Spine

“The First Writing Ceremony Auditorium in Yu Yin Shan Fang Garden”

01-02-2020 –

Journal Article

No abstract available

Understanding Thoracic Spine Morphology, Shape, and Proportionality

01-02-2020 – Lafage, Renaud; Steinberger, Jeremy; Pesenti, Sebastien; Assi, Ayman; Elysee, Jonathan C.; Iyer, Sravisht; Lenke, Lawrence G.; Schwab, Frank J.; Kim, Han Jo; Lafage, Virginie

Journal Article

Study Design. Retrospective review.
Objective. The aim of this study was to describe thoracic kyphosis (TK) in a normal asymptomatic population and to evaluate the association between TK magnitude and its shape.
Summary of Background Data. Understanding spinal anatomy requires a three-dimensional appreciation of the spines shape, morphology, and proportions. The customary definition of TK is the angle between T4 and T12. However, little is known on the actual shape of TK in adults.
Methods. Asymptomatic volunteers were recruited; demographic data along with full-body standing radiographs were recorded. Radiographic data such as T1–12 and T4–12 angles were collected. Maximum TK and vertebral orientation/tilt were also collected, in addition to cumulative TK and Centered Kyphosis at T7. The cohort was stratified by T1–12 value (60°) and comparisons and regressions were performed afterward.
Results. One hundred nineteen subjects were included (average age 50.8 yrs, 81 female). Mean T1–12 kyphosis was 49.5°, mean T4–12 kyphosis 41.5°, and mean maximum TK was 52.6°. T1 was the most anteriorly tilted vertebra, L1 the most posteriorly tilted; T7 was horizontal, independently of T1–12 value or age. Cumulative kyphosis analysis revealed that the apex of kyphosis was located at T6-T7. Regression analysis predicting the value and the percentage of T1–7 both yielded T1–12 as a predictor (Adj. r2 = 0.32, Adj. r2 = 0.13).
Conclusion. Changes in kyphosis distribution in an asymptomatic population suggest that TK is not a simple circle arc: with low TK, 2/3 of the kyphosis is located in the upper part and when TK increases, the distribution of kyphosis will be symmetric around T7. It is possible to predict the amount of kyphosis in the upper part using total kyphosis value. This could help estimate preoperative compensation and predict reciprocal change.
Level of Evidence: 3

PIEZO2: A Novel Molecule Involved in the Development of AIS

01-02-2020 – Wu, Zhichong; Wang, Yuwen; Xia, Chao; Feng, Zhenhua; Qiu, Yong; Cheng, Jack Chun-Yiu; Xu, Leilei; Zhu, Zezhang

Journal Article

Study Design. A case–control study.
Objective. This study aimed to investigate the potential role of PIEZO2 gene in the development of AIS.
Summary of Background Data. Mutations of PIEZO2 gene have been reported to be associated with progressive scoliosis and impaired proprioception. Previous studies showed that patients with AIS may have impaired proprioception. However, there is lack of knowledge concerning the mechanism underlying the proprioception of AIS patients and the role of PIEZO2 gene in the etiology of AIS.
Methods. Proprioception tests were performed in both AIS patients and age-matched healthy controls. Based on the falling risk scores, AIS patients were divided into impaired proprioception group and unimpaired proprioception group. Paraspinal muscle was collected from 34 AIS patients during surgery. The tissue expression of PIEZO2 was compared between the impaired group and the unimpaired group. In addition, the average number of muscle fibers in the muscle spindle was compared between the two groups.
Results. Proprioception test showed that patients had significantly higher falling index (41.7 ± 16.5 vs. 11.3 ± 8.3, P = 0.004). In addition, the expression of PIEZO2 gene was remarkably decreased in the impaired group (0.51 ± 0.24 vs. 1.00 ± 0.33, P = 0.04). The average number of muscle fibers in the muscle spindle was significantly decreased in AIS patients of the impaired group than those of the unimpaired group (2.2 ± 1.3 vs. 3.5 ± 2.1, P = 0.04). PIEZO2 expression level was remarkably correlated with the average number of muscle fibers in the muscle spindle (r = 0.352, P = 0.04).
Conclusion. Proprioception is remarkably impaired in patients with AIS. Abnormal expression of PIEZO2 may play a role in AIS via altered proprioception and number of muscle fibers in the muscle spindles. Further investigation is warranted to illustrate the mechanism regulating PIEZO2 expression in AIS.
Level of Evidence: 4

