Spine

OBJECTIVE: Degenerative cervical myelopathy (DCM) is among the most common pathologies affecting the spinal cord but its natural history is poorly characterized. The purpose of this study was to investigate functional outcomes in patients with DCM who were managed nonoperatively as well as the utility of quantitative clinical measures and MRI to detect deterioration. METHODS: Patients with newly diagnosed DCM or recurrent myelopathic symptoms after previous surgery who were initially managed nonoperatively were included...

OBJECTIVE: Diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures essentially require operative treatment due to severe fracture site instability and high potential risk of posttraumatic neurological deficit. However, the optimal surgical procedure remains unclear. The purpose of this study was to assess the efficacy of posterior spinal fixation with penetrating endplate screws (PESs) for DISH-related thoracolumbar fractures. METHODS: The authors conducted a retrospective, single-center, observational study...

Progressive resistance training (PRT) combined with weight-bearing impact exercise are recommended to optimize bone health, but the optimal frequency and dose of training remains uncertain. This study, which is a secondary analysis of an 18-month intervention in men aged 50-79 years, examined the association between exercise frequency and the volume of training with changes in DXA and QCT-derived femoral neck (FN) and lumbar spine (LS) bone outcomes, respectively. Men were allocated to either thrice-weekly PRT plus impact exercise training (n = 87) or a non-exercising (n = 85) group...

BACKGROUND: Abdominal aortic calcification (AAC) identified on dual-energy x-ray absorptiometry (DXA) vertebral fracture assessment (VFA) lateral spine images is predictive of cardiovascular outcomes, but is time-consuming to perform manually. Whether this procedure can be automated using convolutional neural networks (CNNs), a class of machine learning algorithms used for image processing, has not been widely investigated. METHODS: Using the Province of Manitoba Bone Density Program DXA database, we selected a random sample of 1100 VFA images from individuals qualifying for VFA as part of their osteoporosis assessment...

PURPOSE: To evaluate the efficacy of pre-operative low-dose radiation computed tomography (CT) in optimizing screw placement in patients with adolescent idiopathic scoliosis (AIS). METHODS: 49 patients with AIS who required correction and posterior fusion between January 2018 and December 2019 were included in this retrospective study. All patients underwent surgery performed by the same team of experienced surgeons. Patients were divided in two groups. The study group received a pre-operative low-dose CT scan (CT group, n = 25), differently from the control group (CG, n = 24)...

PURPOSE: Spinal metastases are common in cancer. This preferential migration/growth in the spine is not fully understood. Dura has been shown to affect the surrounding microenvironment and promote cancer growth. Here, we investigate the role of dural cytokines in promoting the metastatic potential of prostate cancer (PCa) and the involvement of the CXCR2 signaling pathway. METHODS: The role of dural conditioned media (DCM) in proliferation, migration and invasion of five PCa cell lines with various hormone sensitivities was assessed in the presence or absence of the CXCR2 inhibitor, SB225002...

PURPOSE: There is considerable controversy on the role of genetics, mechanical and environmental factors, and, recently, on subclinical infection in triggering inflammaging leading to disk degeneration. The present study investigated sequential molecular events in the host, analyzing proteome level changes that will reveal triggering factors of inflammaging and degeneration. METHODS: Ten MRI normal disks (ND) from braindead organ donors and 17 degenerated disks (DD) from surgery were subjected to in-gel-based label-free ESI-LC-MS/MS analysis...

OBJECTIVE: To study the effectiveness of the Second Short Form of the McGill Pain Questionnaire (SF-MPQ-2) as an instrument for assessment and comparison of quantitative characteristics of pain in patients with chronic musculoskeletal impairment of the cervical spine and nonspecific neck pain accompanied by chronic migraine or cervicogenic headache (CeH). MATERIAL AND METHODS: Forty-nine patients, aged from 19 to 60 years (mean age 42.8±10.4), were divided into 2 comparable by age and gender groups with migraine ( n =18) and CeH ( n =31)...

OBJECTIVE: To assess the efficacy and safety of high (300 mg) doses of the biologically active additive neurouridin (Unifarm) as part of complex therapy of patients with nonspecific low-back pain. MATERIAL AND METHODS: Fifty patients (30 in the main group and 20 patients in the control group) were studied using a visual analogue scale (VAS), data from a general clinical analysis of blood and urine, a wide range of biochemical parameters, including liver function tests, glucose levels, creatinine, electrolyte levels...

Pancoast tumours are defined as tumours arising from the upper lobe and invading the thoracic inlet,representing less than 5% of all lung cancers. Clinical features depend on the involved structures. For many years invasion of the spine was considered unresectable and fatal. Due to the progress in spine surgery, en bloc resection including the spine is nowadays possible. We report the first case of a successful en bloc vertebral resection of a Pancoast tumour in a 66 year-old male, with a squamous cell carcinoma, treated at our department in a multidisciplinary setting, after induction chemoradiotherapy...

