, inhibited the polarization of pro-inflammatory microglia by suppressing the activation of the nuclear factor-κB/p65 and Janus kinase/signal transducer and activator of transcription signaling pathways. In vivo experiments showed that Gas6 inhibited the polarization of pro-inflammatory microglia and reactive astrocytes in the injured spinal cord, thereby promoting tissue repair and motor function recovery. Overall, Gas6 may play a role in the treatment of spinal cord injury. It can inhibit the inflammatory pathway of microglia and polarization of astrocytes, attenuate the interaction between microglia and astrocytes in the inflammatory microenvironment, and thereby alleviate local inflammation and reduce scar formation in the spinal cord.
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Affiliation(s)
- Jiewen Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Xiaolin Zeng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Le Wang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Wenwu Zhang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Gang Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Xing Cheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Peiqiang Su
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Yong Wan
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
| | - Xiang Li
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong Province, China
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Olaya AMS, Almeida FM, Martinez AMB, Marques SA. Treatment of spinal cord injury with biomaterials and stem cell therapy in non-human primates and humans. Neural Regen Res 2025; 20:343-353. [PMID: 38819038 PMCID: PMC11317961 DOI: 10.4103/nrr.nrr-d-23-01752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 06/01/2024] Open
Abstract
Spinal cord injury results in the loss of sensory, motor, and autonomic functions, which almost always produces permanent physical disability. Thus, in the search for more effective treatments than those already applied for years, which are not entirely efficient, researches have been able to demonstrate the potential of biological strategies using biomaterials to tissue manufacturing through bioengineering and stem cell therapy as a neuroregenerative approach, seeking to promote neuronal recovery after spinal cord injury. Each of these strategies has been developed and meticulously evaluated in several animal models with the aim of analyzing the potential of interventions for neuronal repair and, consequently, boosting functional recovery. Although the majority of experimental research has been conducted in rodents, there is increasing recognition of the importance, and need, of evaluating the safety and efficacy of these interventions in non-human primates before moving to clinical trials involving therapies potentially promising in humans. This article is a literature review from databases (PubMed, Science Direct, Elsevier, Scielo, Redalyc, Cochrane, and NCBI) from 10 years ago to date, using keywords (spinal cord injury, cell therapy, non-human primates, humans, and bioengineering in spinal cord injury). From 110 retrieved articles, after two selection rounds based on inclusion and exclusion criteria, 21 articles were analyzed. Thus, this review arises from the need to recognize the experimental therapeutic advances applied in non-human primates and even humans, aimed at deepening these strategies and identifying the advantages and influence of the results on extrapolation for clinical applicability in humans.
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Affiliation(s)
- Ana Milena Silva Olaya
- PhD Program in Pathological Anatomy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Maria Blanco Martinez
- Graduate Program in Pathological Anatomy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Suelen Adriani Marques
- Graduate Program in Pathological Anatomy (PPGAP/UFRJ), Department of Neurobiology/Institute of Biology, Campus do Gragoatá, Niterói, Rio de Janeiro, Brazil
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4
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Jun L, Zou T, Wei JJ, Huo T, Min W, Wei C, Zhao H. Comparison of the effects between oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal interbody fusion (MIS-TLIF) in the treatment of adult degenerative lumbar scoliosis. J Orthop 2024; 58:58-65. [PMID: 39055286 PMCID: PMC11266858 DOI: 10.1016/j.jor.2024.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background Managing adult degenerative lumbar scoliosis (ADLS) presents a complex challenge, requiring advanced, minimally invasive surgical techniques. Objective This study aims to evaluate and compare the efficacy and outcomes of oblique lateral interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treating ADLS, with an emphasis on surgical methods, recovery times, and spinal correction results. Methods We reviewed 42 patients with ADLS who did not respond to conservative treatments. These patients underwent either OLIF or MIS-TLIF procedures. Key factors analyzed included surgical duration, blood loss, complications, and changes in preoperative and postoperative lumbar lordosis (LL), anterior and posterior disc height (ADH, PDH), and Cobb angles. Statistical analysis was conducted using SPSS software, with significance determined at p < 0.05. Results The OLIF technique showed notable benefits in multi-segment spinal corrections, particularly in enhancing intervertebral disc height and correcting Cobb angles. While both surgical methods effectively addressed spinal deformities, OLIF was less invasive, resulting in reduced blood loss, shorter surgery times, and fewer complications. No significant differences were found between the two techniques for single-segment corrections. Conclusion For multi-segment spinal corrections in ADLS, OLIF is a superior choice due to its minimal invasiveness and favorable recovery profile. However, for patients with primarily radicular symptoms and no significant postural alterations, MIS-TLIF may be more appropriate.
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Affiliation(s)
- Li Jun
- Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Spine Surgery, Changzhou 213000, PR China
| | - Tao Zou
- Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Spine Surgery, Changzhou 213000, PR China
| | - Jia J. Wei
- Yunnan Province Hospital of Traditional Chinese Medicine, Departmen of Orthopedics, Kunming 650000, PR China
| | - Tianqun Huo
- Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Spine Surgery, Changzhou 213000, PR China
| | - Wen Min
- Jiangsu Province Hospital of Traditional Chinese Medicine, Departmen of Orthopedics, Nanjing 210000, PR China
| | - Chengjian Wei
- Jiangsu Province Hospital of Traditional Chinese Medicine, Departmen of Orthopedics, Nanjing 210000, PR China
| | - Hong Zhao
- Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Department of Spine Surgery, Changzhou 213000, PR China
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5
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Hao P, Yang Z, So KF, Li X. A core scientific problem in the treatment of central nervous system diseases: newborn neurons. Neural Regen Res 2024; 19:2588-2601. [PMID: 38595278 PMCID: PMC11168522 DOI: 10.4103/nrr.nrr-d-23-01775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/06/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024] Open
Abstract
It has long been asserted that failure to recover from central nervous system diseases is due to the system's intricate structure and the regenerative incapacity of adult neurons. Yet over recent decades, numerous studies have established that endogenous neurogenesis occurs in the adult central nervous system, including humans'. This has challenged the long-held scientific consensus that the number of adult neurons remains constant, and that new central nervous system neurons cannot be created or renewed. Herein, we present a comprehensive overview of the alterations and regulatory mechanisms of endogenous neurogenesis following central nervous system injury, and describe novel treatment strategies that target endogenous neurogenesis and newborn neurons in the treatment of central nervous system injury. Central nervous system injury frequently results in alterations of endogenous neurogenesis, encompassing the activation, proliferation, ectopic migration, differentiation, and functional integration of endogenous neural stem cells. Because of the unfavorable local microenvironment, most activated neural stem cells differentiate into glial cells rather than neurons. Consequently, the injury-induced endogenous neurogenesis response is inadequate for repairing impaired neural function. Scientists have attempted to enhance endogenous neurogenesis using various strategies, including using neurotrophic factors, bioactive materials, and cell reprogramming techniques. Used alone or in combination, these therapeutic strategies can promote targeted migration of neural stem cells to an injured area, ensure their survival and differentiation into mature functional neurons, and facilitate their integration into the neural circuit. Thus can integration replenish lost neurons after central nervous system injury, by improving the local microenvironment. By regulating each phase of endogenous neurogenesis, endogenous neural stem cells can be harnessed to promote effective regeneration of newborn neurons. This offers a novel approach for treating central nervous system injury.
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Affiliation(s)
- Peng Hao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Zhaoyang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Kwok-Fai So
- Guangdong-HongKong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, Guangdong Province, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, Guangdong Province, China
- Department of Ophthalmology and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administration Region, China
- Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, Guangdong Province, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Xiaoguang Li
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Banerjee R, Patel D, Farooque K, Gupta D, Seth A, Kochhar KP, Garg B, Jain S, Kumar N, Jain S. Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial. MethodsX 2024; 13:102826. [PMID: 39049927 PMCID: PMC11268124 DOI: 10.1016/j.mex.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.
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Affiliation(s)
- Rohit Banerjee
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deeksha Patel
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Jain
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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7
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Liang Y, Xu H, Tang W, Du X. The impact of metal implants on the dose and clinical outcome of radiotherapy (Review). Mol Clin Oncol 2024; 21:66. [PMID: 39091418 PMCID: PMC11289751 DOI: 10.3892/mco.2024.2764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
Radiotherapy (RT) is one of the most widely used and effective cancer treatments. With the increasing need for organ reconstruction and advancements in material technology, an increasing number of patients with cancer have metallic implants. These implants can affect RT dosage and clinical outcomes, warranting careful consideration by oncologists. The present review discussed the mechanisms by which different types of metallic implants impact various stages of the RT process, examined methods to mitigate these effects during treatment, and discussed the clinical implications of metallic implants on RT outcomes. In summary, when metallic implants are present within the RT field, oncologists should carefully assess their impact on the treatment.
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Affiliation(s)
- Yuwen Liang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Haonan Xu
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Wenqiang Tang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
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Wang J, Jiang Y, Zhu C, Liu Z, Qi L, Ding H, Wang J, Huang Y, Li Y, Song Y, Feng G, Zhang L, Liu L. Mitochondria-engine with self-regulation to restore degenerated intervertebral disc cells via bioenergetic robust hydrogel design. Bioact Mater 2024; 40:1-18. [PMID: 38873262 PMCID: PMC11167444 DOI: 10.1016/j.bioactmat.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Previous studies have confirmed that intervertebral disc degeneration (IDD) is closely associated with inflammation-induced reactive oxygen species (ROS) and resultant cell mitochondrial membrane potential (MMP) decline. Clearance of ROS in an inflammatory environment is essential for breaking the vicious cycle of MMP decline. Additionally, re-energizing the mitochondria damaged in the inflammatory milieu to restore their function, is equally important. Herein, we proposed an interesting concept of mitochondrion-engine equipped with coolant, which enables first to "cool-down" the inflammatory environment, next to restore the MMP, finally to allow cells to regain normal energy metabolism through materials design. As such, we developed a multi-functional composite composed of a reactive oxygen species (ROS)-responsive sodium alginate/gelatin hydrogel infused into a rigid 3D-printed thermoplastic polyurethane (TPU) scaffold. The TPU scaffold was coated with conductive polypyrrole (PPy) to electrophoretically deposit l-arginine, which could upregulate the Mammalian target of rapamycin (mTOR) pathway, thus increasing MMP and energy metabolism to stimulate extracellular matrix synthesis for IVD repair. While the ROS-responsive hydrogel acting as the "mito-engine coolant" could scavenge the excessive ROS to create a favorable environment for IVD cells recovery. Demonstrated by in vitro and in vivo evaluations, the mito-engine system markedly promoted the proliferation and collagen synthesis of nucleus pulposus cells while enhancing the mitochondrial respiration and MMP under oxidative stress. Radiological and histological assessments in vivo revealed the efficacy of this system in IVD repair. This unique bioinspired design integrated biomaterial science with mitochondrial biology, presents a promising paradigm for IDD treatment.
