Spinal Disease Research Articles

Clinical features and sequelae of detrusor underactivity: a study of possible cause and effect.

To describe the clinical presentation and urodynamic findings in detrusor underactivity (DU) patients and investigate the association between DU and straining related complications such as pelvic organ prolapse (POP), inguinal hernia, and hemorrhoids. We retrospectively reviewed all consecutive patients who underwent urodynamic studies (UDS) from 2012 to 2023, divided into two groups: those with evidence of DU (n = 573), and control subjects with normal voiding parameters (n = 522). Exclusion criteria were patients who lacked sufficient data, those with obstructive voiding parameters, and those who had received intravesical botulinum toxin injections within the previous nine months. Demographic information, clinical presentation, straining related complications, and UDS findings were compared between the two groups using univariate statistical analysis. The male DU group had a statistically significant higher prevalence of spinal disease and previous cerebrovascular accidents, while the female DU group had a statistically significant higher prevalence of spinal disease, multiple sclerosis, diabetes, previous colorectal surgery, previous transabdominal gynecological surgery, POP surgery, and recurrent UTIs. Female DU patients had a higher prevalence of pronounced vaginal bulging symptoms, recurrent POP, inguinal hernia, and hemorrhoids. The predominant LUTS were voiding symptoms (81.2% in males and 77.9% in females), followed closely by storage symptoms (66.2% in males and 74.7% in females). The median Qmax, PdetQmax, and PVR were 6ml/sec, 18 cmH2O, 190ml for male DU patients, and 8ml/sec, 11 cmH2O, and 200ml for female DU patients, respectively. Risk factors for DU that were identified include age, neurological diseases (spinal disease, CVA in men, MS in women), diabetes and transabdominal surgery (colorectal, gynecological) that can cause pelvic denervation in women. DU patients commonly present with both voiding and storage symptoms. There is approximately twice the risk of having POP surgery and inguinal hernia, an eight-fold risk of hemorrhoids, and a three-fold risk of recurrent UTIs for females. This is thought to be secondary to increased intra-abdominal pressure during urinary straining.

Combined intra-extradural approach for posterolateral thoracic disk herniations: how I do it.

Thoracic disc herniation is a rare degenerative spine disease that can cause severe neurological deficits. Nowadays, controversies still stand on the most effective surgical route. Herein, we describe the combined intra-extradural approach for a posterolateral thoracic disk herniation. We divided the technique into four steps: bony, extradural, intradural and intra-extradural. We disclose perioperative shrewdness aimed at improving outcomes and reducing complications. The combined intra-extradural approach represents an effective technique for posterolateral thoracic disk herniations, reducing both the risk of spinal cord damages and post-operative CSF leaks.

Impact of instrumentation material on local recurrence: a case-matched series using carbon fiber-PEEK vs. titanium.

Spine metastases are a major burden of oncologic care, contributing to substantial morbidity. A well-established treatment paradigm for patients with metastatic epidural spinal cord compression includes separation surgery followed by stereotactic body radiotherapy (SBRT). Innovations in implant technology have brought about the incorporation of Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation for spinal fixation. We present our experience of CFR-PEEK instrumentation, comparing outcomes and complication profiles with a matched cohort of titanium instrumented cases for spine metastatic disease. Oncology patients who underwent spinal fusion for metastatic spine disease from 2012 to 2023 were retrospectively reviewed. Ninety-nine cases with CFR-PEEK fusions were case-control matched with 50 titanium controls (2:1 ratio) based upon primary tumor type and spinal instability neoplastic score (SINS) location. Demographic, clinical, radiographic and progression free survival (PFS) were analyzed. In the study years, 263 patients underwent spinal decompression and fusion, for which 148 patients met predetermined inclusion criteria. Of these, 49 had titanium instrumentation, and 99 had CFR-PEEK. Complication profiles, including hardware failure and infection were similar between the groups. There was no significant difference in PFS between all CFR-PEEK and titanium patients (143 days versus 214 days; p = 0.41). When comparing patients in which recurrence was noted, CFR-PEEK patients had recurrence detected two times earlier than titanium patients (94 days versus 189 days; p = 0.013). In this case matched cohort, CFR-PEEK demonstrated decreased overall PFS suggestive of earlier local recurrence identification. Long-term studies are warranted for better evaluation of the impact on survival and systemic disease progression.

Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine.

Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. Seventy-four patients were included, with a mean age of 62.9years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4s) and patient measurements (18.4 ± 9.7s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.

The Effect of Osteopenia and Osteoporosis on Screw Loosening in MIS-TLIF and Dynamic Stabilization.

Retrospective series. Screw loosening in the surgical treatment of lumbar spine disease is a major complication of osteopenia or osteoporosis. This study investigated the risk of screw loosening following either MIS-TLIF or pedicle screw-based dynamic stabilization (DS) in patients with osteopenia or osteoporosis. We retrospectively enrolled patients receiving 1- or 2-level MIS-TLIF or DS in a single institute. All patients were diagnosed as having lumbar spondylosis without concurrent spondylolisthesis and found by dual-energy X-ray absorptiometry to have osteopenia or osteoporosis. Screw loosening was identified by X-ray and CT. Clinical outcomes were also assessed. A total of 103 patients (50 MIS-TLIF and 53 DS) were confirmed to have osteopenia (-2.5<T-score < -1.0) or osteoporosis (T-score≦-2.5). The two groups, which were followed for 33.6 ± 24.7 and 52 ± 34.5 months, had similar T-scores (-1.97 ± 0.7 and -1.97 ± 0.6, respectively, P = 0.960). While both groups had significant improvements in back and leg pain assessed by VAS, ODI, and JOA scores, there was a significant difference in overall screw loosening rates between the MIS-TLIF and DS groups analyzed by percent of patients 38% and 18.9% (P = 0.039*) and by percent of screws 16.9% and 8% (P = 0.002*), respectively. Subgroup analysis showed a significant difference in screw loosening rate in osteopenia patients (P = 0.039* by person; P = 0.002* by screw), but no difference in osteoporosis patients. The screw loosening rate was higher in the MIS-TLIF group in the entire cohort. Osteopenia patients receiving MIS-TLIF were at significantly higher risk of screw loosening, while that risk was not different for osteoporosis patients, compared to DS.

Gender differences in spine surgery for degenerative lumbar disease: prospective cohort study.

Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions. Consecutive adult patients undergoing spinal surgery for degenerative lumbar conditions (disc herniation [DH], spinal canal stenosis [SCS], and degenerative spondylolisthesis [DS]) were prospectively enrolled across 16 tertiary academic centers. Outcome domains included pain, disability, health-related quality of life (HRQOL), expectations of surgery, and satisfaction with surgical outcome. Covariates pertaining to the preoperative use of healthcare resources, diagnostic testing, and visits to healthcare providers were compared between genders before and after propensity score matching for 13 baseline demographic and procedural variables. Data were analyzed for 5038 patients (2396 female, 2642 male) with degenerative spinal pathologies including SCS (40.2%), DS (33.2%), and DH (26.6%). Surgical treatment effect was similar for both genders. For all conditions, female patients had worse pre- and postoperative pain, disability, and HRQOL. Significant gender differences were identified for marital status, education, employment status, exercise activities, and disability claims. Female patients were more likely to use select medications, diagnostic imaging tests, and nonsurgical therapeutic interventions, and access various healthcare providers. Findings were similar following post hoc propensity score matching. In this multicenter, prospective, observational cohort study, male and female patients benefitted similarly from surgery for degenerative lumbar spine disease. However, female patients had worse preoperative clinical assessment scores and were more likely to use select healthcare resources.

Early Experience of Using Transfacetal Screws for Lumbar Spine Stabilization without Decompression in Cases of Degenerative Spine Disease

Early Experience of Using Transfacetal Screws for Lumbar Spine Stabilization without Decompression in Cases of Degenerative Spine Disease

Alignment considerations in degenerative spinal conditions: A narrative review

BackgroundWith an aging population, degenerative spinal diseases are contributing significantly to the healthcare's burden. Spinal alignment in the context of adult spinal deformities has become an important domain of research. MethodsWe conducted a narrative review of the latest considerations in spinal alignment within the context of degenerative spinal conditions, discussed current strategies for morphological assessment and finally identified potential areas for future research. ResultsThis review reported that degenerative spinal conditions lead to a complex disruption of spinal alignment. It also highlighted the importance of spino-pelvic alignment with specific attention to compensatory mechanisms that occur in response to spinal deformities. Emerging technologies including Artificial Intelligence and epigenetics are showing promises in terms of patient care. ConclusionsUnderstanding spinal alignment in degenerative conditions underscores the importance of dynamic and individualized assessments. Future research should integrate emerging technologies along with traditional clinical practices in order to optimize patient outcomes and minimize complications for patients suffering from degenerative spinal diseases.

