RESUMEN
A 36-year-old woman with a history of spondylolisthesis underwent respondylodesis 13 years after spondylodesis of vertebrae L3-L4. The respondylodesis was performed by screw fixation augmented with cement. One year after respondylodesis, the patient developed pulmonary complaints. Chest radiology revealed pulmonary cement embolism.
Asunto(s)
Embolia Pulmonar , Fusión Vertebral , Espondilolistesis , Humanos , Femenino , Adulto , Embolia Pulmonar/etiología , Embolia Pulmonar/cirugía , Fusión Vertebral/efectos adversos , Espondilolistesis/cirugía , Reoperación , Cementos para Huesos/efectos adversos , Vértebras Lumbares/cirugíaRESUMEN
BACKGROUND: With life expectancy on the rise, there has been an increase in patients with concomitant degenerative hip and spine pathology, defined as hip-spine syndrome (HSS). Patients affected by HSS may require both total hip arthroplasty (THA) and lumbar spinal fusion (LSF), although there is a paucity of data regarding how the sequential timing of these procedures may influence clinical outcomes. This study aims to compare complications and spinopelvic parameters in patients with HSS who underwent either LSF first or THA first. METHODS: A systematic search of PubMed and Scopus was conducted for randomized and nonrandomized studies investigating complications and spinopelvic parameters in patients with HSS who had undergone THA and LSF. The Methodological Index for Non-Randomized Studies (MINORS) tool was utilized to assess the risk of bias in included studies. Relevant outcomes were pooled for meta-analysis. RESULTS: Eleven articles were included in this study. There was a significantly higher THA dislocation rate in patients who had undergone LSF first compared to those who had THA first (OR: 3.17, 95% CI 1.23-8.15, P = 0.02). No significant difference was found in terms of THA aseptic loosening (OR: 0.86; 95% CI 0.32-2.32, p = 0.77) and revision rate (OR: 1.18, 95% CI: 0.53-2.62) between these two groups. Individuals who received THA only showed a significantly lower risk of hip dislocation (OR: 0.14, 95% CI: 0.08-0.25, P < 0.00001) and THA revision (OR: 0.22, 95% CI: 0.14-0.36, P < 0.00001) compared to patients with a previous LSF. CONCLUSIONS: In HSS patients who underwent both LSF and THA, those who received LSF first displayed an increased risk of hip dislocation after subsequent THA. Additionally, the relative risks of dislocation and revision rate appeared significantly lower in patients who had undergone THA only when compared to THA patients with a history of previous LSF. Due to the impact of LSF on spinopelvic biomechanics, caution must be exercised when performing THA in individuals with instrumented spines. PROSPERO ID: CRD42023412447. LEVEL OF EVIDENCE: LL.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Vértebras Lumbares , Fusión Vertebral , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Fusión Vertebral/efectos adversos , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Síndrome , Factores de Riesgo , Luxación de la Cadera/etiología , Luxación de la Cadera/epidemiología , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagenRESUMEN
STUDY OBJECTIVE: To determine if baseline cytokines/chemokines and their changes over postoperative days 0-2 (POD0-2) predict acute and chronic postsurgical pain (CPSP) after major surgery. DESIGN: Prospective, observational, longitudinal nested study. SETTING: University-affiliated quaternary children's hospital. PATIENTS: Subjects (≥8 years old) with idiopathic scoliosis undergoing spine fusion or pectus excavatum undergoing Nuss procedure. MEASUREMENTS: Demographics, surgical, psychosocial measures, pain scores, and opioid use over POD0-2 were collected. Cytokine concentrations were analyzed in serial blood samples collected before and up to two weeks after surgery, using Luminex bead arrays. After data preparation, relationships between pre- and post-surgical cytokine concentrations with acute (% time in moderate-severe pain over POD0-2) and chronic (pain score > 3/10 beyond 3 months post-surgery) post-surgical pain were analyzed using univariable and multivariable regression analyses with adjustment for covariates and mixed effects models were used to associate longitudinal cytokine concentrations with pain outcomes. MAIN RESULTS: Analyses included 3,164 repeated measures of 16 cytokines/chemokines from 112 subjects (median age 15.3, IQR 13.5-17.0, 54.5 % female, 59.8 % pectus). Acute postsurgical pain was associated with higher baseline concentrations of GM-CSF (ß = 0.95, SE 0.31; p = 0.003), IL-1ß (ß = 0.84, SE 0.36; p = 0.02), IL-2 (ß = 0.78, SE 0.34; p = 0.03), and IL-12 p70 (ß = 0.88, SE 0.40; p = 0.03) and longitudinal postoperative elevations in GM-CSF (ß = 1.38, SE 0.57; p = 0.03), IFNγ (ß = 1.36, SE 0.6; p = 0.03), IL-1ß (ß = 1.25, SE 0.59; p = 0.03), IL-7 (ß = 1.65, SE 0.7; p = 0.02), and IL-12 p70 (ß = 1.17, SE 0.58; p = 0.04). In contrast, CPSP was associated with lower baseline concentration of IL-8 (ß = -0.39, SE 0.17; p = 0.02), and the risk of developing CPSP was elevated in patients with lower longitudinal postoperative concentrations of IL-6 (ß = -0.57, SE 0.26; p = 0.03), IL-8 (ß = -0.68, SE 0.24; p = 0.006), and IL-13 (ß = -0.48, SE 0.22; p = 0.03). Covariates female (vs. male) sex and surgery type (pectus surgery vs. spine) were associated with higher odds for CPSP in baseline adjusted cytokine-CPSP association models for IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNFα, and IL-8, IL-10, respectively. CONCLUSION: We identified pro-inflammatory cytokine profiles associated with higher risk of acute postoperative pain. Interestingly, pleiotropic cytokine IL-6, chemokine IL-8 (which promotes neutrophil infiltration and monocyte differentiation), and monocyte-released anti-inflammatory cytokine IL-13, were associated with lower CPSP risk. Our results suggest heterogenous outcomes of cytokine/chemokine signaling that can both promote and protect against post-surgical pain. These may serve as predictive and prognostic biomarkers of pain outcomes following surgery.
Asunto(s)
Citocinas , Dolor Postoperatorio , Escoliosis , Fusión Vertebral , Humanos , Femenino , Masculino , Citocinas/sangre , Adolescente , Estudios Prospectivos , Escoliosis/cirugía , Niño , Fusión Vertebral/efectos adversos , Dolor Crónico , Estudios Longitudinales , Tórax en Embudo/cirugía , Dolor Agudo , Dimensión del Dolor/métodosRESUMEN
CASE: A rarely reported complication with sacroiliac joint fusion (SJF) is an iatrogenic injury to the superior gluteal artery (SGA). This case series includes 3 cases which had a suspected injury to the SGA. Case 1 describes how hemostasis achieved with exploration of the wound followed by embolization by interventional radiology (IR). In Case 2, electrocautery, hemostatic agents, and pressure were used with success. Case 3 highlights the use of IR as the initial method for controlling bleeding. CONCLUSION: This report describes a rare complication during SJF and provides an algorithm to help guide surgeons in decision making.
Asunto(s)
Articulación Sacroiliaca , Humanos , Articulación Sacroiliaca/cirugía , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/diagnóstico por imagen , Nalgas/irrigación sanguínea , Nalgas/cirugía , Nalgas/lesiones , Femenino , Masculino , Persona de Mediana Edad , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Anciano , Adulto , Embolización TerapéuticaRESUMEN
CASE: We present a case of a 66-year-old man with lumbar vertebral body erosions after glue embolization of a Type II endoleak secondary to endovascular repair of an infrarenal aortic aneurysm. Multiple biopsies of the affected vertebrae were culture-negative confirming no evidence of infection. He underwent posterior spinal fusion from L2 to L5 with complete resolution of mechanical low back pain and improved functional outcomes. CONCLUSION: Vertebral body osseous erosion is a rare complication of aortic endoleak intervention that can be successfully treated with spinal fusion.
