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  • Occult thoracic disco-ligamentous Chance fracture in computed tomography: a case report
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-23
    Daniel García-Pérez, Irene Panero, Alfonso Lagares, José A. Alén, Igor Paredes

    Abstract We report on a 46-year-old woman who was involved in a road traffic accident. Neurological examination demonstrated paraplegia, while initial CT showed bilateral pneumothorax and hemothorax, rib fractures, a C2 vertebral body fracture with C2–C3 dislocation and active arterial bleeding at the sacral level. Given the fact that her neurological status did not particularly correspond with what we observed on CT scan, MRI was obtained due to the suspicion that a much more severe occult injury could be present. MRI showed a complete rupture of the posterior ligamentous complex along with the intervertebral disk and the posterior longitudinal ligament at T8–T9 level. The patient underwent minimally invasive posterior fixation with pedicle screws. Chance fractures of the thoracic spine are uncommon. To our knowledge, this is the first report of a pure soft-tissue Chance fracture located in the thoracic spine. Given that the initial CT showed no fracture evidence or vertebral malalignment, a high index of suspicion, based on the mechanism of injury, clinical examination and/or concomitant lesions, is necessary to identify such extremely unstable injury. Early recognition is crucial for appropriate therapy and to minimize the extent of neurological deficit.

    更新日期:2020-01-23
  • Revision surgery for tumors of the thoracic and lumbar spine: causes, prevention, and treatment strategy
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-20
    Pedro Berjano, Riccardo Cecchinato, Alvin Pun, Stefano Boriani

    Abstract Introduction Revision surgery in spine tumor surgery can offer peculiar challenges given the severity of the majority of these lesions and the complexity of surgical procedures that are required. Materials and Methods and Results Based on literature review and on personal experience, surgical site infection, cerebrospinal fluid leakage, tumor recurrence and hardware failures are some of the possible causes of surgical revision in this set of patients. Conclusions The aim of this study is to evaluate the most frequent complications that can lead to revision in spine tumor patients, to provide suggestions on how to prevent these events and to offer reasonable strategies to properly plan and perform a revision surgery. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-21
  • Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-18
    J. Berger-Groch, D. M. Thiesen, D. Ntalos, F. Hennes, M. J. Hartel

    Abstract Purpose Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. Patients and methods Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher − 1, n = 26) was compared with a group with impaired bone density (T-score lower − 1, n = 24). Results A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. Conclusions HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. Level of evidence III. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-21
  • Is there cervical spine muscle weakness in patients with Hirayama disease? A morphological study about cross-sectional areas of muscles on MRI
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-16
    Zhechen Li, Wenming Zhang, Wence Wu, Chao Wei, Xuanwei Chen, Jianhua Lin

    Abstract Purpose Patients with Hirayama disease (HD) present with a larger range of neck flexion and show signs of cervical spine instability. Cervical spine stability largely relies on cervical spine muscles. The purpose of this study was to compare the cross-sectional areas (CSAs) of cervical spine muscles between patients with HD and healthy controls, providing some insights into whether there is cervical spine muscle weakness and incongruence in HD patients. Methods In this retrospective study, cervical spine muscles CSAs of 44 HD patients, as well as that of 44 age- and sex-matched healthy counterparts, were measured on the T2-weighted axial MR images. The ratios of cervical spine muscles CSA to the corresponding vertebral body areas, defined as R-CSAs, and the flexor/extensor CSA ratios were computed and compared between two groups. Results Compared with healthy counterparts, R-CSAs of total cervical spine muscles, total extensors, superficial extensors, and deep flexors were significantly lower in HD patients. HD patients also demonstrated a significantly greater superficial flexor/superficial extensor CSA ratio than the healthy counterparts, indicating a mismatch between superficial flexors CSA and superficial extensors CSA in HD patients. Conclusions In this pioneering study, HD patients had decreased size in most cervical spine muscles and a mismatch between CSAs of superficial flexor and that of superficial extensors. These results indicate generalized weakness and incongruence of cervical spine muscles, which may predispose cervical spine of HD patients to a less stable situation. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-17
  • Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-16
    Yang Li, Saihu Mao, Bo Shi, Zhen Liu, Dun Liu, Xu Sun, Yong Qiu, Zezhang Zhu

    Distal radius and ulna (DRU) classification scheme has been proposed for predicting skeletal maturity in patients with idiopathic scoliosis (IS). However, the utilization of DRU classification scheme in the assessment of growth peak and curve progression in IS was still inconclusive. This study aimed to correlate the distal radius and ulna stages with several indicators for growth potential and to evaluate the predictive value of DRU system for curve progression in braced female IS patients.

    更新日期:2020-01-17
  • Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-16
    Anne Marie Gausel, Stefan Malmqvist, Knut Andersen, Inger Kjærmann, Jan Petter Larsen, Ingvild Dalen, Inger Økland

    The purpose of this study was to investigate the subjective recovery from pregnancy-related pelvic girdle pain (PGP) during the first 6 weeks after delivery and to detect possible risk factors for a poor recovery.

    更新日期:2020-01-16
  • Correction to: Association of vitamin D receptor gene polymorphisms with disc degeneration
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Adam Biczo, Julia Szita, Iain McCall, Peter Pal Varga, the Genodisc Consortium, Aron Lazary

    Unfortunately, the following reference was missed out in the original publication.

    更新日期:2020-01-14
  • Relationship between cervical and global sagittal balance in patients with dropped head syndrome
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Kazuma Murata, Kenji Endo, Takato Aihara, Hidekazu Suzuki, Yuji Matsuoka, Hirosuke Nishimura, Taichiro Takamatsu, Takuya Kusakabe, Asato Maekawa, Kengo Yamamoto

    DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. There is a paucity of literature about the pathophysiology of DHS including knowledge about spinal sagittal alignment. We conducted this study to clarify the relationship between cervical sagittal alignment and global sagittal balance in DHS.

    更新日期:2020-01-14
  • Defining and measuring imaging appropriateness in low back pain studies: a scoping review
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Mark Yates, Crystian B. Oliveira, James B. Galloway, Chris G. Maher

    Abstract Purpose Patients with low back pain (LBP) rarely have serious underlying pathology but frequently undergo inappropriate imaging. A range of guidelines and red flag features are utilised to characterise appropriate imaging. This scoping review explores how LBP imaging appropriateness is determined and calculated in studies of primary care practice. Methods This scoping review builds upon a previous meta-analysis, incorporating articles identified that were published since 2014, with an updated search to capture articles published since the original search. Electronic databases were searched, and citation lists of included papers were reviewed. Inclusion criteria were studies assessing adult LBP imaging appropriateness in a primary care setting. Twenty-three eligible studies were identified. Results A range of red flag features were utilised to determine imaging appropriateness. Most studies considered appropriateness in a binary manner, by the presence of any red flag feature. Ten guidelines were referenced, with 7/23 (30%) included studies amending or not referencing any guideline. The method for calculating the proportion of inappropriate imaging varied. Ten per cent of the studies used the total number of patients presenting with LBP as the denominator, suggesting most studies overestimated the rate of inappropriate imaging, and did not capture where imaging is not performed for clinically suspicious LBP. Conclusion Greater clarity is needed on how we define and measure imaging appropriateness for LBP, which also accounts for the problem of failing to image when indicated. An internationally agreed methodology for imaging appropriateness studies would ultimately lead to an improvement in the care delivered to patients. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-14
  • Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Ho-Joong Kim, Heoung-Jae Chun, Feng Shen, Kyoung-Tak Kang, Bong-Soon Chang, Choon-Ki Lee, Jin S. Yeom

    To analyze pelvic compensation during walking in patients with severe sagittal plane deformity by using motion analysis.

    更新日期:2020-01-14
  • Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Francisco Rodriguez-Fontan, Bradley J. Reeves, Andriy Noshchenko, David Ou-Yang, Christopher J. Kleck, Christopher Cain, Evalina Burger-Van der Walt, Vikas V. Patel

    This is a retrospective, single-institution, cohort study.

