Holey Sheets Enhance the Packing and Osmotic Energy Harvesting of Graphene Oxide Membranes.

Layered membranes assembled from two-dimensional (2D) building blocks such as graphene oxide (GO) are of significant interest in desalination and osmotic power generation because of their ability to selectively transport ions through interconnected 2D nanochannels between stacked layers. However, architectural defects in the final assembled membranes (e.g., wrinkles, voids, and folded layers), which are hard to avoid due to mechanical compliant issues of the sheets during the membrane assembly, disrupt the ionic channel pathways and degrade the stacking geometry of the sheets. This leads to degraded ionic transport performance and the overall structural integrity. In this study, we demonstrate that introducing in-plane nanopores on GO sheets is an effective way to suppress the formation of such architectural imperfections, leading to a more homogeneous membrane. Stacking of porous GO sheets becomes significantly more compact, as the presence of nanopores makes the sheets mechanically softer and more compliant. The resulting membranes exhibit ideal lamellar microstructures with well-aligned and uniform nanochannel pathways. The well-defined nanochannels afford excellent ionic conductivity with an effective transport pathway, resulting in fast, selective ion transport. When applied as a nanofluidic membrane in an osmotic power generation system, the holey GO membrane exhibits higher osmotic power density (13.15 W m-2) and conversion efficiency (46.6%) than the pristine GO membrane under a KCl concentration gradient of 1000-fold.

Deep Learning Method for Precise Landmark Identification and Structural Assessment of Whole-Spine Radiographs.

This study measured parameters automatically by marking the point for measuring each parameter on whole-spine radiographs. Between January 2020 and December 2021, 1017 sequential lateral whole-spine radiographs were retrospectively obtained. Of these, 819 and 198 were used for training and testing the performance of the landmark detection model, respectively. To objectively evaluate the program's performance, 690 whole-spine radiographs from four other institutions were used for external validation. The combined dataset comprised radiographs from 857 female and 850 male patients (average age 42.2 ± 27.3 years; range 20-85 years). The landmark localizer showed the highest accuracy in identifying cervical landmarks (median error 1.5-2.4 mm), followed by lumbosacral landmarks (median error 2.1-3.0 mm). However, thoracic landmarks displayed larger localization errors (median 2.4-4.3 mm), indicating slightly reduced precision compared with the cervical and lumbosacral regions. The agreement between the deep learning model and two experts was good to excellent, with intraclass correlation coefficient values >0.88. The deep learning model also performed well on the external validation set. There were no statistical differences between datasets in all parameters, suggesting that the performance of the artificial intelligence model created was excellent. The proposed automatic alignment analysis system identified anatomical landmarks and positions of the spine with high precision and generated various radiograph imaging parameters that had a good correlation with manual measurements.

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.

Electrical stimulation promotes functional recovery after spinal cord injury by activating endogenous spinal cord-derived neural stem/progenitor cell: an in vitro and in vivo study.

BACKGROUND CONTEXT: Electrical stimulation is a noninvasive treatment method that has gained popularity in the treatment of spinal cord injury (SCI). Activation of spinal cord-derived neural stem/progenitor cell (SC-NSPC) proliferation and differentiation in the injured spinal cord may elicit considerable neural regenerative effects. PURPOSE: This study aimed to explore the effect of electrical stimulation on the neurogenesis of SC-NSPCs. STUDY DESIGN: This study analyzed the effects of electrical stimulation on neurogenesis in rodent SC-NSPCs in vitro and in vivo and evaluated functional recovery and neural circuitry improvements with electrical stimulation using a rodent SCI model. METHODS: Rats (20 rats/group) were assigned to sham (Group 1), SCI only (Group 2), SCI + electrode implant without stimulation (Group 3), and SCI + electrode with stimulation (Group 4) groups to count total SC-NSPCs and differentiated neurons and to evaluate morphological changes in differentiated neurons. Furthermore, the Basso, Beattie, and Bresnahan scores were analyzed, and the motor- and somatosensory-evoked potentials in all rats were monitored. RESULTS: Biphasic electrical currents enhanced SC-NSPC proliferation differentiation and caused qualitative morphological changes in differentiated neurons in vitro. Electrical stimulation promoted SC-NSPC proliferation and neuronal differentiation and improved functional outcomes and neural circuitry in SCI models. Increased Wnt3, Wnt7, and ß-catenin protein levels were also observed after electrical stimulation. CONCLUSIONS: Our study proved the beneficial effects of electrical stimulation on SCI. The Wnt/ß-catenin pathway activation may be associated with this relationship between electrical stimulation and neuronal regeneration after SCI. CLINICAL SIGNIFICANCE: The study confirmed the benefits of electrical stimulation on SCI based on cellular, functional, electrophysiological, and histological evidence. Based on these findings, we expect electrical stimulation to make a positive and significant difference in SCI treatment strategies.

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.

What are the risk factors for a second osteoporotic vertebral compression fracture?