Asunto(s)
Embolización Terapéutica , Endofuga , Humanos , Masculino , Anciano , Endofuga/etiología , Endofuga/diagnóstico por imagen , Endofuga/terapia , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Cuerpo Vertebral/diagnóstico por imagen , Cuerpo Vertebral/cirugía , Procedimientos Endovasculares/efectos adversos , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentaciónRESUMEN
PURPOSE: The objective of this systematic review and metaanalysis is to compare the efficacy and safety of decompression alone versus decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. METHODS: A comprehensive search of the PubMed, Embase, Cochrane Library, and Ovid Medline databases was conducted to find randomized control trials (RCTs) or cohort studies that compared decompression alone and decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. Operation time; reoperation; postoperative complications; postoperative Oswestry disability index(ODI) scores and scores related to back and leg pain were collected from eligible studies for meta-analysis. RESULTS: We included 3 randomized controlled trials and 9 cohort studies with 6182 patients. The decompression alone group showed less operative time(P < 0.001) and intraoperative blood loss(p = 0.000), and no significant difference in postoperative complications was observed in randomized controlled trials(p = 0.428) or cohort studies(p = 0.731). There was no significant difference between the other two groups in reoperation(P = 0.071), postoperative ODI scores and scores related to back and leg pain. CONCLUSIONS: In this study, we found that the decompression alone group performed better in terms of operation time and intraoperative blood loss, and there was no significant difference between the two surgical methods in rate of reoperation and postoperative complications, ODI, low back pain and leg pain. Therefore, we come to the conclusion that decompression alone is not inferior to decompression and fusion in patients with single-level lumbar spinal stenosis with spondylolisthesis.
Asunto(s)
Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Espondilolistesis , Humanos , Estenosis Espinal/cirugía , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Espondilolistesis/cirugía , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tempo Operativo , ReoperaciónRESUMEN
BACKGROUND: Transforaminal lumbar interbody fusion (TLIF) has become a common tool to achieve interbody fusion in lumbar spine surgery while avoiding the time, expense, and morbidity associated with an anterior approach. Nonexpandable (NE) devices have excellent fusion results but are limited to implant size by spinal anatomy; conversely, expandable implants have been associated with increased intraoperative subsidence. Dual-plane expandable (DPE) devices are theorized to have reduced subsidence risk, but DPE cages have not been directly compared to NE and single plane expandable (SPE) implants in vivo. STUDY DESIGN: A retrospective review of patients who underwent TLIF at a single metropolitan academic medical center from 2018 through 2021 was conducted to compare intraoperative subsidence between NE versus SPE or DPE devices. Patients were propensity score matched (PSM) by age and bone density according to implant type. A second PSM cohort comparing DPE with SPE devices was performed. RESULTS: A total of 402 patients underwent PSM with 46 NE and 49 DPE cases matched, and 103 SPE patients were matched with 24 DPE cases. The average age was 59 years with 52.5% female patients. Mean body mass index was 29. Nonexpandable TLIF was the most common device implanted 62%, followed by SPE (26%) and DPE (12.2%). Dual-plane expandable devices had a significantly greater intraoperative subsidence than NE devices (12% vs. 0%). Nonexpandable and SPE devices had significantly larger implant lordosis when compared to DPE (10.93 SPE vs. 6. 17 NE vs. 3.83 DPE). Single plane expandable devices had a significantly greater discrepancy between implant lordosis and interbody level lordosis compared to DPE. CONCLUSIONS: Dual-plane expandable cages are associated with increased intraoperative subsidence compared to NE and SPE implants. Additionally, SPE devices have greater discrepancy between stated implant lordosis and interbody level lordosis compared with DPE devices.
Asunto(s)
Vértebras Lumbares , Puntaje de Propensión , Fusión Vertebral , Humanos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Femenino , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Resultado del Tratamiento , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. METHODS: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. RESULTS: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. CONCLUSION: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise.
Asunto(s)
Degeneración del Disco Intervertebral , Vértebras Lumbares , Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Anciano , Degeneración del Disco Intervertebral/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Endoscopía/métodos , Tempo Operativo , Estudios de Seguimiento , Factores de TiempoRESUMEN
CASE: A 51-year-old woman, who had previously undergone C5-C7 anterior cervical discectomy and fusion, presented with symptomatic hardware failure and subsequently underwent instrumentation removal. Her postoperative course was complicated by an esophageal perforation. Despite initial repair using a rotational flap, the leak persisted, prompting esophageal reconstruction with a radial forearm free flap (RFFF). CONCLUSION: Persistent esophageal perforation is exceedingly rare and difficult to treat. This report discusses the surgical technique for RFFF, an excellent option for revising failed sternocleidomastoid rotational flaps. The decision between rotational repair and free flap reconstruction depends on factors such as defect size, vascularization, wound condition, and donor site morbidity.
