Traumatic spinal cord injury in South Korea for 13 years (2008-2020).

Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40-59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.

Lactoferrin-Anchored Tannylated Mesoporous Silica Nanomaterials-Induced Bone Fusion in a Rat Model of Lumbar Spinal Fusion.

Lactoferrin (LF) is a potent antiviral, anti-inflammatory, and antibacterial agent found in cow and human colostrum which acts as an osteogenic growth factor. This study aimed to investigate whether LF-anchored tannylated mesoporous silica nanomaterials (TA-MSN-LF) function as a bone fusion material in a rat model. In this study, we created TA-MSN-LF and measured the effects of low (1 µg) and high (100 µg) TA-MSN-LF concentrations in a spinal fusion animal model. Rats were assigned to four groups in this study: defect, MSN, TA-MSN-LF-low (1 µg/mL), and TA-MSN-LF-high (100 µg/mL). Eight weeks after surgery, a greater amount of radiological fusion was identified in the TA-MSN-LF groups than in the other groups. Hematoxylin and eosin staining showed that new bone fusion was induced in the TA-MSN-LF groups. Additionally, osteocalcin, a marker of bone formation, was detected by immunohistochemistry, and its intensity was induced in the TA-MSN-LF groups. The formation of new vessels was induced in the TA-MSN-LF-high group. We also confirmed an increase in the serum osteocalcin level and the mRNA expression of osteocalcin and osteopontin in the TA-MSN-LF groups. TA-MSN-LF showed effective bone fusion and angiogenesis in rats. We suggest that TA-MSN-LF is a potent material for spinal bone fusion.

Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling.

Conventional cage and plate (CCP) implants usually used in ACDF surgery, do have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury. To reduce the risk of these complications, zero-profile stand-alone cage were developed. We used finite-element modeling to compare the total von Mises stress applied to the bone, disc, endplate, cage and screw when using CCP and ZPSC implants. A 3-dimensional FE (Finite element) analysis was performed to investigate the effects of the CCP implant and ZPSC on the C3 ~ T1 vertebrae. We confirmed that the maximum von Mises stress applied with ZPSC implants was more than 2 times greater in the endplate than that applied with CCP implants. The 3D analysis of the ZPSC model von Mises stress measurements of screw shows areas of higher stress in red. Although using ZPSC implants in ACDF reduces CCP implant-related sequalae such as dysphagia, we have shown that greater von Mises stress is applied to the endplate, and screw when using ZPSC implants. This may explain the higher subsidence rate associated with ZPSC implant use in ACDF. When selecting an implant in ACDF, surgeons should consider patient characteristics and the advantages and disadvantages of each implant type.

Clinical features and prognostic factors of spinal metastatic pancreatic cancer: A retrospective observational study.

Pancreatic cancer is an aggressive malignant cancer that shows the lowest survival rates. Recently, the 5-year survival rate of pancreatic cancer has been increasing, owing to early diagnosis and therapeutic advancement. The purpose of this study was to investigate the clinical characteristics and significant prognostic factors of spinal metastatic pancreatic cancer. Seventeen patients diagnosed with spinal metastases originating from pancreatic cancer from January 2005 to December 2022 were divided into 2 groups: those who underwent spinal surgery and those who did not. We collected patients' demographic data, clinical features, prognosis, and radiologic data. Age, sex, neurologic symptoms, symptom duration, metastasis location, non-neurologic symptoms, adjuvant therapy, overall survival, survival after spinal metastasis, pain score, and quality of life were compared. The average age was 64.05 (50-80) years. The average interval from pancreatic cancer diagnosis to spinal metastasis diagnosis was 12.53 (0-39) months. Eleven patients underwent spinal surgery, while six did not. Preoperative European Cooperative Oncology Group performance status score of the surgery group was 1.91 ± 1.04 and that of the non-surgery group was 2.5 ± 0.84. Survival time after spinal metastasis in the surgical group was 6.14 ± 6.0 months, while that in the non-surgery group was 2.54 ± 2.38 months. The 1-year survival rate after spinal metastasis was 18% in the surgical group, while that of the non-surgery group was 0% (P = .042). Pancreatic cancer patients with spinal metastases showed poor prognoses and extremely short survival rates. Despite poor prognosis, appropriate surgical treatment may improve prognoses.

Predicting Mechanical Complications After Adult Spinal Deformity Operation Using a Machine Learning Based on Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density.

