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13 pages, 2631 KiB

Open AccessArticle

Automated Detection and Diagnosis of Spinal Schwannomas and Meningiomas Using Deep Learning and Magnetic Resonance Imaging

by Sadayuki Ito, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Masahiro Oda, Ippei Yamauchi, Ryotaro Oishi, Yuichi Miyairi, Kensaku Mori and Shiro Imagama

J. Clin. Med. 2023, 12(15), 5075; https://doi.org/10.3390/jcm12155075 - 02 Aug 2023

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Abstract

Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop [...] Read more.

Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop an automated system for detecting and diagnosing spinal schwannomas and meningiomas based on deep learning using You Only Look Once (YOLO) version 4 and MRI. In this retrospective diagnostic accuracy study, the data of 50 patients with spinal schwannomas, 45 patients with meningiomas, and 100 control cases were reviewed, respectively. Sagittal T1-weighted (T1W) and T2-weighted (T2W) images were used for object detection, classification, training, and validation. The object detection and diagnosis system was developed using YOLO version 4. The accuracies of the proposed object detections based on T1W, T2W, and T1W + T2W images were 84.8%, 90.3%, and 93.8%, respectively. The accuracies of the object detection for two spine surgeons were 88.9% and 90.1%, respectively. The accuracies of the proposed diagnoses based on T1W, T2W, and T1W + T2W images were 76.4%, 83.3%, and 84.1%, respectively. The accuracies of the diagnosis for two spine surgeons were 77.4% and 76.1%, respectively. We demonstrated an accurate, automated detection and diagnosis of spinal schwannomas and meningiomas using the developed deep learning-based method based on MRI. This system could be valuable in supporting radiological diagnosis of spinal schwannomas and meningioma, with a potential of reducing the radiologist’s overall workload. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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13 pages, 3797 KiB

Open AccessArticle

Postoperative Radiological Improvement after Staged Surgery Using Lateral Lumbar Interbody Fusion for Preoperative Coronal Malalignment in Patients with Adult Spinal Deformity

by Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato and Masahiko Watanabe

J. Clin. Med. 2023, 12(6), 2389; https://doi.org/10.3390/jcm12062389 - 20 Mar 2023

Cited by 2 | Viewed by 1258

Abstract

This retrospective observational study evaluated improvement in coronal malalignment (CM) after anteroposterior staged surgery using lateral lumbar interbody fusion (LLIF) in patients with coronal lumbar curve adult spinal deformity (ASD). Sixty patients with ASD underwent surgery; 34 had SRS–Schwab type L lumbar curve. [...] Read more.

This retrospective observational study evaluated improvement in coronal malalignment (CM) after anteroposterior staged surgery using lateral lumbar interbody fusion (LLIF) in patients with coronal lumbar curve adult spinal deformity (ASD). Sixty patients with ASD underwent surgery; 34 had SRS–Schwab type L lumbar curve. Patients with a coronal balance distance (CBD) ≥20 mm were diagnosed with CM. Using the Obeid CM classification, we classified the preoperative coronal pattern as concave CM (type 1) or convex CM (type 2). Demographic, surgical, and radiological parameters were compared. Whole-spine standing radiographs were assessed preoperatively and postoperatively. Twenty-three patients had type 1A, six had type 2A, five had no CM, and none had type 1B or 2B according to the Obeid CM classification. Compared with patients with Obeid type 1A, those with Obeid type 2A had significantly higher preoperative and postoperative coronal L4 tilts and a smaller change in corrected CBD (Δ|CBD|) (76.6 mm vs. 24.1 mm, p < 0.001). At the final follow-up, 58.6% (17/29 patients) of patients with SRS–Schwab type L CM showed improvement after corrective fusion using LLIF. Although the difference was not statistically significant, CM improved in 69.6% (16/23 patients) of patients with Obeid type 1A type but only 16.7% (1/6 patients) of those with Obeid type 2A type (p = 0.056). CM was more likely to remain after anteroposterior staged surgery using LLIF in patients with preoperative Obeid type 2A ASD. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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9 pages, 1788 KiB

Open AccessArticle

Clinical Trial for the Safety and Feasibility of Pedicle Screws Coated with a Fibroblast Growth Factor-2-Apatite Composite Layer for Posterior Cervical Fusion Surgery

by Katsuya Nagashima, Yuki Hara, Hirotaka Mutsuzaki, Yasukazu Totoki, Eriko Okano, Kentaro Mataki, Yukei Matsumoto, Yohei Yanagisawa, Hiroshi Noguchi, Yu Sogo, Atsuo Ito, Masao Koda and Masashi Yamazaki

J. Clin. Med. 2023, 12(3), 947; https://doi.org/10.3390/jcm12030947 - 26 Jan 2023

Cited by 1 | Viewed by 1301

Abstract

To solve the instrument loosening problem, we developed a fibroblast growth factor-2-calcium phosphate composite layer as a novel coating material to improve screw fixation strength. The primary aim of the present study was to demonstrate the safety and feasibility of screws coated with [...] Read more.