BACKGROUND CONTEXT: Osteoporosis is characterized by decreased bone strength and an increased risk of fracture. Osteoporosis-related fractures are associated with increased morbidity, mortality, dysfunction, access to health care, health-care costs, and reduced quality of life. Therefore, preventing osteoporotic vertebral compression fractures (OVCF) is important. Secondary OVCFs often occur after the first OVCF. PURPOSE: This study aimed to identify risk factors for a second OVCF after a first OVCF. STUDY DESIGN: Retrospective observational study. PATIENT SAMPLE: One hundred seventy-eight patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019 were enrolled in this study. OUTCOME MEASURES: The following data were observed for all cases: patient demographics, bone mineral density, and pelvic parameters. METHODS: We retrospectively reviewed patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019. Demographic factors, medication (oral bisphosphonate, zoledronic acid, denosumab), bone mineral density (BMD), body mass index (BMI), fat, and muscle amount of the trunk using dual-energy X-ray absorptiometry (DEXA), and pelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence minus lumbar lordosis) were investigated. RESULTS: Of 178 patients who had an OVCF, 68 (38.2%) had a second OVCF. Patients were followed up for >2 years and wore braces for an average of 6 months. The mean age was 71.9±8.63 years, mean BMD T-score was -3.1±1.09, and mean BMI was 23.3±2.96. Comparing those with and without a second OVCF, the smaller the BMD T-score and trunk muscle mass to fat ratio, the more likely a second OVCF occurred (p<.05). There were fewer second OVCF cases in the injection medication group than in the peroral group (p<.05). There were no significant differences in radiologic parameters between these groups. CONCLUSIONS: Patients who had a second OVCF had an average of 21.3 months after the first OVCF. Risk factors for a second OVCF are low T-scores in the femur, and low M/F ratio of the trunk, android, and gynoid regions. For patients with an OVCF, injection medications may be advisable.

Impermeable Graphene Skin Increases the Heating Efficiency and Stability of an MXene Heating Element.

A Joule heater made of emerging 2D nanosheets, i.e., MXene, has the advantage of low-voltage operation with stable heat generation owing to its highly conductive and uniformly layered structure. However, the self-heated MXene sheets easily get oxidized in warm and moist environments, which limits their intrinsic heating efficiencies. Herein, an ultrathin graphene skin is introduced as a surface-regulative coating on MXene to enhance its oxidative stability and Joule heating efficiency. The skin layer is deposited on MXene using a scalable solution-phased layer-by-layer assembly process without deteriorating the excellent electrical conductivity of the MXene. The graphene skin comprises narrow and hydrophobic channels, which results in ≈70 times higher water impermeability of the hybrid film of graphene and MXene (GMX) than that of the pristine MXene. A complementary electrochemical analysis confirms that the graphene skin facilitates longer-lasting protection than conventional polymer coatings owing to its tortuous pathways. In addition, the sp2 planar carbon surface with a low heat loss coefficient improves the heating efficiency of the GMX, indicating that this strategy is promising for developing adaptive heating materials with a tractable voltage range and high Joule heating efficiency.

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.

Artificial Intelligence for Neurosurgery : Current State and Future Directions.

Artificial intelligence (AI) is a field of computer science that equips machines with human-like intelligence and enables them to learn, reason, and solve problems when presented with data in various formats. Neurosurgery is often at the forefront of innovative and disruptive technologies, which have similarly altered the course of acute and chronic diseases. In diagnostic imaging, such as X-rays, computed tomography, and magnetic resonance imaging, AI is used to analyze images. The use of robots in the field of neurosurgery is also increasing. In neurointensive care units, AI is used to analyze data and provide care to critically ill patients. Moreover, AI can be used to predict a patient's prognosis. Several AI applications have already been introduced in the field of neurosurgery, and many more are expected in the near future. Ultimately, it is our responsibility to keep pace with this evolution to provide meaningful outcomes and personalize each patient's care. Rather than blindly relying on AI in the future, neurosurgeons should gain a thorough understanding of it and use it to enhance their patient care.

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.

Sub-Second Joule-Heated RuO2-Decorated Nitrogen- and Sulfur-Doped Graphene Fibers for Flexible Fiber-type Supercapacitors.

Graphene-based fiber-shaped supercapacitors (FSSCs) have received considerable attention as potential wearable energy storage devices owing to their simple operating mechanism, flexibility, and long-term stability. To date, energy storage capacities of supercapacitors have been significantly improved via strategies such as heteroatom doping and the incorporation of pseudocapacitive metal oxides. Herein, we develop a novel and scalable direct-hybridization method that combines heteroatom doping and metal oxide hybridization for the fabrication of high-performance FSSCs. Using porous and highly conductive nitrogen and sulfur co-doped graphene fibers (NS-GFs) as self-heating units, we successfully convert ruthenium hydroxide anchored to the surface into ruthenium oxide nanoparticles after programmed sub-second electrothermal annealing without structural damage of the fibers. The resulting fibers show an increased gravimetric capacitance of 68.88 F g-1 compared to that of the pristine NS-GF (8.32 F g-1), excellent cyclic stability maintaining 96.67% of the initial capacitance after 20 000 continuous charging/discharging cycles, and good mechanical flexibility. The findings of this work advocate a successful Joule heating strategy for preparing high-performance graphene-based metal oxide hybrid FSSCs for use in energy storage applications.

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.