Asunto(s)
Vértebras Cervicales , Perforación del Esófago , Fusión Vertebral , Humanos , Femenino , Persona de Mediana Edad , Perforación del Esófago/cirugía , Perforación del Esófago/etiología , Vértebras Cervicales/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Remoción de Dispositivos , Antebrazo/cirugía , Colgajos Tisulares Libres/efectos adversos , Discectomía/efectos adversos , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
OBJECTIVES: To optimize cervical vertebral bone quality (C-VBQ) score and explore its effectiveness in predicting cage subsidence in Anterior Cervical Corpectomy and Fusion (ACCF) and identify a new method for evaluating subsidence without different equipment and image scale interference. METHODS: Collecting demographic, imaging, and surgical related information. Measuring Cage Subsidence with a new method. Multifactorial logistic regression was used to identify risk factors associated with subsidence. Pearson's correlation was used to determine the relationship between C-VBQ and computed tomography (CT) Hounsfield units (HU). The receiver operating characteristic (ROC) curve was used to assess C-VBQ predictive ability. Correlations between demographics and C-VBQ scores were analyzed using linear regression models. RESULTS: 92 patients were included in this study, 36 (39.1%) showed subsidence with a C-VBQ value of 2.05 ± 0.45, in the no-subsidence group C-VBQ Value was 3.25 ± 0.76. The multifactorial logistic regression showed that C-VBQ is an independent predictor of cage subsidence with a predictive accuracy of 93.4%. Pearson's correlation analysis showed a negative correlation between C-VBQ and HU values. Linear regression analysis showed a positive correlation between C-VBQ and cage subsidence. Univariate analyses showed that only age was associated with C-VBQ. CONCLUSIONS: The C-VBQ values obtained using the new measurements independently predicted postoperative cage subsidence after ACCF and showed a negative correlation with HU values. By adding the measurement of non-operated vertebral heights as a control standard, the results of cage subsidence measured by the ratio method are likely to be more robust, perhaps can exclude unavoidable errors caused by different equipment and proportional.
Asunto(s)
Vértebras Cervicales , Fusión Vertebral , Humanos , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Masculino , Fusión Vertebral/instrumentación , Fusión Vertebral/efectos adversos , Femenino , Persona de Mediana Edad , Anciano , Adulto , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Valor Predictivo de las Pruebas , Densidad Ósea , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnósticoRESUMEN
Effective internal fixation with pedicle screw is a key factor in the success of lumbar fusion with internal fixation. Whether navigation robots can improve the efficacy and safety of screw placement is controversial. Thirty-eight patients who underwent oblique lateral lumbar interbody fusion internal fixation from March 2022 to May 2023 were retrospectively analyzed, 16 cases in the navigational robot group and 22 cases in the fluoroscopy group. Using visual analog score (VAS) for the low back and lower limbs, Oswestry Disability Index to compare the clinical efficacy of the 2 groups; using perioperative indexes such as the duration of surgery, intraoperative blood loss, intraoperative fluoroscopy times, and postoperative hospital stay to compare the safety of the 2 groups; and using accuracy of pedicle screws (APS) and the facet joint violation (FJV) to compare the accuracy of the 2 groups. Postoperative follow-up at least 6 months, there was no statistically significant difference between the 2 groups in the baseline data (Pâ >â .05). The navigational robot group's VAS-back was significantly lower than the fluoroscopy group at 3 days postoperatively (Pâ <â .05). However, the differences between the 2 groups in VAS-back at 3 and 6 months postoperatively, and in VAS-leg and Oswestry Disability Index at 3 days, 3 months, and 6 months postoperatively were not significant (Pâ >â .05). Although duration of surgery in the navigational robot group was significantly longer than in the fluoroscopy group (Pâ >â .05), the intraoperative blood loss and the intraoperative fluoroscopy times were significantly lower than in the fluoroscopy group (Pâ <â .05). The difference in the PHS between the 2 groups was not significant (Pâ >â .05). The APS in the navigation robot group was significantly higher than in the fluoroscopy group, and the rate of FJV was significantly lower than in the fluoroscopy group (Pâ <â .05). Compared with the traditional fluoroscopic technique, navigation robot-assisted lumbar interbody fusion with internal fixation provides less postoperative low back pain in the short term, with less trauma, less bleeding, and lower radiation exposure, as well as better APS and lower FJV, resulting in better clinical efficacy and safety.
