Spine

"The Night View of Bund in Shanghai, China" No abstract available

It is Time to Change Our Mindset and Perform More High-quality Research in Low Back Pain No abstract available

The Impact of Anterior Spondylolisthesis and Kyphotic Alignment on Dynamic Changes in Spinal Cord Compression and Neurological Status in Cervical Spondylotic Myelopathy: A Radiological Analysis Involving Kinematic CT Myelography and Multimodal Spinal Cord Evoked Potentials Study Design. A retrospective study of prospectively collected data. Objective. This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs). Summary of Background Data. Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures. Methods. Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2–7 angle, C2–7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively. Results. Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24 ± 0.82 vs. 2.83 ± 1.09, P = 0.016). In the multiple logistic regression analysis, a small C2–7 angle during extension (β = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54–0.90) and the slip percentage during flexion (β = 5%, odds ratio: 1.42, 95% CI: 1.09–1.85) were identified as significant predictors of belonging to Group F. Conclusion. Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2–7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column. Level of Evidence: 4

Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment Study Design. A case control study. Objective. The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. Summary of Background Data. Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. Methods. Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. Results. The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = −0.181 rUTr = −0.275), FRRSpl correlated well with VAS (rSpl = −0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = −0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). Conclusion. Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment. Level of Evidence: 3

Preoperative Opioid Weaning Before Major Spinal Fusion: Simulated Data, Real-World Insights Study Design. Retrospective cohort. Objective. To identify gaps in opioid prescription immediately prior to spinal fusion and to study the effect of such simulated "opioid weaning/elimination" on risk of long-term postoperative opioid use. Summary of Background Data. Numerous studies have described preoperative opioid duration and dose thresholds associated with sustained postoperative opioid use. However, the benefit and duration of preoperative opioid weaning before spinal fusion has not been elaborated. Methods. Humana commercial insurance data (2007-Q1 2017) was used to study primary cervical and lumbar/thoracolumbar fusions. More than 5000 total morphine equivalents in the year before spinal fusion were classified as chronic preoperative opioid use. Based on time between last opioid prescription (<14-days' supply) and spinal fusion, chronic opioid users were divided as; no gap, >2-months gap (2G) and >3-months gap (3G). Primary outcome measure was long-term postoperative opioid use (>5000 total morphine equivalents between 3 and 12-mo postoperatively). The effect of "opioid gap" on risk of long-term postoperative opioid use was studied using multiple-variable logistic regression analyses. Results. 17,643 patients were included, of whom 3590 (20.3%) had chronic preoperative opioid use. Of these patients, 41 (1.1%) were in the 3G group and 106 (3.0%) were in the 2G group. In the 2G group, 53.8% patients ceased to have long-term postoperative use as compared with 27.8% in NG group. This association was significant on logistic regression analysis (OR 0.30, 95% CI: 0.20–0.46, P < 0.001). Conclusions. Chronic opioid users whose last opioid prescription was >2-months prior to spinal fusion and less than 14-days' supply had significantly lower risk of long-term postoperative opioid use. We have simulated "opioid weaning" in chronic opioid users undergoing major spinal fusion and our analysis provides an initial reference point for current clinical practice and future clinical studies. Level of Evidence: 3