    更新日期:2020-01-14
  • Cervical muscle diseases are associated with indefinite and various symptoms in the whole body
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-14
    Takayoshi Matsui, Kazuhiro Hara, Takamasa Kayama, Makoto Iwata, Nobuyuki Shitara, Shuntaro Hojo, Yuzo Endo, Hideoki Fukuoka, Noriko Yoshimura, Hiroshi Kawaguchi

    Patients with various and indefinite symptoms in the whole body occasionally have coincident with stiffness or tenderness of the cervical muscles. This prospective case series examined the effect of local modulation of the cervical muscles in patients with cervical disorders reporting indefinite whole-body symptoms.

    更新日期:2020-01-14
  • Revision strategies for failed adult spinal deformity surgery
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-11
    Carlotta Martini, Francesco Langella, Luca Mazzucchelli, Claudio Lamartina

    The aim of this study is to analyse the results of revision surgery for failed adult spinal deformity patients and to describe the surgical strategy selection process, based on the identification of the main clinical diagnosis responsible for failure.

    更新日期:2020-01-13
  • Reliability and validity of lateral curvature assessments using clinical ultrasound for the patients with scoliosis: a systematic review
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-10
    Hui-Dong Wu, Wei Liu, Man-Sang Wong

    Abstract Purpose Clinical ultrasound is radiation-free, low cost and user friendly, which makes it probable in assessment of scoliosis. Numerous studies have been conducted about the feasibility of using clinical ultrasound to assess scoliosis; thus, an inclusive review of the literature would be beneficial for researchers, clinicians and patients. This study aimed to systematically review the reliability and validity of coronal curvature assessments obtained from different clinical ultrasound imaging methods. Methods A comprehensive search of 6 databases and Google Scholar search engine was performed for retrieving articles assessing reliability and/or validity of spinal curvature measurements obtained from clinical ultrasound. Two reviewers assessed the methodological quality of selected articles independently using criteria appraisal instrument. The results were analysed and synthesized qualitatively using level of evidence method. Results Fourteen articles were included. Thirteen articles investigated both the reliability and validity, of which nine were of high quality; and one article evaluated only the reliability and was of high quality. Totally five ultrasound methods were evaluated. Very high reliability (intra-class correlation coefficient = 0.80–1.00) but limited levels of evidence were found for the majority of the studied ultrasound methods. Almost all the methods showed good to excellent validity (correlation coefficient = 0.76–1.00) but limited to moderate levels of evidence. Conclusion A high level of evidence was found in support of the reliability and validity of the COL (centre of lamina) ultrasound method. Further reliability and validity studies should be conducted to strengthen the level of evidence for those ultrasound methods with moderate, limited or conflicting level of evidence. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-11
  • Correction to: Revision surgery in thoracic disc herniation
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-09
    Stephan Dützmann, Roli Rose, Daniel Rosenthal

    Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

    更新日期:2020-01-09
  • Low back pain: critical assessment of various scales
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-08
    Amit Garg, Hardik Pathak, Maxim V. Churyukanov, Rajendra B. Uppin, Tatyana M. Slobodin

    Abstract Purpose To study the various pain assessment tools based on their psychometric properties and ease of use. Methods Published articles on psychometric properties of pain tools were accessed and data collected for low back pain (LBP)-specific tools, generic tools, neuropathic LBP tools, tools for cognitively impaired patients, and tools for acute LBP. Results Among the LBP-specific tools, Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) have good construct validity and reliability, and responsiveness over short intervals. Quebec Back Pain Disability Scale (QBPDS) gauges only disability and sleep. Among the generic tools, McGill Pain Questionnaire (MPQ), West Haven-Yale Multidimensional Pain Inventory (MPI), and Brief Pain Inventory (BPI) show good responsiveness, but BPI is the only tool validated for LBP. Neuropathic Pain Scale (NPS) and Short Form-MPQ-2 (SF-MPQ-2) are both reliable tools for neuropathic LBP. For cognitively impaired patients, Pain Assessment in Advanced Dementia (PAINAD), Abbey Pain Scale (APS), and Doloplus-2 are all reliable tools, but PAINAD has good construct validity. For acute pain, Clinically Aligned Pain Assessment (CAPA) is reliable and responsive, but presently, unidimensional tools and SF-MPQ-2 are the tools most preferred. Conclusion Based on psychometric properties and ease of use, the best tools for LBP seem to be RMDQ/ODI (among LBP-specific tools), BPI (among generic tools), SF-MPQ-2/NPS (for neuropathic LBP), PAINAD (for cognitively impaired patients), and unidimensional tools and SF-MPQ-2 (for acute pain). Overall, BPI seems to be a tool that can be relied upon the most. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-08
  • Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-08
    A. Rushton, N. R. Heneghan, M. W. Heymans, J. B. Staal, P. Goodwin

    To conduct a meta-analysis to describe clinical course of pain and disability in adult patients post-lumbar discectomy (PROSPERO: CRD42015020806).

    更新日期:2020-01-08
  • Revision surgery of spinal dynamic implants: a literature review and algorithm proposal
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-08
    R. Cecchinato, A. Bourghli, I. Obeid

    Abstract Introduction Dynamic stabilization of the spine has been performed since the 1990s with the double purpose of restoring spinal segmental stability and allowing residual movement at the operated level. When we take into account the different motion-preserving devices and the spinal areas where they are applied, we can identify three categories of spinal implants: anterior cervical, anterior lumbar, and posterior lumbar. However, as in all prosthetic procedures performed in orthopedic surgery, the life span of a joint replacement device is a central topic of discussion, and this is true also for spinal dynamic devices, being revision surgery a complex procedure in specific cases. Materials and methods We performed a literature review on the different dynamic spinal implants and the most common causes of failure, providing clinical cases as illustrative options for revision surgery. Results The review of the literature showed a 11.3% to 22.6% revision rate in posterior lumbar dynamic systems, with a peak of 40.6% in case of adjacent segment disease. In lumbar TDRs, infection and severe dislocations are the most frequent causes of anterior revisions, while posterior pedicle screw fixation could be a suitable option in minimal subsidence or TDR displacement. An algorithm for the planning of revision surgery is proposed. Conclusions Surgical revision of spinal dynamic implants could be a demanding surgery especially in anterior approaches. Anterior cervical revision remains globally safe, but careful preoperative evaluation of vessels and ureter are suggested to avoid intraoperative complications in the lumbar spine. In posterior revision, a proper sagittal alignment of the spine should be restored. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-08
  • Useful and innovative methods for the treatment of postoperative coronal malalignment in adult scoliosis: the “kickstand rod” and “tie rod” procedures
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-06
    Andrea Redaelli, Francesco Langella, Michal Dziubak, Riccardo Cecchinato, Marco Damilano, Giuseppe Peretti, Pedro Berjano, Claudio Lamartina

    Surgical technique description and case series.

    更新日期:2020-01-06
  • Cauda equina syndrome: false-positive diagnosis of neurogenic bladder can be reduced by multichannel urodynamic study
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-06
    Kalyan Kumar Varma Kalidindi, Harvinder Singh Chhabra, Dinesh Suman, Abhishek Mannem, Mohd Rafiq Bhat

    Abstract Background The present consensus suggests urgent surgical decompression if clinical features of cauda equina syndrome (CES) are supported by MRI evidence of pressure on cauda equina. However, clinical diagnosis has a high false-positive rate and MRI is a poor indicator. Though urodynamic studies (UDS) provide objective information about the lower urinary tract symptoms experienced by patients including neurogenic bladder, its role in the diagnosis of CES is not established. Objective To evaluate the ability of an objective urological assessment protocol using uroflowmetry + USG-PVR as screening test and invasive UDS as confirmatory test in patients with suspected CES to rule out neurological impairment of the bladder function. Methods A retrospective study was conducted on all patients who were referred to our institution with equivocal findings of cauda equina syndrome from January 2014 to December 2018 with positive MRI findings. An algorithm using multichannel UDS was followed in all the included patients. Results Out of 249 patients who fulfilled the inclusion criteria, 34 patients (13.65%) had normal uroflowmetry and USG-PVR findings; 211 patients underwent the invasive UDS. Only 141(57.6%) patients out of 245 patients had neurovesical involvement due to compression of cauda equina; 67 patients were treated conservatively using the objective protocol. Only one patient treated conservatively had to undergo emergency decompression for deterioration in symptoms. Conclusions Multichannel UDS provides an objective diagnostic tool to definitively establish the neurovesical involvement in CES. Utilising multichannel UDS as an adjunct to clinical findings avoids the probability of false-positive diagnosis of CES. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-06
  • Chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain from childhood to young adulthood: a systematic review with meta-analysis
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-06
    Amber M. Beynon, Jeffrey J. Hebert, Christopher J. Hodgetts, Leah M. Boulos, Bruce F. Walker

    To report evidence of chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain in children, adolescents, and young adults.