Asunto(s)
Vértebras Lumbares , Procedimientos Quirúrgicos Robotizados , Fusión Vertebral , Humanos , Estudios Retrospectivos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Femenino , Masculino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Fluoroscopía/métodos , Anciano , Tornillos Pediculares , Resultado del Tratamiento , Degeneración del Disco Intervertebral/cirugía , Tempo Operativo , Pérdida de Sangre Quirúrgica/estadística & datos numéricosRESUMEN
Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48 h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.
Asunto(s)
Antifibrinolíticos , Pérdida de Sangre Quirúrgica , Escoliosis , Fusión Vertebral , Ácido Tranexámico , Humanos , Ácido Tranexámico/uso terapéutico , Escoliosis/cirugía , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Adolescente , Estudios Prospectivos , Adulto , Transfusión Sanguínea/estadística & datos numéricos , Resultado del Tratamiento , Periodo Posoperatorio , Tiempo de Internación , Adulto Joven , Hemorragia Posoperatoria/epidemiologíaRESUMEN
BACKGROUND: Non-contiguous two-level Anterior Cervical Discectomy and Fusion (ACDF) may be a viable option for patients with degenerative cervical myelopathy and imaging-evident spine and radicular compression at two non-contiguous cervical levels. The risk of hastening degeneration and triggering Adjacent Segment Disease at the spine levels located between the fused levels is a putative adverse event, which was assessed in a few studies. The aim of this study is to investigate the clinical outcomes of patients undergoing non-contiguous two levels ACDF and to assess biomechanical modifications at non-fused segments. METHOD: We retrospectively reviewed all patients with noncontiguous two-level spine and radicular compression, who underwent simultaneous noncontiguous two-level ACDF at our center. We analyzed clinical and radiological outcomes and investigated the rate of adjacent segment disease. Radiographic parameters were calculated on pre- and postoperative images. RESULTS: Thirty-two patients underwent simultaneous noncontiguous two-level ACDF for cervical myelo-radiculopathy between 2015 and 2021 and were followed up for a mean period of 43.3 months. For all patients, the mJOA score significantly improved from 14.57 ± 2.3 to 16.5 ± 2.1 (p<0.01) and the NDI score significantly decreased from 21.45 ± 4.3 to 12.8 ± 2.3 (p<0.01) postoperatively. Cervical lordosis increased after surgery (from 9.65° ±9.47 to 15.12° ± 6.09); intermediate disc height decreased (5.68 mm ± 0.57 to 5.27 mm ±0.98); the ROMs of intermediate (from 12.45 ± 2.33 to 14.77 ± 1.98), cranial (from 14.63 ± 1.59 to 15.71 ± 1.02), and caudal (from 11.58 ± 2.32 to 13.33 ± 2.67) segments slightly increased. During follow-up assessment, in one patient the myelopathy worsened due to spine compression at the intermediate level. CONCLUSIONS: Simultaneous and non-contiguous two-level ACDF is a safe and effective procedure. The occurrence of postoperative adjacent and intermediate segment disease is rare.