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Affiliation(s)
| | | | - Ce Zhu
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Zheng Liu
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Lin Qi
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Hong Ding
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Jing Wang
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Yong Huang
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Yubao Li
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Yueming Song
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Ganjun Feng
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Li Zhang
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
| | - Limin Liu
- Analytical & Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610065, China
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9
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Brüningk SC, Bourguignon L, Lukas LP, Maier D, Abel R, Weidner N, Rupp R, Geisler F, Kramer JLK, Guest J, Curt A, Jutzeler CR. Prediction of segmental motor outcomes in traumatic spinal cord injury: Advances beyond sum scores. Exp Neurol 2024; 380:114905. [PMID: 39097076 DOI: 10.1016/j.expneurol.2024.114905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/14/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly challenged by the level of the lesion and the high heterogeneity in severity (different degrees of in/complete SCI) and spinal cord syndromes (hemi-, ant-, central-, and posterior cord). So far outcome predictions in clinical trials are limited in targeting sum motor scores of the upper (UEMS) and lower limb (LEMS) while neglecting that the distribution of motor function is essential for functional outcomes. The development of data-driven prediction models of detailed segmental motor recovery for all spinal segments from the level of lesion towards the lowest motor segments will improve the design of rehabilitation programs and the sensitivity of clinical trials. METHODS This study used acute-phase International Standards for Neurological Classification of SCI exams to forecast 6-month recovery of segmental motor scores as the primary evaluation endpoint. Secondary endpoints included severity grade improvement, independent walking, and self-care ability. Different similarity metrics were explored for k-nearest neighbor (kNN) matching within 1267 patients from the European Multicenter Study about Spinal Cord Injury before validation in 411 patients from the Sygen trial. The kNN performance was compared to linear and logistic regression models. RESULTS We obtained a population-wide root-mean-squared error (RMSE) in motor score sequence of 0.76(0.14, 2.77) and competitive functional score predictions (AUCwalker = 0.92, AUCself-carer = 0.83) for the kNN algorithm, improving beyond the linear regression task (RMSElinear = 0.98(0.22, 2.57)). The validation cohort showed comparable results (RMSE = 0.75(0.13, 2.57), AUCwalker = 0.92). We deploy the final historic control model as a web tool for easy user interaction (https://hicsci.ethz.ch/). DISCUSSION Our approach is the first to provide predictions across all motor segments independent of the level and severity of SCI. We provide a machine learning concept that is highly interpretable, i.e. the prediction formation process is transparent, that has been validated across European and American data sets, and provides reliable and validated algorithms to incorporate external control data to increase sensitivity and feasibility of multinational clinical trials.
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Affiliation(s)
- Sarah C Brüningk
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland.
| | - Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
| | - Louis P Lukas
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Rainer Abel
- Spinal Cord Injury Center, Klinikum Bayreuth, Bayreuth, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Fred Geisler
- University of Saskatchewan, Saskatchewan, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada; Hugill Centre for Anesthesia, University of British Columbia, Canada
| | - James Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, USA; Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, USA
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
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10
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Hsu YC, Liu YF, Chang CJ, Hsiao YM, Huang YH, Liu KC, Chen CM, Kim HS, Lin CL. How to Prevent Nerve Root Injury in Uniportal Full Endoscopic Lumbar Fusion Surgery? Insights From a Cadaveric Anatomic Study With Simulation Surgery. Spine (Phila Pa 1976) 2024; 49:1301-1310. [PMID: 38872241 DOI: 10.1097/brs.0000000000005066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
STUDY DESIGN The study included 2 fresh-frozen cadavers. OBJECTIVE To elucidate the positional relationship between surgical instruments and nerve roots during full endoscopic facet-sparing (FE fs-TLIF) and full endoscopic facet-resecting (FE fr-TLIF) transforaminal lumbar interbody fusion and propose safe instrumentation insertion procedures and recommend cage glider designs aimed at protecting nerve roots. BACKGROUND Endoscopic surgical techniques are increasingly used for minimally invasive lumbar fusion surgery, with FE fr-TLIF and FE fs-TLIF being common approaches. However, the risk of nerve root injury remains a significant concern during these procedures. PATIENTS AND METHODS Eight experienced endoscopic spine surgeons performed uniportal FE fr-TLIF and FE fs-TLIF on cadaveric lumbar spines, totaling 16 surgeries. Postoperation, soft tissues were removed to assess the positional relationship between the cage entry point and nerve roots. Distances between the cage entry point, traversing nerve root, and exiting nerve root were measured. Safe instrumentation design and insertion procedures were determined. RESULTS In FE fr-TLIF, the mean distance between the cage entry point and traversing nerve root was significantly shorter compared with FE fs-TLIF (3.30 ± 1.35 vs . 8.58 ± 2.47 mm, respectively; P < 0.0001). Conversely, the mean distance between the cage entry point and the exiting nerve root was significantly shorter in FE fs-TLIF compared with FE fr-TLIF (3.73 ± 1.97 vs . 6.90 ± 1.36 mm, respectively; P < 0.0001). For FE fr-TLIF, prioritizing the protection of the traversing root using a 2-bevel tip cage glider was crucial. In contrast, for FE fs-TLIF, a single-bevel tip cage glider placed in the caudal location was recommended. CONCLUSION This study elucidates the anatomic relationship between cage entry points and nerve roots in uniportal endoscopic lumbar fusion surgery. Protection strategies should prioritize the traversing root in FE fr-TLIF and the exiting root in FE fs-TLIF, with corresponding variations in surgical techniques. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Yu-Chia Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Fu Liu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Jui Chang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Meng Hsiao
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Yi-Hung Huang
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Keng-Chang Liu
- Department of Orthopedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biomedical Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - Hyeun-Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Zhu MT, Hu BS, Chen CM, Liu HQ, Lin GX. Comparison of Full Endoscopic Lumbar Diskectomy Using the Transforaminal Approach versus Interlaminar Approach for L5-S1 Lumbar Disk Herniation Treatment: A Meta-Analysis. J Neurol Surg A Cent Eur Neurosurg 2024; 85:501-512. [PMID: 36918155 DOI: 10.1055/a-2053-8365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Numerous studies have examined the clinical effectiveness of transforaminal full endoscopic lumbar diskectomy (T-FELD) and interlaminar full endoscopic lumbar diskectomy (I-FELD) for L5-S1 lumbar disk herniation (LDH), with mixed findings. The goal of this systematic review and meta-analysis was to evaluate the perioperative outcomes, clinical results, and complications of T-FELD and I-FELD to determine their efficacy and safety for treating L5-S1 LDH and to examine the features of complications in depth. METHODS Several databases were searched for articles that matched all of the inclusion criteria. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to assess the clinical results. Information on perioperative outcomes and complications was gathered and analyzed. RESULTS Eight studies with 756 participants were included. There were no significant differences in postoperative bed time (p = 0.44) and hospitalization time (p = 0.49) between T-FELD and I-FELD. When compared with I-FELD, T-FELD was associated with substantially longer fluoroscopy time (p < 0.0001) and operating time (p < 0.0001). There were no significant differences in the preoperative and postoperative VAS and ODI scores between T-FELD and I-FELD. The rates for overall complications, postoperative dysesthesia, postoperative lower extremity pain, incomplete decompression, recurrence, and conversion to open surgery were comparable for T-FLED and I-FELD. CONCLUSION T-FELD and I-FELD had equal clinical results and safety for treatment of L5-S1 LDH. Fluoroscopy and operative times were shorter for I-FELD than for T-FELD.
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Affiliation(s)
- Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
| | - Hong-Qi Liu
- Department of Orthopedics, Zhangpu Country Hospital, Zhangzhou, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
- The Third Clinical Medical College, The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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12
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Chen H, Wu T, Pan S, Zhang L, Zhao Y, Chen X, Sun Y, Lu WW, Zhou F. Finite element analysis of a new preoperative traction for cervical kyphosis: suspensory traction. Med Biol Eng Comput 2024; 62:2867-2877. [PMID: 38709337 PMCID: PMC11330378 DOI: 10.1007/s11517-024-03113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
A finite element model of cervical kyphosis was established to analyze the stress of cervical spine under suspensory traction and to explore the mechanism and effect of it. A patient with typical cervical kyphosis (C2-C5) underwent CT scan imaging, and 3D slicer was used to reconstruct the C2 to T2 vertebral bodies. The reconstructed data was imported into Hypermesh 2020 and Abaqus 2017 for meshing and finite element analysis. The changes of the kyphotic angle and the von Mises stress on the annulus fibrosus of each intervertebral disc and ligaments were analyzed under suspensory traction conditions. With the increase of suspensory traction weight, the overall kyphosis of cervical spine showed a decreasing trend. The correction of kyphosis was mainly contributed by the change of kyphotic segments. The kyphotic angle of C2-C5 was corrected from 45° to 13° finally. In cervical intervertebral discs, the stress was concentrated to anterior and posterior part, except for C4-5. The stress of the anterior longitudinal ligament (ALL) decreased from the rostral to the caudal, and the high level von Mises stress of the kyphotic segments appeared at C2-C3, C3-C4, and C4-C5. The roles of the other ligaments were not obvious. The kyphotic angle was significantly reduced by the suspensory traction. Shear effect due to the high von Mises stress in the anterior and posterior parts of annulus fibrosus and the tension on the anterior longitudinal ligament play a role in the correction of cervical kyphosis.
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Affiliation(s)
- Hongyu Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Tianchi Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - Shengfa Pan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Li Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yanbin Zhao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xin Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
| | - Feifei Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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13
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Bhushan A, Beland A, Poelstra C, Butterfield J, Angel M, Cheung T, Plater E, Guha D, Pahuta M, Macedo LG. Immobilization protocols for the treatment of cervical spine fracture: a scoping review. Spine J 2024; 24:1571-1594. [PMID: 38908439 DOI: 10.1016/j.spinee.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking. PURPOSE Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols? STUDY DESIGN Scoping review was performed. PATIENT SAMPLE Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture. OUTCOME MEASURES Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes. METHODS 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0-C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute. RESULTS This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use. CONCLUSION This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review.
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Affiliation(s)
- Akhilesh Bhushan
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexa Beland
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Chantelle Poelstra
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Butterfield
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Marina Angel
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Tiffany Cheung
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma Plater
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Daipayan Guha
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Markian Pahuta
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
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14
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Payas A, Kocaman H, Yıldırım H, Batın S. Prediction of adolescent idiopathic scoliosis with machine learning algorithms using brain volumetric measurements. JOR Spine 2024; 7:e1355. [PMID: 39011367 PMCID: PMC11247394 DOI: 10.1002/jsp2.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/05/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
Background It is known that neuroanatomical and neurofunctional changes observed in the brain, brainstem and cerebellum play a role in the etiology of adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether volumetric measurements of brain regions can be used as predictive indicators for AIS through machine learning techniques. Methods Patients with a severe degree of curvature in AIS (n = 32) and healthy individuals (n = 31) were enrolled in the study. Volumetric data from 169 brain regions, acquired from magnetic resonance imaging (MRI) of these individuals, were utilized as predictive factors. A comprehensive analysis was conducted using the twelve most prevalent machine learning algorithms, encompassing thorough parameter adjustments and cross-validation processes. Furthermore, the findings related to variable significance are presented. Results Among all the algorithms evaluated, the random forest algorithm produced the most favorable results in terms of various classification metrics, including accuracy (0.9083), AUC (0.993), f1-score (0.970), and Brier score (0.1256). Additionally, the most critical variables were identified as the volumetric measurements of the right corticospinal tract, right corpus callosum body, right corpus callosum splenium, right cerebellum, and right pons, respectively. Conclusion The outcomes of this study indicate that volumetric measurements of specific brain regions can serve as reliable indicators of AIS. In conclusion, the developed model and the significant variables discovered hold promise for predicting scoliosis development, particularly in high-risk individuals.