    更新日期:2020-01-06
  • The normal appearance of CT myelograms
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-04
    Brett Rocos, David R. S. Evans, Brathaban Rajayogeswaran, M. John Hutchinson

    CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural compression has been questioned as its normal appearances are not defined in the study. In this study, we examine a series of CT myelograms to define the normal appearances of the neural elements of the spine.

    更新日期:2020-01-04
  • Cross-cultural adaption and validation of the Swedish version of the Core Outcome Measures Index for low-back pain
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-04
    Hannah Granström, Anna Langborg, Anne F. Mannion, Eva Rasmussen-Barr

    There is a wide selection of instruments and questionnaires available, but many are time consuming in their administration, for patients, practitioners and researchers alike. The Core Outcome Measures Index (COMI) is a short, self-administrated, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back pain. The purpose of this study was to cross-culturally adapt the COMI from English to Swedish and to test the face and construct validity and reproducibility of its results in patients with low-back pain.

    更新日期:2020-01-04
  • Revision surgery in cervical spine
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-04
    Luca Papavero, Paolo Lepori, Gregor Schmeiser

    Abstract Purpose To report the indications, presurgical planning, operative techniques, complications for making decisions in cervical revision surgery (CRS). Methods Hundred and two patients underwent CRS over a four-year period. Epidemiological data, the type of first surgery, CRS surgical techniques and complications were retrospectively evaluated. Pain and neurological symptoms were assessed according to the validated Odom criteria. CRS indications were classified into five categories: adjacent segment disease (ASD), infection (INF), implant failure–pseudarthrosis (IFP), non-infectious complication, and deformity. Patients were classified into three groups, according to the approach of the index procedure: anterior, posterior, or 360°. Results The mean patient age was 63 years (59% males). ASD (40%), INF (23%), and IFP (22%) were observed in 85% of patients. CRS was performed with the same approach that was used in the index procedure in 64% of the anterior group and in 83% of the posterior group. In the 360° group, 64% of CRSs was performed with a posterior access. The early complication rate was 4.9%. The outcome was excellent in 19 patients (19%), good in 37 patients (36%), satisfactory in 27 patients (26%), and poor in six patients (6%). Thirteen patients (13%) were lost to follow-up. No implants failed radiologically or required surgical revision. Conclusions CRS required painstaking planning and mastery of a variety of surgical techniques. The results were rewarding in half and satisfactory in a quarter of the patients. The complication rate was lower than expected. In the most complex cases, referral to a specialized center is recommended. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • Cement augmentation of odontoid peg fractures: the effect of cement volume and distribution on construct stiffness
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-04
    Lukas Capek, Petr Rehousek, Petr Henys, Sabri Bleibleh, Edward Jenner, Marketa Kulvajtova, Jiri Skala-Rosenbaum

    Abstract Purpose The cement augmentation of a conventional anterior screw fixation in type II odontoid process fractures for elderly patients significantly increased stiffness and load to failure under anterior–posterior load in comparison with non-augmented fixation. The amount and quality of bone cement are usually taken ad hoc in clinical practise. In this study, we wanted to clarify the role of bone cement amount and its quality to the stiffness of odontoid and vertebrae body junction. Methods Finite-element method was used to achieve different scenarios of cement augmentation. For all models, an initial stiffness was calculated. Model (1) the intact vertebrae were virtually potted into a polymethylmethacrylate base via the posterior vertebral arches. A V-shaped punch was used for loading the odontoid in an anterior–posterior direction. (2) The odontoid fracture type IIa (Anderson–D’Alonzo classification) was achieved by virtual transverse osteotomy. Anterior screw fixation was virtually performed by putting self-drilling titanium alloy 3.5 mm diameter anterior cannulated lag screw with a 12 mm thread into the inspected vertebrae. A V-shaped punch was used for loading the odontoid in an anterior–posterior direction. The vertebrae body was assumed to be non-cemented and cemented with different volume. Results The mean cement volume was lowest for body base filling with 0.47 ± 0.03 ml. The standard body filling corresponds to 0.95 ± 0.15 ml. The largest volume corresponds to 1.62 ± 0.12 ml in the presence of cement leakage. The initial stiffness of the intact C2 vertebrae was taken as the reference value. The mean initial stiffness for non-porous cement (E = 3000 MPa) increased linearly (R2 = 0.98). The lowest stiffness (123.3 ± 5.8 N/mm) was measured in the intact C2 vertebrae. However, the highest stiffness (165.2 ± 5.2 N/mm) was measured when cement leakage out of the odontoid peg occurred. The mean initial stiffness of the base-only cemented group was 147.2 ± 8.4 N/mm compared with 157.9 ± 6.6 N/mm for the base and body cemented group. This difference was statistically significant (p < 0.0061). The mean initial stiffness for porous cement (E = 500 MPa) remains constant. Therefore, there is no difference between cemented and non-cemented junction. This difference was not statistically significant (p < 0.18). Conclusion The present study showed that the low porous cement was able to significantly influence the stiffness of the augmented odontoid screw fixation in vitro, although further in vivo clinical studies should be undertaken. Our results suggest that only a small amount of non-porous cement is needed to restore stiffness at least to its pre-fracture level and this can be achieved with the injection of 0.7–1.2 ml of cement. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • In which cases do surgeons specializing in total disc replacement perform fusion in patients with cervical spine symptoms?
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-02
    Richard D. Guyer, Donna D. Ohnmeiss, Scott L. Blumenthal, Jack E. Zigler

    Abstract Purpose The purpose was to investigate reasons and their frequency for why total disc replacement (TDR) specialty surgeons performed anterior cervical discectomy and fusion (ACDF) rather than TDR. Methods A consecutive series of 464 patients undergoing cervical spine surgery during a 5-year period by three TDR specialty surgeons was reviewed. For each ACDF, the reason for not performing TDR was recorded. Results TDR was performed in 76.7% of patients (n = 356) and ACDF in 23.3% (n = 108). The most common reason for ACDF versus TDR was anatomical (conditions that may not be adequately addressed with TDR and/or may interfere with device function), which occurred in 64 of 464 patients (13.79%). The second most common reason was insurance (denial/lack of coverage n = 17, 3.23%), and deformity/kyphosis not addressable with TDR was noted in 13 (2.80%). Pseudoarthrosis repair led to ACDF in three patients (0.65%), two did not receive TDR due to osteoporosis (0.43%), and in two others (0.43%) ACDF was undertaken due to high risk of heterotopic ossification. There was one case (0.22%) each of: nickel allergy, trauma with posterior element fracture, TDR removal, multiple prior cervical spine surgeries, concern about artifact on future imaging studies, benign osteoblastic bone, and limitation to adequate surgical approach for TDR. ACDF patients’ mean age was significantly greater than TDR patients’ (55.3 vs. 46.7 years; p < 0.01). TDR group had significantly more single-level procedures than ACDF (60.8% vs. 43.5%; p < 0.05). Conclusion The most common reason for ACDF versus TDR was anatomy that may compromise segmental stability and/or TDR functionality. Older age and greater number of operated levels may be related to anatomical factors, primarily significant osteophytes and severely degenerated facets. These factors, as well as deformity/kyphosis, are more common in older patients and require multi-level treatment. This study found that many patients are good cervical TDR candidates; however, even among TDR specialists, ACDF may be preferred where it is prudent to not take undue risks. Graphic abstract These slides can be retrieved under Electronic Supplementary Material

    更新日期:2020-01-04
  • A novel tool to provide predictable alignment data irrespective of source and image quality acquired on mobile phones: what engineers can offer clinicians
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-02
    Teng Zhang, Chuang Zhu, Qiaoyun Lu, Jun Liu, Ashish Diwan, Jason Pui Yin Cheung

    Existing automated spine alignment is based on original X-rays that are not applicable for teleradiology for spinal deformities patients. We aim to provide a novel automated vertebral segmentation method enabling accurate sagittal alignment detection, with no restrictions imposed by image quality or pathology type.