Asunto(s)
Vértebras Cervicales , Discectomía , Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Discectomía/métodos , Discectomía/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Anciano , Resultado del Tratamiento , Adulto , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Radiculopatía/cirugía , Radiculopatía/etiología , Degeneración del Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagenRESUMEN
BACKGROUND: The number of surgical trials is increasing but such trials can be complex to deliver and pose specific challenges. A multi-centre, Phase III, RCT comparing Posterior Cervical Foraminotomy versus Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Brachialgia (FORVAD Trial) was unable to recruit to target. A rapid qualitative study was conducted during trial closedown to understand the experiences of healthcare professionals who participated in the FORVAD Trial, with the aim of informing future research in this area. METHODS: Semi-structured interviews were conducted with 18 healthcare professionals who had participated in the FORVAD Trial. Interviews explored participants' experiences of the FORVAD trial. A rapid qualitative analysis was conducted, informed by Normalisation Process Theory. RESULTS: Four main themes were generated in the data analysis: (1) individual vs. community equipoise; (2) trial set-up and delivery; (3) identifying and approaching patients; and (4) timing of randomisation. The objectives of the FORVAD trial made sense to participants and they supported the idea that there was clinical or collective equipoise regarding the two FORVAD interventions; however, many surgeons had treatment preferences and lacked individual equipoise. The site which had most recruitment success had adopted a more structured process for identification and recruitment of patients, whereas other sites that adopted more "ad hoc" screening strategies struggled to identify patients. Randomisation on the day of surgery caused both medico-legal and practical concerns at some sites. CONCLUSIONS: Organisation and implementation of a surgical trial in neurosurgery is complex and presents many challenges. Sites often reported low recruitment and discussed the logistical issues of conducting a complex surgical RCT. Future trials in neurosurgery may need to offer more flexibility and time during set-up to maximise opportunities for larger recruitment numbers. Rapid qualitative analysis informed by Normalisation Process Theory was able to quickly identify key issues with trial implementation so rapid qualitative analysis may be a useful approach for teams conducting qualitative research in trials. TRIAL REGISTRATION: ISRCTN, ISRCTN reference: 10,133,661. Registered 23rd November 2018.
Asunto(s)
Vértebras Cervicales , Discectomía , Foraminotomía , Selección de Paciente , Investigación Cualitativa , Humanos , Discectomía/métodos , Vértebras Cervicales/cirugía , Foraminotomía/métodos , Entrevistas como Asunto , Equipoise Terapéutico , Resultado del Tratamiento , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Factores de TiempoRESUMEN
BACKGROUND: Morphometric analysis of the psoas major muscle has shown utility in predicting postoperative morbidity in various surgical fields, but its usefulness in predicting complications in elderly patients undergoing multilevel lumbar fusion surgery has not been studied. The study aimed to investigate if psoas major parameters are independent risk factors of early postoperative complication among elderly patients. METHODS: Patients who underwent multilevel lumbar fusion for degenerative lumbar spinal stenosis (DLSS) were included. The psoas major was measured at the lumbar 3/4 intervertebral disc level in three ways on computed tomography image: psoas muscle mass index, mean muscle attenuation, and morphologic change of the psoas major. Early complications were graded using the Clavien-Dindo classification system and the Comprehensive complication index (CCI). A CCI ≥ 26.2 indicated severe complications. Logistic regression was performed to identify independent risk factors. RESULTS: This retrospective study reviewed 108 patients (mean age 70.9 years, female to male ratio 1.8:1). Complications were observed in 72.2% of patients, with allogeneic blood transfusion being the most frequent (66.7%), followed by wound infection, acute heart failure (2.8% each). Severe complications occurred in 13.9% of patients. After multivariable regression analysis, those in the lowest psoas muscle attenuation tertile had higher odds of experiencing early postoperative complications (OR: 3.327, 95% CI 1.134-9.763, p = 0.029) and severe complications (OR: 6.964, 95% CI 1.928-25.160, p = 0.003). CONCLUSION: The psoas muscle attenuation can be used as a predictor of early postoperative complications in elderly patients undergoing multilevel lumbar fusion surgery for DLSS.