Through statistical analysis, we have found that inflammation and low femoral and lumbar spine BMD were strongly correlated with a high SIJ CT grade, and inflammation, low vitamin D levels, and a longer disease course within a certain time range influenced bone loss in axSpA. PURPOSE: We investigated the relationship between bone mineral density (BMD), vitamin D, and computed tomography (CT)-based progression of disease grades of the sacroiliac joint (SIJ), and sought to identify parameters predicting low BMD in patients with axial spondyloarthropathy (axSpA)...

The use of full-endoscopic decompression for lumbar spinal stenosis has been increasing recently. It is a minimally invasive surgical procedure that has few complications. Spinal subdural hematoma (SSH) following endoscopic surgery has never been reported. Previously described SSHs have occurred spontaneously or due to surgery-related iatrogenic injury. We describe the first case of SSH after endoscopic decompression. A 68-year-old woman presented with bilateral radiating pain and neurological claudication due to lumbar spinal stenosis at the L4-5 level...

Anterior lumbar interbody fusion (ALIF) is performed for the surgical management of lumbar degenerative disc disease with excellent results, particularly for discogenic low back pain. Commonly reported complications associated with this approach include vessel injury, retrograde ejaculation, and ureteral and viscus organ injury. The development of a varicocele after ALIF has not been previously described in the literature. We report a case of varicocele in a 35-year-old patient who underwent ALIF via a left retroperitoneal approach...

Posterior cervical spine surgery often requires large posterior midline incision which can result in poorly controlled postoperative pain, arises from iatrogenic mechanical damage, intraoperative retraction and resection to structures such as bone, ligaments, muscles, intervertebral disks, and zygapophysial joints. Local anesthetics may be utilized for infiltration of the surgical wound; however, their analgesic efficacy has not been studied in this surgical approach. Here we report a case series. Given the potential for targeted sensory dorsal ramus nerve blocks to provide better and extended analgesia, we explored the feasibility of using cervical paraspinal interfascial plane (PIP) blocks in conjunction with neurophysiologic monitoring for postoperative analgesia after posterior cervical laminectomy...

Spinal deformity is a complex issue that can lead to global spine imbalance with subsequent neurologic deficits, clinical deformity, and chronic back pain. The vertebral column resection (VCR) osteotomy technique is used in select cases of rigid severe spinal deformities to achieve significant curve correction. We present a previously undiagnosed ankylosing spondylitis patient with a previously fused spine in marked coronal and sagittal malalignment that required a staged two level non-contiguous VCR for treatment of his fixed thoracic and cervicothoracic kyphoscoliosis...

Minimally invasive techniques have become part of the spine surgeons' armamentarium and are currently utilized to treat many conditions involving the cervical, thoracic, lumbar and sacral spine. Surgical treatment of severe degenerative conditions such as multilevel spinal stenosis, tandem stenosis, combination of stenosis or disk herniation and spondylolisthesis at adjacent spinal levels, as well as extensive infections or hematomas, may require a multilevel tailored approach with all the challenges that such surgical planning entails...

Background: Osteoporotic vertebral fractures (OVFs) that present with posterior wall cortical injury pose a higher risk for instability. Surgical management includes standard cement augmentation techniques like balloon kyphoplasty (BKP) or percutaneous posterior instrumentation with pedicle screws (PS) or both. Neither treatment has yet demonstrated superiority, and posterior cement leakage is of special concern in these fractures. Methods: At a single tertiary care center, 25 patients with 32 OVFs with posterior wall injury treated with percutaneous instrumentation and cement augmentation (PS group) were retrospectively included and matched (1:1) using propensity scores to 25 patients with 29 OVFs with posterior wall injury treated with standalone BKP (BKP group) from 2010 to 2018...

Background: The COVID-19 pandemic first came to prominence in December 2019, and since then has swept the globe, causing one of the largest public health problems seen. It has had a wide-ranging impact on healthcare provision, with a cessation of elective operating. We aimed to assess the impact of COVID-19 on a tertiary referral centre for spinal surgery in England. Methods: An 82-day study period from 20th March 2020 to 10th June 2020 was used, and all spinal surgical patients were followed up prospectively, comparing patients from the same date range in 2019...

Background: As the opioid epidemic in the United States has continued to gain momentum in recent years, the current study aims to explore the efficacy of ketamine in a traditionally challenging setting regarding pain control, and contribute toward developing an opioid-free intraoperative pain protocol in spinal deformity surgery. Methods: Fifty-four patients who underwent spinal deformity surgery between January 1, 2017 and December 31, 2017 by one senior surgeon were included...

Background: Generally, most spine surgeons agree that increased segmental motion viewed on flexion-extension radiographs is a reliable predictor of instability; however, these views can be limited in several ways and may underestimate the instability at a given lumbar segment. Methods: Consecutively collected adult (≥18 years old) patients with symptomatic single-level lumbar spondylolisthesis were reviewed from a two-surgeon database from 2015 to 2019. Routine standing lumbar X-rays (neutral, flexion, extension) and supine lumbar MRI (sagittal T2-weighted imaging sequence) were performed...