    更新日期:2020-01-04
  • The role of cervical collar in functional restoration and fusion after anterior cervical discectomy and fusion without plating on single or double levels: a systematic review and meta-analysis
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-01
    Luca Ricciardi, Alba Scerrati, Alessandro Olivi, Carmelo Lucio Sturiale, Pasquale De Bonis, Nicola Montano

    Abstract Purpose Even though the anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, a consensus on the real need for prescribing a cervical collar (CC) after surgery is still missing. In fact, the role of external immobilization in decreasing non-fusion rate and implants displacement has not been clarified yet. Methods This study was conducted according to the PRISMA statement. Six different online medical databases were screened. Papers reporting the neck disability index (NDI), cervical range of motion (RoM) and fusion rate after ACDF without plating, on single or multiple levels, for cervical spondylosis were considered for eligibility. Results There were no significant differences in terms of NDI scores at 2 weeks (WMD = 4.502; 95% CI − 5.953, 14.957; p = 0.399; I2 = 65.14%; p = 0.090) and 1-year (WMD = 2.052; 95% CI − 1.386, 5.490 p = 0.242; I2 = 0%; p = 0.793), RoM reduction at 1-year (WMD = 1.597; 95% CI − 5.886, 9.079; p = 0.676; I2 = 0%; p = 0.326) or fusion rate (OR = 1.127; 95% CI 0.387, 3.282; p = 0.827; I2 = 2.166%; p = 0.360). Conclusions The use of a CC after ACDF without plating on single or double levels for cervical spondylosis seems not supported by scientific evidence. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • Multiple injections for low back pain: What’s the future?
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-01
    Oluwatobi O Onafowokan, Nicola F. Fine, Francis Brooks, Oliver M. Stokes, Timothy WR Briggs, Mike Hutton

    To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data.

    更新日期:2020-01-04
  • Safe range of shortening the middle thoracic spine, an experimental study in canine
    Eur. Spine J. (IF 2.513) Pub Date : 2020-01-01
    Le Ji, Xiaoying Ma, Wenchen Ji, Shengli Huang, Min Feng, Jingyuan Li, Lisong Heng, Yajuan Huang, Binshang Lan

    To determine the safe range of shortening the spinal column at middle thoracic spine and to observe the changes in blood-spinal cord barrier (BSCB), microglia/macrophage activation and inducible nitric oxide synthase (iNOS) activity after shortening-induced spinal cord injury.

    更新日期:2020-01-04
  • Correction to: Disc inflammation and Modic changes show an interaction effect on recovery after surgery for lumbar disc herniation
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-31
    Niek Djuric, Xiaoyu Yang, Raymond W. J. G. Ostelo, Sjoerd G. van Duinen, Geert J. Lycklama à Nijeholt, Bas F. W. van der Kallen, Wilco C. Peul, Carmen L. A. Vleggeert-Lankamp

    In Tables 3 and 4: In the first column and row, the text reads “Mixed model test (patients with Modic changes)”. This should have been just “Mixed model”. The complete correct Tables 3 and 4 are given below.

    更新日期:2020-01-04
  • Cross-cultural adaptation and validation of the Polish version of the Spine Functional Index
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-31
    Agnieszka Bejer, Mateusz Kupczyk, Joanna Kwaśny, Angelika Majkut, Krzysztof Moskal, Mateusz Niemiec, Charles Philip Gabel

    Abstract Purpose The purpose of this study was a cross-cultural adaptation of the Spine Functional Index to produce a Polish version (SFI-PL). Further, the psychometric properties were evaluated with standardized criteria patient reported outcome measures (PROMs) in a symptomatic Polish spine population. Methods Linguistic adaptation complied with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines to produce the SFI-PL. Subjects with spine conditions, all areas and multi-area, were recruited from a Polish Specialist Hospital (n = 225, age = 45.7 ± 16.0 years, range 18–87, female = 60%, symptoms duration = 13.93 ± 27.56 weeks, range 5–84). Baseline internal consistency, reliability and validity were examined and included the SFI-PL, Oswestry Disability Index (ODI), Neck Disability Index (NDI), EuroQol 5 Dimensions, 5-level version (EQ-5D-5L) and an 11-point pain Numerical Rating Scale (NRS) with retest at 3–7 days (= 5 days). Practicality for readability was considered within the face and content validity and completion and scoring time calculated. Results Statistical analysis showed excellent internal consistency (α = 0.90) and high test–retest reliability (ICC = 0.98). The error score was determined with the SEM = 3.14 (MDC 90% CI = 7.33%). The construct validity analysis demonstrated strong correlations between the SFI-PL, the NDI (r = 0.73) and the ODI (r = 0.82); moderate with the EQ index value (0.70) and EQ-VAS (r = 0.56). Time to complete (229 s) and score (27 s) were determined. Conclusions The SFI-PL is a psychometrically sound PROM for Polish-speaking patients with spine conditions. The results support previous findings from the original—English and six other language versions for internal consistency, reliability, measurement error and validity. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-26
    Amer Sebaaly, Martin Gehrchen, Clément Silvestre, Khalil Kharrat, Tanvir Johanning Bari, Gabi Kreichati, Maroun Rizkallah, Pierre Roussouly

    Abstract Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5–4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • Efficacy and safety of bone substitutes in lumbar spinal fusion: a systematic review and network meta-analysis of randomized controlled trials
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-23
    Jiang-tao Feng, Xiong-gang Yang, Feng Wang, Xin He, Yong-cheng Hu

    Abstract Purpose A variety of alternative grafts to autologous iliac crest bone (ICBG) have been developed for lumbar spondylodesis, due to frequent complications following ICBG harvest. The optimal alternative graft to ICBG, however, remains elusive till now. The purpose of this study was to compare the efficacy and safety of fusion materials in lumbar degeneration diseases and to provide a ranking spectrum of the grafts. Methods Randomized controlled trials (RCTs) comparing different bone grafts in lumbar arthrodesis were eligible for inclusion. A network meta-analysis was performed for endpoints including fusion rate and incidence of adverse events. Results Twenty-seven RCTs involving 2488 patients and 13 available interventions were included. rhBMP-2 provided the highest fusion rate, being significantly superior to that of ICBG (OR = 0.21, p < 0.001), autograft local bone (ALB) (OR = 0.18, p = 0.022), rhBMP-7 (OR = 0.15, p < 0.001), allograft (OR = 0.13, p = 0.009), and DBM + ALB (OR = 0.07, p = 0.048). The treatment efficacy of allograft could be significantly enhanced by bone marrow concentrate (BMC) supplying (OR = 0.16, p = 0.010). ICBG ranks second on the frequency of complications, which is significantly higher than that of allograft (OR = 0.14, p = 0.041) and ALB (OR = 0.14, p = 0.030). All of the other comparisons showed similar efficacy and safety profiles between groups. Conclusion Ranking spectrums of the efficacy and safety for various bone grafts were provided graphically. Though rhBMP-2 was of the highest success rate, the application should be taken with proper caution because of the widely proposed life-threatening adverse events. ALB, ALB plus synthetic ceramic materials and allograft mixed with BMC were also proved to be potentially effective alternative graft to ICBG. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-23
    Zhian He, Yufu Ou, Bo Hou, Jianxun Wei, Xiaoping Mu

