Impact of sarcopenia on outcomes following lumbar spine surgery for degenerative disease: an updated systematic review and meta-analysis.

PURPOSE: This study aimed to consolidate the evidence regarding the prognostic influence of sarcopenia in degenerative lumbar spine surgeries. METHODS: A literature search of public databases was conducted up to Nov 15, 2023 using combinations of the key words "sarcopenia" and "lumbar spine surgery". Eligible studies were those that focused on adults undergoing decompression or fusion surgery for degenerative lumbar spine diseases, and compared the outcomes between patients with and without preoperative sarcopenia. Primary outcomes were change in ODI and back and leg pain VAS pain scores. Secondary outcomes were changes in Eq. 5D, JOA, SFHS-p scores, and LOS. RESULTS: Ultimately, nine retrospective studies with a total of 993 patients were included. Sarcopenic patients exhibited significantly worse functional improvement as assessed by ODI compared to non-sarcopenic patients (pooled standardized mean difference [pSMD] = 0.53, 95% confidence interval [CI]: 0.17-0.90). Back pain (pSMD = 0.31, 95% CI:0.15-0.47) and leg pain (pSMD = 0.21, 95% CI:0.02 - 0.39) improvement were also less in sarcopenic patients. Non-sarcopenic patients had greater improvements in Eq. 5D (pSMD = 0.25) and SFHS-p (pSMD = 0.39), and shorter LOS (pSMD = 0.62). CONCLUSIONS: As compared to patients without sarcopenia, those with sarcopenia undergoing lumbar spine surgery for degenerative diseases have lower improvements in functional ability, quality of life, physical health, pain relief and extended hospitalization compared to those without sarcopenia.

Navigation-Assisted One-Staged Posterior Spinal Fusion Using Pedicle Screw Instrumentation in Adolescent Idiopathic Scoliosis-A Case Series.

Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent three-dimensional spinal disorder, with a multifactorial pathogenesis, including genetics and environmental aspects. Treatment options include non-surgical and surgical treatment. Surgical interventions demonstrate positive outcomes in terms of deformity correction, pain relief, and improvements of the cardiac and pulmonary function. Surgical complications, including excessive blood loss and neurologic deficits, are reported in 2.27-12% of cases. Navigation-assisted techniques, such as the O-arm system, have been a recent focus with enhanced precision. This study aims to evaluate the results and complications of one-stage posterior instrumentation fusion in AIS patients assisted by O-arm navigation. Materials and Methods: This retrospective study assesses 55 patients with AIS (12-28 years) who underwent one-stage posterior instrumentation correction supported by O-arm navigation from June 2016 to August 2023. We examined radiological surgical outcomes (initial correction rate, loss of correction rate, last follow-up correction rate) and complications as major outcomes. The characteristics of the patients, intraoperative blood loss, operation time, number of fusion levels, and screw density were documented. Results: Of 73 patients, 55 met the inclusion criteria. The average age was 16.67 years, with a predominance of females (78.2%). The surgical outcomes demonstrated substantial initial correction (58.88%) and sustained positive radiological impact at the last follow-up (56.56%). Perioperative complications, including major and minor, occurred in 18.18% of the cases. Two patients experienced a major complication. Blood loss (509.46 mL) and operation time (402.13 min) were comparable to the literature ranges. Trend analysis indicated improvements in operation time and blood loss over the study period. Conclusions: O-arm navigation-assisted one-stage posterior instrumentation proves reliable for AIS corrective surgery, achieving significant and sustained positive radiological outcomes, lower correction loss, reduced intraoperative blood loss, and absence of implant-related complications. Despite the challenges, our study demonstrates the efficacy and maturation of this surgical approach.

Computed Tomography-Guided Endoscopic Surgery in Lumbar Disc Herniation With High-grade Migration: A Retrospective, Comparative Study.

