Finite element analysis of lumbar vertebra biomechanics after transforaminal lumbar interbody fusion combined with bilateral transpedicular transdiscal lumbar screw fixation / 中国组织工程研究

BACKGROUND:Transpedicular transdiscal lumbar screw is a new type of spinal minimally invasive internal fixation technology.Compared with traditional bilateral pedicle screws,only one screw is needed to fix one segment on one side.It has the characteristics of being more economical,less trauma and easy to operate.However,studies on the application of transpedicular transdiscal lumbar screws combined with transforaminal lumbar interbody fusion(TLIF)and fixation are still rare. OBJECTIVE:To evaluate the effect of TLIF combined with various surgery methods on stress distribution of cage,fixation,disc lower and endplate and range of motion of lumbar vertebrae by constructing three kinds of finite element models including modified TLIF(cage alone)model,modified TLIF combined with bilateral pedicle screw(cage+BPS)model and modified TLIF combined with bilateral transpedicular transdiscal lumbar screw(cage+BTPTDS)model. METHODS:The CT images of the adult lumbar spine were used to establish the three kinds of TLIF finite element models:cage alone,cage+BPS and cage+BTPTDS using software Mimics,Geomagic and SolidWorks.ANSYS Workbench was used to simulate the application of six different motion loads of human body flexion and extension,left and right bending,and left and right rotation to calculate stress distribution and the changes in the range of motion of the lumbar spine of the cage,fixation,endplate and disc of the three lumbar spine surgery models and to compare the effects of three surgical options on the biomechanical effects of the lumbar spine. RESULTS AND CONCLUSION:(1)The cage alone model,cage+BPS model and cage+BTPTDS model were constructed successfully.(2)In flexion and lateral bending conditions,the maximum stress of the cage of cage+BTPTDS model was smaller than that of the cage alone model and a little greater than that of the cage+BPS model.In the extension condition,the maximum stress of the cage of the cage+BPS model was obviously smaller than that of the other two models.When it came to rotating condition,the maximum stress of the cage in the cage+BPS model and the cage+BTPTDS model presented no obvious difference,which was both smaller than the cage alone model.(3)The maximum stress of fixation of the cage+BTPTDS model was obviously bigger than the cage+BPS model in flexion and extension conditions,close to the cage+BPS model in lateral bending conditions,and smaller than the cage+BPS model in rotation conditions.(4)The maximum stress of the lower endplate of the fusion segment of the cage+BPS model was between the two other models.(5)In terms of the range of motion,the cage+BTPTDS model presented no obvious difference with that of the cage+BPS model at flexion and extension,left and right bending,and left and right rotation.(6)It is concluded that modified TLIF combined with transpedicular transdiscal lumbar screw provides stable support for the vertebral body of the fusion segment,ensures the motion range of the lumbar spine and has a good biomechanical effect.

Translation and Cross-cultural Adaptation of the SOSG-OQ 2.0 Questionnaire into Brazilian Portuguese / Tradução e adaptação transcultural do questionário SOSG-OQ 2.0 para o português brasileiro

Abstract Objective: To perform the cross-cultural adaptation and translation into Brazilian Portuguese of the Spine Oncology Study Group - Outcomes Questionnaire 2.0 (SOSG-OQ 2.0) to enable its application to Brazilian patients and to allow Brazilian researchers to use a questionnaire that is on trend in the scientific literature. Materials and Methods: The present is a basic, non-randomized, non-comparative study. The translation followed the proposal by Reichenheime and Moraes, mainly for the semantic equivalence and measurement equivalence sessions, as well as the recommendations by Coster and Mancini mainly in the translation stage. The stages were as follows: first - translation into Brazilian Portuguese; second - back-translation; third - semantic comparison; fourth - validation of the final construct. Results: The translations of the SOSG-OQ 2.0 made by three translators presented a high degree of similarity for most questions. The translators kept all question titles and subtitles, as well as their internal and external orders. Two sworn translators, with native proficiency in English, performed the back-translation of the amalgamated text. Both back-translations were quite similar, and any differences were solved through consensus between the main author and the sworn translators, and the translated text was considered the final version. Conclusion: The present study shows a translated version of the SOSG-OQ 2.0 with semantic validity with the original version published in English. As such, researchers can apply the questionnaire to the Brazilian population, adding another tool for spine surgeons to improve the monitoring of this complex group of patients.