Lycorine Induces Apoptosis and G1 Phase Arrest Through ROS/p38 MAPK Signaling Pathway in Human Osteosarcoma Cells In Vitro and In Vivo

01-02-2020 – Ning, Lei; Wan, Shuanglin; Jie, Zhiwei; Xie, Ziang; Li, Xiang; Pan, Xin; Wan, Xinyu; Chen, Wenxiang; Huang, Hai; Wang, Jiying; Qin, An; Fan, Shunwu; Zhao, Xiangde

Journal Article

Study Design. Xenograft osteosarcoma mouse model.
Objective. We determined the effect of lycorine on osteosarcoma.
Summary of Background Data. Osteosarcoma is an aggressive malignant neoplasm, is most prevalent in teenagers and adults and current treatment approaches have reached a survival plateau and attempts to improve osteosarcoma prognosis have proven unsuccessful. Thus there is clear evidence that development of new agents with high efficacy and fewer side effects to provide better prognostic outcome is urgently needed.
Methods. The toxicity, function and mechanism of lycorine (LY) on osteosarcoma were accessed in vitro by CCK-8 assay, flow cytometry, and western blotting and in vivo by the xenograft osteosarcoma mouse model.
Results. In this study, we found that LY exhibited dose-dependent and time-dependent cytotoxic effects on human osteosarcoma cell-lines SJSA-1 and U2OS, inducing G1 phase cell cycle arrest and cellular death via apoptosis. Mechanistically, LY treatment elevated ROS generation that activates the p38 mitogen-activated protein kinases (MAPKs) and p53-dependent apoptotic program. Inhibition of ROS generation by NAC or p38 MAPK signaling by SB203580 attenuated the p53-mediated cell cycle arrest and apoptosis induced by LY. In vivo administration of LY markedly reduced tumor growth with little organ-related toxicity in a mouse xenograft model of osteosarcoma.
Conclusion. Collectively, our data suggests that LY exhibit therapeutic potential for the treatment of osteosarcoma.
Level of Evidence: N/A

Solid Organ Transplant Is Associated With Increased Morbidity and Mortality in Patients Undergoing One or Two-level Anterior Cervical Decompression and Fusion

01-02-2020 – Labaran, Lawal A.; Harris, Andrew B.; Puvanesarajah, Varun; Amin, Raj; Raad, Micheal; Jain, Amit; Hassanzadeh, Hamid

Journal Article

Study Design. Retrospective database review
Objective. The aim of this study was to analyze the implications of solid organ transplant (SOT) on postoperative outcomes following elective one or two-level anterior cervical discectomy and fusion (ACDF).
Summary of Background Data. Although SOTs have been associated with increased morbidity, postoperative outcomes in SOT recipients undergoing cervical spinal surgery are not well studied.
Methods. A retrospective database review of Medicare patients younger than 85 years who underwent an elective one to two-level ACDF from 2006-2013 was conducted. Following our exclusion criteria, patients were then divided into the following groups: those with a prior history of kidney, liver, heart or lung transplant (SOT group) and non-SOT patients. Both groups were compared for hospital length of stay, 90-day major medical complications, 90-day hospital readmission, 1-year surgical site infection (SSI), 1-year revision ACDF, and 1-year mortality.
Results. A total of 992 (0.5%) SOT recipients (1,144 organs) were identified out of 199,288 ACDF patients. SOT recipients had a significantly longer length of stay (2.32 vs. 5.22 days, p<0.001), higher rate of major medical complications (8.2% vs. 4.5%; OR 1.85, 95% CI 1.45-2.33, p<0.001) and hospital readmission (19.5% vs. 7.5%, OR 2.05, 95% CI 1.74-2.41, p<0.001). In addition, SOT patients had increased mortality within one year of surgery (5.8% vs. 1.3%; OR 3.01, 95% CI 2.26-3.94, p<0.001) compared to non-SOT patients. SOT was not independently associated with SSI (OR 1.25, 95% CI 0.85-1.75, p=0.230), and there was no significant difference in revision rate (0.9% vs. 0.5%; OR 1.54, 95% CI 0.73-2.82, p=0.202) between both groups.
Conclusion. SOT is independently associated with longer hospital stay, increased rate of major medical complications, hospital readmission and mortality. Spine surgeons should be aware of the higher rates of morbidity and mortality in these patients and take it into consideration when developing patient-specific treatment plans.
Level of Evidence: 3