    Abstract Purpose The aim of this study is to investigate, using a meta-analysis, differences in safety and effectiveness between a titanium mesh bone graft and bone graft alone for the treatment of thoracolumbar spinal tuberculosis. Methods PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang (Chinese) and other databases were searched up to April 2019 using predetermined terms. Published studies investigating the safety and effectiveness of a titanium mesh bone graft versus a bone graft alone for the treatment of thoracolumbar spinal tuberculosis were included. Two authors independently extracted the data and evaluated the quality of the included articles. A meta-analysis of relevant outcome indicators was performed using Stata 14 and RevMan 5.3 software. Results We retrieved 8 retrospective studies that met the inclusion criteria and enrolled a total of 401 patients, including 203 patients in the titanium mesh group and 198 in the bone graft only group. Each study was rated as high quality. The meta-analysis results showed no statistically significant differences between the 2 bone graft methods in terms of surgery-related indicators, clinical effectiveness, imaging and complications. Conclusions Both titanium mesh and bone grafts alone are effective for the treatment of thoracolumbar spinal tuberculosis based on safety. However, the results of this study do not support the superiority of titanium mesh bone grafts reported in previous studies. Because of the high risk of bias of the conclusions of a meta-analysis of non-randomized studies and the small sample sizes for some of the most important outcomes, randomized controlled trials are expected to further examine the reliability of the present findings. Graphic abstract

    更新日期:2020-01-04
  • Influence of body position and axial load on spinal stiffness in healthy young adults
    Eur. Spine J. (IF 2.513) Pub Date : 2019-12-18
    Melanie Häusler, Léonie Hofstetter, Petra Schweinhardt, Jaap Swanenburg

    Abstract Purpose This study aimed at investigating the effects of different body positions and axial loads on spinal stiffness to better understand spinal stabilisation mechanisms. Methods The posterior-to-anterior lumbar and thoracic spinal stiffness of 100 young healthy adults (mean age 23 years; 50 females) were measured in three test situations: prone, standing and standing while carrying a load equal to 50% of the subject’s body weight. Each test situation comprised three trials. Results Spinal stiffness in all test situations showed good reliability. Repeated measures analysis of covariance showed significantly higher spinal stiffness in standing than in the prone position [F(1/1694) = 433.630, p < 0.001]. However, spinal stiffness was significantly lower when standing while carrying a load of 50% of the body weight than when standing without additional load [F(1/1494) = 754.358, p < 0.001]. Conclusion This study showed that spinal lumbar and thoracic stiffness increases when body position is changed from prone to standing. Additional axial load of 50% of the subject’s body weight results in reduced spinal stiffness during standing. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2020-01-04
  • Minor effect of loss to follow-up on outcome interpretation in the Swedish spine register.
    Eur. Spine J. (IF 2.513) Pub Date : null
    P Endler,P Ekman,F Hellström,H Möller,P Gerdhem

    BACKGROUND AND PURPOSE Loss to follow-up in observational studies may skew results and hamper study reliability. We evaluated the importance of loss to follow-up in the Swedish spine register. PATIENTS Patients operated in the lumbar spine and scheduled for a postal questionnaire follow-up during part of 2016 were identified. Out of the 351 patients, 203 had responded. After multiple attempts, 115 of the 148 non-responders were reached; 68 returned the complete questionnaire; and 47 answered a brief questionnaire by phone. Analyses were made with the Chi-square test, analysis of covariance or logistic regression. Some analyses were adjusted. RESULTS At baseline, the non-responders were younger than the responders (55 vs 61 years, p < 0.001) and had higher Oswestry Disability Index (ODI) (54 vs 48, p = 0.003), lower SF-36 physical component summary score (PCS) (36 vs 40, p = 0.011) and lower EQ-5D (0.17 vs 0.27, p = 0.018). Mean back pain, leg pain, ODI, EQ-5D, SF-36 mental component summary score (MCS) improved significantly in both groups (all p < 0.001). SF-36 PCS did not improve in the non-responder group (p = 0.063). Non-responders perceived less improvement in back pain (global assessment back 60% vs 72%, p = 0.002). At follow-up, there were no differences in patient-reported outcome measures between the groups (all p ≥ 0.06), with the exception of a lower SF-36 MCS among the non-responders (p = 0.015). INTERPRETATION After surgery for lumbar spine degenerative disorders, non-responders achieve similar outcome as responders in the Swedish spine register, with the exception of a lower mental health and less perceived improvement in back pain. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Does image guidance decrease pedicle screw-related complications in surgical treatment of adolescent idiopathic scoliosis: a systematic review update and meta-analysis.
    Eur. Spine J. (IF 2.513) Pub Date : null
    Andrew Chan,Eric Parent,Jason Wong,Karl Narvacan,Cindy San,Edmond Lou

    PURPOSE Surgical treatment of severe adolescent idiopathic scoliosis (AIS) with posterior spinal instrumentation and fusion with pedicle screws is common, requiring careful screw insertion to prevent pedicle breaches and neurologic complications. Image guidance has been suggested to improve breach rates, though the radiation risk for AIS precludes its common usage. The purpose of this systematic review and meta-analysis was to compare the breach rates and screw-related complications for AIS patients undergoing spine surgery with pedicle screws between freehand screw insertion and image guidance methods. METHODS A comprehensive search of MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science databases was conducted. Two reviewers independently screened abstracts, full-texts, extracted data and performed risk of bias assessment using the QUIPS quality appraisal tool. Level of evidence summary statements were formulated based on consistency and quality of reporting. RESULTS Ninety-four studies were found, with 18 studies of moderate risk of bias or better. Moderate evidence from two head-to-head studies shows CT guidance has lower breach rates than freehand methods (OR 0.28 [0.20-0.40, I2 = 1%]), with no complications in either study. From individual studies, moderate evidence showed lower breach rates for image guidance versus freehand methods (13%, I2 = 98% vs. 20%, I2 = 95%). Complication rates were conflicting (0-1.6% for image guidance, 0-1.7% for freehand). Moderate evidence showed increased surgical time for image guidance versus freehand (257.7 min vs. 226.8 min). CONCLUSIONS Meta-analyzed breach rates show moderate evidence of decreased breaches with CT navigation compared with freehand methods. Complication rates remain unknown due to the low complication rates from small sample sizes. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Biomechanics of sacropelvic fixation: a comprehensive finite element comparison of three techniques.
    Eur. Spine J. (IF 2.513) Pub Date : null
    Fabio Galbusera,Gloria Casaroli,Ruchi Chande,Derek Lindsey,Tomaso Villa,Scott Yerby,Ali Mesiwala,Matteo Panico,Enrico Gallazzi,Marco Brayda-Bruno

    PURPOSE Sacropelvic fixation is frequently used in combination with thoracolumbar instrumentation for complex deformity correction and is commonly associated with pseudoarthrosis, implant failure and loosening. This study compared pedicle screw fixation (PED) with three different sacropelvic fixation techniques, namely iliac screws (IL), S2 alar-iliac screws (S2AI) and laterally placed triangular titanium implants (SI), all in combination with lumbosacral instrumentation, accounting for implant micromotion. METHODS Existing finite element models of pelvis-L5 of three patients including lumbopelvic instrumentation were utilized. Moments of 7.5 Nm in the three directions combined with a 500 N compressive load were simulated. Measured metrics included flexibility, instrumentation stresses and bone-implant interface loads. RESULTS Fixation effectively reduced the sacroiliac flexibility. Compared to PED, IL and S2AI induced a reduction in peak stresses in the S1 pedicle screws. Rod stresses were mostly unaffected by S2AI and SI, but IL demonstrated a stress increase. In comparison with a previous work depicting full osteointegration, SI was found to have similar instrumentation stresses as those due to PED. CONCLUSIONS Fixation with triangular implants did not result in stress increase on the lumbosacral instrumentation, likely due to the lack of connection with the posterior rods. IL and S2AI had a mild protective effect on S1 pedicle screws in terms of stresses and bone-implant loads. IL resulted in an increase in the rod stresses. A comparison between this study and previous work incorporating full osteointegration demonstrates how these results may be applied clinically to better understand the effects of different treatments on patient outcomes. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • ISSLS PRIZE IN BASIC SCIENCE 2020: Beyond microstructure-circumferential specialization within the lumbar intervertebral disc annulus extends to collagen nanostructure, with counterintuitive relationships to macroscale material properties.
    Eur. Spine J. (IF 2.513) Pub Date : null
    Tyler W Herod,Samuel P Veres