BACKGROUND: Symptomatic herniated intervertebral discs are debilitating. However, surgical management poses a significant challenge for endoscopic spine surgeons, especially in high-grade migrated lesions. OBJECTIVES: This study aimed to  assess the surgical and clinical outcomes after applying a computed tomography navigated percutaneous endoscopic lumbar discectomy. STUDY DESIGN: The data of patients with high-grade lumbar disc migration who underwent percutaneous endoscopic lumbar discectomy at our spine center were retrospectively collected and analyzed from November 2017 to May 2019. The patients were divided into 2 groups based on different workflows, with group O who underwent percutaneous endoscopic lumbar discectomy with computed-tomography navigation (O-arm), and group C who underwent conventional fluoroscopic guidance (C-arm). SETTING: Twenty-one (n = 21) patients were enrolled with data fully documented. There were 9 patients in group O (n = 9) and 12 patients in group C (n = 12). METHODS: An intraoperative 3-dimensional image was obtained using the O-arm device (O-arm®, Medtronic, Inc., Louisville, CO, United States) after patient positioning in group O, and enable multiplanar visualization during exploring the entry point, trajectory, orientation, and finally discectomy. In group C, conventional imaging scanner intensifier (C-arm) was used during the procedure. RESULTS: The operative time (99.4 ± 40.7 vs 86.9 ± 47.9 minutes, P = .129), blood loss (11.1 ± 15.7 vs 6.7 ± 8.2 mL, P = .602), and hospital stay (2.9 ± 0.3 vs 2.8 ± 0.6 days, P = .552) were similar between the 2 groups. However, group O showed more reduction in the pain and faster functional recovery immediately after the surgery (Visual Analog Score [VAS]: -9 vs -6.7, P =.277; Oswestry Disability Index [ODI]: -53.2% vs -29.1%, P = 0.006) and during the one-year follow-up (VAS: -8.1 vs -7.3, P =.604; ODI: -56.7% vs -40.1%, P = .053) compared with group C. LIMITATIONS: The retrospective nature of the study design, the small population size, and the shorter period of follow-up required further study. CONCLUSIONS: Computed tomography-navigated percutaneous endoscopic surgery is safe and effective for lumbar disc herniation with high-grade migration, and enhance early functional recovery even compared with conventional fluoroscopic guidance.

Periprosthetic knee infection reconstruction with a hinged prosthesis: Implant survival and risk factors for treatment failure.

BACKGROUND: Severe bone and soft tissue defects are common after failed two-stage exchange arthroplasty for periprosthetic joint infection (PJI). There is a paucity of evidence on the outcomes of using a hinged prosthesis for knee PJI reconstruction during second-stage re-implantation, especially regarding implant survivorship, reinfection risk factors, and functionality after successful reconstruction. METHODS: A total of 58 knee PJI patients with Anderson Orthopaedic Research Institute (AORI) type II/III defect and soft tissue insufficiency underwent reconstruction with hinged prosthesis. Enrolled patients adhered to a two-stage exchange arthroplasty protocol and were evaluated for a mean follow up of 65.1 months. Kaplan-Meier analysis was conducted for implant survivorship and infection-free survival. Multivariate analysis was used to determine independent risk factors for recurrent infections. Knee Society Score (KSS) was used to evaluate functional outcomes. RESULTS: The survivorship of hinged prosthesis was 86.2% at 2 years and 70.2% at 5 years. Infection-free analysis revealed an estimation of 68.9% at 2 years and 60.6% at 5 years. Of the 58 patients, 13 (22.4%) developed recurrent PJI, three (5.2%) aseptic loosening, and one (1.7%) periprosthetic fracture. Multivariate analysis revealed that obesity (hazard ratio (HR), 3.11), high-virulent pathogen (HR, 3.44), and polymicrobial infection (HR, 3.59) were independent risk factors for reinfection. Patients showed a mean improvement of 32.8 ± 7.7 in Knee Society Clinical Score (KSCS) and 30.8 ± 11.0 in Knee Society Function Score (KSFS) after successful reconstruction (P<0.001). CONCLUSIONS: Using hinged knee prosthesis for PJI reconstruction provided an overall implant survival of 70.2% and an infection-free survival of 60.6% at mid-term follow up. Obesity, virulent pathogens, and polymicrobial infections were independent risk factors for infection recurrence.