The Course of Orofacial Pain and Jaw Disability After Whiplash Trauma: A 2-year Prospective Study

01-02-2020 – Lampa, Ewa; Wänman, Anders; PhD, Erik Nordh; Stålnacke, Britt-Marie; Häggman-Henrikson, Birgitta

Journal Article

Study Design. Prospective cohort study.
Objective. The aim of this study was to evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability, and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.
Summary of Background Data. Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.
Methods. Within 1 month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, nonspecific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.
Results. Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain were correlated to nonspecific physical symptoms and to depression.
Conclusion. Orofacial pain and jaw disability related to neck pain are often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.
Level of Evidence: 3

Diagnostic Efficacy, Sensitivity, and Specificity of Xpert MTB/RIF Assay for Spinal Tuberculosis and Rifampicin Resistance

01-02-2020 – Patel, Jwalant; Upadhyay, Mihir; Kundnani, Vishal; Merchant, Zahir; Jain, Sanyam; Kire, Neil

Journal Article

Study Design. A cross-sectional observational study.
Objective. This study aims to determine the diagnostic accuracy, sensitivity, and specificity of the Xpert MTB/RIF assay (Mycobacterium Tuberculosis/Rifampicin resistance) for the detection of spinal Tuberculosis (TB) and rifampicin (RIF) resistance.
Summary of Background Data. The Spinal TB is often a paucibacillary extra pulmonary tuberculosis which gives a major challenge in early diagnosis and initializing the correct anti-tubercular treatment (ATT). Due to its rapidity and sensitivity, the dependence and reliability on the Xpert MTB/RIF assay has increased in the last few years. The studies describing accuracy of the Xpert MTB/RIF assay in spinal TB are scanty.
Methods. This institutional review board-approved study included 360 diagnosed spinal TB patients. To determine the accuracy of the Xpert MTB/RIF assay, it was compared with other diagnostic tests like histopathology, acid fast bacilli (AFB) smear, culture, and drug sensitivity testing (DST).
Results. The Xpert MTB/RIF assay showed 86.3% sensitivity and 85.3% specificity when compared with culture for the diagnosis of Spinal TB and showed 75.86% sensitivity, 96.12% specificity for RIF resistance when compared to DST. Four cases were false positive and 11 cases were false negative for RIF resistance on the Xpert MTB/RIF assay.
Conclusion. The Xpert MTB/RIF assay is an efficient technique for the rapid diagnosis of spinal TB; however, a clinician should not solely rely on it for starting ATT. As there are false results also with this test which should be read cautiously and be well correlated with culture and DST pattern to guide the start of sensitive drug regimen only. The purpose is to prevent exposure of the second line drugs to false cases found on the Xpert MTB/RIF assay and avoid emergence of new acquired drug resistance.
Level of Evidence: 4

Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery: A Consecutive Series

01-02-2020 – Kobayashi, Yutaka; Inose, Hiroyuki; Ushio, Shuta; Yuasa, Masato; Hirai, Takashi; Yoshii, Toshitaka; Okawa, Atsushi