ID: 305483 Discogenic Spinal Disease Resulting in Cervical ‘Angina': An Overlooked Source of Non-cardiac Chest Pain

ID: 305483 Discogenic Spinal Disease Resulting in Cervical ‘Angina': An Overlooked Source of Non-cardiac Chest Pain

Incidence and Risk Factors for Lumbar Sympathetic Chain Injury After Oblique Lumbar Interbody Fusion.

Oblique lumbar interbody fusion (OLIF), performed using a retroperitoneal approach, can lead to complications related to the approach, such as lumbar sympathetic chain injury (LSCI). Although LSCI is a common complication of OLIF, its reported incidence varies across studies due to an absence of specific diagnostic criteria. Moreover, research on the risk factors of postoperative sympathetic chain injuries after OLIF remains limited. Therefore, this study aimed to describe the incidence, and identify independent risk factors for LSCI, in patients with degenerative lumbar spinal diseases who underwent OLIF. Between October 2020 and August 2023, a retrospective review was conducted at our institute on 200 patients who underwent OLIF at 1 to 4 consecutive spinal levels (L1-5) for degenerative spinal diseases including spinal stenosis, spondylolisthesis, degenerative scoliosis. We excluded those with infections, trauma, tumors, and lower extremity edema/warmth due to other causes. The patients were categorized into 2 groups: those with and without LSCI symptoms. Demographic data, operative data, and pre- and postoperative parameters were evaluated for their association with LSCI using a univariate logistic regression model. Variables with a p-value <0.1 in the univariate analysis were included in a multivariate model to identify the independent risk factors. Thirty-five of 200 patients (17.5%) developed LSCI symptoms after OLIF. Multivariate logistic regression analysis indicated that prolonged retraction time, particularly exceeding 31.5 miniutes, remained an independent risk factor (adjusted odds ratio, 12.59; p<0.001). This study demonstrated that prolonged retraction time was an independent risk factor for LSCI following OLIF, particularly when it exceeded 31.5 minutes. Protecting the lumbar sympathetic chain during surgery and minimizing retraction time are crucial to avoiding LSCI following OLIF.

Cervical ossification of the posterior longitudinal ligament revealed by cervical trauma: A case report with literature review

Background: Ossification of the posterior longitudinal ligament (OPLL) refers to bone formation within the posterior longitudinal ligament of the spinal column. This disease of the cervical spine results in a reduced volume of the spinal canal and can cause spinal cord damage. The onset of cervical OPLL is insidious. OPLL may increase the risk of spinal cord injury with various neurological deficits after minor trauma. An acute event can reveal a previously unknown or paucysymptomatic cervical OLLP. The aim: To present a case of unknown cervical OLLP revealed by cervical trauma after a traffic road accident. Case report: A 47-year-old female presented intractable cervicobrachial neuralgia in the posttraumatic aftermath of a traffic road accident. Computed Tomography (CT) and Magnetic resonance imaging (MRI) demonstrated an isolated OPLL from C5 to C6, causing significant nerve compression operated via anterior approach with discectomy and intervertebral cervical cage. Conclusion: Acute cervical trauma must be considered a mode of revelation of previously unknown or paucisymptomatic cervical OLLP and must be considered in the emergency room.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M = 5.66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

Calcium phosphate complex of recombinant human thrombomodulin promote bone formation in interbody fusion.