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Affiliation(s)
- Ahmet Payas
- Faculty of Medicine, Department of Anatomy Amasya University Amasya Turkey
| | - Hikmet Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation Karamanoglu Mehmetbey University Karaman Turkey
| | - Hasan Yıldırım
- Faculty of Kamil Özdağ Science, Department of Mathematics Karamanoğlu Mehmetbey University Karaman Turkey
| | - Sabri Batın
- Orthopedics and Traumatology Department Kayseri City Education and Training Hospital Kayseri Turkey
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15
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Fotakopoulos G, Georgakopoulou VE, Trakas N, Sklapani P, Brotis AG. Malignant character of an ossified posterior longitudinal ligament in a hyperflexion injury: A case report. MEDICINE INTERNATIONAL 2024; 4:48. [PMID: 39006813 PMCID: PMC11240858 DOI: 10.3892/mi.2024.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024]
Abstract
The present study reports the case of a 50-year-old obese male with ankylosing spondylitis, Scheuermann's kyphosis. The patient was asymptomatic concerning the ectopic ossification of the posterior longitudinal ligament (OPLL) at the cervical spine; he developed quadriparesis and respiratory insufficiency following minor head trauma. Even though trauma to the cervical spine in patients with OPLL is common, to the best of our knowledge, this is the first reported case of an extensive osteophyte with a lethal outcome after syncope. In rare occasions, it may be present with syncope and potentially lethal outcomes, particularly when precipitated by trauma. Therefore, the management of OPLL with significant canal stenosis should not be unnecessarily delayed.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
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16
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Lama CJ, Hartnett DA, Donnelly JC, Yang DS, Kosinski LR, Katarincic JA, Gil JA. YouTube as a Source of Patient Information for Cubital Tunnel Syndrome: An Analysis of Video Reliability, Quality, and Content. Hand (N Y) 2024; 19:986-994. [PMID: 36799471 PMCID: PMC11342704 DOI: 10.1177/15589447231151428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND This study seeks to examine the reliability, quality, and content of YouTube videos on cubital tunnel syndrome, on which there is presently a paucity of information. METHODS The top 50 unique YouTube videos by relevance resulting from the Boolean search term "cubital tunnel + cubital tunnel syndrome" were identified, with video properties for analysis including source, upload date, duration, views, and comments. Content was assessed using the Journal of American Medical Association (JAMA) criteria, the Global Quality Score (GQS), and a "Cubital Tunnel-Specific Score" (CTSS). RESULTS The average video saw 72 108 ± 199 362 views, with videos produced by allied (nonphysician) health professionals demonstrating the highest mean views (111 789 ± 294 471 views). Videos demonstrated low mean JAMA scores (2.4/4 ± 0.7), GQS (2.8/5 ± 1.3), and CTSS (7.5/21 ± 4.3), with academic and nonacademic physician videos demonstrating significantly greater mean GQS and CTSS scores when compared with videos by allied health professionals. Positive independent predictors for GQS included academic sources (β = 1.871), nonacademic physician sources (β = 1.651), and video duration (β = 0.102), which were likewise positive predictors for CTSS (β = 4.553, 4.639, 0.374). Content relating to surgical techniques or approaches for cubital tunnel decompression had the greatest CTSS scores (11.2 [4.2]). CONCLUSIONS YouTube is a source of highly accessible information on cubital tunnel syndrome, although the average video presents generally poor and inadequate information. Directing patients toward higher quality video resources can be a meaningful component of patient education.
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Affiliation(s)
| | - Davis A. Hartnett
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph C. Donnelly
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel S. Yang
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Joseph A. Gil
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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17
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Akgun MY, Orak Hİ, Akgul MH, Ates O. Efficacy and Advantages of Spinal Anesthesia in Lumbar Disk Surgery. J Neurol Surg A Cent Eur Neurosurg 2024; 85:439-443. [PMID: 38599624 DOI: 10.1055/s-0043-1771267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature. METHODS Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation. RESULTS There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 ± 16.71 years (range: 18-58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22-68 minutes). Average blood loss was 85 mL (range: 55-125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores (p < 0.05). CONCLUSIONS In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects.
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Affiliation(s)
| | - Helin İlkay Orak
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
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18
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Passias PG, Onafowokan OO, Joujon-Roche R, Smith J, Tretiakov P, Buell T, Diebo BG, Daniels AH, Gum JL, Hamiltion DK, Soroceanu A, Scheer J, Eastlack RK, Fessler RG, Klineberg EO, Kim HJ, Burton DC, Schwab FJ, Bess S, Lafage V, Shaffrey CI, Ames C. Expectations of clinical improvement following corrective surgery for adult cervical deformity based on functional disability at presentation. Spine Deform 2024; 12:1431-1439. [PMID: 39083198 DOI: 10.1007/s43390-024-00896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/07/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE To assess impact of baseline disability on HRQL outcomes. METHODS CD patients with baseline (BL) and 2 year (2Y) data included, and ranked into quartiles by baseline NDI, from lowest/best score (Q1) to highest/worst score (Q4). Means comparison tests analyzed differences between quartiles. ANCOVA and logistic regressions assessed differences in outcomes while accounting for covariates (BL deformity, comorbidities, HRQLs, surgical details and complications). RESULTS One hundred and sixteen patients met inclusion (Age:60.97 ± 10.45 years, BMI: 28.73 ± 7.59 kg/m2, CCI: 0.94 ± 1.31). The cohort mean cSVA was 38.54 ± 19.43 mm and TS-CL: 37.34 ± 19.73. Mean BL NDI by quartile was: Q1: 25.04 ± 8.19, Q2: 41.61 ± 2.77, Q3: 53.31 ± 4.32, and Q4: 69.52 ± 8.35. Q2 demonstrated greatest improvement in NRS Neck at 2Y (-3.93), compared to Q3 (-1.61, p = .032) and Q4 (-1.41, p = .015). Q2 demonstrated greater improvement in NRS Back (-1.71), compared to Q4 (+ 0.84, p = .010). Q2 met MCID in NRS Neck at the highest rates (69.9%), especially compared to Q4 (30.3%), p = .039. Q2 had the greatest improvement in EQ-5D (+ 0.082), compared to Q1 (+ 0.073), Q3 (+ 0.022), and Q4 (+ 0.014), p = .034. Q2 also had the greatest mJOA improvement (+ 1.517), p = .042. CONCLUSIONS Patients in Q2, with mean BL NDI of 42, consistently demonstrated the greatest improvement in HRQLs whereas those in Q4, (NDI 70), saw the least. BL NDI between 39 and 44 may represent a disability "Sweet Spot," within which operative intervention maximizes patient-reported outcomes. Furthermore, delaying intervention until patients are severely disabled, beyond an NDI of 61, may limit the benefits of surgery.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, Neurological Surgery, New York Spine Institute, NYU Langone Medical Center-Orthopaedic Hospital, 301 East 17th St, New York, NY, 10003, USA.
| | - Oluwatobi O Onafowokan
- Department of Orthopaedics, Neurological Surgery, New York Spine Institute, NYU Langone Medical Center-Orthopaedic Hospital, 301 East 17th St, New York, NY, 10003, USA
| | - Rachel Joujon-Roche
- Department of Orthopaedics, Neurological Surgery, New York Spine Institute, NYU Langone Medical Center-Orthopaedic Hospital, 301 East 17th St, New York, NY, 10003, USA
| | - Justin Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, US
| | - Peter Tretiakov
- Department of Orthopaedics, Neurological Surgery, New York Spine Institute, NYU Langone Medical Center-Orthopaedic Hospital, 301 East 17th St, New York, NY, 10003, USA
| | - Thomas Buell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, US
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, US
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, US
| | | | - D Kojo Hamiltion
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, US
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, US
| | | | - Richard G Fessler
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago Il, US
| | | | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, US
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, US
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, US
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, US
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, US
| | | | - Christopher Ames
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, US
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Fields MW, Zaifman J, Malka MS, Lee NJ, Rymond CC, Simhon ME, Quan T, Roye BD, Vitale MG. Utilizing a comprehensive machine learning approach to identify patients at high risk for extended length of stay following spinal deformity surgery in pediatric patients with early onset scoliosis. Spine Deform 2024; 12:1477-1483. [PMID: 38702550 DOI: 10.1007/s43390-024-00889-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Early onset scoliosis (EOS) patient diversity makes outcome prediction challenging. Machine learning offers an innovative approach to analyze patient data and predict results, including LOS in pediatric spinal deformity surgery. METHODS Children under 10 with EOS were chosen from the American College of Surgeon's NSQIP database. Extended LOS, defined as over 5 days, was predicted using feature selection and machine learning in Python. The best model, determined by the area under the curve (AUC), was optimized and used to create a risk calculator for prolonged LOS. RESULTS The study included 1587 patients, mostly young (average age: 6.94 ± 2.58 years), with 33.1% experiencing prolonged LOS (n = 526). Most patients were female (59.2%, n = 940), with an average BMI of 17.0 ± 8.7. Factors influencing LOS were operative time, age, BMI, ASA class, levels operated on, etiology, nutritional support, pulmonary and neurologic comorbidities. The gradient boosting model performed best with a test accuracy of 0.723, AUC of 0.630, and a Brier score of 0.189, leading to a patient-specific risk calculator for prolonged LOS. CONCLUSIONS Machine learning algorithms accurately predict extended LOS across a national patient cohort and characterize key preoperative drivers of increased LOS after PSIF in pediatric patients with EOS.
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Affiliation(s)
- Michael W Fields
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Jay Zaifman
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Matan S Malka
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA.
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - Nathan J Lee
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Christina C Rymond
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Matthew E Simhon
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University, New York, NY, USA
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
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Zeller SL, Stein A, Frid I, Carpenter AB, Soldozy S, Rawanduzy C, Rosenberg J, Bauerschmidt A, Al-Mufti F, Mayer SA, Kinon MD, Wainwright JV. Critical Care of Spinal Cord Injury. Curr Neurol Neurosci Rep 2024; 24:355-363. [PMID: 39008022 DOI: 10.1007/s11910-024-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes. RECENT FINDINGS Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.
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Affiliation(s)
- Sabrina L Zeller
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Ilya Frid
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Austin B Carpenter
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Cameron Rawanduzy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Jon Rosenberg
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Andrew Bauerschmidt
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - John V Wainwright
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA.
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA.
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21
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Santangelo G, Wathen C, Pieters T, George DD, Worley L, Macaluso D, Dagli MM, Catanzaro S, Gu B, Welch WC, Petrov D, Vates GE, Ozturk AK, Schuster J, Stone JJ. Multi-institutional review of characteristics and management of gunshot wounds to the spine. Spine J 2024; 24:1553-1560. [PMID: 38740190 DOI: 10.1016/j.spinee.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND CONTEXT Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data. PURPOSE To characterize the management and follow-up of GSWs to the spine. STUDY DESIGN/SETTING A multi-institutional retrospective review of the experience of two urban Level 1 trauma centers. PATIENT SAMPLE Patients with GSWs to the spine between 2010-2021. OUTCOME MEASURES Measures included work status, follow-up healthcare utilization, and pain management were collected. METHODS Charts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY). RESULTS A total of 271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score. CONCLUSIONS Given the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population.
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Affiliation(s)
- Gabrielle Santangelo
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA.
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Pieters
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Derek D George
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Logan Worley
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Dominick Macaluso
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mert Marcel Dagli
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Catanzaro
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ben Gu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dmitry Petrov
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Schuster
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Stone
- Department of Neurosurgery, University of Rochester, 601 Elmwood Ave., Rochester, NY 14620, USA
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22
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Martin A, Zahir J, Smith N, Raji O, Nelles D, Kondrashov D. High incidence of dural tears with 3-column osteotomies: a systematic review of adult spinal deformity surgery literature for the past decade. Spine Deform 2024; 12:1253-1260. [PMID: 38914908 DOI: 10.1007/s43390-024-00916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Dural tear (DT) is a well-known complication of spinal surgery. We aimed to systematically review the literature from the past decade and determine the incidence and risk factors for DT in the adult spinal deformity (ASD) population to improve both the surgical strategy and counseling of patients undergoing ASD correction. METHODS A systematic review from 2013 to 2023 utilizing PRISMA guidelines was performed. The MEDLINE database was used to collect primary English language articles. The inclusion criterion for patients was degenerative ASD. Pediatric studies, animal studies, review articles, case reports, studies investigating minimally invasive surgery (MIS), studies lacking data on DT incidence, and articles pertaining to infectious, metastatic or neoplastic, traumatic, or posttraumatic etiologies of ASD were excluded. RESULTS Our results demonstrate that the incidence of DT in ASD surgery ranges from 2.0% to 35.7%, which is a much broader range than the reported incidence for non deformity surgery. Moreover, the average rate of DT during ASD surgery stratified by surgical technique was greater for osteotomy overall (19.5% +/- 7.9%), especially for 3-column osteotomy (3CO), and lower for interbody fusion (14.3% +/- 9.9%). Risk factors for DT in the ASD surgery cohort included older age, revision surgery, chronic severe compression, higher-grade osteotomy, complexity of surgery, rheumatoid arthritis (RA), and higher Anesthesiology Society of America (ASA) grade. CONCLUSION To our knowledge, this is the first systematic review discussing the incidence of and risk factors for DT in the ASD population. We found that the risk factors for DT in ASD patients were older age, revision surgery, chronic severe compression, a greater degree of osteotomy, complexity of surgery, RA, and a higher ASA grade. These findings will help guide spine surgeons in patient counseling as well as surgical planning.