Journal Article

Study Design. Retrospective observational study.
Objective. To analyze a large consecutive cohort of patients who had undergone spinal instrumentation surgery, to characterize a patient population with surgical site infections (SSI), and to identify preoperative risk factors associated with SSI.
Summary of Background Data. Malnutrition is a risk factor for SSI in many health conditions; however, the evidence connecting preoperative malnutrition with SSI in spinal instrumentation surgery is limited because of the small number of retrospective studies. While the modified Glasgow prognostic score (m
GPS), C-Reactive protein (CRP)–albumin ratio (CAR), controlling nutritional status index (CONUT), prognostic nutritional index (PNI), platelet–lymphocyte ratio (PLR), and neutrophil–lymphocyte ratio (NLR) are established methods for evaluating nutritious status, little has been reported on the predictive value of these indicators with respect to postoperative spinal infection.
Methods. We retrospectively investigated 384 patients who underwent spinal instrumentation surgery. We evaluated the significance of risk factors, including m
GPS, CAR, CONUT, PNI, PLR, and NLR. We then performed stepwise logistic regression analysis to analyze the concurrent effects of various factors on the prevalence of SSI.
Results. Of the 384 patients analyzed, 14 were diagnosed with SSIs. Univariate analysis showed that preoperative BMI, lymphocyte count, albumin, erythrocyte sedimentation rate, CRP, CONUT, m
GPS, CAR, and PNI were risk factors for SSI. Stepwise logistic regression analysis revealed that higher m
GPS and lower BMI before surgery were independent risk factors for SSI. A receiver operating characteristic curve showed that the cut-off values of m
GPS and BMI were 1 and 20.39, respectively.
Conclusion. The risk factors for SSI after spinal instrumentation surgery were m
GPS more than or equal to 1 and BMI less than or equal to 20.39 kg/m2. These findings could help to identify patients at higher risk of SSI after spinal instrumentation surgery.
Level of Evidence: 4

The True Effect of a Lumbar Dural Tear on Complications and Cost

01-02-2020 – Alluri, Ram; Kang, H. Paco; Bouz, Gabriel; Wang, Jeffrey; Hah, Raymond J.

Journal Article

Study Design. Retrospective database analysis.
Objective. The aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications.
Summary of Background Data. Current data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors.
Methods. The Pearl
Diver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed.
Results. The 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio OR 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001).
Conclusion. Sustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient.
Level of Evidence: 3

Spinal Lengthening With Magnetically Controlled Growing Rods: Data From the Largest Series of Explanted Devices

01-02-2020 – Rushton, Paul R.P.; Smith, Simon L.; Kandemir, Göksu; Forbes, Liam; Fender, David; Bowey, Andrew J.; Gibson, Michael J.; Joyce, Thomas J.

Journal Article

Study Design. Laboratory analysis of explanted MAGnetic Expansion Control (MAGEC) rods.
Objective. The aim of this study was to identify the in vivo lengthening of MAGEC rods.
Summary of Background Data. Little data is available regarding the lengthening achieved by MAGEC rods.
Methods. Cases were identified from the largest series of independently analyzed explanted MAGEC rods. The in vivo growth of rods was determined by the distance between the first “growth mark” and the actuator. The instrumented spinal lengthening was calculated for each construct. Constructs were considered functional if all rods could lengthen with external remote controller activation and no rods were “telescoping”.
Results. Fifty-five MAGEC constructs (99 rods) from 53 patients treated at 10 centers were included. The mean age at insertion was 8.5 years with rods implanted a mean of 35 months. Sixty rods were suitable for analysis with mean lengthening 21.7 mm, 8.9 mm/year. Of these 60 rods, three were maximally distracted. Mean instrumented spinal lengthening for 38 suitable cases was 22.1 mm, 8.4 mm/year. This was positively correlated with the duration of implantation (r = 0.34, P = 0.04) but negatively with patient age at insertion (r = −0.35, P = 0.03). The rate of instrumented spinal lengthening was negatively correlated with duration of implantation (r = −0.47, P = 0.004). Of 55 constructs, 34 were nonfunctional at time of removal with nine functional and 12 indeterminate. Functional constructs had been implanted significantly less time (20.0 vs. 39.7 months, P < 0.001) and lengthened less than those nonfunctional (12.3 mm vs. 23.3 mm, P = 0.04).
Conclusion. This multicenter explant study represents the largest cohort managed with MAGEC rods reported. Rods are very rarely removed having fully lengthened with mean instrumented spinal growth of 22 mm over the implants life. This may be explained by a high rate of lengthening mechanism failure in received rods after around 3 years in vivo. Our findings question the effectiveness of the MAGEC system and mandate urgent comparative clinical studies.
Level of Evidence: 4