    PURPOSE To determine whether the annulus of lumbar intervertebral discs contains circumferential specialization in collagen nanostructure and assess whether this coincides with functional differences in macroscale material properties. METHODS Anterior and posterior disc wall samples were prepared from 38 mature ovine lumbar segments. Regional differences in molecular thermal stability and intermolecular network integrity of the annulus' tension-bearing collagen fibres were examined with hydrothermal isometric tension (HIT) analysis, with and without preceding NaBH4 treatment to stabilize labile crosslinks. Energetics of collagen denaturation were studied by differential scanning calorimetry (DSC). Tensile mechanics of annular lamellae were studied using oblique sagittal bone-disc-bone samples loaded to rupture. Annular failure characteristics of the ruptured test segments were compared via microscopy of serial sections. RESULTS HIT showed that tension-bearing collagen fibres of the posterior annulus were composed of collagen molecules with significantly greater thermal stability and intermolecular network integrity than those of the anterior annulus. NaBH4 treatment confirmed that labile intermolecular crosslinks did not significantly contribute to network integrity in either region. Regional differences seen in DSC were smaller than those observed in HIT, indicating structural similarities in annular collagen outside of the main fibre bundles. Mechanical testing showed that the posterior annulus was significantly weaker than the anterior annulus. For both regions, ultimate tensile strengths of annular fibres were significantly greater than those previously reported. Ruptures in both regions were predominantly due to annular failure. CONCLUSION Specializations in collagen nanostructure exist between different circumferential regions of the annulus and coincide with significant differences in material properties. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • The contradictory effect of macrophage-related cytokine expression in lumbar disc herniations: a systematic review.
    Eur. Spine J. (IF 2.513) Pub Date : null
    N Djuric,G C M Lafeber,C L A Vleggeert-Lankamp

    PURPOSE Sciatic symptoms due to lumbar disc herniation are likely to be caused not solely by mechanical compression of the nerve root, but also by pain-inducing elements from inflammatory processes. Key components in the inflammatory reaction are M1 and M2 macrophages, with the M1 type being associated with pro-inflammatory processes and M2 with anti-inflammatory-processes. METHOD The present systematic review summarizes all studies on associations between M1 and M2 macrophages and their related inflammation factors and pain symptoms in lumbar disc herniations. Literature search was performed using an optimally sensitive search string. Studies were selected for inclusion by means of predefined inclusion and exclusion criteria and subsequently graded for risk of bias. A total of 14 studies were included. Overall risk of bias was moderate (8/14), and three studies had high risk of bias and three has low risk of bias. RESULTS Regarding M1-related cytokines, high levels of TNF-α, TNFR1, IL-6, IL-8, and IFN-γ were all associated high VAS scores. In contrast, high levels of TNFR2 were associated with lower VAS scores. Moreover, no associations were found for IL-1a and IL-1β. Results regarding M2-related cytokines revealed the opposite: high levels of both IL-4 and IL-10 were associated with lower VAS scores. No associations were established for TGF-β. Moreover, the presence of macrophages (CD68) was negatively associated with VAS scores. CONCLUSION While M1-related pro-inflammatory cytokines worsen pain symptoms, M2-related anti-inflammatory cytokines alleviate pain symptoms. Nevertheless, the present evidence is limited, and further research on the underlying pathophysiological mechanism in sciatica is required. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Association of vitamin D receptor gene polymorphisms with disc degeneration.
    Eur. Spine J. (IF 2.513) Pub Date : null
    Adam Biczo,Julia Szita,Iain McCall,Peter Pal Varga,,Aron Lazary

    PURPOSE Numerous candidate genes and single-nucleotide polymorphisms (SNPs) have been identified in the background of lumbar disc degeneration (LDD). However, in most of these underpowered studies, definitions of LDD are inconsistent; moreover, many of the findings have not been replicated and are contradictory. Our aim was to characterize LDD by well-defined phenotypes and possible endophenotypes and analyse the association between these and candidate vitamin D receptor (VDR) gene polymorphisms on a large (N = 1426) dataset. METHODS Seven candidate VDR SNPs were genotyped. Individual association, haplotype and gene-gene interaction analyses were performed. All degenerative endophenotypes were significantly associated with one or more candidate VDR gene variants. RESULTS Haplotype analyses confirmed the association between the 3'-end VDR variants (BsmI, ApaI, TaqI) and Modic changes as well as the relationship of 5'-end variants (Cdx2, A1012G) with endplate defects. We also found significant interactions between the 3'- and 5'-end regulatory regions and endplate defects. Based on our results, VDR and its gene variants are highly associated with specific degenerative LDD endophenotypes. CONCLUSION Understanding relationships between phenotype and gene variants is crucial for describing the pathways leading to the multifactorial, polygenic degeneration process and LDD-related conditions. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • ISSLS prize in clinical science 2020: the reliability and interpretability of score change in lumbar spine research.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-11-25
    C Parai,O Hägg,B Lind,H Brisby

    PURPOSE A statistically significant score change of a PROM (Patient-Reported Outcome Measure) can be questioned if it does not exceed the clinically Minimal Important Change (MIC) or the SDC (Smallest Detectable Change) of the particular measure. The aim of the study was to define the SDC of three common PROMs in degenerative lumbar spine surgery: Numeric Rating Scale (NRSBACK/LEG), Oswestry Disability Index (ODI) and Euroqol-5-Dimensions (EQ-5DINDEX) and to compare them to their MICs. The transition questions Global Assessment (GABACK/LEG) were also explored. METHODS Reliability analyses were performed on a test-retest population of 182 symptomatically stable patients, with similar characteristics as the Swespine registry population, who underwent surgery for degenerative lumbar spine conditions 2017-2018. The MIC values were based on the entire registry (n = 98,732) using the ROC curve method. The ICC for absolute agreement was calculated in a two-way random-effects single measures model. For categorical variables, weighted kappa and exact agreement were computed. RESULTS For the NRS, the SDC exceeded the MIC (NRSBACK:3.6 and 2.7; NRSLEG: 3.7 and 3.2, respectively), while they were of an equal size of 18 for the ODI. The gap between the two estimates was remarkable in the EQ-5DINDEX, where SDC was 0.49 and MIC was 0.10. The GABACK/LEG showed an excellent agreement between the test and the retest occasion. CONCLUSION For the tested PROM scores, the changes must be considerable in order to distinguish a true change from random error in degenerative lumbar spine surgery research. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • 19th SGS annual meeting.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-11-05

    更新日期:2019-11-01
  • Vertebral rotation estimation from frontal X-rays using a quasi-automated pedicle detection method.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-10-05
    Shahin Ebrahimi,Laurent Gajny,Claudio Vergari,Elsa D Angelini,Wafa Skalli

