Degenerative Spinal Disorders Research Articles

The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine.

Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery. Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling. From 731 eligible patients, 547 (61.0 ± 12.5years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3months' FU in men (β = 0.36) and 12months' FU in men and women (both β = 0.20) (all p < 0.001). The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.

Do TLIF and PLIF Techniques Differ in Perioperative Complications? - Comparison of Complications Rates of Two High Volume Centers.

Retrospective bicentric Cohort Study. Posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF) have been clinically proven for the surgical treatment of degenerative spinal disorders. Despite many retrospective studies, the superiority of either technique has not been proven to date. In the literature, the complication rate of the conventional PLIF technique is reported to be significantly higher, but with inconsistent complication recording. In this retrospective bicentric study, a less invasive PLIF technique was compared with the conventional TLIF technique and complications were recorded using the validated SAVES V2 classification system. 1142 patients underwent PLIF (702) or TLIF (n = 440) up to 3 levels in two specialized centers. Epidemiological data, intra- and postoperative complications during hospitalization and after discharge were analyzed according to SAVES V2. The overall complication rate was 13.74%. TLIF-patients had slightly significant more complications than PLIF-patients (TLIF = 16.6%/PLIF = 11.9%, P = .0338). Accordingly, complications during revision surgeries were more frequent in the first cohort (TLIF = 20.9%/PLIF = 12.6%; P = .03252). In primary interventions, the surgical technique did not correlate with the complication rate (TLIF = 12.4%/PLIF = 11.7%). There were no significant differences regarding severity of complications. An important component of this work is the complication recording according to a uniform classification system (SAVES V2). In contrast to previous literature, we could demonstrate that there is not a significant difference between the two surgical techniques.

Spine Surgery in a Geriatric Population. Is it Really Different?

Spinal degenerative disorders are a major cause of morbidity in the elderly resulting in high dependency. Most of them have a trend to be managed conservatively considering age, comorbidities, and apprehensions of surgical complications. Surgical intervention at early stage with appropriate indications can have better outcomes rather than conservative management in fit patients. The objective of the study is to evaluate the functional outcome in geriatric patients > 60 years who have undergone various spinal procedures for degenerative spine. The study is retrospective, which includes all cases of spinal degenerative disease operated between 2014 and 2016. They were divided into geriatric (>60 years) and non-geriatric cohorts. These include all patients undergoing spinal decompression and/or instrumentation for degenerative disorders of the spine. Patients were interviewed for their functional outcomes in the follow-up period. A total of 184 spine cases were operated upon by a single surgeon, out of which a total of 139 cases were operated for the spinal degenerative condition. Forty-eight patients underwent lumbar spinal fusion procedures, 67 underwent non-instrumented lumbar decompression, and 24 patients underwent cervical procedures. These were further divided into 65 geriatric cases and 74 non-geriatric cases. The outcome was assessed with improvement and functional outcomes for spinal disability. Statistical analysis was performed using SPSS 20. It is concluded that surgical intervention for spinal problems in geriatric patients is not different from the general population. The outcome is also satisfactory provided, the choice of surgical procedure as per its indication is appropriate. The usual preoperative evaluation for the geriatric age group is very important. The performance status before surgery and the comorbidities have a direct bearing on the outcome in these patients.

Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery

The Radboudumc developed a smartphone-application (WondGezond) to collect surgical wound healing information provided by the patient. We evaluated usability and outcomes to assess its potential for early surgical site infection (SSI) detection. This research was initiated by the neurosurgery department. Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post-surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photo and answered four questions about their wound daily, for 14 days. Afterwards, participants indicated if they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV). After 2009 surgeries, 1695 QR-codes were distributed and 412(21%) were activated. 232(56%) participants completed the 14-day period of whom 22(10%) reported SSI-treatment. Physician-assessment identified 15(7%) SSIs. Concordance was reached in 88% of cases. Amongst 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity(33%) and PPV(23%), but high NPV(95%). WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results renders the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required by comparing physician-assessed and participant-reported outcomes to microbiological cultures ("golden-standard").