Minimally Invasive Transforaminal Lumbar Interbody Debridement and Fusion with Percutaneous Pedicle Screw Instrumentation for Spondylodiscitis.

BACKGROUND: Minimally invasive transforaminal lumbar interbody debridement and fusion (MiTLIDF) with percutaneous pedicle screw instrumentation (PSI) is a less invasive treatment for lumbar spondylodiscitis. METHODS: Patients with single-level lumbar spondylodiscitis were surgically treated by interbody debridement and fusion through an anterior or transforaminal approach combined with open or percutaneous PSI (group A: anterior debridement and interbody fusion with open posterior PSI; group B: transforaminal lumbar interbody debridement and fusion [TLIDF] with open posterior PSI; group C: anterior debridement and interbody fusion with percutaneous PSI; group D: MiTLIDF with percutaneous PSI). Perioperative data, fusion status, infection-free survival, and clinical outcome measurements were compared among the 4 surgical groups. RESULTS: A total of 82 patients were included in this study. TLIDF was associated with shorter operative time when compared with the anterior approach (group A: 302.8 ± 59.9 minutes; group B: 209.2 ± 31.0 minutes; group C: 260.6 ± 62.5 minutes; group D: 207.1 ± 33.6 minutes; P < 0.001). Percutaneous PSI resulted in less intraoperative blood loss (group A: 907.5 ± 253.7 mL; group B: 859.4 ± 201.2 mL; group C: 532.9 ± 193.7 mL; group D: 399.1 ± 84.3 mL) and reduced immediate postoperative pain (group A: 5.5 ± 0.9; group B: 4.9 ± 0.9; group C: 3.9 ± 0.7; group D: 3.2 ± 0.7) than open PSI (P < 0.001). There were no significant differences in terms of overall infection-free survival (P = 0.936). CONCLUSIONS: This study demonstrated MiTLIDF with percutaneous PSI is a safe and effective treatment for lumbar spondylodiscitis while incurring no adverse effects in terms of fusion rate, functional recovery, and infection eradication.

Reliability of the michigan state university (msu) classification of lumbar disc herniation / Confiabilidade da universidade do estado de michigan (msu) classificação da herniação de disco lombar

ABSTRACT Objective: The Michigan State University (MSU) classification of lumbar disc herniation (LDH) is periodically used by various authors to classify disc herniation. We assessed the reliability of this classification system among orthopedic residents at our institute. Methods: Fifty T2 axial-cut magnetic resonance images (MRI) corresponding to the level of maximal disc herniation from patients diagnosed with a single LDH were selected and distributed to six orthopedic residents. All six residents gave a specific rating for each image based on the MSU classification; in addition, three residents gave ratings on two different occasions. The degree of agreement among residents was analyzed by calculating inter-observer and intra-observer reliability using the Kappa statistic. Results: The inter-observer reliability among the six residents calculated as the Fleiss' Kappa was 0.422, which indicates moderate reliability. The intra-observer reliability of three selected residents calculated by Cohen's Kappa was 0.750, 0.772, and 0.859, which indicates substantial to almost perfect reliability. Variations in ratings were frequent in images portraying a broad-based disc herniation with spinal canal stenosis. Conclusion: Our findings demonstrate moderate homogeneity of ratings given by residents; however, test-retest results proved the ratings to be consistent. Level of Evidence II, Diagnostic studies - investigating a diagnostic examination.