    PURPOSE Measurement of vertebral axial rotation (VAR) is relevant for the assessment of scoliosis. Stokes method allows estimating VAR in frontal X-rays from the relative position of the pedicles and the vertebral body. This method requires identifying these landmarks for each vertebral level, which is time-consuming. In this work, a quasi-automated method for pedicle detection and VAR estimation was proposed. METHOD A total of 149 healthy and adolescent idiopathic scoliotic (AIS) subjects were included in this retrospective study. Their frontal X-rays were collected from multiple sites and manually annotated to identify the spinal midline and pedicle positions. Then, an automated pedicle detector was developed based on image analysis, machine learning and fast manual identification of a few landmarks. VARs were calculated using the Stokes method in a validation dataset of 11 healthy (age 6-33 years) and 46 AIS subjects (age 6-16 years, Cobb 10°-46°), both from detected pedicles and those manually annotated to compare them. Sensitivity of pedicle location to the manual inputs was quantified on 20 scoliotic subjects, using 10 perturbed versions of the manual inputs. RESULTS Pedicles centers were localized with a precision of 84% and mean difference of 1.2 ± 1.2 mm, when comparing with manual identification. Comparison of VAR values between automated and manual pedicle localization yielded a signed difference of - 0.2 ± 3.4°. The uncertainty on pedicle location was smaller than 2 mm along each image axis. CONCLUSION The proposed method allowed calculating VAR values in frontal radiographs with minimal user intervention and robust quasi-automated pedicle localization. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Bacteria: back pain, leg pain and Modic sign-a surgical multicentre comparative study.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-10-03
    Peter Fritzell,Christina Welinder-Olsson,Bodil Jönsson,Åsa Melhus,Siv G E Andersson,Tomas Bergström,Hans Tropp,Paul Gerdhem,Olle Hägg,Hans Laestander,Björn Knutsson,Anders Lundin,Per Ekman,Eric Rydman,Mikael Skorpil

    PURPOSE To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence. METHODS Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33-49) and 20 control patients with scoliosis (median age 17, IQR 15-20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes. RESULTS No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated. CONCLUSIONS Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Surgical outcome differences between the 3D subtypes of right thoracic adolescent idiopathic scoliosis.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-09-26
    Saba Pasha,Keith Baldwin

    BACKGROUND The current classifications of adolescent idiopathic scoliosis (AIS) aim to guide surgical decision making. However, variance exists within treatment recommendations and suboptimal outcomes have been observed while following these guidelines based on two-dimensional images. We used previously developed 3D classification for right thoracic AIS patients and aimed to determine the variation in surgical decision making and the risk of suboptimal outcomes in each subtype according to our classification. METHODS Seventy-six right thoracic AIS patients with 2-year follow-up were included retrospectively. Five 3D preoperative subgroups were determined based on a previous classification system. The upper and lower instrumented vertebrae (UIV and LIV) and the radiographic surgical outcomes at 2-year [frontal balance (FB), proximal junctional kyphosis (PJK), and adding on] were compared between the subtypes. RESULTS The fusion length and the rate of radiographic suboptimal outcomes were statistically different between the five groups. LIV at T12 in Type 1 and UIV at T2 in Type 2 were associated with improved FB and lower PJK, respectively. Type 3 had the highest rate of suboptimal FB and developing PJK. Type 4 had the longest fusion, and suboptimal FB was observed in 42% of the patients independent from the LIV level. Type 5 had the lowest rate of unsatisfactory radiographic outcomes at 2 years. CONCLUSION Following the preoperative 3D classification of the AIS patients, we showed that the UIV and LIV selection has a different impact on the surgical outcomes in each of the five subtypes. The proposed 3D classification has the potential for risk stratification following a posterior spinal surgery in right thoracic AIS. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Factors leading to postoperative pain in adolescent idiopathic scoliosis patients including sagittal alignment and lumbar disc degeneration.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-09-26
    Tetsuhiko Mimura,Shota Ikegami,Hiroki Oba,Masashi Uehara,Michihiko Koseki,Jun Takahashi

    PURPOSE This study examined for factors contributing to postoperative pain in adolescent idiopathic scoliosis (AIS), including those of sagittal alignment and lumbar disc degeneration. METHODS A total of 101 consecutive patients who underwent posterior spinal fusion for AIS and who were followed for a minimum of 2 years were included in this investigation. We assessed Lenke curve type, age, Risser grade, body mass index (BMI), radiographic parameters, lumbar disc degeneration, correction rate, number of fused vertebrae, lowest instrumented vertebra, preoperative SRS-22r survey mental health score, and pre- and postoperative SRS-22r survey pain scores. Univariate and multivariate general linear models were employed to identify factors associated with pain 2 years after AIS surgery. RESULTS In multivariate analysis, patients with a lower preoperative pain score (i.e. higher pain) (P < 0.01) or higher postoperative T5-12 kyphotic angle (P = 0.02) had a worsened pain score 2 years after surgery. There were no remarkable differences for Lenke curve type, age, BMI, coronal radiographic parameters, lumbar disc degeneration, correction rate, number of fused vertebrae, or lowest instrumented vertebra. Higher preoperative Risser grade (P = 0.01) and lower preoperative SRS-22r mental health score (P < 0.01) were significantly related to a diminished preoperative SRS-22r pain score. CONCLUSION While preoperative lumbar disc degeneration was not associated with pre- or postoperative pain in AIS, higher preoperative pain and higher postoperative T5-12 kyphotic angle had significant associations with augmented postoperative pain. Higher preoperative pain was related to increased Risser grade and lower mental health score. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-09-16
    Sipeng Li,Hongtao Rong,Xueqin Zhang,Zhengshan Zhang,Chao Wang,Rui Tan,Yi Wang,Ting Zheng,Tao Zhu

    OBJECTIVES To systematically evaluate the impact of topical vancomycin powder for microbial profile in spinal surgical site infections. METHODS All available literature regarding the topical use of vancomycin powder to prevent postoperative spinal infections was retrieved from the MEDLINE, EMBASE, and Cochrane databases starting from the creation date and up until September 30, 2018. RESULTS A total of 21 studies involving 15,548 patients were reviewed. The combined odds ratio showed that topical use of vancomycin powder was effective for reducing the incidence of gram-positive bacterial infections in spinal surgical sites (OR 0.41, P < 0.00001) without affecting its efficacy in the prevention of polymicrobial infections (OR 0.30, P = 0.03). Additionally, it could significantly reduce the infection rate of methicillin-resistant staphylococcus (OR 0.34, P < 0.0001). However, topical vancomycin powder showed no advantage for preventing gram-negative bacterial infections (OR 0.94, P = 0.75). CONCLUSIONS Topical administration of vancomycin powder may not increase the rates of gram-negative bacterial or polymicrobial infections in spinal surgical sites. On the contrary, it can significantly reduce the infection rates of gram-positive bacteria, methicillin-resistant staphylococcus (MRS) and microorganism. Of course, the topical vancomycin powder cannot change the rates of gram-negative bacterial infections, which may be related to the antimicrobial spectrum of vancomycin. Due to the limited number of articles included in this study, additional large-scale and high-quality studies are needed to provide more reliable clinical evidence.

    更新日期:2019-11-01
  • CT-based study of vertebral and intravertebral rotation in right thoracic adolescent idiopathic scoliosis.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-09-13
    Rob C Brink,Jelle F Homans,Tom P C Schlösser,Marijn van Stralen,Koen L Vincken,Lin Shi,Winnie C W Chu,Max A Viergever,René M Castelein,Jack C Y Cheng

    PURPOSE To define the longitudinal rotation axis around which individual vertebrae rotate, and to establish the various extra- and intravertebral rotation patterns in thoracic adolescent idiopathic scoliosis (AIS) patients, for better understanding of the 3D development of the rotational deformity. METHODS Seventy high-resolution CT scans from an existing database of thoracic AIS patients (Cobb angle: 46°-109°) were included to determine the vertebral axial rotation, rotation radius, intravertebral axial rotation, and local mechanical torsion for each spinal level, using previously validated image processing techniques. RESULTS For all levels, the longitudinal rotation axis, from which the vertebrae rotate away from the midline, was localized posterior to the spine. The axis became closer to the spine at the apex: apex, r = 11.5 ± 5.1 cm versus two levels above (radius = 15.8 ± 8.5 cm; p < 0.001) and beneath (radius = 14.2 ± 8.2 cm; p < 0.001). The vertebral axial rotation, intravertebral axial rotation, and local mechanical torsion of the vertebral bodies were largest at the apex (21.9° ± 7.4°, 8.7° ± 13.5° and 3.0° ± 2.5°) and decreased toward the neutral, junctional zones (p < 0.001). CONCLUSION In AIS, the vertebrae rotate away around an axis that is localized posterior to the spine. The distance between this axis and the spine is minimal at the apex and increases gradually to the neutral zones. The vertebral axial rotation is accompanied by smaller amounts of intravertebral rotation and local mechanical torsion, which increases toward the apical region. The altered morphology and alignment are important for a better understanding of the 3D pathoanatomical development of AIS and better therapeutic planning for bracing and surgical intervention. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Evaluation of a computer-aided method for measuring the Cobb angle on chest X-rays.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-08-26
    Yaling Pan,Qiaoran Chen,Tongtong Chen,Hanqi Wang,Xiaolei Zhu,Zhihui Fang,Yong Lu

