Impact of body mass index on surgical outcomes and complications in adult spinal deformity.

BACKGROUND: Several studies have reported that overweightness and obesity are associated with higher complication rates in lumbar spine surgery. However, little is known about the effect of obesity on postoperative complications in adult spinal deformity (ASD) surgery, especially in the elderly. This study aimed to examine the effect of body mass index (BMI) on surgical outcomes and postoperative complications in elderly ASD patients undergoing surgical correction in Japan. METHODS: We conducted a retrospective, multicenter, observational study of 234 consecutive patients diagnosed with ASD who underwent corrective surgery. Patients were divided into two groups according to BMI, BMI <25 (153 patients, mean age 71.9 years) and BMI ≥ 25 (overweight/obese, 81 patients, mean age 73.3 years). Radiographic results and perioperative complications were compared between the two groups. RESULTS: Surgical complications occurred in approximately 20% of patients in each group; complications did not significantly differ between the two groups. A greater proportion of patients in the BMI ≥ 25 group experienced mechanical failure and DJK, although the difference was not significant. Preoperative mean lumbar lordosis (LL), pelvic incidence (PI) minus LL, sacral slope (SS) and sagittal vertical axis (SVA) were similar in the BMI < 25 and BMI ≥ 25 groups. However, the BMI ≥25 group had lower mean LL (p = 0.015) and higher PI minus LL (p = 0.09) postoperatively. The BMI ≥25 groups also had significantly smaller LL (p = 0.026), smaller SS (p = 0.049) and higher SVA (p = 0.041) at the final follow-up, compared to the BMI < 25 group. CONCLUSIONS: In the present study, no difference in medical or surgical complications after ASD surgery was found between overweight/obese patients (BMI ≥ 25) and those with BMI < 25. However, correction of LL and SVA was smaller in patients with overweight/obese patients.

Comparison of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion as Corrective Surgery for Patients with Adult Spinal Deformity-A Propensity Score Matching Analysis.

Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients' backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients' characteristics, including radiographic parameters and preoperative comorbidities, and one-to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence-LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.

Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients.

BACKGROUND: The aim of the study was to compare the accuracy of percutaneous pedicle screw (PPS) insertion (P-side) with that of conventional open screw insertion (O-side) during unilateral open transforaminal lumbar interbody fusion (TLIF) in the same patients. We also sought to determine the incidence of pedicle screw misplacement and to identify relevant risk factors. METHODS: The study was a retrospective analysis of prospectively collected data for 766 pedicle screws placed in 181 consecutive patients who underwent a unilateral open-TLIF procedure in the lumbosacral spine. Our minimally invasive TLIF was performed by unilateral open freehand insertion of pedicle screws for decompression on one side and PPS on the opposite side. Using this approach, we were able to compare the accuracy of PPS insertion with that of conventional open screw insertion in the same patients. There were 383 PPSs and 383 screws inserted by the open method. The accuracy of screw placement was evaluated on reconstructed computed tomography images obtained postoperatively, and screw misplacement was classified. Potential risk factors for screw misplacement were investigated in three-level mixed-effects logistic regression analysis. RESULTS: Thirty-four screws (8.9%) were misplaced on the P-side and 37 (9.5%) were misplaced on the O-side; the difference was not statistically significant (P = 0.803). Subclassification analysis revealed minor perforation of 28 screws (7.3%) on the P-side and 32 (8.4%) on the O-side, moderate perforation of 5 screws (1.3%) on the P-side and 4 (1.0%) on the O-side, and severe perforation of 1 screw (0.3%) on each side. Three-level mixed-effects logistic regression analysis identified body mass index as a significant risk factor for screw misplacement on the P-side (odds ratio 1.194, 95% confidence interval 1.066-1.338). CONCLUSIONS: Accuracy of pedicle screw insertion was not significantly different between PPS insertion and conventional open screw insertion in the same patients. Body mass index had a significant influence on the risk of screw misplacement in PPS insertion.

Critical involvement of Rho GTPase activity in the efficient transplantation of neural stem cells into the injured spinal cord.

BACKGROUND: Transplantation of neural stem/progenitor cells is a promising approach toward functional restoration of the damaged neural tissue, but the injured spinal cord has been shown to be an adverse environment for the survival, migration, and differentiation of the donor cells. To improve the efficiency of cell replacement therapy, cell autonomous factors in the donor cells should be optimized. In light of recent findings that Rho family GTPases regulate stem cell functions, genetic manipulation of Rho GTPases can potentially control phenotypes of transplanted cells. Therefore we expressed mutant forms of Rho GTPases, Rac, Rho, and Cdc42, in the neural stem/progenitor cells and examined their survival and migration after transplantation. RESULTS: Manipulation of the individual Rho GTPases showed differential effects on survival, with little variation in their migratory route and predominant differentiation into the oligodendroglial lineage. Combined suppression of both Rac and Rho activity had a prominent effect on promoting survival, consistent with its highly protective effect on drug-induced apoptosis in culture. CONCLUSION: Manipulation of Rac and Rho activities fully rescued suppression of cell survival induced by the spinal cord injury. Our results indicate that precise regulation of cell autonomous factors within the donor cells can ameliorate the detrimental environment created by the injury.