RESUMO Objetivo: A classificação da hérnia de disco lombar (LDH) da Michigan State University (MSU) é usada periodicamente por vários autores para classificar as hérnias discais. Pretendemos avaliar a confiabilidade deste sistema de classificação entre os residentes de ortopedia em nosso instituto. Métodos: Cinqüenta imagens de RM axial do corte T2 correspondendo ao nível de hérnia discal máxima de pacientes que foram diagnosticados com uma única LDH foram selecionadas e distribuídas para seis residentes ortopédicos. Todos os seis residentes deram uma classificação específica para cada imagem com base na classificação MSU; Além disso, três residentes deram notas em duas ocasiões diferentes. O grau de concordância entre os residentes foi analisado calculando-se a confiabilidade interobservador e intraobservador pela estatística Kappa. Resultados: Descobrimos que a confiabilidade interobservador entre seis residentes, calculando o Kappa de Fleiss, foi de 0,422; isso indica confiabilidade moderada. No entanto, a confiabilidade intra-observador de três residentes selecionados mostrou-se substancial (Kappa de Cohen = 0,750, 0,772 e 0,859 em três residentes, respectivamente). Variações na observação foram frequentes se houvesse hérnia discal ampla com estenose do canal vertebral. Conclusão: Nossos achados demonstram homogeneidade moderada das avaliações dadas pelos residentes; no entanto, teste-reteste provou que as classificações eram consistentes. Nível de Evidencia II, Estudos diagnósticos - investigação de um exame para diagnóstico.

RELIABILITY OF THE MICHIGAN STATE UNIVERSITY (MSU) CLASSIFICATION OF LUMBAR DISC HERNIATION.

OBJECTIVE: The Michigan State University (MSU) classification of lumbar disc herniation (LDH) is periodically used by various authors to classify disc herniation. We assessed the reliability of this classification system among orthopedic residents at our institute. METHODS: Fifty T2 axial-cut magnetic resonance images (MRI) corresponding to the level of maximal disc herniation from patients diagnosed with a single LDH were selected and distributed to six orthopedic residents. All six residents gave a specific rating for each image based on the MSU classification; in addition, three residents gave ratings on two different occasions. The degree of agreement among residents was analyzed by calculating inter-observer and intra-observer reliability using the Kappa statistic. RESULTS: The inter-observer reliability among the six residents calculated as the Fleiss' Kappa was 0.422, which indicates moderate reliability. The intra-observer reliability of three selected residents calculated by Cohen's Kappa was 0.750, 0.772, and 0.859, which indicates substantial to almost perfect reliability. Variations in ratings were frequent in images portraying a broad-based disc herniation with spinal canal stenosis. CONCLUSION: Our findings demonstrate moderate homogeneity of ratings given by residents; however, test-retest results proved the ratings to be consistent. Level of Evidence II, Diagnostic studies - investigating a diagnostic examination.

OBJETIVO: A classificação da hérnia de disco lombar (LDH) da Michigan State University (MSU) é usada periodicamente por vários autores para classificar as hérnias discais. Pretendemos avaliar a confiabilidade deste sistema de classificação entre os residentes de ortopedia em nosso instituto. MÉTODOS: Cinqüenta imagens de RM axial do corte T2 correspondendo ao nível de hérnia discal máxima de pacientes que foram diagnosticados com uma única LDH foram selecionadas e distribuídas para seis residentes ortopédicos. Todos os seis residentes deram uma classificação específica para cada imagem com base na classificação MSU; Além disso, três residentes deram notas em duas ocasiões diferentes. O grau de concordância entre os residentes foi analisado calculando-se a confiabilidade interobservador e intraobservador pela estatística Kappa. RESULTADOS: Descobrimos que a confiabilidade interobservador entre seis residentes, calculando o Kappa de Fleiss, foi de 0,422; isso indica confiabilidade moderada. No entanto, a confiabilidade intra-observador de três residentes selecionados mostrou-se substancial (Kappa de Cohen = 0,750, 0,772 e 0,859 em três residentes, respectivamente). Variações na observação foram frequentes se houvesse hérnia discal ampla com estenose do canal vertebral. CONCLUSÃO: Nossos achados demonstram homogeneidade moderada das avaliações dadas pelos residentes; no entanto, teste-reteste provou que as classificações eram consistentes. Nível de Evidencia II, Estudos diagnósticos - investigação de um exame para diagnóstico.