    OBJECTIVES To automatically measure the Cobb angle and diagnose scoliosis on chest X-rays, a computer-aided method was proposed and the reliability and accuracy were evaluated. METHODS Two Mask R-CNN models as the core of a computer-aided method were used to separately detect and segment the spine and all vertebral bodies on chest X-rays, and the Cobb angle of the spinal curve was measured from the output of the Mask R-CNN models. To evaluate the reliability and accuracy of the computer-aided method, the Cobb angles on 248 chest X-rays from lung cancer screening were measured automatically using a computer-aided method, and two experienced radiologists used a manual method to separately measure Cobb angles on the aforementioned chest X-rays. RESULTS For manual measurement of the Cobb angle on chest X-rays, the intraclass correlation coefficients (ICC) of intra- and inter-observer reliability analysis was 0.941 and 0.887, respectively, and the mean absolute differences were < 3.5°. The ICC between the computer-aided and manual methods for Cobb angle measurement was 0.854, and the mean absolute difference was 3.32°. These results indicated that the computer-aided method had good reliability for Cobb angle measurement on chest X-rays. Using the mean value of Cobb angles in manual measurements > 10° as a reference standard for scoliosis, the computer-aided method achieved a high level of sensitivity (89.59%) and a relatively low level of specificity (70.37%) for diagnosing scoliosis on chest X-rays. CONCLUSION The computer-aided method has potential for automatic Cobb angle measurement and scoliosis diagnosis on chest X-rays. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Clinical photography in severe idiopathic scoliosis candidate for surgery: is it a useful tool to differentiate among Lenke patterns?
    Eur. Spine J. (IF 2.513) Pub Date : 2019-08-10
    Juan Bago,Javier Pizones,Antonia Matamalas,Elisa D'Agata

    PURPOSE Clinical photography has proven to be reliable for posture assessment in adolescents and young adults with idiopathic scoliosis. This paper attempts to elucidate whether clinical photography is capable of distinguishing the distinctive characteristics in trunk deformity of the different Lenke patterns in patients with severe scoliosis candidate for surgery. METHODS One hundred and seventy-three patients (82% women), average age of 20.8 years and average largest curve magnitude of 58.7° were included. PA standing full-spine X-rays and digital photographs from the back of the trunk were measured. RADIOLOGICAL MEASUREMENTS It is used to measure magnitude of the proximal thoracic (PTC), main thoracic (MTC) and thoracolumbar/lumbar (TL/LC) curves, T1 tilt and the clavicle-rib intersection angle. PHOTOGRAPHIC MEASUREMENTS It is used to measure shoulder height angle, axilla height angle, waist height angle (WHA), right and left waist angles and trunk areas. STATISTICAL ANALYSIS One-way ANOVA to test mean differences among Lenke types for radiological and photographic measurements was performed. ROC curve analysis was conducted to find out cutoff values in photographic measurements to differentiate among curve patterns. RESULTS Most radiological and photographic measurements differ among curve patterns. On ROC curve analysis, solid cutoff values were found for WHA (AUC = 0.8), left waist angle (AUC = 0.81), right waist angle (AUC = 0.81) and the difference between left and right waist angles (AUC = 0.86) to differentiate between types 1 and 2 and the other three types (3, 5 and 6). CONCLUSIONS Clinical photography is a valid method for assessing trunk asymmetry in severe idiopathic scoliosis. Specifically, for waist area measurements, robust cutoff values can be determined to discriminate among different curve patterns according to Lenke classification. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • A critical thoracic kyphosis is required to prevent sagittal plane deterioration in selective thoracic fusions in Lenke I and II AIS.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-08-08
    Dominique A Rothenfluh,Alexandra Stratton,Colin Nnadi,Nicolas Beresford-Cleary

    PURPOSE Thoracic hypokyphosis following AIS correction may be associated with reduced lumbar lordosis with potential adverse effects on the global sagittal balance. In the present study, we were interested in how the amount of thoracic kyphosis influences the sagittal profile and balance in selective thoracic (STF) and thoracolumbar fusions. METHODS Out of 154 patients, 86 patients had correction of AIS Lenke I or II with a side-loading pedicle screw system and completed a 2-year follow-up. Patient factors such as age, Risser grade, lowest and upper instrumented vertebra, and lumbar modifier were recorded. Coronal Cobb and sagittal parameters were measured using Surgimap. Statistical analysis according to distributions and multiple linear and logistic regressions was performed using STATA for Mac v13. RESULTS In STF, logistic regression against post-operative change in SVA versus thoracic kyphosis allowed calculation of a critical thoracic kyphosis of 23° (ROC AUC 0.65, spec 0.70, sens 0.63), below which deterioration of the sagittal vertical axis is more likely (PPV 71.4%). Patients with hypokyphosis exhibited an increase in the SVA (pre-operative 7.2 ± 37.1 mm vs. 23.1 ± 27.6 mm at 2 years, p = 0.0164), whereas it was maintained from pre-operative to 2 years post-operative if thoracic kyphosis is above 23° (pre-operative 2.5 ± 28.9 mm vs. 5.4 ± 26.9 mm at 2 years, p = 0.579). CONCLUSION A critical thoracic kyphosis of 23° and more should be aimed for in hypokyphotic patients to potentially avoid post-operative sagittal plane deterioration with mechanical and likely also clinical consequences. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
  • Concomitant low-grade isthmic L5-spondylolisthesis does not affect the course of adolescent idiopathic scoliosis.
    Eur. Spine J. (IF 2.513) Pub Date : 2019-08-04
    Dietrich Schlenzka,Mauno Ylikoski,Mikko Poussa,Timo Yrjönen,Leena Ristolainen

    BACKGROUND Scoliosis with spondylolisthesis was described in 4.4-48%. No information on clinical impact or outcome is available. PURPOSE To determine the prevalence of this pathology and to investigate its affect on the course of adolescent idiopathic scoliosis (AIS). METHODS A retrospective comparative study using patients' records, radiographs, the national inpatient registry, and Patient-rated outcome measures (PROM): Oswestry disability index (ODI), modif.SRS-24 questionnaire, WHO-Quality of life index (WHOQoL), Numerical rating scale (NRS) for pain. Clinical follow-up time was 4.4 (4.3) years, and follow-up rate was 95%. PROM follow-up time 26.4 (2.8) years χ2 statistics and t-tests were applied. Significance threshold was set at P < 0.05. RESULTS Out of 1531 consecutive Caucasian AIS patients, aged 13.9 (1.8) years, primary curve 29.2 (11.5) drs., 120 (7.8%) had low-grade isthmic L5-slip of mean 15.0 (8.3)% (Study group = S). The distribution of the curve types in the study group was comparable to the remaining 1411 patients with AIS only. In comparison with a pair-matched control group (C) at admission, back pain interfering with activities of daily living had 4.2% of the study group and 1.7% of the control group, at clinical follow-up 2.6/4.2% resp. (n.s.). Between groups S/C, there was no significant difference concerning scoliosis treatment: observation 38.3/45.8%, bracing 48.3/46.6%, surgery 10.8/10.2%. Results of treatment were equal in both groups. Long-term outcomes (ODI, SRS-24, WHOQoL, NRS-back/leg pain) were comparable. CONCLUSIONS The prevalence of low-grade isthmic L5-spondylolisthesis in AIS patients was 7.8%. The presence of low-grade isthmic spondylolisthesis did not influence the curve type of AIS nor did it affect the course or long-term outcome. These slides can be retrieved under Electronic Supplementary Material.

    更新日期:2019-11-01
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