Selenium-SelK-GPX4 axis protects nucleus pulposus cells against mechanical overloading-induced ferroptosis and attenuates senescence of intervertebral disc

Intervertebral disc degeneration (IVDD) is one of the most prevalent spinal degenerative disorders and imposes places heavy medical and economic burdens on individuals and society. Mechanical overloading applied to the intervertebral disc (IVD) has been widely recognized as an important cause of IVDD. Mechanical overloading-induced chondrocyte ferroptosis was reported, but the potential association between ferroptosis and mechanical overloading remains to be illustrated in nucleus pulposus (NP) cells. In this study, we discovered that excessive mechanical loading induced ferroptosis and endoplasmic reticulum (ER) stress, which were detected by mitochondria and associated markers, by increasing the intracellular free Ca2+ level through the Piezo1 ion channel localized on the plasma membrane and ER membrane in NP cells. Besides, we proposed that intracellular free Ca2+ level elevation and the activation of ER stress are positive feedback processes that promote each other, consistent with the results that the level of ER stress in coccygeal discs of aged Piezo1-CKO mice were significantly lower than that of aged WT mice. Then, we confirmed that selenium supplementation decreased intracellular free Ca2+ level by mitigating ER stress through upregulating Selenoprotein K (SelK) expression. Besides, ferroptosis caused by the impaired production and function of Glutathione peroxidase 4 (GPX4) due to mechanical overloading-induced calcium overload could be improved by selenium supplementation through Se-GPX4 axis and Se-SelK axis in vivo and in vitro, eventually presenting the stabilization of the extracellular matrix (ECM). Our findings reveal the important role of ferroptosis in mechanical overloading-induced IVDD, and selenium supplementation promotes significance to attenuate ferroptosis and thus alleviates IVDD, which might provide insights into potential therapeutic interventions for IVDD.

Quality of life in lumbar spinal stenosis: Does it correlate with magnetic resonance imaging and spinopelvic parameters?

PurposeDegenerative lumbar spinal stenosis (LSS) is a common degenerative spinal disorder with debilitating symptoms that can impact quality of life (QoL). However, the anatomical basis for typical complaints has been poorly quantified. This study aims to correlate QoL assessments of patients with LSS with radiographic spinopelvic parameters and magnetic resonance imaging (MRI) measurements. MethodsWe screened 371 patients hospitalized for LSS and excluded those with a history of spine surgery. Ultimately, we analyzed the data of 34 patients retrospectively. Two independent members of our research group evaluated the alignment parameters on preoperative spinal radiographs, MRI, and classified the images according to the Pfirrmann grading. The spinopelvic alignment was then compared with the clinical QoL scores Core Outcome Measures Index (COMI) and the Oswestry Disability Index (ODI) as collected by the Spine Tango registry. In addition, the interobserver reliability was analyzed. ResultsThe individual MRI measurements correlated significantly. This correlation could not be found when compared with the spinopelvic parameters on radiographs. Neither the COMI nor the ODI scores showed a significant correlation with the MRI or radiographic imaging. ConclusionsThe severity of LSS related disability according to QoL questionnaires could not be quantified by any MRI or spinopelvic parameter that was measured. There was also no correlation of the MRI and spinopelvic parameters among themselves. Consequently, treatment recommendations for symptomatic LSS should never be based on radiological data only.

Comparison between Three-Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial.