Rib Regeneration Morphology After Thoracoplasty in Adolescent Idiopathic Scoliosis

01-02-2020 – Yang, Jae Hyuk; Suh, Seung-Woo; Chang, Dong-Gune

Journal Article

Study Design. A retrospective study.
Objective. The purpose of this study was to evaluate the morphology of rib regeneration and to analyze the influence of demographics and curve characteristics on regeneration potential after thoracoplasty in the treatment of adolescent idiopathic scoliosis (AIS).
Summary of Background Data. Studies on the physiological effects after thoracoplasty have been performed for several decades. However, rib cage anatomical regeneration patterns and reformation have been rarely studied.
Methods. A total of 120 AIS patients who underwent thoracoplasty with deformity correction were included. Patients were followed for >12 months and radiographic assessment was done at 3, 6, and 12 months. Conventional or short apical rib resection thoracoplasty was performed and 543 ribs were resected. Demographic and curve parameters were recorded and a rib regeneration classification was used to analyze regeneration. Computed tomography (CT) scan was performed only in selected patients (n = 74).
Results. At end of 3, 6, and 12 months, 23%, 45%, and 60% of the ribs had fused respectively. On multiple logistic regression analysis, age <10 years (odds ratio OR: 3.5, 95% confidence interval CI: 0.754–16.982), age 11 to 12 years (OR: 2.7, 95% CI: 2.709–31.595), age 13 to 14 years (OR: 6.2, 95% CI: 2.504–15.391), age 15 to 16 years (OR: 4.8, 95% CI: 2.064–11.571), five or more ribs excision (OR: 2.0, 95% CI: 1.294–3.108) enhance regeneration. Lenke type 2 (OR: 0.5, 95% CI: 0.305–0.898) Lenke type 4 (OR: 2.3, 95% CI: 1.033–5.144), and Risser grade (OR: 0.8, 95% CI: 0.694–0.967) had a negative influence on regeneration.
Conclusion. The regeneration potential of the resected ribs after thoracoplasty in AIS patients depends on age, Risser grade, Lenke classification, and number of ribs resected. Age was the single most important factor affecting regeneration.
Level of Evidence: 4

The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes

01-02-2020 – Protopsaltis, Themistocles S.; Ramchandran, Subaraman; Tishelman, Jared C.; Smith, Justin S.; Neuman, Brian J.; Jr, Gregory M. Mundis; Lafage, Renaud; Klineberg, Eric O.; Hamilton, D. Kojo; LaFage, Virginie; Gupta, Munish C.; Hart, Robert A.; Schwab, Frank J.; Burton, Douglas C.; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.; International Spine Study Groupm