To solve the instrument loosening problem, we developed a fibroblast growth factor-2-calcium phosphate composite layer as a novel coating material to improve screw fixation strength. The primary aim of the present study was to demonstrate the safety and feasibility of screws coated with the FGF-2-calcium phosphate composite layer for posterior instrumented surgery of the cervical spine. The trial design was a single-arm, open-label, safety and feasibility study. Patients receiving fusion of the cervical spine from C2 (or C3) to C7 (or T1) were recruited. The primary endpoint to confirm safety was any screw-related adverse events. Seven patients who underwent posterior fusion surgery of the cervical spine were enrolled in the present study. The coated pedicle screws were inserted bilaterally into the lowest instrumented vertebrae. There was only one severe adverse event unrelated with the coated screw. Three out of the fourteen coated screws showed loosening. The present results prove the safety and feasibility of pedicle screws coated with the FGF-2-calcium phosphate composite layer for fusion surgery in the cervical spine. This is the first step to apply this novel surface coating in the field of spine surgery. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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8 pages, 3895 KiB

Open AccessArticle

Treatment of Thoracolumbar Pyogenic Spondylitis with Minimally Invasive Posterior Fixation without Anterior Lesion Debridement or Bone Grafting: A Multicenter Case Study

by Hisanori Gamada, Toru Funayama, Akihiro Yamaji, Shun Okuwaki, Tomoyuki Asada, Shigeo Izawa, Hiroshi Kumagai, Kengo Fujii, Kuniaki Amano, Itsuo Shiina, Masaki Tatsumura, Masafumi Uesugi, Tsukasa Nakagawa, Masashi Yamazaki and Masao Koda

J. Clin. Med. 2023, 12(3), 932; https://doi.org/10.3390/jcm12030932 - 25 Jan 2023

Cited by 2 | Viewed by 1476

Abstract

The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive [...] Read more.

The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation alone were retrospectively evaluated at nine affiliated hospitals since April 2016. The study included 31 patients (23 men and 8 women; mean age, 73.3 years). The clinical course of the patients and requirement of additional anterior surgery constituted the study outcomes. The postoperative numerical rating scale score for lower back pain was significantly smaller than the preoperative score (5.8 vs. 3.6, p = 0.0055). The preoperative local kyphosis angle was 6.7°, which was corrected to 0.1° after surgery and 3.7° at the final follow-up visit. Owing to failed infection control, three patients (9.6%) required additional anterior debridement and autogenous bone grafting. Thus, in this multicenter case series, a large proportion of patients with thoracolumbar pyogenic spondylitis could be treated with minimally invasive posterior fixation alone, thereby indicating it as a treatment option for pyogenic spondylitis. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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12 pages, 277 KiB

Open AccessArticle

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries—A Multicenter Retrospective Study of 1512 Cases

by Motoya Kobayashi, Noriaki Yokogawa, Satoshi Kato, Takeshi Sasagawa, Hiroyuki Tsuchiya, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Junichi Yamane, Satoshi Nori, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke Hirota, Hidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Nobuyuki Suzuki, Kenji Kato, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Akiyoshi Kuroda, Gen Inoue, Kenichiro Kakutani, Yuji Kakiuchi, Katsuhito Kiyasu, Hiroyuki Tominaga, Hiroto Tokumoto, Yoichi Iizuka, Eiji Takasawa, Koji Akeda, Norihiko Takegami, Haruki Funao, Yasushi Oshima, Takashi Kaito, Daisuke Sakai, Toshitaka Yoshii, Tetsuro Ohba, Bungo Otsuki, Shoji Seki, Masashi Miyazaki, Masayuki Ishihara, Seiji Okada, Shiro Imagama and Kota Watanabe Show full author list Hide full author list

J. Clin. Med. 2023, 12(2), 708; https://doi.org/10.3390/jcm12020708 - 16 Jan 2023

Cited by 2 | Viewed by 1695

Abstract

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 [...] Read more.