The three-dimensional printing titanium (3DPT) cage with excellent biomechanical properties and osseointegration capabilities has been initially used in spinal fusion, while the polyetheretherketone (PEEK) cage, a bioinert material device, has been a widely used for decades with relatively excellent clinical outcomes. This study was performed to investigate the early radiographic and clinical outcomes of 3DPT cage versus PEEK cage in patients undergoing anterior cervical discectomy and fusion (ACDF) and transforaminal lumbar interbody fusion (TLIF). This prospective controlled trial, from December 2019 to June 2022, included patients undergoing ACDF and TLIF with 3DPT cages and compared them to patients using PEEK cages for treating spinal degenerative disorders. The outcome measures included radiographic parameters (intervertebral height [IH], subsidence, fusion status, and bone-cage interface contact) and clinical outcomes (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Oswestry Disability Index [ODI], Short Form 12-Item Survey [SF-12], Visual Analog Scale [VAS], and Odom's criteria). Student's independent samples t test and Pearson's chi-square test were used to compare the outcome measures between the two groups before surgery and at 1 week, 3 and 6 months after surgery. For the patients undergoing ACDF, the 3DPT (18 patients/[26 segments]) and PEEK groups (18 patients/[26 segments]) had similar fusion rates at 3 months and 6 months follow-up (3 months: 96.2% vs. 83.3%, p = 0.182; 6 months: 100% vs. 91.7%, p = 0.225). The subsidence in the 3DPT group was significantly lower than that in the PEEK group (3 months: 0.4 ± 0.2 mm vs. 0.9 ± 0.7 mm p = 0.004; 6 months: 0.7 ± 0.3 mm vs. 1.5 ± 0.8 mm, p < 0.001). 3DPT and PEEK cage all achieved sufficient contact with the cervical endplates. For the patients undergoing TLIF, the 3DPT (20 patients/[26 segments]) and PEEK groups (20 patients/[24 segments]) had no statistical difference in fusion rate (3 months: 84.6% vs. 58.3%, p = 0.059; 6 months: 92.3% vs. 75%, p = 0.132). The subsidence was lower than that in the PEEK group without significantly difference (3 months: 0.9 ± 0.7 mm vs.1.2 ± 0.9 mm p = 0.136; 6 months: 1.6 ± 1.0 mm vs. 2.0 ± 1.0 mm, p = 0.200). At the 3-month follow-up, the bone-cage interface contact of the 3DPT cage was significantly better than that of the PEEK cage (poor contact: 15.4% vs. 75%, p < 0.001). The values of UAR were higher in the 3DPT group than in the PEEK group during the follow-up in cervical and lumbar fusion, there were more statistical differences in lumbar fusion. There were no significant differences in the clinical assessment between 3DPT or PEEK cage in spinal fusion. The 3DPT cage and PEEK cage can achieve excellent clinical outcomes in cervical and lumbar fusion. The 3DPT cage has advantage in fusion quality, subsidence severity, and bone-cage interface contact than PEEK cage.

Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders.

Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms ofblood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include aprolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation ratesandhigher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties anddevelop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.

A Systematic Review for Cervical Intervertebral Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Spine Disorders

Background Cervical disc arthroplasty (CDA) is an increasingly accepted procedure for the treatment of symptomatic cervical degenerative disc disease. Multiple Level I evidence clinical trials have established cervical TDR to be a safe and effective procedure in the short-term. Aim of the Study is to provide a long-term assessment of cervical disc arthroplasty (CDA) versus anterior discectomy and fusion (ACDF) for the treatment of one- and two-level disc disease. Patients and Methods Systematic review of published English literature, the study was done from July 2014 to June 2020 and the study setting was Internet search through MEDLINE and Cochrane Collaboration Library. Results Our study provided further evidence that CDA is superior in achieving long-term clinical outcomes such as overall success, NDI success and neurological success, VAS neck pain and arm pain, symptomatic ASD, total secondary surgery, and secondary surgery at the index level and at the adjacent level. Conclusion However, no clear benefit could be identified in regard to NDI score, total reported AE, serious AE, device/surgery- related AE, and radiological superior and inferior ASD. Welldesigned worldwide RCT with long-term follow up are still necessary for further evaluation in the future.

A Redox Homeostasis Modulatory Hydrogel with GLRX3+ Extracellular Vesicles Attenuates Disc Degeneration by Suppressing Nucleus Pulposus Cell Senescence.