OBJECTIVE: This study aimed to create an ideal machine learning model to predict mechanical complications in adult spinal deformity (ASD) surgery based on GAPB (modified global alignment and proportion scoring with body mass index and bone mineral density) factors. METHODS: Between January 2009 and December 2018, 238 consecutive patients with ASD, who received at least 4-level fusions and were followed-up for ≥ 2 years, were included in the study. The data were stratified into training (n = 167, 70%) and test (n = 71, 30%) sets and input to machine learning algorithms, including logistic regression, random forest gradient boosting system, and deep neural network. RESULTS: Body mass index, bone mineral density, the relative pelvic version score, the relative lumbar lordosis score, and the relative sagittal alignment score of the global alignment and proportion score were significantly different in the training and test sets (p < 0.05) between the complication and no complication groups. In the training set, the area under receiver operating characteristics (AUROCs) for logistic regression, gradient boosting, random forest, and deep neural network were 0.871 (0.817-0.925), 0.942 (0.911-0.974), 1.000 (1.000-1.000), and 0.947 (0.915-0.980), respectively, and the accuracies were 0.784 (0.722-0.847), 0.868 (0.817-0.920), 1.000 (1.000-1.000), and 0.856 (0.803-0.909), respectively. In the test set, the AUROCs were 0.785 (0.678-0.893), 0.808 (0.702-0.914), 0.810 (0.710-0.910), and 0.730 (0.610-0.850), respectively, and the accuracies were 0.732 (0.629-0.835), 0.718 (0.614-0.823), 0.732 (0.629-0.835), and 0.620 (0.507-0.733), respectively. The random forest achieved the best predictive performance on the training and test dataset. CONCLUSION: This study created a comprehensive model to predict mechanical complications after ASD surgery. The best prediction accuracy was 73.2% for predicting mechanical complications after ASD surgery.

Unsubtracted Roadmap Technique for Preventing Cement Leakage During Percutaneous Vertebroplasty: A Retrospective Cohort Study.

OBJECTIVE: To determine the effectiveness of the unsubtracted roadmap technique (USRT) for decreasing cement leakage (CL) during percutaneous vertebroplasty (PVP). METHODS: In this retrospective cohort study, patients who underwent PVP between January and November 2018 were included. Patients were divided into the unsubtracted roadmap (UR) (n = 20) and conventional venography (CV) (n = 22) groups. USRT was performed before cement injection in the UR group. Computed tomography was performed on the first day after PVP in both groups to assess the CL. The vertebral height restoration rate was confirmed by radiography before and after the procedure. The CL location was classified as basivertebral vein (type B), segmental vein (type S), or cortical defect (type C). Visual analog scale and Oswestry Disability Index scores before and after surgery were calculated to confirm clinical outcomes. RESULTS: Based on the computed tomography images, CL occurred in 7 (34.78%) and 15 (63.64%) cases in the UR and CV groups, respectively. Number of CL type B, S, and C in the UR and CV groups were 2 and 6, 3 and 6, and 2 and 3, respectively. The injected cement volume was not significantly different between the UR (4.86 mL) and the CV (4.75 mL) groups (P = 0.450). Regarding vertebral body height restoration (P = 0.856) and clinical outcomes, there were no significant differences between both groups. Radiation exposure was significantly less in the UR group (P = 0.019). CONCLUSIONS: USRT is an effective method for reducing CL and radiation exposure during PVP.

Immediate postoperative lumbar spine magnetic resonance imaging: Correlation with postoperative pain in lumbar microdiscectomy.

Magnetic resonance imaging (MRI) has been extensively used in the management of patients with a herniated lumbar disc. Nevertheless, immediate postoperative MRI has not become a standard procedure, with limited research suggesting that the findings are often similar to preoperative MRI in both symptomatic and asymptomatic patients. This study aimed to determine the benefits of immediate postoperative MRI in patients with or without postoperative symptoms and its correlation with these symptoms. A total of 172 patients who underwent lumbar spine microdiscectomy at our institution between 2014 and 2021 were included. Patients who had previous spinal surgery and lumbar fusion were excluded. Patient data were collected from medical records. MRI was performed 3 days after surgery and assessed by 2 neurosurgeons to minimize bias. Immediate postoperative MRI results showed dural sac compression or foraminal stenosis in 29 patients (16.86%), of which 10 had postoperative pain and 19 were pain free. Among the 143 patients (83.14%) without these findings on MR imaging, 38 had postoperative pain. Immediate postoperative MRI did not correlate with postoperative pain (P = .421/.357). Intraoperative bleeding and the Charlson comorbidity index (CCI) showed significant correlations with postoperative pain (P = .018 and .002, respectively). In a multivariate analysis, intraoperative blood loss and CCI independently correlated with postoperative pain (P = .001 and .001, respectively). Based on our findings, intraoperative blood loss and CCI appear to be the factors that may predict the persistence of postoperative pain, despite normal findings on MRI.