Interbody fusion is an orthopedic surgical procedure to connect two adjacent vertebrae in patients suffering from spinal disc disease. The combination of synthetic bone grafts with protein-based drugs is an intriguing approach to stimulate interbody bone growth, specifically in patients exhibiting restricted bone progression. Recombinant human thrombomodulin (rhTM), a novel protein drug characterized by its superior stability and potency, shows promise in enhancing bone formation. A composite bone graft, termed CaP-rhTM, has been synthesized, combining calcium phosphate (CaP) microparticles as a delivery vehicle for rhTM to facilitate interbody fusion. In vitro studies have demonstrated that rhTM significantly promotes the proliferation and maturation of preosteoblasts at nanogram dosage, while exerting minimal impact on osteosarcoma cell growth. The expression levels of mature osteoblast markers, including osteocalcin, osteopontin, alkaline phosphatase, and calcium deposition were also enhanced by rhTM. In rat caudal disc model of interbody fusion, CaP-rhTM with 800 ng of drug doaeage was implanted along with a polylactic acid (PLA) cage, to ensure structural stability within the intervertebral space. Microcomputed tomography analyses revealed that from 8 to 24 weeks, CaP-rhTM substantially improves both bone volume and trabecular architecture, in addition to the textural integrity of bony endplate surfaces. Histological examination confirmed the formation of a continuous bone bridge connecting adjacent vertebrae. Furthermore, biomechanical assessment via three-point bending tests indicated an improved bone quality of the fused disc. This study has demostrated that rhTM exhibits considerable potential in promoting osteogenesis. The use of CaP-rhTM has also shown significant improvements in promoting interbody fusion.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M 66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

Use of two-point and six-point Dixon MRI for fat fraction analysis in the lumbar vertebral bodies and paraspinal muscles in healthy dogs: comparison with magnetic resonance spectroscopy.

Fatty degeneration of the vertebral bodies and paravertebral muscles is associated with the presence, severity, and prognosis of spinal disease such as intervertebral disc degeneration. Therefore, the fat fraction (FF) of the vertebral bodies and paraspinal muscles has been considered a potential biomarker for assessing the pathophysiology, progression, and treatment response of spinal disease. Magnetic resonance spectroscopy (MRS) is considered the reference standard for fat quantification; however, it has limitations of a long acquisition time and is technically demanding. Chemical shift-encoding water-fat imaging, called the Dixon method, has recently been applied for rapid fat quantification with high spatial resolution. However, the Dixon method has not been validated in veterinary medicine, and we hypothesized that the Dixon method would provide a comparable assessment of the FF to MRS but would be faster and easier to implement in dogs. In this prospective study, we assessed the FF of the lumbar vertebral bodies and paravertebral muscles from the first to sixth lumbar vertebrae using MRS, the two-point Dixon method (LAVA-FLEX), and the six-point Dixon method (IDEAL-IQ) and compared these techniques. The FFs of vertebral bodies and paravertebral muscles derived from LAVA-FLEX and IDEAL-IQ showed significant correlations and agreement with those obtained with MRS. In particular, the FFs obtained with IDEAL-IQ showed higher correlations and better agreement with those obtained with MRS than those derived by LAVA-FLEX. Both Dixon methods showed excellent intra- and interobserver reproducibility for FF analysis of the vertebral bodies and paraspinal muscles. However, the test-retest repeatability of vertebral body and paraspinal muscle FF analysis was low for all three sequences, especially for the paraspinal muscles. The results of this study showed that LAVA-FLEX and IDEAL-IQ have high reproducibility and that their findings were highly correlated with the FFs of the lumber vertebral bodies and paraspinal muscles determined by MRS in dogs. The FF analysis could be performed much more easily and quickly using LAVA-FLEX and IDEAL-IQ than using MRS. In conclusion, LAVA-FLEX and IDEAL-IQ can be used as routine procedures in spinal magnetic resonance imaging in dogs for FF analysis of the vertebral bodies and paraspinal muscles.

Hereditary Spastic Paraparesis Mimicking Primary Progressive Multiple Sclerosis Due to CYP7B1 Gene Mutation: A Case Report

The hereditary spastic paraplegias (HSPs) are a group of disorders characterised by progressive lower limb weakness and spasticity. This report presents the a case of a 49-year-old female with spastic paraparesis, initially suspected to be primary progressive multiple sclerosis (PPMS). Genetic testing later identified two mutations in the CYP7B1 gene that was associated with the SPG5 form of HSP. This case highlights the challenge of distinguishing HSP from other chronic spinal cord diseases and emphasizes the role of genetic analysis in rare cases of spastic paraplegia.

Innovative 3D Navigation Module for Precise Unilateral Pedicle Screw Combined with Contralateral Translaminar Facet Screw Placement in Lumbar Spine Surgery.