Characterized by nucleus pulposus (NP) cell senescence and extracellular matrix (ECM) degradation, disc degeneration is a common pathology for various degenerative spinal disorders. To date, effective treatments for disc degeneration are absent. Here, we found that Glutaredoxin3 (GLRX3) is an important redox-regulating molecule associated with NP cell senescence and disc degeneration. Using a hypoxic preconditioning method, we developed GLRX3+ mesenchymal stem cell-derived extracellular vehicles (EVs-GLRX3), which enhanced the cellular antioxidant defense, thus preventing reactive oxygen species (ROS) accumulation and senescence cascade expansion in vitro. Further, a disc tissue-like biopolymer-based supramolecular hydrogel, which was injectable, degradable, and ROS-responsive, was proposed to deliver EVs-GLRX3 for treating disc degeneration. Using a rat model of disc degeneration, we demonstrated that the EVs-GLRX3-loaded hydrogel attenuated mitochondrial damage, alleviated the NP senescence state, and restored ECM deposition by modulating the redox homeostasis. Our findings suggested that modulation of redox homeostasis in the disc can rejuvenate NP cell senescence and thus attenuate disc degeneration.

Neurostimulation for Spinal Lesions: Enhancing Recovery and Axonal Regeneration.

Spinal neurostimulation is a promising approach for treating spinal lesions and has implications in various neurological disorders. It promotes axonal regeneration and neuronal plasticity to reestablish disrupted signal transduction pathways following spinal injuries or degeneration. This paper reviews the current technology and its differing utilities in various types of neurostimulation, including invasive and noninvasive methods. The paper also explores the efficacy of spinal compression and decompression therapy, with a primary focus on degenerative spinal disorders. Moreover, the potential of spinal neurostimulation in therapies for motor disorders, such as Parkinson's disease and demyelinating disorders, is discussed. Finally, the paper examines the changing guidelines of use for spinal neurostimulation following surgical tumor resection. The review suggests that spinal neurostimulation is a promising therapy for axonal regeneration in spinal lesions. This paper concludes that future research should focus on the long-term effects and safety of these existing technologies, optimizing the use of spinal neurostimulation to enhance recovery and exploring its potential for other neurological disorders.

Microendoscopic Surgery for Degenerative Disorders of the Cervical and Lumbar Spine: The Influence of the Tubular Workspace on Instrument Angulation, Clinical Outcome, Complications, and Reoperation Rates.

Long-term clinical outcomes with microendoscopic spine surgery (MESS) are poorly investigated. The effect of instrument angulation on clinical outcomes has yet to be assessed. A total of 229 consecutive patients operated on via two MESS systems were analyzed. Instrument angulation for both MESS systems, which differ from each other regarding the working space for instruments, was assessed using a computer model. Patients' charts and endoscopic video recordings were reviewed to determine clinical outcomes, complications, and revision surgery rates. At a minimum follow-up of two years, clinical outcomes were assessed employing the Neck Disability Index (NDI) and Oswestry Disability Index (ODI). A total of 52 posterior cervical foraminotomies (PCF) and 177 lumbar decompression procedures were performed. The mean follow-up was six years (range 2-9 years). At the final follow-up, 69% of cervical and 76% of lumbar patients had no radicular pain. The mean NDI was 10%, and the mean ODI was 12%. PCF resulted in excellent clinical outcomes in 80% of cases and 87% of lumbar procedures. Recurrent disc herniations occurred in 7.7% of patients. The surgical time and repeated procedure rate were significantly lower for the MESS system with increased working space, whereas the clinical outcome and rate of complication were similar. MESS achieves high success rates for treating degenerative spinal disorders in the long term. Increased instrument angulation improves access to the compressive pathology and lowers the surgical time and repeated procedure rate.