The Effect of Denosumab and Risk Factors for Recurrence in Spinal Giant Cell Tumors: A Systematic Review and Meta-Analysis.

PURPOSE: Giant cell tumors (GCTs) are common benign primary bone tumors and are well known for their locally aggressive performance and tendency to recur. The purpose of this study was to analyze the effects of denosumab and risk factors for recurrent spinal GCTs. MATERIALS AND METHODS: We searched PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify differences between individuals treated with and without denosumab and risk factors for spinal GCT recurrence. Patient data, including age, sex, tumor resection range, location, denosumab use, Campanacci grade, and radiotherapy, were documented. Comparable factors were evaluated using odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). RESULTS: Sixteen studies were included. The overall incidence of spinal GCT recurrence was 29%. Campanacci grade III tumors showed better recurrence outcomes than grades I and II (OR, 16.36; 95% CI, 4.19-63.93; p<0.001). Gross total resection (OR, 0.09; 95% CI, 0.04-0.19; p<0.001), radiotherapy (OR, 0.27; 95% CI, 0.11-0.65; p=0.004), and the use of denosumab during subtotal resection (OR, 2.95; 95% CI, 1.07-8.17; p=0.04) were important factors for reducing recurrence. CONCLUSION: Clinicians must consider the effects of gross total resection, radiotherapy use, and denosumab use in cases of subtotal resection during spinal GCT treatment. So far, many researchers have used denosumab in spinal GCT, but none have clearly suggested an endpoint. Most studies, however, recommend using it for more than 6 months.

Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

PURPOSE: With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs. MATERIALS AND METHODS: We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, "readmission" and "ACDF." A total of 10 studies were included. RESULTS: Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30-5.56; p<0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10-1.36; p<0.001], and private insurance (OR, 0.34; 95% CI, 0.17-0.69; p<0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41-3.25; p<0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20-2.11; p=0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13-3.86; p<0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68-2.72; p<0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29-1.51; p<0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21-70.41; p<0.001) was significantly associated with unplanned readmission. CONCLUSION: Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.

Postoperative spinal deformity and instability after cervical spinal cord tumor resection in adults: A systematic review and meta-analysis.

OBJECTIVE: To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies. METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI). RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 âˆ¼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 âˆ¼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 âˆ¼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery. CONCLUSION: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.

Risk factors for reoperation after lumbar spine surgery in a 10-year Korean national health insurance service health examinee cohort.

Degenerative lumbar spine disease is becoming increasingly prevalent in the aging population. Surgical treatment is the standard treatment modality for intractable cases, but the reoperation rate remains high. We conducted this study to longitudinally evaluate the impact of health risk factors on the risk of lumbar spine reoperation in Koreans aged over 40 years. Subjects aged > 40 years who underwent their first lumbar spinal surgery between January 2005 and December 2008 were selected and followed up until 2015. A total of 6300 people were included. The reoperation rate during the 10-year follow-up period was 13.2% (831/6300 patients). The reoperation rate was the highest in patients in their 60 s (15.4%, P < 0.05). The reoperation rates were also significantly higher in men (vs. women: 14.7% vs. 11.7%, P < 0.05), smokers (vs. non-smokers: 15.2% vs. 12.7%, P < 0.05), alcohol drinkers (vs. non-drinkers: 14.7% vs. 12.4%, P < 0.05), and those with a higher Charlson Comorbidity Index (CCI) score (CCI 0, 11.6%; 1-2, 13.2%; and ≥ 3, 15%; P < 0.05). Among patients undergoing lumbar spine surgery, reoperation is performed in 13.2% of patients within 10 years. Male sex, age in the 60 s, alcohol use, smoking, higher Hgb and a high CCI score increased the risk of reoperation after lumbar spine operation.