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Affiliation(s)
- Anna Martin
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Jamal Zahir
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Nathan Smith
- Penn State College of Medicine, Hershey, PA, USA
| | - Oluwatodimu Raji
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - David Nelles
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Dimitriy Kondrashov
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA.
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA.
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23
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Morales Ciancio RA, Lucas J, Tucker S, Ember T, Harris M, Broomfield E. Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study. Spine Deform 2024; 12:1403-1410. [PMID: 38683285 DOI: 10.1007/s43390-024-00880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to determine whether Cobb and pelvic obliquity corrections can be predicted using supine traction radiographs in patients with cerebral palsy (CP) who underwent posterior spinal fusion (PSF) from T2/3 to L5. METHODS From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent PSF using pedicle screws in two quaternary centers with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed. RESULTS A total of 106 patients aged 15.6 ± 0.4 years were included. All patients had significant correction of the Cobb angle (MC), pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL) without loss of correction at the last FU (LFU). Curve flexibility was significantly correlated with Cobb correction (δMC) immediately postoperatively (p < 0.0001, r = 0.8950), followed by the amount of correction in pelvic obliquity under traction (δPOT) (p = 0.0252, r = 0.2174). For correction in PO (δPO), the most significant variable was δPOT (p < 0.0001, r = 0.7553), followed by curve flexibility (p = 0.0059, r = 0.26) and the amount of correction in Cobb under traction (p = 0.0252, r = 0.2174). CONCLUSIONS Cobb and PO corrections can be predicted using supine traction films for non-ambulatory CP patients treated with PSF from T2/3 to L5. The variables evaluated were interconnected, reinforcing preoperative planning for these patients. Comparative large-scale studies on patient-related clinical outcomes are required to determine whether this predicted correction is associated with improved surgical outcomes and reduced complication rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Jonathan Lucas
- Paediatric Spine Department, Evelina London Children Hospital, London, UK
| | - Stewart Tucker
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Thomas Ember
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Mark Harris
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Edel Broomfield
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
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24
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Li K, Tao X, Liu J, Yang J, Shi J, Wu X, Jia W, Fan X, Qiao H. The application value and improved warning criterion of D-wave monitoring in intramedullary spinal cord tumor surgery. Spine J 2024; 24:1704-1711. [PMID: 38679075 DOI: 10.1016/j.spinee.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND CONTEXT The primary treatment method for intramedullary spinal cord tumor (IMSCT) is surgical resection, but this procedure carries a significant risk of neurological damage. Intraoperative neurophysiological monitoring (IONM) has become a necessary adjunctive tool for IMSCT resection. PURPOSE The current study aimed to explore the application value of D-wave monitoring in IMSCT surgery, and tried to investigate a tailored criterion for its early warning. STUDY DESIGN A retrospective clinical study. PATIENT SAMPLE A retrospective analysis was conducted based on the data of patients who underwent IMSCT surgeries performed by the same neurosurgical team at our hospital. IONM was applied in all surgeries. According to inclusion and exclusion criteria, ultimately 90 patients were enrolled in the study. OUTCOME MEASURES The McCormick Scale (MMS) was applied to assess the functional outcome through outpatient visits or telephone follow-up at one month and six months postoperatively. Patients with an MMS grade over II one month after surgery were considered to have newly developed postoperative motor dysfunction (PMD). If the MMS grade could be restored to I or II six months after surgery, it was defined as a short-term PMD. Otherwise, it was defined as a long-term PMD. METHODS The predictive value of different IONM modalities, including somatosensory evoked potential (SEP), muscle motor evoked potential (MEP), and D-wave for PMD, was assessed with sensitivity, specificity, positive predictive value, negative predictive value, and subsequent logistic regression analysis. At last, the cut-off value of the D-wave amplitude reduction ratio for predicting PMD was obtained through the receiver operating characteristic (ROC) curve analysis. RESULTS SEP showed the worst performance in predicting short-term and long-term PMD. Significant MEP changes were indicated as an independent predictive factor for short-term PMD (OR 5.062, 95% CI 1.947-13.166, p=.001), while D-wave changes were demonstrated as an independent predictor for long-term PMD (OR 339.433, 95% CI 11.337-10770.311, p=.001). The optimum cut-off value of the D-wave amplitude reduction ratio for predicting long-term PMD was 42.18%, with a sensitivity of 100% and a specificity of 93.8% (AUC=0.981, p<.001). CONCLUSIONS D-wave monitoring showed extremely high specificity in predicting PMD compared to SEP and MEP monitoring. Moreover, the authors suggested that a D-wave amplitude reduction of over 40% during IMSCT surgery generally indicates long-term PMD for patients.
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Affiliation(s)
- Ke Li
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Xiaorong Tao
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Jiajia Liu
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Jun Yang
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Jiawei Shi
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Xiao Wu
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Wenqing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Xing Fan
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China
| | - Hui Qiao
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, P.R. China.
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25
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Jacome FP, Lee JJ, Hiltzik DM, Cho S, Pagadala M, Hsu WK. Single Position Prone Lateral Lumbar Interbody Fusion: A Review of the Current Literature. Curr Rev Musculoskelet Med 2024; 17:386-392. [PMID: 39090374 PMCID: PMC11336012 DOI: 10.1007/s12178-024-09913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW Spinal fusion, vital for treating various spinal disorders, has evolved since the introduction of the minimally invasive Lateral Lumbar Interbody Fusion (LLIF) by Pimenta in 2001. Traditionally performed in the lateral decubitus position, LLIF faces challenges such as intraoperative repositioning, neurological complications, and lack of access to lower lumbar levels. These challenges lead to long surgery times, increased rates of perioperative complications, and increased costs. The more recently popularized prone lateral approach mitigates these issues primarily by eliminating patient repositioning, thereby enhancing surgical efficiency, and reducing operative times. This review examines the progression of spinal fusion techniques, focusing on the advantages and recent findings of the prone lateral approach compared to the traditional LLIF. RECENT FINDINGS The prone lateral approach has shown improved patient outcomes, including lower blood loss and shorter hospital stays, and has been validated by multiple studies for its safety and efficacy compared to the LLIF approach. Significant enhancements in postoperative metrics, such as the Oswestry Disability Index, Visual Analog Scale, and radiological improvements have been noted. Comparatively, the prone lateral approach offers superior segmental lordosis correction and potentially better subjective outcomes than the lateral decubitus position. Despite these advances, both techniques present similar risks of neurological complications. Overall, the prone lateral approach has emerged as a promising alternative in lumbar interbody fusion, combining efficiency, safety, and improved clinical outcomes.
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Affiliation(s)
- Freddy P Jacome
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- , Chicago, USA
| | - Justin J Lee
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
| | - David M Hiltzik
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
| | - Sia Cho
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
| | - Manasa Pagadala
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
- Simpson Querrey Institute (SQI), Northwestern University, 303 E Superior, Chicago, IL, 60611, USA
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26
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Bourghli A, Boissiere L, Obeid I. Lumbar pedicle subtraction osteotomy: techniques and outcomes. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100516. [PMID: 39188669 PMCID: PMC11345922 DOI: 10.1016/j.xnsj.2024.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024]
Abstract
Pedicle subtraction osteotomy has been thoroughly described and studied over the past 2 decades, being applied mainly in the lumbar spine, followed by the thoracic spine. Our better understanding of alignment biomechanics, and the progressive refinements of the surgical technique over time made it a very efficient procedure for the management of fixed sagittal malalignment. However, a long learning curve is mandatory to mitigate the associated risks particularly neurological deficits and achieve satisfactory clinical and radiological outcomes with an acceptable rate of complications.
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Affiliation(s)
- Anouar Bourghli
- Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Louis Boissiere
- Spine surgery department, Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Ibrahim Obeid
- Spine surgery department, Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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27
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Knebel A, Daher M, Singh M, Fisher L, Daniels AH, Diebo BG. Sagittal spinal alignment measurements and evaluation: Historical perspective. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100519. [PMID: 39188671 PMCID: PMC11345912 DOI: 10.1016/j.xnsj.2024.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024]
Abstract
Spinal alignment analysis play an important role in evaluating patients and planning surgical corrections for adult spinal deformity. The history of these parameters is relatively short with the first parameter, the Cobb angle, introduced in 1948 as part of an effort to improve scoliosis evaluation. New developments in the field were limited for nearly 30 years before better imaging technology encouraged new theories and later data about spinal alignment and the relationship between the spine and pelvis. These efforts would ultimately contribute to the creation of foundational spinal alignment parameters, including pelvic incidence, pelvic tilt, and sacral slope. By the 1990s, spinal alignment had become a sustained area of investigation for spinal surgeons and researchers. Novel alignment parameters have since been introduced as our knowledge has evolved and has allowed for valuable research that demonstrates the clinical and surgical value of alignment measurement. This manuscript will explore the history of spinal alignment analysis over the decades.
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Affiliation(s)
- Ashley Knebel
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
| | - Mohammad Daher
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
| | - Manjot Singh
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
| | - Lauren Fisher
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
| | - Alan H. Daniels
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
| | - Bassel G. Diebo
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, United States
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Al-Naseem AO, Al-Muhannadi A, Ramadhan M, Alfadhli A, Marwan Y, Shafafy R, Abd-El-Barr MM. Robot-assisted pedicle screw insertion versus navigation-based and freehand techniques for posterior spinal fusion in scoliosis: a systematic review and meta-analysis. Spine Deform 2024; 12:1203-1215. [PMID: 38619784 PMCID: PMC11343815 DOI: 10.1007/s43390-024-00879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE The role of robotics in spine surgery remains controversial, especially for scoliosis correction surgery. This study aims to assess the safety and efficacy of robotic-assisted (RA) surgery specifically for scoliosis surgery by comparing RA to both navigation systems (NS) and conventional freehand techniques (CF). METHODS As per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted via an electronic search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). All papers comparing RA to either NS or CF for posterior spinal fusion in scoliosis were included. Fixed and random effects models of analysis were utilised based on analysis heterogeneity. RESULTS 10 observational studies were included in total. RA had significantly greater odds of accurate pedicle screw placement relative to both NS (OR = 2.02, CI = 1.52-2.67, p < 0.00001) and CF (OR = 3.06, CI = 1.79-5.23, p < 0.00001). The downside of RA was the significantly greater operation duration relative to NS (MD = 10.74, CI = 3.52-17.97, p = 0.004) and CF (MD = 40.27, CI = 20.90, p < 0.0001). Perioperative outcomes including estimated blood loss, radiation exposure, length of hospital stay, cobb angle correction rate, postoperative SRS score, VAS pain score, JOA score, as well as rates of neurological injury and revision surgery, were comparable between the groups (p > 0.05). CONCLUSION RA offers significantly greater pedicle screw placement accuracy relative to NS and CF, however, surgery can take longer. In terms of perioperative outcomes, all three techniques are comparable.
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Affiliation(s)
| | | | | | | | - Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
| | - Roozbeh Shafafy
- Division of Surgery & Interventional Science, University College London, London, UK.
- Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK.
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University Medical Centre, Durham, USA.
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Mao S, Qiu Y, Liu Z, Shi B, Li S, Jiang J, Zhu Z. Posterior-only approach cervical hemivertebrectomy and short fusion with pedicle screws in young children with cervical scoliosis: case report and technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08459-4. [PMID: 39190038 DOI: 10.1007/s00586-024-08459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/10/2023] [Accepted: 08/17/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Cervical hemivertebrae (C3-6) causing significant osseous torticollis, head tilt and facial asymmetry are rare and complicated. Cervical hemivertebrectomy (CHVE) by a posterior-only approach was never reported because it is highly risky and its efficacy remains controversial. This study is to evaluate the feasibility and preliminary clinical outcomes of posterior-only approach for CHVE and torticollis correction in young children. METHODS Four young children aged 5-9 years old with significant torticollis caused by cervical hemivertebrae underwent deformity correction consisting of cervical pedicle screw (CPS) placement with O-arm-based intraoperative navigation, CHVE using ultrasonic bone scalpel and short-segmental posterior instrumentation and fusion. Details of this novel technique were presented. The preliminary short-term clinical and radiographic outcomes were assessed. RESULTS On average, the operative time was 312.5 ± 49.9 min, and the surgical blood loss was 375.0 ± 150.0 ml. The structural cervical scoliosis was corrected from 31.5 ± 7.3° to 11.0 ± 4.1°, and the average correction rate was 64.9%. Head tilt was favorably corrected from 11.0 ± 4.2° to 3.5 ± 2.6°. The shoulder balance improved from 6.3 ± 1.3° to 1.5 ± 1.9°. One case with C6 CHVE had convex side radiating nerve root pain but no sign of muscle power weakness. Full recovery was achieved one month after surgery. No other complication occurred. CONCLUSIONS CHVE by a posterior-only approach was a feasible alternative option for the treatment of congenital cervical scoliosis. It could resect the CHV effectively and achieve satisfactory torticollis correction without additional anterior access surgery. Successful CPS placement in this child population was essentially important to enable reliable osteotomy closure and firm posterior instrumentation.
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Affiliation(s)
- Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Benlong Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Jun Jiang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
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Cheers GM, Weimer LP, Neuerburg C, Arnholdt J, Gilbert F, Thorwächter C, Holzapfel BM, Mayer-Wagner S, Laubach M. Advances in implants and bone graft types for lumbar spinal fusion surgery. Biomater Sci 2024. [PMID: 39190323 DOI: 10.1039/d4bm00848k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.
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Affiliation(s)
- Giles Michael Cheers
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Lucas Philipp Weimer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Jörg Arnholdt
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Susanne Mayer-Wagner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
| | - Markus Laubach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
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Durand WM, Khanna R, Nazario-Ferrer GI, Lee SH, Skolasky RL, Jain A. Revision Surgery after Single Level Anterior Cervical Discectomy and Fusion With Plate vs Stand-Alone Cage over 2 to 5 Year Follow-Up. Global Spine J 2024:21925682241279528. [PMID: 39191238 DOI: 10.1177/21925682241279528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
STUDY DESIGN retrospective study. OBJECTIVE To investigate the incidence of all-cause revision surgery between plated vs stand-alone cage constructs for single level ACDF. METHODS We retrospectively analyzed a commercial insurance claims database. Patients 18-65 years-old were included if they underwent single-level inpatient ACDF (defined with CPT codes) from 2010 - 2018, with a minimum of 2-year continuous insurance enrollment. The primary independent variable was the use of anterior plating vs zero profile device or stand-alone cage. Synthetic (ie, metal, PEEK, etc.) vs allograft interbody was a secondary independent variable. The primary outcome variable was revision cervical arthrodesis after the index operation. RESULTS In total, 21092 patients undergoing single-level inpatient ACDF were included. 10.0% received a stand-alone cage during the index operation. Mean follow-up duration was 4.5 years. Revision arthrodesis occurred in 8.2% of patients overall, at a mean of 2.4 years after the index surgery. Patients with anterior plating had a lower rate of all-cause revision surgery in unadjusted (overall rate 8.1% vs 9.6%, P = 0.0185) and adjusted analysis (OR 0.78, P = 0.0016) vs stand-alone cages. Patients with stand-alone cages had higher rates of revision with a posterior approach than did patients with plated constructs. In sub-analysis, the combination of a stand-alone interbody device with an allograft had significantly higher odds of revision than other combinations of devices. CONCLUSION Among commercially insured patients ≤65 years-old undergoing single-level ACDF, anterior plating was associated with a reduced incidence of revision surgery compared to stand-alone cages within the follow up period of our study.
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Affiliation(s)
- Wesley M Durand
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Rajan Khanna
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Sang H Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Moscatelli MA, Vargas AR, de Lima MV, Komp M, Silva RB, de Carvalho MOP, Dos Santos JR, Pokorny G, Ruetten S. New ipsilateral full endoscopic interlaminar approach for L5-S1 foraminal and extraforaminal decompression: technique description and initial case series. Neurosurg Rev 2024; 47:490. [PMID: 39190169 DOI: 10.1007/s10143-024-02720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 06/17/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The L5-S1 interlaminar access described in 2006 by Ruetten et al. represented a paradigm shift and a new perspective on endoscopic spinal approaches. Since then, the spinal community has shown that both the traditional ipsilateral and novel contralateral interlaminar approaches to the L5-S1 foramen are good alternatives to transforaminal access. This study aimed to provide a technical description and brief case series analysis of a new endoscopic foraminal and extraforaminal approach for pathologies at the lumbar L5-S1 level using a new ipsilateral interlaminar approach. METHODS Thirty patients with degenerative stenotic conditions at the L5-S1 disc level underwent the modified interlaminar approach. The surgical time, blood loss, occurrence of complications, and clinical outcomes were recorded. The data were compiled in Excel and analyzed using R software version 4.2. All continuous variables are presented as the mean, median, minimum, and maximal ranges. For categorical variables, data are described as counts and percentages. RESULTS Thirty patients were included in the study. The cohort showed significant improvements in all quality-of-life scores (ODI, visual analog scale of back pain, and visual analog scale of leg pain). Five cases of postoperative numbness and three cases of postoperative dysesthesia have been reported. No case of durotomy or leg weakness has been reported. CONCLUSIONS The fundamental change proposed by this procedure, the new ipsilateral approach, presents potential advantages to surgeons by overcoming anatomical challenges at the L5-S1 level and by providing surgeon-friendly visualization and access. This approach allows for extensive foraminal and extraforaminal decompression, including the removal of hernias and osteophytosis, without causing neural retraction of the L5-S1 roots while maintaining the stability of the operated level.
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Affiliation(s)
- Marco Aurélio Moscatelli
- Department of Neurosurgery, NeuroLife Clinic Natal/Hospital Casa de Saúde São Lucas, Natal, Brazil.
- Avenida Governador Silvio Pedroza 246, apto 1102, bairro areia preta, Natal, CEP 59014100, Rio Grande do Norte, Brazil.
| | - Antonio Roth Vargas
- Department of Neurosurgery, Hospital Centro Médico Campinas, Campinas, Brazil
| | - Marcos Vaz de Lima
- Department of Orthopaedics and Traumatology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Martin Komp
- Center for Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology of the St. Elisabeth Group, Marien Hospital Herne, Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University Hospital/Marien Hospital Witten, Herne, Germany
| | | | | | | | | | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology of the St. Elisabeth Group, Marien Hospital Herne, Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University Hospital/Marien Hospital Witten, Herne, Germany
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Liles C, Chanbour H, Zakieh O, Peterson K, Dambrino RJ, Younus I, Jonzzon S, Berkman RA, Lugo-Pico JG, Abtahi AM, Stephens BF, Zuckerman SL, Gardocki RJ. Open Versus Endoscopic Approach for Thoracic Disk Herniations: Equivalent Short-Term Outcomes With Significantly Different Costs. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01304. [PMID: 39189741 DOI: 10.1227/ons.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Open thoracic diskectomy often requires significant bone resection and fusion, whereas an endoscopic thoracic diskectomy offers a less invasive alternative. Therefore, we sought to compare one-level open vs endoscopic thoracic diskectomy regarding (1) perioperative outcomes, (2) neurological recovery, and (3) total cost. METHODS A single-center, retrospective, cohort study using prospectively collected data of patients undergoing one-level thoracic diskectomy was undertaken from 2018 to 2023. The primary exposure variable was open vs endoscopic. The primary outcome was perioperative outcomes and neurological recovery. Secondary outcomes were total cost of care. Multivariable regression analysis controlled for age, body mass index, sex, symptom onset, disk characteristics, operative time, and length of stay. RESULTS Of 29 patients undergoing thoracic diskectomy, 17 were open and 12 were endoscopic. Preoperative demographics, symptoms, and radiographic findings were comparable between the cohorts. Perioperatively, open surgery had significantly higher mean length of stay (4.9 ± 1.5 vs 0.0 ± 0.0 days, P < .001), median (IQR) longer operative time (342.8 [68.4] vs 141.5 [36] minutes, P < .001), and more blood loss (350 [390] vs 6.5 [20] mL; P < .001). 16 (94%) open patients required fusion vs 0 endoscopic (P < .001). Postoperative opioid use (P = .119), readmission (P = .665), reoperation (P = .553), and rate of neurological improvement (P > .999) were similar between the 2 groups. Financially, open surgical median costs were 7x higher than endoscopic ($59 792 [$16 118] vs $8128 [$1848]; P < .001), driven by length of stay (β = $2261/night, P < .001), open surgery (β = $24 106, P < .001), and number of pedicle screws (β = $1829/screw, P = .002) on multivariable analysis. On sensitivity analysis, open surgery was never cost-efficient against endoscopic surgery and excess endoscopic revision rates of 86% above open revision rates were required for break-even costs between the surgical approaches. CONCLUSION Endoscopic thoracic diskectomy was associated with decreased length of stay, operative time, blood loss, and total cost compared with the open approach, with similar neurological outcomes. These findings may help patients and surgeons seek endoscopic approach as a less morbid and less costly alternative.
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Affiliation(s)
- Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Omar Zakieh
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keyan Peterson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julian G Lugo-Pico
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Schmidt FA, Hussain I, Boadi B, Sommer FJ, Thomé C, Härtl R. The Use of Augmented Reality as an Educational Tool in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01299. [PMID: 39185869 DOI: 10.1227/ons.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/03/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES One of the major challenges in training neurosurgical and orthopedic residents the technique for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the lack of visualization of surgical landmarks (pedicle, pars, lamina). This is due to the limited access to the bony spine through a tubular retractor, in addition to a smaller working corridor or patient-specific factors such as bony overgrowth, disk space collapse, and listhesis. These factors increase the possibility for surgical error and prolonged surgery time. With augmented reality (AR), relevant surgical anatomy can be projected directly into the user's field of view through the microscope. The purpose of this study was to assess the utility, accuracy, efficiency, and precision of AR-guided MIS-TLIF and to determine its impact in spine surgery training. METHODS At 2 centers, 12 neurosurgical residents performed a one-level MIS-TLIF on a high-fidelity lumbar spine simulation model with and without AR projection into the microscope. For the MIS-TLIF procedures with AR, surgical landmarks were highlighted in different colors on preoperative image data. These landmarks were visualized in the spinal navigation application on the navigation monitor and in the microscope to confirm the relevant anatomy. Postprocedural surveys (National Aeronautics and Space Administration Task Load Index) were given to the residents. RESULTS Twelve residents were included in this trial. AR-guided procedures had a consistent impact on resident anatomical orientation and workload experience. Procedures performed without AR had a significantly higher mental demand (P = .003) than with AR. Residents reported to a significantly higher rate that it was harder work for them to accomplish their level of performance without AR (P = .019). CONCLUSION AR can bring a meaningful value in MIS teaching and training to confirm relevant anatomy in situations where the surgeon will have less direct visual access. AR used in surgical simulation can also speed the learning curve.