Relationship Between Pulmonary Function and Thoracic Morphology in Adolescent Idiopathic Scoliosis: A New Index, the "Apical Vertebra Deviation Ratio", as a Predictive Factor for Pulmonary Function Impairment Study Design. A retrospective study. Objective. The aim of this study was to investigate the relationship between thoracic morphology (TM) and pulmonary function (PF) in patients with adolescent idiopathic scoliosis (AIS) and the feasibility of the "apical vertebra deviation ratio (AVDR)" as a predictor of PF impairment. Summary of Background. The PF of AIS is one of the key focuses of clinicians' attention. Early identification of AIS patients who are at risk of developing impaired PF is important for improving patient management. Methods. Preoperative PF and radiographic examination data of 108 patients with thoracic AIS were collected. The following TM data were collected: the costophrenic angle distance (CAD), distance between T1 and mean diaphragm height (T1-diaphragm), T1-T12 height, and AVDR. The correlation coefficient between PF and TM measurements was analyzed, and univariable and multivariable linear regressions were used to determine whether the TM measurements could predict PF. Results. The CAD, T1-diaphragm, and T1-T12 height were significantly positively correlated with forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity, and total lung capacity (r = 0.54–0.74, P < 0.01). A linear equation between CAD and pulmonary volume could be established: FVC (L) = −3.46 + CAD (cm) × 0.27 (R2 = 0.54). If T1-T12 height is included, the correlation is further enhanced (R2 = 0.68). There was a significant negative correlation between the AVDR and predicted values of forced vital capacity (FVC%), FEV1%, predicted values of vital capacity, and predicted values of total lung capacity (r = −0.46 to −0.52, P < 0.01). The AVDR could predict the value of each of these variables. One of the linear equations is as follows: FVC% = 110.70–99.73 × AVDR (R2 = 0.272). Conclusion. The two novel, two-dimensional TM measurements, CAD and AVDR, can be used as moderate to strong predictors of PF outcome in statistical terms. An AVDR >0.2 suggests that the patient may suffer from moderate or severe PF damage. Level of Evidence: 4

Predictive Probability of the Global Alignment and Proportion Score for the Development of Mechanical Failure Following Adult Spinal Deformity Surgery in Asian Patients Study Design. This is a multicenter retrospective review of 257 surgically treated consecutive ASD patients who had a minimum of five fused segments, completed a 2-year follow-up (53 ± 19 yrs, females: 236 [92%]). Objective. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Summary of Background Data. The GAP score is a recently established risk stratification model for MF following ASD surgery. However, the predictive ability of the GAP score is not well studied. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Methods. Comparisons of the immediate postoperative GAP scores between MF the and MF-free groups were performed. We evaluated the discriminative ability of the GAP score based on the area under the receiver operating characteristic curve (AUROC). The Cuzick test was performed to determine whether there is a trend between the GAP score and the incidence of MF or revision surgery. Univariate logistic regression analyses were performed to explore the associations between the GAP score and the incidence of MF or revision surgery. Results. No difference was observed in the GAP score between the MF and MF-free groups (MF vs. MF-free; GAP: 5.9 ± 3.3 vs. 5.2 ± 2.7, P = 0.07). The Cuzick analysis showed no trend between the GAP score and the risk for MF or revision surgery. Likewise, the MF rate was not correlated with the GAP score, as shown by the ROC curve (AUC of 0.56 [95% CI 0.48–0.63], P = 0.124). Univariate logistic regression confirmed no associations between the GAP score and the incidence of MF or revision surgery (MF; moderately disproportioned [MD]: OR: 0.6 [95% CI: 0.3–1.2], P = 0.17, severely disproportioned [SD]: OR: 1.2 [95% CI: 0.6–2.3], P = 0.69, revision surgery; MD: OR: 0.8 [95% CI: 0.2–2.8], P = 0.71, SD: OR: 1.2 [95% CI: 0.9–8.7], P = 0.08). Conclusion. In this multicenter study, in an Asian ASD patient cohort, the GAP score was not associated with the incidence of MF or revision surgery. Additional studies on the predictive ability of the GAP score in different patient cohorts are warranted. Level of Evidence: 3

Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis Study Design. Retrospective radiographic reliability study. Objective. The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation. Summary of Background Data. There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine. Methods. A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements. Results. EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS. Conclusion. EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement. Level of Evidence: 4