Journal Article

Study Design. Retrospective review of a prospectively collected database.
Objective. To define a simplified singular measure of cervical deformity (CD), C2 slope (C2S), which correlates with postoperative outcomes.
Summary of Background Data. Sagittal malalignment of the cervical spine, defined by the cervical sagittal vertical axis (c
SVA) has been associated with poor outcomes following surgical correction of the deformity. There has been a proliferation of parameters to describe CD. This added complexity can lead to confusion in classifying, treating, and assessing outcomes of CD surgery.
Methods. A prospective database of CD patients was analyzed. Inclusion criteria were cervical kyphosis>10°, cervical scoliosis>10°, c
SVA>4 cm, or chin-brow vertical angle >25°. Patients were categorized into two groups and compared based on whether the apex of the deformity was in the cervical (C) or the cervicothoracic (CT) region. Radiographic parameters were correlated to C2S, T1 slope (T1S) and 1-year health-related quality-of-life outcomes as measured by the Euro
Qol 5 Dimension questionnaire (EQ5D), modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and the Neck Disability Index (NDI).
Results. One hundred four CD patients (C = 74, CT = 30; mean age 61 yr, 56% women, 42% revisions) were included. CT patients had higher baseline c
SVA and T1S (P  0.5, P≤0.05). Using linear regression, moderate disability by EQ5D corresponded to C2S of 20°(r2 = 0.08). For CT patients, C2S = 17° corresponded to moderate disability by NDI (r2 = 0.4), and C2S = 20° by EQ5D (r2 = 0.25).
Conclusion. C2S correlated with upper-cervical and subaxial alignment. C2S correlated strongly with TS-CL (R = 0.98, P < 0.001) because C2S is a mathematical approximation of TS-CL. C2S is a useful marker of CD, linking the occipitocervical and cervico-thoracic spine. C2S defines the presence of a mismatch between cervical lordosis and thoracolumbar alignment. Worse 1-year postoperative C2 slope correlated with worse health outcomes.
Level of Evidence: 3

The Effect of an Educational and Interactive Informed Consent Process on Patients With Cervical Spondylotic Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament

01-02-2020 – Lee, Young-Seok; Cho, Dae-Chul; Sung, Joo-Kyung; Han, Inbo; Kim, Chi Heon; Kim, Ji-Yoon; Kim, Kyoung-Tae

Journal Article

Study Design. Prospective observational cohort study.
Objective. In this study, an educational and interactive informed consent (EIC) program was proposed for patients with cervical spondylotic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL-CSM) to improve their comprehension level during the informed consent process.
Summary of Background Data. OPLL-CSM is a slow progressive disease, and it is difficult for patients to understand the disease. Few studies have evaluated very specific programs to improve the informed consent process for these patients.
Methods. This prospective study evaluated patients with OPLL-CSM who either underwent the proposed EIC process (n = 63) or the standard consent process (n = 124). The standard consent process only included a physician–patient interview. During the EIC process, information was provided regarding OPLL-CSM through information booklets, a video, verbal information, and initial and second physician–patient interviews. After the second physician–patient interview, the patient was requested to answer 14 medical questions to assess their knowledge about OPLL-CSM. The proposed EIC process took approximately 90 minutes. They were asked to report the most useful educational method and the most effective method of reinforcing verbal communication.
Results. The mean questionnaire scores were higher in the EIC group than in the control group (P < 0.001). Video was selected by 50/63 patients (79.4%) as the most useful EIC process method, and the most effective method of reinforcing verbal communication was video (n = 61; 96.8%). Patients in the EIC group reported having higher satisfaction with surgery (P = 0.024) than did those in the control group.
Conclusion. The proposed EIC process was shown to result in good patient comprehension and recall regarding OPLL-CSM. Using a video was the most informative and effective reinforcement of verbal communication. The enhanced educational group had better knowledge and improved satisfaction following surgery. The EIC process might help physicians educate and counsel patients regarding OPLL-CSM and its treatment.
Level of Evidence: 2

Are Outcomes of Anterior Cervical Discectomy and Fusion Influenced by Presurgical Depression Symptoms on the Mental Component Score of the Short Form-12 Survey?