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

8 pages, 939 KiB

Open AccessArticle

Upper Extremity Skeletal Muscle Mass Asymmetry Exacerbated by Shoulder Imbalance in Lenke1A Adolescent Idiopathic Scoliosis

by Tetsuro Ohba, Go Goto, Nobuki Tanaka, Kotaro Oda, Marina Katsu, Hayato Takei, Kensuke Koyama, Hiroki Oba and Hirotaka Haro

J. Clin. Med. 2022, 11(23), 7117; https://doi.org/10.3390/jcm11237117 - 30 Nov 2022

Cited by 1 | Viewed by 1186

Abstract

Limb muscle strength asymmetry affects many physical abilities. The present study (1) quantified limb muscle asymmetry in patients with adolescent idiopathic scoliosis (AIS); (2) compared AIS patients with major thoracolumbar/lumbar (TL/L) or major thoracic (MT) curves; (3) examined correlations between limb muscle asymmetry [...] Read more.

Limb muscle strength asymmetry affects many physical abilities. The present study (1) quantified limb muscle asymmetry in patients with adolescent idiopathic scoliosis (AIS); (2) compared AIS patients with major thoracolumbar/lumbar (TL/L) or major thoracic (MT) curves; (3) examined correlations between limb muscle asymmetry and radiographic parameters. Patients with AIS with major TL/L curves (Lenke type 5C) and MT curves (Lenke Type 1A) who underwent posterior spinal fusion at our university hospitals were included. Patients with left hand dominance were excluded. Body composition was measured using whole-body dual-energy X-ray absorptiometry and asymmetry of left and right side skeletal muscles were evaluated. Upper extremity skeletal muscles on the dominant side were significantly larger than those on the nondominant side in both Lenke1A and 5C groups. The asymmetry of upper extremity skeletal muscles was significantly greater in the Lenke1A group than in the Lenke5C group. Additionally, the size of the asymmetry did not correlate with the magnitude of the major curve and rotational deformation but did correlate with a right shoulder imbalance in the Lenke1A group. These results suggest that in AIS with a constructive thoracic curve, right shoulder imbalance is an independent risk factor for upper extremity skeletal muscle asymmetry. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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12 pages, 1890 KiB

Open AccessArticle

Can Proximal Junctional Kyphosis after Surgery for Adult Spinal Deformity Be Predicted by Preoperative Dynamic Sagittal Alignment Change with 3D Gait Analysis? A Case–Control Study

by Tomoyuki Asada, Kousei Miura, Masao Koda, Hideki Kadone, Toru Funayama, Hiroshi Takahashi, Hiroshi Noguchi, Yosuke Shibao, Kosuke Sato, Fumihiko Eto, Kentaro Mataki and Masashi Yamazaki

J. Clin. Med. 2022, 11(19), 5871; https://doi.org/10.3390/jcm11195871 - 04 Oct 2022

Cited by 4 | Viewed by 1498

Abstract

Background: Severe spinal deformity is a risk factor for proximal junctional kyphosis (PJK) in surgery for adult spinal deformity (ASD). However, standing X-ray imaging in patients with dynamic spinal imbalance can underestimate the risk of PJK because of compensation mechanisms. This study aimed [...] Read more.

Background: Severe spinal deformity is a risk factor for proximal junctional kyphosis (PJK) in surgery for adult spinal deformity (ASD). However, standing X-ray imaging in patients with dynamic spinal imbalance can underestimate the risk of PJK because of compensation mechanisms. This study aimed to investigate whether preoperative dynamic spinal alignment can be a predictive factor for PJK. Methods: We retrospectively included 27 ASD patients undergoing three-dimensional (3D) gait analysis before surgery. Dynamic spinal parameters were obtained using a Nexus motion capture system (Vicon, Oxford, UK). The patients were instructed to walk as long as possible around an oval walkway. The averaged dynamic parameters in the final lap were compared between patients with PJK (+) and with PJK (−). Results: PJK occurred in seven patients (26%). The dynamic angle between the thoracic spine and pelvis was larger in patients with PJK (+) than in those with PJK (−) (32.3 ± 8.1 vs. 18.7 ± 13.5 °, p = 0.020). Multiple logistic regression analysis identified this angle as an independent risk factor for PJK. Conclusions: Preoperative thoracic anterior inclination exacerbated by gait can be one of preoperative independent risk factors for PJK in patients undergoing corrective surgery for ASD. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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9 pages, 2572 KiB

Open AccessArticle

Comparative Study of S2-Alar-Iliac Screw Trajectories between Males and Females Using Three-Dimensional Computed Tomography Analysis: The True Lateral Angulation of the S2-Alar-Iliac Screw in the Axial Plane

by Haruki Funao, Kento Yamanouchi, Naruhito Fujita, Yukihiro Kado, Shuzo Kato, Nao Otomo, Norihiro Isogai, Yutaka Sasao, Shigeto Ebata, Yuko Kitagawa, Kota Watanabe, Hideaki Obara and Ken Ishii

J. Clin. Med. 2022, 11(9), 2511; https://doi.org/10.3390/jcm11092511 - 29 Apr 2022

Cited by 2 | Viewed by 1204

Abstract

The S2 alar-iliac screw (S2AIS) is commonly used for long spinal fusion as a rigid distal foundation in spinal deformity surgeries, and it is also used in percutaneous sacropelvic fixation for providing an in-line connection to the proximal spinal constructs without using offset [...] Read more.