Asunto(s)
Vértebras Lumbares , Complicaciones Posoperatorias , Músculos Psoas , Fusión Vertebral , Estenosis Espinal , Humanos , Masculino , Femenino , Anciano , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Músculos Psoas/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X , Persona de Mediana EdadRESUMEN
BACKGROUND: Degenerative cervical myelopathy (DCM) is a leading cause of nontraumatic spinal cord injury. Surgery aims to arrest neurological decline and improve conditions, but controversies surround risks and benefits in elderly patients, outcomes in mild myelopathy, and the risk of adjacent segment disease (ASD). METHODS: Retrospective data of patients who underwent anterior cervical discectomy and fusion for DCM in our hospital were collected. Patients were stratified by preoperative modified Japanese Orthopaedic Association (mJOA) (mild, moderate, severe) and age (under 70, over 70). Clinical outcomes, complications, and ASD rate were analyzed. We evaluated the relationship between mJOA recovery rate and the risk of complications and various preoperative parameters. RESULTS: Five hundred seven consecutive patients were included in the study, with a mean follow-up of 43.52 months (12-71). Improvement in all outcome variables was observed in mild, moderate, and severe myelopathy categories, with elderly patients showing a lower improvement. Except for age, no other variable correlated with mJOA recovery rate. We observed 45 complications (11.1% of patients), with 14 in the U70 group and 31 in the O70 group (P value < 0.001). Age, Charlson comorbidity index, and ASA score were found to be predictors of complications. Fourteen patients (2.8% of total), mean age 54.2, developed radiological and clinical ASD. Most had cranial-level ASD with Pfirmann grade ≥ 2 before index surgery. CONCLUSIONS: Most myelopathic patients improve after anterior cervical discectomy and fusion. Elderly patients show a lower improvement and higher complication rates than their younger counterparts. ASD rates are low, and younger patients with preexisting cranial level alterations are more susceptible.
Asunto(s)
Vértebras Cervicales , Discectomía , Complicaciones Posoperatorias , Fusión Vertebral , Humanos , Discectomía/métodos , Discectomía/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Vértebras Cervicales/cirugía , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Enfermedades de la Médula Espinal/cirugía , Adulto , Anciano de 80 o más Años , Estudios de SeguimientoRESUMEN
BACKGROUND: Using three-dimensional image analysis, we previously reported suppression of ossification progression following posterior fusion surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Here, we aimed to evaluate the morphological changes in thoracic OPLL using three-dimensional analysis. METHODS: Seventeen patients (eight males and nine females; mean age, 56.9 years) who underwent posterior decompression and fusion (PDF) for thoracic OPLL were included. We evaluated the OPLL volume using a novel analysis involving creating a three-dimensional model from computed tomography images to measure the volume accurately. Additionally, OPLL thickness, width, and length were measured on sagittal and axial computed tomography planes. We investigated the morphological changes in OPLL after PDF. Furthermore, patients were classified into reduced volume and increased volume groups and associated factors were compared. RESULTS: The mean OPLL volume was 1,677 mm3 preoperatively and 1,705 mm3 at the final examination and did not significantly differ. Volume reduction was observed in 7 of 17 cases (41 %). Although OPLL width and length significantly increased postoperatively, OPLL thickness significantly reduced from 7.1 mm preoperatively to 6.5 mm postoperatively (all, p < 0.05). The annual thickness changes significantly differed (p <0.05) in the reduced volume group (-0.36 mm/year) compared to that in the increased volume group (-0.06 mm/year). CONCLUSIONS: Thoracic OPLL after PDF becomes thinner in the anteroposterior direction but increases horizontally and craniocaudally. The reduction in OPLL thickness was related to a reduction in ossification volume. We believe that volume reduction in thoracic OPLL is influenced by pulsation of the dural sac.
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Descompresión Quirúrgica , Imagenología Tridimensional , Osificación del Ligamento Longitudinal Posterior , Fusión Vertebral , Vértebras Torácicas , Humanos , Masculino , Femenino , Osificación del Ligamento Longitudinal Posterior/cirugía , Osificación del Ligamento Longitudinal Posterior/diagnóstico por imagen , Osificación del Ligamento Longitudinal Posterior/patología , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Anciano , Adulto , Tomografía Computarizada por Rayos X , Estudios RetrospectivosRESUMEN
Despite less invasive surgical procedures in adult spinal deformity (ASD) surgery, some older patients have complications and long recovery time. We investigated patients' willingness to undergo the same surgery again and sought to elucidate the factors related to their perception of surgical outcomes. Enrolled were 60 of our patients (≥65 years old) that underwent long corrective fusion using lateral interbody fusion and who had a minimum of 2 years of follow-up. Patients were asked whether they would theoretically undergo the same surgery again: 28 answered yes (46.7 %; Group-Y), and 32 answered no (53.3 %; Group-N). There was no difference between the groups in age, sex, body mass index, frailty, preoperative patient-reported outcomes (PROs; Oswestry disability index [ODI] and Scoliosis Research Society 22r [SRS-22r]), surgical time, estimated blood loss, or pre-operative and 2-year post-operative radiographic parameters. Major complications had occurred more frequently in Group-N (P = 0.048). Although at 2-year follow-up there was significant improvement of spinal deformity and PROs (P < 0.001) in both groups, PROs in Group-N were inferior (Visual analogue scale [VAS] for low back pain, P = 0.043; VAS for satisfaction, P = 0.001; ODI: P = 0.005; SRS-22r: pain, P = 0.032; self-image, P = 0.014; subtotal, P = 0.005; satisfaction, P < 0.001). After multivariate logistic regression analysis with the willingness to undergo the same surgery again as an objective factor, incidence of major complication was found to be an independently-associated factor in unwillingness to undergo the same surgery again for older patients with ASD if they had the same condition in the future. Avoiding major perioperative complications is important in obtaining satisfactory perception of outcomes in ASD surgery.