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Affiliation(s)
- Franziska A Schmidt
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York, New York, USA
| | - Blake Boadi
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York, New York, USA
| | - Fabian J Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York, New York, USA
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York, New York, USA
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Zhang B, Du Y, Zhang C, Qi M, Meng H, Jin T, Cui G, Guan J, Duan W, Chen Z. Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision. Orthop Surg 2024. [PMID: 39187976 DOI: 10.1111/os.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire. METHODS This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences. RESULTS We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments. CONCLUSION Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.
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Affiliation(s)
- Boyan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Maoyang Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Hongfeng Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Tianyu Jin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Guoqing Cui
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
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36
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Dai A, Zhang J, Liu R, Jiang H, Liu Y, Liu Q. A Novel Classification of Migrated Lumbar Disk Herniation Based on Magnetic Resonance Imaging and Algorithm Recommendations for Full-Endoscopic Discectomy. Orthop Surg 2024. [PMID: 39187393 DOI: 10.1111/os.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE The purpose of this study was to establish a novel classification of migrated lumbar disk herniation (LDH) based on magnetic resonance imaging and provide appropriate treatment strategies for each type through algorithms. SUMMARY OF BACKGROUND DATA Full-endoscopic lumbar discectomy is a surgical technique that has been developed rapidly in recent years. For migrated LDH, few surgeons currently classify it with multiplanar positioning, and there is no consensus on the choice of treatment strategy. Therefore, we established a new multiplanar classification criteria that can localize the lesions more accurately than previous studies. METHODS A total of 263 eligible patients from March 2017 to March 2022 were included. Protrusions for each patient were located based on our classification and the surgical approach was selected according to our algorithms. The clinical symptoms of all patients before surgery, and at 1 day, 1 month, 3 months, 6 months, and 12 months after surgery were collected. Evaluations were performed using visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. We used the chi-squared test, one-way analysis of variance (ANOVA), and t-test to compare perioperative results and postoperative 3-month, 6-month, and 12-month follow-up results. RESULTS VAS (low back pain) scores were reduced from 5.33 ± 2.67 to 0.73 ± 0.77 (p < 0.001), and VAS (leg pain) scores were reduced from 7.44 ± 2.21 to 0.37 ± 0.51 (p < 0.001). ODI scores improved from 58.46 ± 8.04 to 12.57 ± 2.51 (p < 0.001). According to the modified MacNab criteria, the excellent and good rate reached 92.78% at the 12-month follow-up. Twenty-six patients developed complications, all of which improved after treatment. Recurrence occurred in 13 patients, and four of them underwent secondary surgery. CONCLUSIONS This is an innovative classification method using multi-plane positioning, and the algorithm used with it can help surgeons make appropriate choices when using endoscopic technology to treat migrated LDH. Statistical analysis of follow-up data confirmed that this is a safe and effective strategy.
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Affiliation(s)
- Anyuan Dai
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jun Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of Orthopaedics, The First Affiliated Hospital of Xinxiang Medical University, Xinjiang, China
| | - Hong Jiang
- Art College of Jilin University, Changchun, China
| | - Yanting Liu
- Department of Neurosurgery Seoul St. Mary's Hospital, Seoul, Korea
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Veith DD, Gill ML, Beck LA, Whitmarsh CL, Fernandez KA, Linde MB, Asp AJ, Mills CJ, Bendel MA, Grahn PJ, Zhao KD. Functional outcomes and participants' perspectives during short-term application of spinal stimulation in individuals with spinal cord injury. J Spinal Cord Med 2024:1-12. [PMID: 39172032 DOI: 10.1080/10790268.2024.2383377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The primary objective of this study was to quantify changes in performance of task-specific motor activities over 12 motor rehabilitation sessions with lumbosacral spinal cord stimulation (SCS) via either transcutaneous stimulation or epidural stimulation. Both stimulation modalities have been used in recent years to restore functions lost to spinal cord injury (SCI). Secondary outcomes examine participants' perspectives captured via the User Experience Questionnaire (UEQ) upon study completion to further understand their perception of SCS. METHODS Six individuals with SCI completed 12 sessions with one modality of SCS during supine and/or side-lying, seated forward reaching, and standing activities. Changes in volitional lower extremity movement, the number of points of contact needed at hips and/or knees to facilitate standing, and changes in seated forward reaching distance were used to quantify performance. The UEQ was administered to gauge participants' perspectives following use of SCS to enable functions impaired due to SCI. RESULTS For all participants, performance of motor activities improved with SCS compared to without stimulation. Responses for the UEQ showed an overall positive perception of trialing SCS with rehabilitation to enhance motor functions impaired by SCI. CONCLUSIONS Regardless of injury severity, location of injury, time since SCI, or SCS modality, all participants experienced gains in motor function in the presence of SCS combined with a condensed rehabilitation program. However, no evidence of sustained motor functions was found in the absence of SCS. UEQ results highlight the positive perception of SCS with rehabilitation as well as the importance of consulting persons with lived experience of SCS during clinical trial design and protocol development.Trial registration: ClinicalTrials.gov identifier: NCT05095454.
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Affiliation(s)
- Daniel D Veith
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan L Gill
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A Beck
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Crystal L Whitmarsh
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - K A Fernandez
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester Minnesota, USA
| | - Margaux B Linde
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Anders J Asp
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Candee J Mills
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Bendel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter J Grahn
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Aiman U, Shahzad UB. "Revolutionising spinal surgery: the impact of STRATAFIX™ symmetric barbed sutures on closure time and costs". Neurosurg Rev 2024; 47:457. [PMID: 39168924 DOI: 10.1007/s10143-024-02733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 08/18/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024]
Abstract
Spinal surgery, crucial for correcting structural abnormalities, involves decompressing nerve structures, realigning or stabilizing vertebral segments, and replacing damaged components to restore spinal integrity. Effective wound closure is vital in these procedures, as it prevents infections, minimizes wound dehiscence, and ensures optimal cosmetic results. Recent advancements, particularly in barbed suture technology like STRATAFIX™ Symmetric, offer promising improvements in surgical outcomes. A study by Steven R. Glener et al. evaluated STRATAFIX™ Symmetric for fascial closure in spinal surgery, comparing it to traditional braided absorbable sutures. Although the difference in closure time was not statistically significant, STRATAFIX™ demonstrated a higher closure rate and required significantly fewer sutures, reducing post-surgical material counts and the risk of accidental needle sticks. No adverse events were observed in either group over a 6-month follow-up period. Despite their benefits in reducing operating room time and costs, barbed sutures remain underutilized in neurosurgery. Studies indicate that barbed sutures can significantly decrease wound closure time, particularly in complex or multilevel spinal surgeries, without compromising clinical outcomes. These findings suggest that adopting barbed suture technology in spinal surgery could enhance surgical efficiency and patient care. Further research with larger sample sizes and multicenter studies is necessary to validate these benefits and refine surgical practices, ultimately improving patient outcomes.
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Affiliation(s)
- Ume Aiman
- Islamic International Medical College, Rawalpindi, 44000, Pakistan.
| | - Umer Bin Shahzad
- Islamic International Medical College, Rawalpindi, 44000, Pakistan
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Trenchfield D, Fras S, McCurdy M, Narayanan R, Lee Y, Issa T, Toci G, Oghli Y, Siddiqui H, Vo M, Mahmood H, Schilken M, Pashaee B, Mangan J, Kurd M, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Opioid Prescription Trends Among Orthopaedic, Primary Care, and Pain Management Providers in Spine Surgery Patients. J Am Acad Orthop Surg 2024:00124635-990000000-01072. [PMID: 39186611 DOI: 10.5435/jaaos-d-24-00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/05/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021. SUMMARY OF BACKGROUND DATA A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention. METHODS All patients aged 18 years and older who underwent elective posterior lumbar decompression and fusion, transforaminal lumbar interbody fusion, and anterior cervical diskectomy and fusion from 2018 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through a Structured Query Language search and manual chart review. Opioid prescription data were collected through Pennsylvania's Prescription Drug Monitoring Program (PDMP) database and grouped into the following prescriber categories: primary care, pain management, physiatry, and orthopaedic surgery. RESULTS Of the 1,062 patients, 302 (28.4%) underwent anterior cervical diskectomy and fusion, 345 (32.4%) underwent posterior lumbar decompression and fusion, and 415 (39.1%) underwent transforaminal lumbar interbody fusion. From 2018 to 2021, there were no significant differences in total opioid prescriptions from orthopaedic surgery (P = 0.892), primary care (P = 0.571), pain management (P = 0.687), or physiatry (P = 0.391) providers. Pain management providers prescribed the most opioids between 1 year and 2 months preoperatively (P = 0.003), between 2 months and 1 year postoperatively (P = 0.018), and overall (P < 0.001). CONCLUSION Despite increasing national awareness of the opioid epidemic and the establishment of statewide prescription drug monitoring programs, prescription rates have not changed markedly in spine patients. Pain management and primary care physicians prescribe opioids at a higher rate in the chronic periods before and after surgery, likely in part because of longitudinal relationships with these patients. LEVEL OF EVIDENCE III. STUDY DESIGN Retrospective Cohort Study.