01-02-2020 – Divi, Srikanth N.; Goyal, Dhruv K.C.; Mangan, John J.; Galetta, Matthew S.; Nicholson, Kristen J.; Fang, Taolin; Goyal, Sourabh; Booth, Thomas J.; Tarazona, Daniel; Lucasti, Christopher; Kaye, I. David; Kurd, Mark F.; Woods, Barrett I.; Radcliff, Kris E.; Rihn, Jeffery A.; Anderson, D. Greg; Hilibrand, Alan S.; Kepler, Christopher K.; Vaccaro, Alexander R.; Schroeder, Gregory D.

Journal Article

Study Design. Retrospective comparative study.
Objective. The purpose of this study was to investigate whether preoperative depressive symptoms, measured by mental component score of the Short Form-12 survey (MCS-12), influence patient-reported outcome measurements (PROMs) following an anterior cervical discectomy and fusion (ACDF) surgery for cervical degeneration.
Summary of Background Data. There is a paucity of literature regarding preoperative depression and PROMs following ACDF surgery for cervical degenerative disease.
Methods. Patients who underwent an ACDF for degenerative cervical pathology were identified. A score of 45.6 on the MCS-12 was used as the threshold for depression symptoms, and patients were divided into two groups based on this value: depression (MCS-12 ≤45.6) and nondepression (MCS-12 >45.6) groups. Outcomes including Neck Disability Index (NDI), physical component score of the Short Form-12 survey (PCS-12), and Visual Analogue Scale Neck (VAS Neck), and Arm (VAS Arm) pain scores were evaluated using independent sample t test, recovery ratios, percentage of patients reaching the minimum clinically important difference, and multiple linear regression – controlling for factors such as age, sex, and BMI.
Results. The depression group was found to have significantly worse baseline pain and disability than the nondepression group in NDI (P < 0.001), VAS Neck pain (P < 0.001), and VAS Arm pain (P < 0.001) scores. Postoperatively, both groups improved to a similar amount with surgery based on the recovery ratio analysis. The depression group continued to have worse scores than the nondepression group in NDI (P = 0.010), PCS-12 (P = 0.026), and VAS Arm pain (P = 0.001) scores. Depression was not a significant predictor of change in any PROMs based on regression analysis.
Conclusion. Patients who presented with preoperative depression reported more pain and disability symptoms preoperatively and postoperatively; however, both groups achieved similar degrees of improvement.
Level of Evidence: 3

The Fremantle Neck Awareness Questionnaire in Chronic Neck Pain Patients: Turkish Version, Validity and Reliability Study

01-02-2020 – Onan, Dilara; Gokmen, Derya; Ulger, Ozlem

Journal Article

Study Design. Cross-cultural adaptation and psychometric analysis.
Objective. The aim of this study wad to develop “Fremantle Neck Awareness Questionnaire Turkish (Fre
NAQ-T)” and to investigate the validity, reliability, and psychometric properties of Fre
NAQ-T in the Turkish population with chronic neck pain (CNP).
Summary of Background Data. As the different beliefs about the nature of the problem in chronic pain (CP) and its future consequences lead to mis-stimulated neuroplastic changes, the perceptual level and proprioceptive-awareness should be examined in CP. The perceptual level and propriceptive awareness in individuals with chronic low back pain and in knee osteoarthritis were evaluated, whereas the neck version has not been studied.
Methods. The neck version was conducted using forward-backward method to translate the Fre
BAQ from English to Turkish. The number of the included patients was 111. The Fre
NAQ-T was applied to 37 patients after 3 days for test–retest reliability. Validity of the Fre
NAQ-T was assessed using Rasch analysis and Spearman correlation coefficient. Reliability of the Fre
NAQ-Ts internal consistency was tested by Person Separation Index (PSI) and Cronbach Alpha. Test–retest reliability was tested by differential item functioning (DIF) by time.
Results. All items of Fre
NAQ-T were found to fit Rasch Model (given Bonferroni adjustment fit level of 0.006 and χ2: 6 (df = 9), P = 0.739). Internal construct validity evaluation was good, overall mean item fit residual was 0.141 (SD 1.089), and mean person fit residual was −0.211 (SD 1.173). In reliability evaluation, the PSI was 0.69 (good) and Cronbach alpha was 0.70 (acceptable). When the test–retest was examined via DIF by time, none of the items showed DIF.
Conclusion. The Fre
NAQ-T is a valid, reliable, unidimensional scale in CNP and suitable for the assessment of neck-specified awareness-perception in Turkish population with CNP.
Level of Evidence: 3