The S2 alar-iliac screw (S2AIS) is commonly used for long spinal fusion as a rigid distal foundation in spinal deformity surgeries, and it is also used in percutaneous sacropelvic fixation for providing an in-line connection to the proximal spinal constructs without using offset connectors. Although the pelvic shape is different between males and females, reports on S2AIS trajectories according to gender have been scarce in the literature. In this paper, S2AIS trajectories are compared between males and females using pelvic three-dimensional computed tomography (3D-CT) in a normal Japanese population. After resetting the caudal angulation in CT-imaging plane manipulation, the angulation of S2AIS was more lateral in the axial plane and more horizontal in the coronal plane in females. Mean distances from the midline to starting points of S2AIS tended to be shorter in females, whereas mean distances from the midline to the posterior superior iliac spine was significantly longer in females. We also found that there were positive correlations between the patients’ height and the maximal lengths of S2AISs, and the patients’ height and minimal areas of S2AIS pathways. Our results are useful not only for conventional open spinal surgery, but also for minimally invasive spine surgery. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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6 pages, 3196 KiB

Open AccessArticle

Efficiency of Long Lateral Mass Screws

by Seiya Watanabe, Kazuo Nakanishi, Kosuke Misaki, Kazuya Uchino, Hideaki Iba and Takachika Shimizu

J. Clin. Med. 2022, 11(7), 1953; https://doi.org/10.3390/jcm11071953 - 31 Mar 2022

Cited by 1 | Viewed by 1565

Abstract

Introduction: Lateral mass screws (LMS) have been widely used for the posterior fusion of the cervical spine. Even though LMS are safe, the screws are short and postoperative fixation is uncertain. Therefore, we measured and reported a technique using long lateral mass screws [...] Read more.

Introduction: Lateral mass screws (LMS) have been widely used for the posterior fusion of the cervical spine. Even though LMS are safe, the screws are short and postoperative fixation is uncertain. Therefore, we measured and reported a technique using long lateral mass screws (LLMS), a new method of screw insertion, using a Zed spine from LEXI (Tokyo, Japan). Materials and Methods: In this study, we evaluated the outcomes of 35 patients who underwent surgery using LLMS at our hospital from 2019 to 2021. Operative time, blood loss, complications, inserted screw length, screw length based on gender differences, and screw deviation rate were evaluated. The Mann–Whitney U test was used to determine the gender differences in screw length. Screw deviation was evaluated by postoperative CT and a Zed spine to determine the screw insertion angle. Results: The mean operative time was 185 ± 51 min (120–327 min), and the mean blood loss was 236 ± 316 g (10–1720 g). The total number of screws was 183. The screw length was 22.2 (16–28) mm for males and 20.8 (16–28) mm for females, with an average length of 21 ± 2.7 mm. No gender differences were observed in terms of screw length (p > 0.01 NS). The number of deviated screws above G3 was one in the third cervical vertebra, three in the fourth cervical vertebra, one in the fifth cervical vertebra, and one in the sixth cervical vertebra. The number of deviated screws was 6 out of 183, and the deviation rate was 3.2%. Conclusions: In this study, the LLMS deviation rate was 3.2%, and strong fixation was possible without any complications. We measured the screw length and screw deviation rate in cases in which LLMS were actually inserted. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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10 pages, 1724 KiB

Open AccessArticle

Posterior Oblique Square Decompression with a Three-Step Wanding Technique in Tubular Minimally Invasive Transforaminal Lumbar Interbody Fusion: Technical Report and Mid-Long-Term Clinical Outcomes

by Takashi Tomita, Keita Kamei, Ryota Yamauchi, Takahiro Nakagawa, Hirotsugu Omi, Yoshiro Nitobe, Toru Asari, Gentaro Kumagai, Kanichiro Wada, Junji Ito and Yasuyuki Ishibashi

J. Clin. Med. 2022, 11(6), 1651; https://doi.org/10.3390/jcm11061651 - 16 Mar 2022

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Abstract

Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the most common procedure in minimally invasive spine stabilization (MISt), details of the technique remain unclear. This technical report shows the mid-long-term clinical outcomes in patients who underwent posterior oblique square decompression (POSDe) with [...] Read more.

Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the most common procedure in minimally invasive spine stabilization (MISt), details of the technique remain unclear. This technical report shows the mid-long-term clinical outcomes in patients who underwent posterior oblique square decompression (POSDe) with the three-step wanding technique of tubular MIS-TLIF for degenerative lumbar disease. Tubular MIS-TLIF (POSDe) was performed on 50 patients (males, 19; age, 69.2 ± 9.6 years), and traditional open surgery was performed (OS) on 27 (males, 4; age, 67.9 ± 6.6 years). We evaluated the clinical outcomes using the Visual Analog Scale for back pain, Japanese Orthopedic Association (JOA) scores, and JOA Back Pain Evaluation Questionnaire. We also assessed the fusion rate using the Bridwell grading system with computed tomography or plain radiography for at least 2 years postoperatively. Although there was no significant difference in the improvement rate of JOA scores between the two groups, the mean operation time and blood loss were significantly lower with MIS-TLIF than with OS. In the tubular MIS-TLIF group, there were no cases of deep wound infection; four cases had a pseudarthrosis, two had dural injury, and three had cage retropulsion. We revealed good clinical outcomes in patients who underwent POSDe. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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15 pages, 1707 KiB

Open AccessArticle

Conditions for Achieving Postoperative Pelvic Incidence-Lumbar Lordosis < 10° in Circumferential Minimally Invasive Surgery for Adult Spinal Deformity

by Masayuki Ishihara, Shinichirou Taniguchi, Takashi Adachi, Yoichi Tani, Masaaki Paku, Muneharu Ando and Takanori Saito

J. Clin. Med. 2022, 11(6), 1586; https://doi.org/10.3390/jcm11061586 - 13 Mar 2022

Cited by 5 | Viewed by 1929

Abstract

This retrospective study aimed to evaluate the clinical outcomes of circumferential minimally invasive surgery (CMIS) using lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw (PPS) in adult spinal deformity (ASD) patients, and to clarify the conditions for achieving postoperative pelvic incidence-lumbar lordosis [...] Read more.

This retrospective study aimed to evaluate the clinical outcomes of circumferential minimally invasive surgery (CMIS) using lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw (PPS) in adult spinal deformity (ASD) patients, and to clarify the conditions for achieving postoperative pelvic incidence-lumbar lordosis (PI-LL) < 10°. Demographics and other parameters of ASD patients who underwent CMIS and who were divided into groups G (achieved postoperative PI-LL < 10°) and P (PI-LL ≥ 10°) were compared. Of the 145 included ASD patients who underwent CMIS, the average fused level, bleeding volume, operative time, and number of intervertebral discs that underwent LLIF were 10.3 ± 0.5 segments, 723 ± 375 mL, 366 ± 70 min, and 4.0 segments, respectively. The rod material was titanium alloy in all the cases. The PI-LL significantly improved from 37.3 ± 17.9° to 1.2 ± 12.2° postoperatively. Pre- and postoperative PI, postoperative LL, preoperative PI-LL, PI-LL after LLIF, and postoperative PI-LL were significantly larger in group P. PI-LL after LLIF was identified as a significant risk factor of postoperative PI-LL < 10° by logistic regression, and the cut-off value on receiver operating characteristic curve analysis was 20°. Sufficient correction was achieved by CMIS. If PI-LL after LLIF was ≤20°, it was corrected to the ideal alignment by the PPS procedure. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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13 pages, 839 KiB

Open AccessArticle

Spontaneous Osseous Fusion after Remodeling Therapy for Chronic Atlantoaxial Rotatory Fixation and Recovery Mechanism of Rotatory Range of Motion of the Cervical Spine

by Kazuya Kitamura, Ken Ishii, Narihito Nagoshi, Kazuhiro Chiba, Morio Matsumoto, Masaya Nakamura and Kota Watanabe

J. Clin. Med. 2022, 11(6), 1504; https://doi.org/10.3390/jcm11061504 - 09 Mar 2022

Cited by 1 | Viewed by 2261

Abstract

We aimed to investigate the risk factors of spontaneous osseous fusion (SOF) of the atlantoaxial joint after closed reduction under general anesthesia followed by halo fixation (remodeling therapy) for chronic atlantoaxial rotatory fixation, and to elucidate the recovery mechanism of the rotatory range [...] Read more.