A new surgical method for treating syringomyelia secondary to arachnoiditis following cervical spine surgery: the syringo-cisterna magna shunt.

PURPOSE: The 5-year postoperative failure rate of conventional shunt treatment for syringomyelia is 50%, with arachnoditis, shunt obstruction, and shunt malfunction being the most common causes. We report a new syringo-cisterna magna (SCM) shunt that allows syrinx cerebrospinal fluid (CSF) drainage normally into the cerebellomedullary cisterns through the subarachnoid space. METHODS: Between November 2012 and February 2017, six patients (mean age: 57.25 years; sex: four male and two female) received the SCM shunt. They had spinal cord injury, abscess formation after a spine operation, and cerebral meningitis-related syringomyelia (syrinx between C0 and T9), and presented sensory changes and motor weakness. Preoperatively and at 1 year postoperatively, the syrinx length and diameter were assessed using magnetic resonance imaging (MRI). Clinical outcomes were evaluated using the visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores. RESULTS: Motor weakness improved, pain subsided, and sensory disturbance resolved in all patients who returned to work within 6 weeks postoperatively. In all cases, the syrinx collapsed (length: 3.3 levels decreased; diameter: decreased from 7.90 to 4.64 mm, p = 0.046) on postoperative MRI. No patient experienced syrinx recurrence and shunt malfunction on MRI or showed spinal instability signs on plain radiography. The VAS (pre- vs post-shunt: 6.50 vs 3.83, p = 0.027) and JOA scores (pre- vs post-shunt: 10.00 vs 11.17, p = 0.167) were improved postoperatively. CONCLUSION: We developed a new shunting system allowing syrinx CSF drainage to the posterior fossa, with symptomatic improvement, minimal complications, and syrinx decrease on follow-up MRI. The SCM shunt is effective for treating syringomyelia.

Characteristics and Risk Factors of Rod Fracture Following Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of study is to investigate the features and risk factors of rod fracture (RF) following adult spinal deformity (ASD) surgery. METHODS: We searched the PubMed, Embase, Web of Science, and Cochrane Library databases to identify relevant studies. Patient's data including age, sex, body mass index (BMI), previous spine surgery, pedicle subtraction osteotomy (PSO), interbody fusion, fusion to the pelvis, smoking history, preoperative sagittal vertical axis (SVA), preoperative pelvic tilt (PT), preoperative pelvic incidence minus lumbar lordosis, preoperative thoracic kyphosis (TK), and change in the SVA were documented. Comparable factors were evaluated using odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS: Seven studies were included. The overall incidence of RF following ASD surgery was 12%. Advanced age (WMD, 2.8; 95% CI, 1.01-4.59; p < 0.002), higher BMI (WMD, 1.98; 95% CI, 0.65-3.31; p = 0.004), previous spine surgery (OR, 1.47; 95% CI, 1.05-2.04; p = 0.02), PSO (OR, 2.28; 95% CI, 1.62-3.19; p < 0.0001), a larger preoperative PT (WMD, 6.17; 95% CI, 3.55-8.97; p < 0.00001), and a larger preoperative TK (WMD, 5.19; 95% CI, 1.41-8.98; p = 0.007) were identified as risk factors for incidence of RF. CONCLUSION: The incidence of RF in patients following ASD surgery was 12%. Advanced age, higher BMI, previous spine surgery, and PSO were significantly associated with an increased occurrence of RF. A larger preoperative PT and TK were also identified as risk factors for occurrence of RF following ASD surgery.

Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density Analysis in Global Alignment and Proportion Score of Each 3 Categories for Predicting Mechanical Complications After Adult Spinal Deformity Surgery.

OBJECTIVE: This study aimed to analyze the prediction rate of the modified Global Alignment and Proportion (GAP) scoring system with body mass index and bone mineral density (GAPB) in each GAP of the 3 categories. METHODS: Between January 2009 and December 2016, 203 consecutive patients with adult spinal deformity (ASD) underwent corrective fusion of more than 4 levels and were followedup for more than 2 years. As a validation of the GAPB, the GAPB was divided into tertiles (Q1, Q2, Q3) for each section of the GAP score. Each patient's GAP score and GAPB system complication rate were examined. RESULTS: Of the 203 patients, 89 patients (44%) developed mechanical complications after ASD surgery. A GAP score analysis of the patients found that 42 patients were proportioned, 85 patients were moderately disproportioned, and 76 patients were severely disproportioned. Mechanical complications occurred with increasing GAPB in the proportioned group, but were not statistically significant (p = 0.0534). However, mechanical complications occurred in a statistically significant manner in the moderately disproportioned and severely disproportioned groups as GAPB increased (p < 0.001). CONCLUSION: The GAPB system showed improved predictability for mechanical complications after surgery for ASD in each category of the GAP score.

Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle).

OBJECTIVE: In this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed. METHODS: Between January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36- item Short Form Health Survey (SF-36) were evaluated. RESULTS: Based on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p < 0.001; area under the curve [AUC] = 0.645). In multivariable analysis, the result was much more related (OR, 2.924; p = 0.001; AUC = 0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88 ± 0.73 vs. 0.68 ± 0.64, p = 0.042), ODI (-24.72 ± 20.16 vs. -19.01 ± 19.95, p = 0.046), SF-36 physical composite score (19.33 ± 18.55 vs. 12.90 ± 16.73, p = 0.011) were significantly improved in OD-HA normal group. CONCLUSION: The goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.

Minimally Invasive Spine Surgery With Midline Cortical Bone Trajectory Screw Fixation for Lumbar Degenerative Disease in a Retrospective Study of 200 Patients.

OBJECTIVE: Midline lumbar interbody fusion is performed for treatment of various lumbar degenerative diseases, with good clinical outcomes and few complications. However, there are no large-scale or long-term studies regarding midline lumbar interbody fusion. Therefore, the purpose of this study was to evaluate the clinical results of midline lumbar interbody fusion and to compare the results according to surgical level. METHODS: Between January 2013 and December 2015, 200 patients with lumbar degenerative disease undergoing midline lumbar interbody fusion surgery were enrolled. The mean patient age was 69.9 ± 15.8 years (range, 40-85 years). The patients were divided into groups according to surgical level: (1) level 1 operation (136 patients), (2) level 2 operation (43 patients), (3) level 3 operation (12 patients), and (4) level 4 or higher (9 patients). Clinical outcomes, fusion rates, and complications were compared among the 4 groups. RESULTS: All clinical outcomes significantly improved after surgery (measured at 3 years postoperatively) in all groups. Mean fusion rate was 90.5% ± 5.21%. Fusion rate was highest in group I (95.8%) and lowest in group IV (85.2%). There were complications in 17 cases (8.5%). Adjacent segment disease occurred in 16 cases, 5 of which required surgery. Group 1 had 1 case, and group 4 had 4 cases. Screw loosening occurred in 1 case in group 4. There were no cases of infection or mechanical complications. CONCLUSION: This large, single-institution, retrospective study demonstrates favorable clinical outcomes after midline lumbar interbody fusion for lumbar degenerative disease regardless of surgical level.

Comparison of Zero-profile Anchored Spacer Versus Plate-and-Cage After 1-Level ACDF With Complete Uncinate Process Resection: A 3-Year Assessment of Radiographic and Clinical Outcomes.

STUDY DESIGN: This is a retrospective study. OBJECTIVE: The purpose of this study is to compare the zero-profile anchored spacer device (Zero-p) and traditional plate-and-cage implant (plate-and-cage) in anterior cervical discectomy and fusion (ACDF) with complete uncinate process resection (UPR) to treat 1-level cervical degenerative disk disease. SUMMARY OF BACKGROUND DATA: We retrospectively surveyed the data from all patients who underwent single-level ACDF with complete UPR between 2009 and 2013. PATIENTS AND METHODS: In total, 80 patients participated in 3 years of follow-up. Among them, Zero-p (38 patients) and plate-and-cage (42 patients) approaches were used in ACDF with complete UPR. Clinical outcomes and radiographic results were compared between 2 groups and they were followed for 39.1±2.2 months. RESULTS: Duration of operation, intraoperative blood loss, and length of hospitalization were significantly lower in the Zero-p group than the plate-and-cage group (P<0.001). The clinical outcomes of visual analog scale, neck disability index, and the Odom criteria were improved after operation in both groups. The fusion rates, C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis, sellar turcica-C7 sagittal vertical axis, and spinocranial angle after single-level ACDF were not significantly different between the 2 groups. Subsidence occurred in 5 cases (13%) in the Zero-p group and 10 cases (37%) in the plate-and-cage group (P<0.05). The horizontal length of the Zero-p implant was longer than that of allograft bone. Fusion occurred in 37 cases (95%) of the Zero-p group and 40 cases (94%) in the plate-and-cage group. CONCLUSIONS: The Zero-p and plate-and-cage are effective when single-level ACDF with complete UPR was performed. Both groups showed good clinical outcomes, but Zero-p has more benefits than plate-and-cage such as lower duration of operation, intraoperative blood loss, length of hospitalization, and rate of subsidence compared with plate-and-cage. Surgeons should be aware of these results so that postoperative complications such as subsidence can be avoided.