Incidence of Surgical Site Infection After Spine Surgery: A Systematic Review and Meta-analysis

01-02-2020 – Zhou, Jiaming; Wang, Rui; Huo, Xiaoyang; Xiong, Wuyi; Kang, Liang; Xue, Yuan

Journal Article

Study Design. A systematic review and meta-analysis.
Objective. The objective of this study was to investigate the incidence of surgical site infection (SSI) in patients following spine surgery and the rate of microorganisms in these cases.
Summary of Background Data. Many studies have investigated the incidence and risk factors of SSI following spinal surgery, whereas no meta-analysis studies have been conducted regarding the comprehensive epidemiological incidence of SSI after spine surgery.
Methods. We searched the PubMed, Embase, and Cochrane Library databases for relevant studies that reported the incidence of SSI after spine surgery, and manually screened reference lists for additional studies. Relevant incidence estimates were calculated. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed.
Results. Our meta-analysis included 27 studies, with 603 SSI cases in 22,475 patients. The pooled SSI incidence was 3.1%. Subgroup analysis revealed that the incidence of superficial SSI was 1.4% and the incidence of deep SSI was 1.7%. Highest incidence (13.0%) was found in patients with neuromuscular scoliosis among the different indications. The incidences of SSI in cervical, thoracic, and lumbar spine were 3.4%, 3.7%, and 2.7%, respectively. Compared with posterior approach surgery (5.0%), anterior approach showed a lower incidence (2.3%) of SSI. Instrumented surgery had a higher incidence of SSI than noninstrumented surgery (4.4% vs. 1.4%). Patients with minimally invasive surgery (1.5%) had a lower SSI incidence than open surgery (3.8%). Lower incidence of SSI was found when vancomycin powder was applied locally during the surgery (1.9%) compared with those not used (4.8%). In addition, the rates of Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococci in microbiological culture results were 37.9%, 22.7%, and 23.1%, respectively.
Conclusion. The pooled incidence of SSI following spine surgery was 3.1%. These figures may be useful in the estimation of the probability of SSI following spine surgery.
Level of Evidence: 3

Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of The Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?

01-02-2020 – Ando, Kei; Imagama, Shiro; Kaito, Takashi; Takenaka, Shota; Sakai, Kenichiro; Egawa, Satoru; Shindo, Shigeo; Watanabe, Kota; Fujita, Nobuyuki; Matsumoto, Morio; Nakashima, Hideaki; Wada, Kanichiro; Kimura, Atsushi; Takeshita, Katsushi; Kato, Satoshi; Murakami, Hideki; Takeuchi, Kazuhiro; Takahata, Masahiko; Koda, Masao; Yamazaki, Masashi; Watanabe, Masahiko; Fujibayashi, Shunsuke; Furuya, Takeo; Kawaguchi, Yoshiharu; Matsuyama, Yukihiro; Yoshii, Toshitaka; Okawa, Atsushi

Journal Article

Study Design. Prospectively collected, multicenter, nationwide study.
Objective. The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF).
Summary of Background Data. A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items.
Methods. Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopedic Association JOA score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgery
Results. The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P < 0.01). The preoperative JOA score was lower (P < 0.05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, P < 0.05).
Conclusion. The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.
Level of Evidence: 3

TO THE EDITOR:

01-02-2020 – Viswanathan, Vibhu Krishnan; Manoharan, Sakthivel Rajan Rajaram; Crowther, Douglas

Journal Article

No abstract available

TO THE EDITOR:

01-02-2020 – Grevitt, Michael

Journal Article

No abstract available