Presurgical Short-Term Halo-Pelvic Traction for Severe Rigid Scoliosis (Cobb Angle >120°): A 2-Year Follow-up Review of 62 Patients Study Design. A 2-year follow-up review of 62 patients with severe rigid scoliosis (>120°). Objective. To evaluate the effectiveness and safety of halo-pelvic traction (HPT) for treating severe rigid scoliosis (>120°). Summary of Background Data. Severe rigid scoliosis (>120°) is still a challenge for spine surgeons. A combination of presurgical HPT traction, osteotomy, and internal fixation could be a safe and effective solution for these cases. Methods. We reviewed the records of all the patients with severe rigid scoliosis (>120°) treated with presurgical HPT from 2013 through 2017. Radiographic measurements were performed. The period of traction, estimated blood loss, operation time, complications, and bed rest period were recorded. Results. A total of 62 patients who had 2-year radiological follow-up were included in the study. In 30 patients, vertebral column resection (VCR) was performed aiming to achieve a better correction rate. In patients who received a VCR, the average preoperative Cobb angle was 133.6°, and the average correction rate at 2 years after surgery was 65.4%. Compared with the average height before treatment, at 2 years after surgery the average height was 12.5 cm greater. In patients who did NOT received VCR, the average preoperative Cobb angle was 131.5°, and the average correction rate at 2 years after surgery was 64.1%. Compared with the average height before treatment, at 2 years after surgery the average height was 14.0 cm greater. Common complications during HPT included infected pelvic pins, brachial plexus palsy, and weakness of the lower extremities. No patients experienced permanent neurological deficits or death. Conclusion. For severe rigid scoliosis with a Cobb angle greater than 120°, a combination of short-term presurgical HPT and posterior surgery is an effective and safe solution. After 4 to 6 weeks of presurgical HPT the Cobb angle can be decreased by approximately 50%, providing a favorable condition for spine corrective surgery. Level of Evidence: 3

Three-Dimensional Analysis of Preoperative and Postoperative Rib Cage Parameters by Simultaneous Biplanar Radiographic Scanning Technique in Adolescent Idiopathic Scoliosis: Minimum 2-Year Follow-Up Study Design. Prospective study. Objective. This study aimed to investigate the changes in rib cage deformity in adolescent idiopathic scoliosis (AIS) by comparing the preoperative and postoperative three-dimensional (3D) reconstruction images using simultaneous biplanar radiographic scanning technique (EOS) (EOS Imaging, Paris, France). Summary of Background Data. EOS data are limited for the analyses of preoperative and postoperative rib cage deformity. Methods. A total of 67 Lenke type 1 or 2 AIS patients who underwent surgery (59 females and 8 males) were enrolled in this study. The mean patient age was 14.4 years (range: 11–17 yr). In all patients, posterior corrective fusion was performed with a rod rotation maneuver based on segmental pedicle fixation. Spinal parameters (scoliosis and kyphosis) and rib cage parameters (max thickness, thoracic index (TI), rib hump (RH), surface spinal penetration index (sSPI), end thoracic hump ratio, vertebra-sternum angle, rib vertebral angle difference at the apex, and vertebral lateral decentering), were measured. 3D images were assessed preoperatively and postoperatively at 2-year follow-up. Results. Both main thoracic (MT) and proximal thoracic scoliosis were significantly corrected (51° to 15°, 30° to 17°, P < 0.0001). The rotation of MT apical vertebrae was also significantly corrected (12° to 5°, P < 0.0001). Thoracic kyphosis (T4-T12) significantly increased (13° to 18°, P < 0.0001). Besides, max thickness, TI, and RH demonstrated significant differences between preoperative and postoperative images (P < 0.01). T8–10 sSPI and end thoracic hump ratio decreased significantly postoperatively (P < 0.05). Although surgery significantly decreased vertebra-sternum angle (P < 0.0001), no significant difference was observed between the preoperative and postoperative rib vertebral angle difference (P = 0.32). Following the surgery, vertebral lateral decentering and rib cage volume were significantly increased (P < 0.0001). Conclusions. 3D reconstruction of the rib cage using biplanar standing stereoradiography is useful to evaluate preoperative and postoperative rib cage deformity in patients with AIS. Level of Evidence: 2

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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