Glycerol induced paraspinal muscle degeneration leads to hyper-kyphotic spinal deformity in wild-type mice

Degenerative spinal disorders, including kyphotic deformity, are associated with a range of degenerative characteristics of the paraspinal musculature. It has therefore been hypothesized that paraspinal muscular dysfunction is a causative factor for degenerative spinal deformity; however, experimental studies demonstrating causative relationships are lacking. Male and female mice received either glycerol or saline injections bilaterally along the length of the paraspinal muscles at four timepoints, each separated by 2 weeks. Immediately after sacrifice, micro-CT was performed to measure spinal deformity; paraspinal muscle biopsies were taken to measure active, passive and structural properties; and lumbar spines were fixed for analysis of intervertebral disc (IVD) degeneration. Glycerol-injected mice demonstrated clear signs of paraspinal muscle degeneration and dysfunction: significantly (p < 0.01) greater collagen content, lower density, lower absolute active force, greater passive stiffness compared to saline-injected mice. Further, glycerol-injected mice exhibited spinal deformity: significantly (p < 0.01) greater kyphotic angle than saline-injected mice. Glycerol-injected mice also demonstrated a significantly (p < 0.01) greater IVD degenerative score (although mild) at the upper-most lumbar level compared to saline-injected mice. These findings provide direct evidence that combined morphological (fibrosis) and functional (actively weaker and passively stiffer) alterations to the paraspinal muscles can lead to negative changes and deformity within the thoracolumbar spine.

Management strategies for the painless foot drop: a systematic review of the literature.

Foot drop can uncommonly be a painless presenting symptom of degenerative spinal disorders. This systematic review aimed to summarise the literature on the management and outcomes of patients with a painless foot drop. We performed a systematic review of PubMed, EMBASE and Medline according to PRISMA guidelines. All studies published after 1980 in English referring to adult patients with a painless foot drop were included. Exclusion criteria included opinion based reports, review articles and articles in which foot drop was not caused by degenerative pathology of the thoracolumbar spine. Of 62 included patients, 30 (48.4%) were male with an average age of 48.7years (range 27-84). The mean duration of symptoms was 69.0days (1-700). 98.8% were managed operatively. 46 (74.2%) patients had symptomatic improvement, with 41 (66.1%) having a post-intervention MRC power grading of 3 or above. Patients with a pre-procedure MRC 0 had a higher median increase in MRC post-procedure than those with MRC > 0. Of two studies comparing painful and painless symptoms, painless foot drop patients were less likely to recover to MRC equal to or over 3 than those with painful symptoms OR 0.31 (95% CI 0.04-2.65). This systematic review and meta-analysis demonstrates a role for surgery in facilitating the neurological recovery of patients with a painless foot drop. Large randomised controlled studies are required to characterise the role of operative intervention in these patients and compare outcomes between patients with painless and painful foot drop.

Exosome-laden injectable self-healing hydrogel based on quaternized chitosan and oxidized starch attenuates disc degeneration by suppressing nucleus pulposus senescence

Disc degeneration is the common pathology underlying various degenerative spinal disorders and currently there is no effective cure. Here, we found nucleus pulposus (NP) cell senescence was closely associated with the severity of disc degeneration, and exosomes (Exos) derived from mesenchymal stem cells (MSCs) ameliorated NP cell senescence and promoted extracellular matrix (ECM) deposition. As chitosan-based hydrogels have been widely used as vehicles to deliver Exos due to their prominent antibacterial capacity, biocompatibility, and biodegradability, we developed an Exos-laden hydrogel based on quaternized chitosan (QCS) and oxidized starch (OST) to treat disc degeneration. The synthesized QCS-OST hydrogel is injectable, self-healing, biocompatible, and demonstrated desirable pore size, injectable properties, and sustainable release of Exos. In a rat model of disc degeneration, the QCS-OST/Exos hydrogel was able to rejuvenate NP cell senescence, promote ECM remodeling, and partially restore the structures of NP and annulus fibrosis. Our findings suggested that the novel QCS-OST/Exos hydrogel is an effective therapeutic strategy for treating disc degeneration via alleviating NP cell senescence.

Dynamic Rod Constructs as the Preventive Strategy against Adjacent Segment Disease in Degenerative Lumbar Spinal Disorders: A Retrospective Comparative Cohort Study.