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Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Femenino , Masculino , Anciano , Escoliosis/cirugía , Resultado del Tratamiento , Estudios de Seguimiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/etiología , Curvaturas de la Columna Vertebral/cirugía , Curvaturas de la Columna Vertebral/psicología , Anciano de 80 o más Años , Reoperación/estadística & datos numéricos , Satisfacción del PacienteRESUMEN
STUDY DESIGN: Retrospective study. OBJECTIVES: The objective of this investigation was to formulate and internally verify a customized machine learning (ML) framework for forecasting cerebrospinal fluid leakage (CSFL) in lumbar fusion surgery. This was accomplished by integrating imaging parameters and using the SHapley Additive exPlanation (SHAP) technique to elucidate the interpretability of the model. SUMMARY OF BACKGROUND DATA: Given the increasing incidence and surgical volume of spinal degeneration worldwide, accurate predictions of postoperative complications are urgently needed. SHAP-based interpretable ML models have not been used for CSFL risk factor analysis in lumbar fusion surgery. METHODS: Clinical and imaging data were retrospectively collected from 3505 patients who underwent lumbar fusion surgery. Six distinct machine learning models were formulated: extreme gradient boosting (XGBoost), decision tree (DT), random forest (RF), support vector machine (SVM), Gaussian naive Bayes (GaussianNB), and K-nearest neighbors (KNN) models. Evaluation of model performance on the test dataset was performed using performance metrics, and the analysis was executed through the SHAP framework. RESULTS: CSFL was detected in 95 (2.71%) of 3505 patients. Notably, the XGBoost model exhibited outstanding accuracy in forecasting CSFLs, with high precision (0.9815), recall (0.6667), accuracy (0.8182), F1 score (0.7347), and AUC (0.7343). In addition, through SHAP analysis, significant predictors of CSFL were identified, including ligamentum flavum thickness, zygapophysial joint degeneration grade, central spinal stenosis grade, decompression segment count, decompression mode, intervertebral height difference, Cobb angle, intervertebral height index difference, operation mode, lumbar segment lordosis angle difference, Meyerding grade of lumbar spondylolisthesis, and revision surgery. CONCLUSIONS: The combination of the XGBoost model with the SHAP is an effective tool for predicting the risk of CSFL during lumbar fusion surgery. Its implementation could aid clinicians in making informed decisions, potentially enhancing patient outcomes and lowering healthcare expenses. This study advocates for the adoption of this approach in clinical settings to enhance the evaluation of CSFL risk among patients undergoing lumbar fusion.
Asunto(s)
Pérdida de Líquido Cefalorraquídeo , Vértebras Lumbares , Aprendizaje Automático , Fusión Vertebral , Humanos , Masculino , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Femenino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Pérdida de Líquido Cefalorraquídeo/etiología , Anciano , Complicaciones Posoperatorias/etiología , Adulto , Factores de RiesgoRESUMEN
BACKGROUND: Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs. METHODS: Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally). RESULTS: Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the Hip-Spine patients had a worse sagittal vertebral axis (SVA) measurement (45.9 ± 45.5 mm, versus 25.1 ± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006). CONCLUSIONS: This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.