Anterior cervical discectomy and fusion vs posterior laminoplasty for the treatment of myelopathy due to two-level localized ossification of the posterior longitudinal ligament.

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ±â€Š10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.

Modified global alignment and proportion scoring with body mass index and bone mineral density (GAPB) for improving predictions of mechanical complications after adult spinal deformity surgery.

BACKGROUND CONTEXT: The global alignment and proportion (GAP) score for predicting mechanical complications of adult spinal deformity (ASD) surgery has limitations due to its lack of bone quality and patient characteristics such as obesity, which has a significant impact on surgical outcome, especially in the elderly population with ASD. PURPOSE: This study aimed to improve the predictability of GAP score after ASD surgery by adding body mass index (BMI) and bone mineral density (BMD). DESIGN: A retrospective comparative study. PATIENT SAMPLE: Between January 2009 and December 2016, 203 consecutive patients with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. OUTCOME MEASURES: The ability of the Scoliosis Research Society (SRS)-Schwab classification, age-adjusted alignment goals, GAP score, and modified global alignment and proportion scoring with BMI and BMD (GAPB) to predict mechanical failure was compared by calculating the area under the receiver operating characteristic curve (AUC). METHODS: The GAPB was developed and validated in patients randomly assigned to derivation (n=125, 61.6%) and validation (n=78, 38.4%) cohorts. Considering multicollinearity, a multivariable logistic regression model with BMD, BMI, and the GAP score was constructed. RESULTS: Patients' average age was 66.8±12.28 years, and they were followed for an average of 30.54±10.25 months. Fifty-five patients of the derivation cohort (44%) and 34 patients of the validation cohort (43%) had mechanical complications after ASD surgery. AUCs of the SRS-Schwab classification, GAP score, age-adjusted alignment goals, and GAPB were 0.532 (95% confidence interval [CI], 0.463-0.602), 0.798 (95% CI, 0.720-0.877), 0.568 (95% CI, 0.495-0.641), and 0.885 (95% CI 0.828-0.941), respectively. CONCLUSIONS: The GAPB system, which includes BMI and BMD, showed improved predictability for predicting mechanical complications compared to the GAP score. Given these results, surgeons should keep in mind the importance of bone quality and BMI as well as proportional alignment.

Retrospective Study on Accuracy of Intraoperative Frozen Section Biopsy in Spinal Tumors.

OBJECTIVE: Histologic types and grades are critical in the diagnosis and treatment of spinal tumors. Intraoperative frozen section is a fast and easy method in confirming pathologic diagnosis during the operation. This study was undertaken to reveal the accuracy of intraoperative frozen section biopsy in order to make proper treatment plans. METHODS: This retrospective study concerned patients who underwent spinal tumor surgeries from 1 January, 2012 to 31 December, 2016. Frozen section biopsy and permanent biopsy were compared, and cases that had differences were counted. RESULTS: Thirty-seven cases out of 324 patients had discrepancies (11.4%). In discrepant cases 11 cases were ependymoma (29.7%) and 6 cases were schwannoma (16.2%). Among 34 patients who were finally diagnosed with an ependymoma, 11 cases had discrepancies, which was the highest mismatch rate among tumor final pathologic types. By frozen biopsy, astrocytoma (n = 5) and ependymoma (n = 5) turned out to be the most discrepant pathologic types and 16 frozen section biopsy cases were "null." Frozen biopsy astrocytoma (n = 5) mostly turned out to be ependymoma in 4 cases. CONCLUSIONS: Pathologic findings from frozen biopsy for spinal cord tumors could not be corresponded to final diagnosis, especially when the results of frozen biopsy were ependymoma or astrocytoma. Therefore careful decision making for treatment plans is required.