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Affiliation(s)
- Delano Trenchfield
- 3pt?>From the Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Davies BM, Yang X, Khan DZ, Mowforth OD, Touzet AY, Nouri A, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Tetreault L, Kwon BK, Boerger TF, Rodrigues-Pinto R, Furlan JC, Chen R, Zipser CM, Curt A, Milligan J, Kalsi-Rayn S, Sarewitz E, Sadler I, Blizzard T, Treanor C, Anderson D, Fallah N, Hazenbiller O, Salzman C, Zimmerman Z, Wandycz AM, Widdop S, Reeves M, Raine R, Ryan SK, Malone A, Gharooni A, Wilson JR, Martin AR, Fehlings MG, McNair AGK, Kotter MRN. A minimum data set-Core outcome set, core data elements, and core measurement set-For degenerative cervical myelopathy research (AO Spine RECODE DCM): A consensus study. PLoS Med 2024; 21:e1004447. [PMID: 39173109 DOI: 10.1371/journal.pmed.1004447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive chronic spinal cord injury estimated to affect 1 in 50 adults. Without standardised guidance, clinical research studies have selected outcomes at their discretion, often underrepresenting the disease and limiting comparability between studies. Utilising a standard minimum data set formed via multi-stakeholder consensus can address these issues. This combines processes to define a core outcome set (COS)-a list of key outcomes-and core data elements (CDEs), a list of key sampling characteristics required to interpret the outcomes. Further "how" these outcomes should be measured and/or reported is then defined in a core measurement set (CMS). This can include a recommendation of a standardised time point at which outcome data should be reported. This study defines a COS, CDE, and CMS for DCM research. METHODS AND FINDINGS A minimum data set was developed using a series of modified Delphi processes. Phase 1 involved the setup of an international DCM stakeholder group. Phase 2 involved the development of a longlist of outcomes, data elements, and formation into domains. Phase 3 prioritised the outcomes and CDEs using a two-stage Delphi process. Phase 4 determined the final DCM minimal data set using a consensus meeting. Using the COS, Phase 5 finalised definitions of the measurement construct for each outcome. In Phase 6, a systematic review of the literature was performed, to scope and define the psychometric properties of measurement tools. Phase 7 used a modified Delphi process to inform the short-listing of candidate measurement tools. The final measurement set was then formed through a consensus meeting (Phase 8). To support implementation, the data set was then integrated into template clinical research forms (CRFs) for use in future clinical trials (Phase 9). In total, 28 outcomes and 6 domains (Pain, Neurological Function, Life Impact, Radiology, Economic Impact, and Adverse Events) were entered into the final COS. Thirty two outcomes and 4 domains (Individual, Disease, Investigation, and Intervention) were entered into the final CDE. Finally, 4 outcome instruments (mJOA, NDI, SF-36v2, and SAVES2) were identified for the CMS, with a recommendation for trials evaluating outcomes after surgery, to include baseline measurement and at 6 months from surgery. CONCLUSIONS The AO Spine RECODE-DCM has produced a minimum data set for use in DCM clinical trials today. These are available at https://myelopathy.org/minimum-dataset/. While it is anticipated the CDE and COS have strong and durable relevance, it is acknowledged that new measurement tools, alongside an increasing transition to study patients not undergoing surgery, may necessitate updates and adaptation, particularly with respect to the CMS.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, Cambridge, United Kingdom
| | - Xiaoyu Yang
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, Cambridge, United Kingdom
| | - Alvaro Y Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Manchester, United Kingdom
| | - Aria Nouri
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Department of Neurosurgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
| | - James D Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Lindsay Tetreault
- Department of Neurology, New York University Langone Health, New York, New York, United States of America
| | - Brian K Kwon
- Department of Orthopaedics, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, United States
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, and KITE Research Institute and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Canada
| | - Carl M Zipser
- University Spine Centre, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- University Spine Centre, Balgrist University Hospital, Zurich, Switzerland
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | | | | | | | | | - David Anderson
- School of Health Sciences, Faculth of Medicine and Health, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | - Rye Raine
- Myelopathy.org, Cambridge, United Kingdom
| | - Sukvinder K Ryan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, and KITE Research Institute and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Ailish Malone
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ali Gharooni
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Allan R Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, United States of America
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Angus G K McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, Cambridge, United Kingdom
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Gao T, Wan SY, Chen ZY, Li T, Lin X, Hu HG, Tang JD, Wu C. Clinical significance of modified unilateral puncture percutaneous vertebroplasty guided by 3D- printed guides in the treatment of osteoporotic vertebral compression fractures: a retrospective study. BMC Musculoskelet Disord 2024; 25:656. [PMID: 39169286 PMCID: PMC11340058 DOI: 10.1186/s12891-024-07750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE To investigate the clinical significance of using 3D printing guides in modified unilateral puncture percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures (OVCF), and to explore a new method for preventing paravertebral vein leakage during PVP in conjunction with a previous study of the optimal puncture-side bone cement/vertebral volume ratio(PSBCV/VV%). METHODS This retrospective study analyzed 99 patients who underwent unilateral puncture PVP between January 2023 and December 2023. Patients were divided into a guide plate group (46 patients) and a conventional group (53 patients). The guide plate group underwent modified unilateral puncture PVP with the guidance of 3D printing guides, while the conventional group underwent unilateral puncture PVP using the conventional pedicle approach. The distribution of bone cement, surgical outcomes, and the occurrence of cement leakage into paravertebral veins were observed in both groups. RESULTS The guide plate group had significantly shorter operating time and required fewer fluoroscopies compared to the conventional group. The amount of bone cement volume (BCV) used in the guide plate group was higher, but the amount of bone cement volume on the puncture side(PSBCV), the PSBCV/VV%, and the rate of paravertebral vein leakage were lower in the guide plate group compared to the conventional group (P < 0.05). Within each group, significant improvements in anterior vertebral margin height, Cobb angle, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were observed at 1 day and 1 month postoperatively compared to preoperative values (P < 0.05). CONCLUSION Using 3D printing guides in modified unilateral puncture PVP is a safe and effective method for treating OVCF. And it has the advantages of short operation time, less fluoroscopy, even distribution of bone cement, and a low rate of paravertebral vein leakage.
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Affiliation(s)
- Tao Gao
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Sheng-Yu Wan
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Zhi-Yu Chen
- Respiratory Medicine of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Tao Li
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Xu Lin
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Hai-Gang Hu
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Jian-Dong Tang
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Chao Wu
- Orthopaedics of Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
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Zaidat B, Kurapatti M, Gal JS, Cho SK, Kim JS. Explainable Machine Learning Approach to Prediction of Prolonged Intesive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression. Global Spine J 2024:21925682241277771. [PMID: 39169510 DOI: 10.1177/21925682241277771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Prolonged ICU stay is a driver of higher costs and inferior outcomes in Adult Spinal Deformity (ASD) patients. Machine learning (ML) models have recently been seen as a viable method of predicting pre-operative risk but are often 'black boxes' that do not fully explain the decision-making process. This study aims to demonstrate ML can achieve similar or greater predictive power as traditional statistical methods and follows traditional clinical decision-making processes. METHODS Five ML models (Decision Tree, Random Forest, Support Vector Classifier, GradBoost, and a CNN) were trained on data collected from a large urban academic center to predict whether prolonged ICU stay would be required post-operatively. 535 patients who underwent posterior fusion or combined fusion for treatment of ASD were included in each model with a 70-20-10 train-test-validation split. Further analysis was performed using Shapley Additive Explanation (SHAP) values to provide insight into each model's decision-making process. RESULTS The model's Area Under the Receiver Operating Curve (AUROC) ranged from 0.67 to 0.83. The Random Forest model achieved the highest score. The model considered length of surgery, complications, and estimated blood loss to be the greatest predictors of prolonged ICU stay based on SHAP values. CONCLUSIONS We developed a ML model that was able to predict whether prolonged ICU stay was required in ASD patients. Further SHAP analysis demonstrated our model aligned with traditional clinical thinking. Thus, ML models have strong potential to assist with risk stratification and more effective and cost-efficient care.
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Affiliation(s)
- Bashar Zaidat
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Mark Kurapatti
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Jonathan S Gal
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Samuel K Cho
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Jun S Kim
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
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Cui P, Wang W, Wang Z, Hu X, Liu X, Kong C, Lu S. The association between body mass index and bone mineral density in older adults: a cross-sectional study of community population in Beijing. BMC Musculoskelet Disord 2024; 25:655. [PMID: 39169318 PMCID: PMC11340083 DOI: 10.1186/s12891-024-07782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Older subjects have a higher risk for vertebral compression fracture. Maintaining a higher bone mineral density (BMD) at this age can protect individuals from osteoporosis-related events. Body mass index (BMI) has been found to have a robust association with BMD. However, excessive BMI is detrimental to bone health and may cause systemic disorders. Therefore, the present study aimed to determine the association between BMI and BMD, and identify a reasonable BMI range. METHODS A total of 961 participants were recruited from community-dwelling residents between August 2021 and May 2022. A weighted multivariate linear regression model was applied to identify the relationship between BMI and BMD. Meanwhile, subgroup stratified analysis by BMI quartile and gender was also performed. A non-linear relationship and threshold value were determined based on the smooth curve fittings and threshold effects analysis model. RESULTS A robust relationship was found between BMI and BMD, which remained significant in subgroups stratified by gender and BMI quartile. The BMI inflection point values in lumbar BMD and femoral neck BMD were 25.2 kg/m2 and 27.3 kg/m2, respectively. For individuals with BMI < 25.2 kg/m2, an increase in BMI was related to an increase in lumbar BMD. For BMI > 25.2 kg/m2, an increase in BMI was associated with a decrease in lumbar BMD. For subjects with BMI < 27.3 kg/m2, the femoral neck BMD rose by 0.008 kg/m2 for each unit rise in BMI. However, when BMI exceeded 27.3 kg/m2, the femoral neck BMD increased only by 0.005 kg/m2. Fracture risk assessment based on the spinal deformity index (SDI) failed to determine the optimal BMI range. CONCLUSIONS This study found an inflection point between BMI and lumbar/ femoral neck BMD in older community-dwelling subjects. An appropriate BMI but not an excessive BMI may allow older adults to have a better BMD.
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Affiliation(s)
- Peng Cui
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Zheng Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, People's Republic of China.
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Mumtaz M, Collins AP, Shekouhi N, Varier K, Tripathi S, Ames CP, Deviren V, Clark AJ, Goel VK, Theologis AA. Effects of pelvic fixation strategies and multi-rod constructs on biomechanics of the proximal junction in long thoracolumbar posterior instrumented fusions: a finite-element analysis. Spine Deform 2024:10.1007/s43390-024-00932-w. [PMID: 39162957 DOI: 10.1007/s43390-024-00932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To assess the effect of various pelvic fixation techniques and number of rods on biomechanics of the proximal junction of long thoracolumbar posterior instrumented fusions. METHODS A validated spinopelvic finite-element (FE) model was instrumented with L5-S1 ALIF and one of the following 9 posterior instrumentation configurations: (A) one traditional iliac screw bilaterally ("2 Iliac/2 Rods"); (B) T10 to S1 ("Sacral Only"); (C) unilateral traditional iliac screw ("1 Iliac/2 Rods"); (D) one traditional iliac screw bilaterally with one midline accessory rod ("2 Iliac/3 rods"); (E) S2AI screws connected directly to the midline rods ("2 S2AI/2 Rods"); and two traditional iliac screws bilaterally with two lateral accessory rods connected to the main rods at varying locations (F1: T10-11, F2: T11-12, F3: T12-L1, F4: L1-2) ("4 Iliac/4 Rods"). Range of motions (ROM) at T10-S1 and T9-T10 were recorded and compared between models. The T9-T10 intradiscal pressures and stresses of the T9-10 disc's annulus in addition to the von Mises stresses of the T9 and T10 vertebral bodies were recorded and compared. RESULTS For T10-S1 ROM, 4 iliac/4 rods had lowest ROM in flexion and extension, while 2 S2AI/2 rods showed lowest ROM in rotation. Constructs with 3 or 4 rods had lower stresses on the primary rods compared to 2-rod constructs. At the proximal adjacent disc (T9-10), 4 iliac/4 rods showed lowest ROM, lowest intradiscal pressures, and lowest annular stress in all directions (most pronounced in flexion-extension). Under flexion and extension, 4 iliac/4 rods also showed the lowest von Mises stresses on the T10 vertebral body but the highest stresses on the T9 vertebral body. CONCLUSIONS Dual iliac screws with 4 rods across the lumbosacral junction and extending to the thoracolumbar junction demonstrated the lowest T10-S1 ROM, the lowest adjacent segment disc (T9-T10) ROM, intradiscal pressures, and annular stresses, and the lowest UIV stresses, albeit with the highest UIV + 1 stresses. Additional studies are needed to confirm whether these biomechanical findings dictate clinical outcomes and effect rates of proximal junctional kyphosis and failure.
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Affiliation(s)
- Muzammil Mumtaz
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Andrew P Collins
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Niloufar Shekouhi
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Karthika Varier
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Sudharshan Tripathi
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | | | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - Vijay K Goel
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
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Hassan FM, Bautista A, Reyes JL, Puvanesarajah V, Coury JR, Mohanty S, Lombardi JM, Sardar ZM, Lehman RA, Lenke LG. Use of the kickstand rod improves coronal alignment and maintains correction compared to control at 2 year follow-up. Spine Deform 2024:10.1007/s43390-024-00950-8. [PMID: 39162958 DOI: 10.1007/s43390-024-00950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To assess and compare coronal alignment correction at 2 year follow-up in adult spinal deformity (ASD) patients treated with and without the kickstand rod (KSR) construct. METHODS ASD patients who underwent posterior spinal fusion at a single-center with a preoperative coronal vertical axis (CVA) ≥ 3 cm and a minimum of 2 year clinical and radiographic follow-up were identified. Patients were divided into two groups: those treated with a KSR and those who were not. Patients were propensity score-matched (PSM) controlling for preoperative CVA and instrumented levels to limit potential biases that my influence the magnitude of coronal correction. RESULTS One hundred sixteen patients were identified (KSR = 42, Control = 74). There were no statistically significant differences in patient characteristics (p > 0.05). At baseline, the control group presented with a greater LS curve (29.0 ± 19.6 vs. 21.5 ± 10.8, p = 0.0191) while the KSR group presented with a greater CVA (6.3 ± 3.6 vs. 4.5 ± 1.8, p = 0.0036). After 40 PSM pairs were generated, there were no statistically significant differences in baseline patient and radiographic characteristics. Within the matched cohorts, the KSR group demonstrated greater CVA correction at 1 year (4.7 ± 2.4 cm vs. 2.9 ± 2.2 cm, p = 0.0012) and 2 year follow-up (4.7 ± 2.6 cm vs. 3.1 ± 2.6 cm, p = 0.0020) resulting in less coronal malalignment one (1.5 ± 1.3 cm vs. 2.4 ± 1.6 cm, p = 0.0056) and 2 year follow-up (1.6 ± 1.0 vs. 2.5 ± 1.5 cm, p = 0.0110). No statistically significant differences in PROMs, asymptomatic mechanical complications, reoperations for non-mechanical complications were observed at 2 year follow-up. However, the KSR group experienced a lesser rate of mechanical complications requiring reoperations (7.1% vs. 24.3%. OR = 0.15 [0.03-0.72], p = 0.0174). CONCLUSIONS Patients treated with a KSR had a greater amount of coronal realignment at the 2 year follow-up time period and reported less mechanical complications requiring reoperation. However, 2 year patient-reported outcomes were similar between the two groups.