We aimed to investigate the risk factors of spontaneous osseous fusion (SOF) of the atlantoaxial joint after closed reduction under general anesthesia followed by halo fixation (remodeling therapy) for chronic atlantoaxial rotatory fixation, and to elucidate the recovery mechanism of the rotatory range of motion (ROM) after halo removal. Twelve patients who underwent remodeling therapy were retrospectively reviewed. Five patients with SOF were categorized as the fusion group and seven patients without SOF as the non-fusion group. Three dimensional CT was used to detect direct osseous contact (DOC) of facet joints before and during halo fixation, while dynamic CT at neutral and maximally rotated head positions was performed to measure rotatory ROM after halo removal. The duration from onset to initial visit was significantly longer (3.2 vs. 5.7 months, p = 0.04), incidence of DOC during halo fixation was higher (0/7 [0%] vs. 4/5 [80%], p = 0.004), and segmental rotatory ROM of Occiput/C1 (Oc/C1) at final follow-up was larger (9.8 vs. 20.1 degrees, p = 0.003) in the fusion group. Long duration from the onset to the initial visit might induce irreversible damage to the articular surface of the affected facet, which was confirmed as DOC during halo fixation and resulted in SOF. Long duration from the onset to the initial visit and DOC during halo fixation could be used to suggest the risk for SOF. Nonetheless, rotatory ROM of Oc/C1 increased to compensate for SOF. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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13 pages, 2027 KiB

Open AccessArticle

Comparative Study of Cage Subsidence in Single-Level Lateral Lumbar Interbody Fusion

by Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Satoshi Nomura, Masato Sato and Masahiko Watanabe

J. Clin. Med. 2022, 11(5), 1374; https://doi.org/10.3390/jcm11051374 - 02 Mar 2022

Cited by 21 | Viewed by 2138

Abstract

We investigated the incidence and clinical features of cage subsidence after single-level lateral lumbar interbody fusion (LLIF). We studied a retrospective cohort of 59 patients (34 males, 25 females; mean age, 68.9 years) who received single-level LLIF. Patients were classified into subsidence and [...] Read more.

We investigated the incidence and clinical features of cage subsidence after single-level lateral lumbar interbody fusion (LLIF). We studied a retrospective cohort of 59 patients (34 males, 25 females; mean age, 68.9 years) who received single-level LLIF. Patients were classified into subsidence and no-subsidence groups. Cage subsidence was defined as any violation of either endplate, classified using radiographs and computed tomography (CT) images. After one year, we compared patient characteristics, surgical parameters, radiological findings, pain scores, and fusion status. We also compared the Hounsfield unit (HU) endplate value obtained on CT preoperatively. Twenty patients (33.9%) had radiographic evidence of interbody cage subsidence. There were significant differences between the subsidence and no-subsidence groups in sex, cage height, fusion rate, and average HU value of both endplates (p < 0.05). There were no significant differences in age, height, weight, or body mass index. Moreover, there were no significant differences in global alignment and Numerical Rating Scale change in low back pain, leg pain, and numbness. Despite suggestions that patients with lower HU values might develop cage subsidence, our results showed that cage subsidence after single-level LLIF was not associated with low back pain, leg pain, or numbness one year post-operation. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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12 pages, 1061 KiB

Open AccessArticle

Comparison of Hybrid Posterior Fixation and Conventional Open Posterior Fixation Combined with Multilevel Lateral Lumbar Interbody Fusion for Adult Spinal Deformity

by Hirooki Endo, Hideki Murakami, Daisuke Yamabe, Yusuke Chiba, Ryosuke Oikawa, Hirotaka Yan and Minoru Doita

J. Clin. Med. 2022, 11(4), 1020; https://doi.org/10.3390/jcm11041020 - 16 Feb 2022

Cited by 2 | Viewed by 1743

Abstract

We compared radiological and clinical outcomes between multilevel lateral lumbar interbody fusion (LLIF) + hybrid posterior fixation (PF) and multilevel LLIF + conventional open PF in patients with adult spinal deformity (ASD). Patients who underwent minimally invasive surgery for ASD in a single [...] Read more.

We compared radiological and clinical outcomes between multilevel lateral lumbar interbody fusion (LLIF) + hybrid posterior fixation (PF) and multilevel LLIF + conventional open PF in patients with adult spinal deformity (ASD). Patients who underwent minimally invasive surgery for ASD in a single institution between 2014 and 2018 were retrospectively reviewed. Fifty-six patients (hybrid PF, 30; open PF, 26) who underwent ASD correction surgery were enrolled between 2014 and 2018. We evaluated patients’ demographics, clinical outcomes, and radiographical parameters in each group. There was significantly less estimated blood loss in the hybrid PF group (662.8 mL vs. 1088.8 mL; p = 0.012). The CRP level 7 days after surgery was significantly lower in the hybrid PF group (2.9 mg/dL vs. 4.3 mg/dL; p = 0.035). There was no significant difference between the two groups in other demographic variables, visual analog scores for back pain and leg pain, Oswestry Disability Index, coronal Cobb angle, lumbar lordosis, pelvic tilt, pelvic incidence–lumbar lordosis mismatch, and sagittal vertical axis. There was a significantly higher percentage of major complications in the open PF group (42.3% vs. 13.3%; p = 0.039). Thus, LLIF + hybrid PF for ASD corrective surgery may be comparable to LLIF + open PF in terms of clinical and radiographic outcomes. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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12 pages, 3104 KiB