Adjacent segment degeneration (ASDe) and adjacent segment disease (ASDi) are potential long-term complications after lumbar fusion with rigid instrumentation. Dynamic fixation techniques (Topping-off) adjacent to the fused segments have been developed to curtail the risk of ASDe and ASDi. The current study sought to investigate whether the addition of dynamic rod constructs (DRC) in patients with preoperative degeneration in the adjacent disc was effective in reducing the risk of ASDi. A retrospective analysis was performed on clinical data of 207 patients with degenerative lumbar disorders (DLD) from January 2012 to January 2019, who underwent posterior transpedicular lumbar fusion (without Topping-off, NoT/O), and posterior dynamic instrumentation with DRC. Clinical and radiological outcomes were evaluated using Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and lumbar radiographs one, three, and 12 months postoperatively and annually. ASDe was defined as disc height collapse > 20% and disc wedging > 5. Patients with confirmed ASDe and aggravation of ODI > 20 or VAS score > 5 at final follow-up were diagnosed as ASDi. The Kaplan-Meier hazard method was used to estimate the cumulative probability of ASDi within 63 months of surgery. Over three years of follow-up, 65 patients in the NoT/O (59.6%) and 52 cases (53.1%) in the DRC groups met the diagnostic criteria for ASDe. Furthermore, 27 (24.8%) patients in the NoT/O group showed ASDi during the follow-up, compared to 14 (14.3%) cases in the DRC group (P=0.059). Revision surgery was performed on 19 individuals in the NoT/O and 8 cases in the DRC groups (P=0.048). The Cox regression model identified a significantly decreased risk of ASDi if DRC was used (Hazard ratio: 0.29; 95% CI: 0.13-0.6). Dynamic fixation adjacent to the fused segment is an effective strategy for preventing ASDi in carefully selected individuals with preoperative degenerative changes at the adjacent level.

Functional and Radiological Outcome of Anterior Cervical Discectomy and Titanium Cage Fusion in the Management of Patients with Degenerative Cervical Spine Disease

Background: The causes of cervical radiculopathy include trauma, disc herniation, instability, spondylosis and, in rare cases, malignancies. Degenerative spinal disorders are often treated by anterior cervical discectomy. Objective: To assess the functional and radiological outcome of anterior cervical discectomy and titanium cage fusion in the management of patients with degenerative cervical spine disease Methodology: The current study was descriptive study carried out at the orthopedic department, Qazi Hussain Ahmad Medical College, Nowshera from August 2021 to August 2022. All the relevant laboratory and radiological investigations were carried out for the enrolled patients. Cervical radiographs were examined for fusion, cage subsidence, and kyphosis at each visit. The functional outcomes, quality of life and pain level was determined for all the patients. IBM SPSS version 23 was employed for analysis of data. Results: In the current study, totally 50 patients were enrolled. The male participants in this study were 30 (60%) while female patients were 20 (40%). The mean age of the patients was 53 (±5.32). The pre-operative mean NDI, VAS and EQ-5D-5L index was 42 (5.90), 8.11 (2.11) and 0.54 (0.01) respectively while the post-operative mean NDI, VAS and EQ-5D-5L index was 19 (2.81), 2 (1.88) and 0.75(0.01) respectively (p=˂0.05). In all the enrolled patients radiographical fusion was achieve successfully. Segmental subsidence was reported in 2 (4%) patients while kyphosis was not observed in any of our patients. Conclusion: Our study concludes that in patients with symptomatic degenerative cervical spine disease, the anterior cervical discectomy and titanium cage fusion is an effective and safe surgical procedure with excellent functional and radiological outcome. Our study observed minimal complication rate by using this procedure. Keywords: Radiological outcome; Anterior cervical discectomy; titanium cage fusion; degenerative cervical spine disease

The search for systemic biomarkers for monitoring degenerative lumbar spinal disorders