The incidence of degenerative diseases of the lumbar spine has increased in recent years. Unilateral pedicle screw combined with contralateral translaminar facet screw fixation offers the advantages of less trauma, better stability, and fewer complications. However, the surgical difficulty and suboptimal pinning accuracy of translaminar facet screw placement in clinical practice limit its use. Therefore, in this study, we designed a novel suspended 3D-printed navigation module to facilitate fast and accurate intraoperative screw placement. The aim of this study is to investigate the digital design, precise implementation, and evaluation methods for placing unilateral pedicle screws in the lumbar spine combined with translaminar facet screw placement using a new suspended 3D navigation module. This retrospective study included 46 patients with single-level lumbar lesions who underwent spine surgery at the Affiliated Hospital of Putian University between June 2022 and December 2023. The suspended navigation module was designed digitally. Preoperative screw placement was simulated using 3D printed models, followed by an intraoperative accurate screw placement facilitated by the navigation module and a postoperative evaluation of the accuracy of screw placement. The absolute difference in three-dimensional coordinates of the inlet and outlet points of the preoperative design and the postoperative screw-nail channel served as the precision index. In a study involving 46 patients, surgery was successful with 92 pedicle screws and 46 translaminar facet screws placed without any penetration of the cortex. The difference in coordinates before and after screw insertion was minimal, with entry points varying between 1.21 to 1.36 mm and exit points between 1.97 to 2.46 mm. When screw accuracy met certain thresholds, there was no significant difference between preoperative design and postoperative coordinates, indicating precise replication of the surgical plan. The new suspended 3D navigation module enables the precise placement of unilateral pedicle screws in the lumbar spine combined with translaminar pedicle screws for precise surgery.

Increased Dose in Spine Stereotactic Radiosurgery for Metastatic Disease: Are We Underestimating the Risks?

Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess the necessity and validity of these higher dose recommendations by evaluating the outcomes and experiences with lower radiation doses. Materials and Methods: A retrospective evaluation of SSRS patients treated at a single institute was conducted. The outcomes and complications of this cohort were compared to the current literature and the data supporting the new ESTRO guidelines. Results: A total of 149 treatment sessions involving 242 spinal levels were evaluated. The overall local control rate was 91.2%. The mean radiation dose for the local control group compared to the local failure group was similar (17.5 vs. 17.6 Gy, not significant). The overall complication rate was 6%. These results are consistent with previous publications evaluating SSRS for metastatic spinal disease. Conclusions: SSRS dose escalation may increase local control efficacy but comes with a higher risk of complications. The evidence supporting the strong recommendations in the recent ESTRO guidelines is not robust enough to justify a universal application. Given the palliative nature of treatment for metastatic patients, dose determination should be individualized based on patient conditions and preferences, with a detailed discussion about the risk-benefit ratio of increased doses and the level of evidence supporting these recommendations.

Prolonged operative time significantly impacts on the incidence of complications in spinal surgery

BackgroundIn spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery.MethodsWe retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications.ResultsA total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events.ConclusionsThis study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient’s safety, without compromising the technical achievement of the procedure.

NURSING APPROACH IN SPINAL MUSCULAR ATROPHY

Spinal muscular atrophy is an important genetic disease that affects motor neurons in the spine, causing muscle weakness, particularly in infancy. Spinal muscular atrophy occurs with a deletion of the survival motor neuron gene and is one of the leading causes of early death in infants. Although some drugs are used for the treatment of spinal muscular atrophy in the world and in Turkey, there is still no treatment method that provides complete recovery. The limited treatment options for spinal muscular atrophy, its inaccessibility and the poor prognosis of the disease negatively affect the quality of life of individuals and their families. All stages of the disease, starting from the diagnosis process, are very difficult for the patient and his family. A multidisciplinary approach is needed to help patients and their families cope with these difficulties. This approach includes areas such as medical care, rehabilitation, psychosocial support and education. It is essential that nurses, as key members of the health care team, improve the patient's quality of life, manage symptoms and support the individual and family in this process. In particular, supporting the patient and family in their care and educating them about their care needs is one of the most important roles of nurses. With this review, an attempt has been made to discuss the diagnostic methods, treatment process and nursing approaches of spinal muscular atrophy disease, which is a current problem in the world and in Turkey.