Open AccessArticle

Radiological Evaluation of Combined Anteroposterior Fusion with Vertebral Body Replacement Using a Minimally Invasive Lateral Approach for Osteoporotic Vertebral Fractures: Verification of Optimal Surgical Procedure

by Takumi Takeuchi, Kenichiro Yamagishi, Kazumasa Konishi, Hideto Sano, Masato Takahashi, Shoichi Ichimura, Hitoshi Kono, Masaichi Hasegawa and Naobumi Hosogane

J. Clin. Med. 2022, 11(3), 629; https://doi.org/10.3390/jcm11030629 - 26 Jan 2022

Cited by 6 | Viewed by 1997

Abstract

The combined anteroposterior fusion with vertebral body replacement (VBR) using a wide footplate expandable cage with a minimally invasive lateral approach has been widely used for pseudoarthrosis after osteoporotic vertebral fractures. The purpose of this study is to evaluate the radiological results of [...] Read more.

The combined anteroposterior fusion with vertebral body replacement (VBR) using a wide footplate expandable cage with a minimally invasive lateral approach has been widely used for pseudoarthrosis after osteoporotic vertebral fractures. The purpose of this study is to evaluate the radiological results of combined anteroposterior surgery using VBR and to recommend the optimal procedure. Thirty-eight elderly patients were included in this study. The mean preoperative local kyphosis angle was 29.3°, and the mean correction loss angle was 6.3°. Cage subsidence was observed in ten patients (26.3%), and UIV or LIV fracture in twelve patients (31.6%). Patients with cage subsidence were compared to those without cage subsidence to determine the causal factors. The mean number of fixed vertebrae was 5.4 vertebrae with cage subsidence and 7.4 vertebrae without cage subsidence. In addition, to precisely clarify the optimal number of fixed vertebrae, those patients with two above–two below fixation were compared to those with less than two above–two below fixation, which revealed that the correction loss angle was significantly less in two above–two below fixation (p = 0.016). Based on these results, we recommend at least two above–two below fixation with VBR to minimize the correction loss angle and prevent cage subsidence. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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11 pages, 3210 KiB

Open AccessArticle

Improved Accuracy and Safety of Pedicle Screw Placement by Using a Probe with an Electrical Conductivity-Measuring Device during Severe Syndromic and Neuromuscular Scoliosis Spine Surgery

by Takashi Yurube, Yutaro Kanda, Masaaki Ito, Yoshiki Takeoka, Teppei Suzuki, Koki Uno, Ryosuke Kuroda and Kenichiro Kakutani

J. Clin. Med. 2022, 11(2), 419; https://doi.org/10.3390/jcm11020419 - 14 Jan 2022

Cited by 5 | Viewed by 1709

Abstract

An electrical conductivity-measuring device (ECD) has recently been developed to support pedicle screw placement. However, no evidence exists regarding its efficacy for syndromic/neuromuscular scoliosis with extremely difficult screwing. We retrospectively reviewed 2010–2016 medical records of 21 consecutive syndromic/neuromuscular scoliosis patients undergoing free-hand segmental [...] Read more.

An electrical conductivity-measuring device (ECD) has recently been developed to support pedicle screw placement. However, no evidence exists regarding its efficacy for syndromic/neuromuscular scoliosis with extremely difficult screwing. We retrospectively reviewed 2010–2016 medical records of 21 consecutive syndromic/neuromuscular scoliosis patients undergoing free-hand segmental fixation surgery at our institution and compared the pedicle screw insertion accuracy and safety between 10 with a conventional non-ECD probe (2010–2013) and 11 with an ECD probe (2014–2016). We analyzed preoperative pedicle shape and postoperative screw placement in computed tomography. There were no significant differences between ECD and non-ECD groups in demographic, clinical, and treatment characteristics including scoliosis severity and pedicle diameter. The abandonment rate due to liquorrhea or perforation was lower in ECD (12.3%) than in non-ECD (26.7%) (p < 0.01). Acceptable insertion without perforation or <2-mm lateral/cranial position was more frequent in ECD (67.1%) than in non-ECD (56.9%) (p = 0.02). Critical ≥5-mm medial/caudal malposition was not seen in ECD (0.0%) but in non-ECD (2.4%) (p = 0.02). The perforation distance was shorter in ECD (2.2 ± 1.1 mm) than in non-ECD (2.6 ± 1.7 mm) (p = 0.01). Results involve small sample size, selection, performance, and learning curve biases; nevertheless, ECD could be useful for more accurate and safer pedicle screw placement in severe syndromic/neuromuscular scoliosis. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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12 pages, 1544 KiB