ObjectivesIn our previous study, we reported that low back pain (LBP) severity and disability significantly correlate with body composition and several blood biochemical factors. Herein, we tested the hypothesis that these covariates are associated with anatomical deformations of the lumbar spine, in particular, radiographic facet joint osteoarthritis (FJOA) and lumbar disc degeneration (LDD) features important contributors to LBP. MethodsCT and MRI images of the lumbar spine were obtained from 200 individuals suffering from LBP-sciatica. We examined the FJOA and total LDD score - the sum of the scores of the three radiographic features (intervertebral disc herniation, osteophythosis and spondylolisthesis) at the L1 - S1 vertebral levels. By implementing a bioelectrical impedance analysis, we assessed the participants for body composition, specifically, extracellular water (ECW). Plasma levels of growth and differentiation factor 15 (GDF-15) and visceral adipose tissue-derived serine protease inhibitor (vaspin), were detected by ELISA. ResultsBy conducting a series of multivariable regression analyses, we report that the circulating levels of GDF-15, vaspin, and ECW are significantly and independently associated with FJOA scores [βGDF15 ​= ​0.38 ​± ​0.08, p ​= ​0.0001; βVASPIN ​= ​0.36 ​± ​0.07, p ​= ​0.000004; βECW ​= ​0.24 ​± ​0.07, p ​= ​0.002]. The levels of GDF-15 (β ​= ​0.30 ​± ​0.10, p ​= ​0.007) and ECW (β ​= ​0.20 ​± ​0.09, p ​= ​0.03) were also found significantly associated with the LDD scores. ConclusionThe obtained new data suggest that GDF-15, vaspin and ECW may serve as biomarkers for FJOA and LDD phenotypes.

A dynamic pedicle screw system using polyethylene insert for the lumbar spine.

Rigid spinal fusion with instrumentation has been widely applied in treating degenerative spinal disorders and has shown excellent and stable surgical results. However, adjacent segment pathology or implants' loosening could be problematic due to the spine's segmental fusion. Therefore, this study verified a novel concept for posterior stabilization with polyethylene inserts inside a pedicle screw assembly using bone models. We observed that although the gripping capacity of the dynamic pedicle screw system using a tensile and compression tester was less than half that of the rigid pedicle screw system, the flexion-extension moment of the dynamic pedicle screws was significantly lower than that of the rigid pedicle screws. Furthermore, while the bending force of the rigid pedicle screw assembly increased linearly with an increase in the bending angle throughout the test, that of the dynamic pedicle screw assembly also increased linearly until a bending angle of 2.5° was reached. However, this angle decreased at a bending angle of more than 2.5°. Additionally, the fatigue test of 1.0 × 106 cycles showed that the pull-out force of the dynamic pedicle screws from two different polyurethane foam blocks was significantly higher than that of the rigid pedicle screws. Therefore, based on our results, we propose that the device can be applied in clinical cases to reduce screw loosening and adjacent segment pathology.

Learning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review.

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is commonly used to treat degenerative lumbar spinal disorders. It facilitates a full-scale spinal decompression and interbody fusion with minimal neural retraction using the tubular retractor system. Despite the benefits of surgical efficiency and minimalism, this technique requires a long learning curve. There is currently no consensus on the learning curve characteristics and proper training methods for MI-TLIF. Thus, this systematic review aimed to discuss the cutoff point at which technical proficiency is achieved and ways to enhance the learning process. Major databases, including PubMed, Embase, and Cochrane Library, were searched for learning curve studies that have evaluated the clinical outcome and learning progress of MI-TLIF using quantitative data. The qualities of the selected studies were assessed using the Newcastle‒Ottawa scale. The plateau points in the "learning curve" were analyzed according to various outcome measures. Nine full-text articles, representing 753 cases, were included from 9743 screened studies. The most commonly used outcome measures were the operative time, followed by the complication rate. The mean cutoff point for the operative time was 31.33 ± 11.98 (range 13‒45) cases. The plateau point in the learning curve for MI-TLIF may differ according to the outcome measures used. Most studies have demonstrated the learning progress based on simple task efficiency, rather than patient outcomes. Moreover, the learning rate may be affected by the patients' and technical conditions. Therefore, great care is required in interpreting the learning curve and cutoff point for MI-TLIF proficiency.