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Affiliation(s)
- Fthimnir M Hassan
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA.
| | - Anson Bautista
- Department of Orthopaedic Surgery, Dwight D. Eisenhower VA Medical Center, Leavenworth, KS, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Varun Puvanesarajah
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
| | - Josephine R Coury
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
- The Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Sarthak Mohanty
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
- The Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
- The Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
- The Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA
- The Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA
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Suvithayasiri S, Kim YJ, Liu Y, Lee C, Vasant Khandge A, Kim JS. Placement of 2 cages using navigation-guided biportal endoscopic transforaminal lumbar interbody fusion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE23512. [PMID: 39159496 PMCID: PMC11337937 DOI: 10.3171/case23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/17/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND In recent developments, full endoscopic and unilateral biportal endoscopic (UBE) spine surgery have emerged to aid the transforaminal lumbar interbody fusion (TLIF) procedure. Yet, both approaches present a challenge due to limited space for cage insertion, potentially leading to complications such as cage subsidence or nonfusion in long-term assessments. Utilizing double cages may mitigate these concerns. This paper presents a unique case in which a patient successfully underwent computed tomography (CT) navigation-guided UBE-TLIF with 2 converging cages, highlighting the potential benefits and feasibility of this innovative approach. OBSERVATIONS A 59-year-old female diagnosed with degenerative spondylolisthesis at the L4-5 level underwent a UBE-TLIF. The operation is detailed step by step and supported by illustrative figures and surgical videos. Postsurgery results revealed a significant improvement in the patient's condition, with the visual analog scale score decreasing from 7 to 3 on the first day, leading to a satisfaction rate of 90% at the last follow-up. LESSONS Utilizing endoscopic visualization complemented by contrast medium has substantially elevated the quality of disc preparation. From their observations, the authors affirm that the integration of intraoperative CT navigation systems significantly augments safety and pinpoint accuracy in UBE-TLIF procedures. The strategy of employing 2 converging cages through a unilateral technique stands as a practical solution, potentially optimizing the fusion outcomes of UBE-TLIF surgery. https://thejns.org/doi/10.3171/CASE23512.
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Affiliation(s)
- Siravich Suvithayasiri
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Young-Jin Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yanting Liu
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Changik Lee
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Prasad K, Fassler C, Miller A, Aweeda M, Pruthi S, Fusco JC, Daniel B, Miga M, Wu JY, Topf MC. More than meets the eye: Augmented reality in surgical oncology. J Surg Oncol 2024. [PMID: 39155686 DOI: 10.1002/jso.27790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND AND OBJECTIVES In the field of surgical oncology, there has been a desire for innovative techniques to improve tumor visualization, resection, and patient outcomes. Augmented reality (AR) technology superimposes digital content onto the real-world environment, enhancing the user's experience by blending digital and physical elements. A thorough examination of AR technology in surgical oncology has yet to be performed. METHODS A scoping review of intraoperative AR in surgical oncology was conducted according to the guidelines and recommendations of The Preferred Reporting Items for Systematic Review and Meta-analyzes Extension for Scoping Reviews (PRISMA-ScR) framework. All original articles examining the use of intraoperative AR during surgical management of cancer were included. Exclusion criteria included virtual reality applications only, preoperative use only, fluorescence, AR not specific to surgical oncology, and study design (reviews, commentaries, abstracts). RESULTS A total of 2735 articles were identified of which 83 were included. Most studies (52) were performed on animals or phantom models, while the remaining included patients. A total of 1112 intraoperative AR surgical cases were performed across the studies. The most common anatomic site was brain (20 articles), followed by liver (16), renal (9), and head and neck (8). AR was most often used for intraoperative navigation or anatomic visualization of tumors or critical structures but was also used to identify osteotomy or craniotomy planes. CONCLUSIONS AR technology has been applied across the field of surgical oncology to aid in localization and resection of tumors.
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Affiliation(s)
- Kavita Prasad
- Department of Otolaryngology-Head & Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Carly Fassler
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexis Miller
- Department of Otolaryngology-Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marina Aweeda
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sumit Pruthi
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph C Fusco
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce Daniel
- Department of Radiology, Stanford Health Care, Palo Alto, California, USA
| | - Michael Miga
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Jie Ying Wu
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee, USA
| | - Michael C Topf
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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De Salvatore S, Longo UG, Vincenzi B, Pantano F, Zollo G, Calabrese G, Denaro V. Clinical performance of implanted devices used in surgical treatment of patients with spinal tumors: a systematic review. BMC Musculoskelet Disord 2024; 25:650. [PMID: 39160506 PMCID: PMC11331752 DOI: 10.1186/s12891-024-07623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/24/2024] [Indexed: 08/21/2024] Open
Abstract
PURPOSE Implanted devices used in metastatic spine tumor surgery (MSTS) include pedicle screws, fixation plates, fixation rods, and interbody devices. A material to be used to fabricate any of these devices should possess an array of properties, which include biocompatibility, no toxicity, bioactivity, low wear rate, low to moderate incidence of artifacts during imaging, tensile strength and modulus that are comparable to those of cortical bone, high fatigue strength/long fatigue life, minimal or no negative impact on radiotherapy (RT) planning and delivery, and high capability for fusion to the contiguous bone. The shortcomings of Ti6Al4V alloy for these applications with respect to these desirable properties are well recognized, opening the field for an investigation about novel biomaterials that could replace the current gold standard. Previously published reviews on this topic have exhibited significant shortcomings in the studies they included, such as a small, heterogenous sample size and the lack of a cost-benefit analysis, extremely useful to understand the practical possibility of applying a novel material on a large scale. Therefore, this review aims to collect information about the clinical performance of these biomaterials from the most recent literature, with the objective of deliberating which could potentially be better than titanium in the future, with particular attention to safety, artifact production and radiotherapy planning interference. The significant promise showed by analyzing the clinical performance of these devices warrants further research through prospective studies with a larger sample size also taking into account each aspect of the production and use of such materials. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The search was performed from March 2022 to September 2023. RESULTS At the end of the screening process, 20 articles were considered eligible for this study. Polyetheretherketone (PEEK), Carbon-fibre reinforced polyetheretherketone (CFR-PEEK), long carbon fiber reinforced polymer (LCFRP), Polymethylmethacrylate (PMMA), and carbon screw and rods were used in the included studies. CONCLUSION CFR-PEEK displays a noninferior safety and efficacy profile to titanium implanted devices. However, it also has other advantages. By decreasing artifact production, it is able to increase detection of local tumor recurrence and decrease radiotherapy dose perturbation, ultimately bettering prognosis for patients necessitating adjuvant treatment. Nonetheless, its drawbacks have not been explored fully and still require further investigation in future studies. This does not exclude the fact that CFR-PEEK could be a valid alternative to titanium in the near future.
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Affiliation(s)
- Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
- Department of Orthopedics, Children's Hospital Bambino Gesù, Palidoro, Rome, 00165, Italy
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy.
| | - Bruno Vincenzi
- Dipartimento di Oncologia Medica, Università Campus Bio-Medico di Roma, Rome, 00128, Italy
| | - Francesco Pantano
- Dipartimento di Oncologia Medica, Università Campus Bio-Medico di Roma, Rome, 00128, Italy
| | - Giuliano Zollo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
| | - Giovanni Calabrese
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
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Elmounedi N, Bahloul W, Keskes H. Current Therapeutic Strategies of Intervertebral Disc Regenerative Medicine. Mol Diagn Ther 2024:10.1007/s40291-024-00729-7. [PMID: 39158834 DOI: 10.1007/s40291-024-00729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/20/2024]
Abstract
Intervertebral disc degeneration (IDD) is one of the most frequent causes of low back pain. No treatment is currently available to delay the progression of IDD. Conservative treatment or surgical interventions is only used to target the symptoms of IDD rather than treat the underlying cause. Currently, numerous potential therapeutic strategies are available, including molecular therapy, gene therapy, and cell therapy. However, the hostile environment of degenerated discs is a major problem that has hindered the clinical applicability of such approaches. In this regard, the design of drugs using alternative delivery systems (macro-, micro-, and nano-sized particles) may resolve this problem. These can protect and deliver biomolecules along with helping to improve the therapeutic effect of drugs via concentrating, protecting, and prolonging their presence in the degenerated disc. This review summarizes the research progress of diagnosis and the current options for treating IDD.
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Affiliation(s)
- Najah Elmounedi
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Sfax Faculty of Medicine, Majida Boulila Road, 3029, Sfax, Tunisia.
| | - Walid Bahloul
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Sfax Faculty of Medicine, Majida Boulila Road, 3029, Sfax, Tunisia
- Department of Orthopedics and Traumatology, CHU Habib Bourguiba, Sfax, Tunisia
| | - Hassib Keskes
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP11 Lab, Sfax Faculty of Medicine, Majida Boulila Road, 3029, Sfax, Tunisia
- Department of Orthopedics and Traumatology, CHU Habib Bourguiba, Sfax, Tunisia
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Giacobbe DR, Marelli C, Guastavino S, Signori A, Mora S, Rosso N, Campi C, Piana M, Murgia Y, Giacomini M, Bassetti M. Artificial intelligence and prescription of antibiotic therapy: present and future. Expert Rev Anti Infect Ther 2024:1-15. [PMID: 39155449 DOI: 10.1080/14787210.2024.2386669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/28/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION In the past few years, the use of artificial intelligence in healthcare has grown exponentially. Prescription of antibiotics is not exempt from its rapid diffusion, and various machine learning (ML) techniques, from logistic regression to deep neural networks and large language models, have been explored in the literature to support decisions regarding antibiotic prescription. AREAS COVERED In this narrative review, we discuss promises and challenges of the application of ML-based clinical decision support systems (ML-CDSSs) for antibiotic prescription. A search was conducted in PubMed up to April 2024. EXPERT OPINION Prescribing antibiotics is a complex process involving various dynamic phases. In each of these phases, the support of ML-CDSSs has shown the potential, and also the actual ability in some studies, to favorably impacting relevant clinical outcomes. Nonetheless, before widely exploiting this massive potential, there are still crucial challenges ahead that are being intensively investigated, pertaining to the transparency of training data, the definition of the sufficient degree of prediction explanations when predictions are obtained through black box models, and the legal and ethical framework for decision responsibility whenever an antibiotic prescription is supported by ML-CDSSs.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- UO Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- UO Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Mora
- UO Information and Communication Technologies, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola Rosso
- UO Information and Communication Technologies, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Campi
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Piana
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ylenia Murgia
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- UO Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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