Open AccessEditor’s ChoiceArticle

Platelet-Rich Plasma Releasate versus Corticosteroid for the Treatment of Discogenic Low Back Pain: A Double-Blind Randomized Controlled Trial

by Koji Akeda, Kohshi Ohishi, Norihiko Takegami, Takao Sudo, Junichi Yamada, Tatsuhiko Fujiwara, Rui Niimi, Takeshi Matsumoto, Yuki Nishimura, Toru Ogura, Satoshi Tamaru and Akihiro Sudo

J. Clin. Med. 2022, 11(2), 304; https://doi.org/10.3390/jcm11020304 - 07 Jan 2022

Cited by 18 | Viewed by 2389

Abstract

Clinical application of platelet-rich plasma is gaining popularity in treating low back pain (LBP). This study investigated the efficacy and safety of platelet-rich plasma releasate (PRPr) injection into degenerated discs of patients with discogenic LBP. A randomized, double-blind, active-controlled clinical trial was conducted. [...] Read more.

Clinical application of platelet-rich plasma is gaining popularity in treating low back pain (LBP). This study investigated the efficacy and safety of platelet-rich plasma releasate (PRPr) injection into degenerated discs of patients with discogenic LBP. A randomized, double-blind, active-controlled clinical trial was conducted. Sixteen patients with discogenic LBP received an intradiscal injection of either autologous PRPr or corticosteroid (CS). Patients in both groups who wished to have PRPr treatment received an optional injection of PRPr eight weeks later. The primary outcome was change in VAS from baseline at eight weeks. Secondary outcomes were pain, disability, quality of life (QOL), image analyses of disc degeneration, and safety for up to 60 weeks. The VAS change at eight weeks did not significantly differ between the two groups. Fifteen patients received the optional injection. Compared to the CS group, the PRPr group had a significantly improved disability score at 26 weeks and walking ability scores at four and eight weeks. Radiographic disc height and MRI grading score were unchanged from baseline. PRPr caused no clinically important adverse events. PRPr injection showed clinically significant improvements in LBP intensity equal to that of CS. PRPr treatment relieved pain, and improved disability and QOL during 60 weeks of observation. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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13 pages, 2892 KiB

Open AccessArticle

Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture

by Naoki Segi, Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Kenyu Ito, Mikito Tsushima, Satoshi Tanaka, Kei Ando, Masaaki Machino, Sadayuki Ito, Hidetoshi Yamaguchi, Hiroyuki Koshimizu, Hiroyuki Tomita, Jun Ouchida, Yoshinori Morita and Shiro Imagama

J. Clin. Med. 2021, 10(23), 5664; https://doi.org/10.3390/jcm10235664 - 30 Nov 2021

Cited by 3 | Viewed by 1382

Abstract

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent [...] Read more.

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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Review

Jump to: Research

10 pages, 263 KiB

Open AccessReview

Innovation of Surgical Techniques for Screw Fixation in Patients with Osteoporotic Spine

by Haruo Kanno, Yoshito Onoda, Ko Hashimoto, Toshimi Aizawa and Hiroshi Ozawa

J. Clin. Med. 2022, 11(9), 2577; https://doi.org/10.3390/jcm11092577 - 04 May 2022

Cited by 11 | Viewed by 2571

Abstract

Osteoporosis is a common disease in elderly populations and is a major public health problem worldwide. It is not uncommon for spine surgeons to perform spinal instrumented fusion surgeries for osteoporotic patients. However, in patients with severe osteoporosis, instrumented fusion may result in [...] Read more.

Osteoporosis is a common disease in elderly populations and is a major public health problem worldwide. It is not uncommon for spine surgeons to perform spinal instrumented fusion surgeries for osteoporotic patients. However, in patients with severe osteoporosis, instrumented fusion may result in screw loosening, implant failure or nonunion because of a poor bone quality and decreased pedicle screw stability as well as increased graft subsidence risk. In addition, revision surgeries to correct failed instrumentation are becoming increasingly common in patients with osteoporosis. Therefore, techniques to enhance the fixation of pedicle screws are required in spinal surgeries for osteoporotic patients. To date, various instrumentation methods, such as a supplemental hook, sublaminar taping and sacral alar iliac screws, and modified screwing techniques have been available for reinforcing pedicle screw fixation. In addition, several materials, including polymethylmethacrylate and hydroxyapatite stick/granules, for insertion into prepared screw holes, can be used to enhance screw fixation. Many biomechanical tests support the effectiveness of these augmentation methods. We herein review the current therapeutic strategies for screw fixation and augmentation methods in the surgical treatment of patients with an osteoporotic spine. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

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