Resumo Objetivo: Realizar a adaptação transcultural e a tradução para o português brasileiro da versão 2.0 do Questionário de Desfechos do Spine Oncology Study Group (Spine Oncology Study Group - Outcomes Questionnaire 2.0, SOSG-OQ 2.0, em inglês) para viabilizar sua aplicação em pacientes brasileiros e permitir a utilização deste questionário que está em voga na literatura científica por pesquisadores brasileiros. Materiais e Métodos: Trata-se de uma pesquisa básica, não randomizada, não comparativa. As etapas de tradução foram realizadas conforme propostas por Reichenheime e Moraes, principalmente as sessões de equivalência semântica e equivalência de mensuração, e também foram seguidas as recomendações de Coster e Mancini, principalmente na etapa de tradução. As etapas foram as seguintes: primeira - tradução do questionário para o português brasileiro; segunda - retroversão; terceira - comparação semântica; e quarta - validação final do constructo. Resultados: As traduções do SOSG-OQ 2.0 feitas por três tradutores apresentaram grande similaridade na maioria das questões. Todos os títulos e subtítulos de perguntas foram mantidos pelos tradutores, assim como as ordens interna e externa das perguntas. A retroversão da tradução conciliada foi realizada por dois tradutores juramentados, com fluência nativa na língua inglesa. Ambas as retroversões foram bastante similares, as divergências foram sanadas por consenso entre o autor principal e os tradutores juramentados, e a versão traduzida foi considerada a versão final. Conclusão: Neste estudo, apresenta-se uma versão traduzida do SOSG-OQ 2.0 que tem validade semântica com a versão original publicada em inglês, o que permite a sua aplicação na população brasileira, e acrescenta mais uma ferramenta para que os cirurgiões de coluna possam acompanhar de forma melhor este complexo grupo de pacientes.

Access to the Lumbosacral Spine: A Current View / Acesso à coluna lombossacral: Visão atual

Abstract The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

Sagittal Alignment Concepts and Spinopelvic Parameters / Conceitos de alinhamento sagital e parâmetros espinopélvicos

Abstract Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Resumo A cirurgia da coluna continua a expandir seus horizontes para cuidar dos pacientes incapacitados com dor e deformidades. Desde a última década, nosso conhecimento sobre o alinhamento espinal, do crânio à pelve, aumentou consideravelmente. Portanto, faz-se necessária a expansão de tal conhecimento para o ortopedista geral, para que possamos proporcionar melhores cuidados para essa população. O alinhamento espinal global é um conceito crítico no entendimento do impacto ocasionado pela condição patológica (doença degenerativa, trauma, deformidade) e mesmo do seu tratamento, como na instrumentação e artrodese da coluna. O tratamento de qualquer doença na coluna deve incluir o entendimento da complexidade do alinhamento espinopélvico. A princípio, todos os parâmetros parecem puramente matemáticos e pouco aplicáveis à realidade do leitor mais desatento. Mas, aos poucos, fica claro que, como tudo em ortopedia, a biomecânica faz parte essencial do conhecimento do sistema musculoesquelético, tornando mais claras as lógicas da fisiologia do movimento. O conhecimento dos conceitos de alinhamento sagital e dos parâmetros espinopélvicos proporcionam uma melhor compreensão dos esqueletos axial e apendicular, além de um melhor entendimento dos processos fisiológicos e adaptativos da coluna frente ao processo degenerativo crescente que ocorre ao longo da vida.

Meta-analysis of risk factors for dysphagia after anterior cervical spine surgery / 中国脊柱脊髓杂志

Objectives:To systematically evaluate the risk factors for dysphagia after anterior cervical spine surgery(ACSS),identify the independent risk factors,and to provide a guidance for the prevention and treatment of perioperative complications.Methods:A total of 8 databases including Wanfang,CBM,CNKI,VIP,PubMed,Embase,Cochrane Library,and Web of Science were searched for case-control and cohort studies about the risk factors of dysphagia after ACSS from the establishment of each database to July 15,2023.Newcastle-Ottawa scale(NOS)was adopted to evaluate the qualities of the included literaure.Related data such as the first author,publication year,research type,sample size,assessment method,evaluation time,and risk factors were extracted and Stata 12 software was used to do the meta-analysis.Results:29 articles were included,consisting of 4 cohort studies and 25 case control studies.All of the articles were of high quality.The total sample size of patients with dysphagia after ACSS was 89571 and the number of patients in the control group was 3092967.Age(OR=1.093,95％CI:1.067-1.120),female(OR=2.419,95％CI:1.654-3.539),diabetes mellitus(OR=2.733,95％CI:2.240-3.333),disease duration(OR=4.259,95％CI:2.458-7.381),levels of surgery(OR=1.791,95％CI:1.718-1.868),operative level(OR=2.332,95％CI:1.812-3.003),operative time(OR=1.434,95％CI:1.110-1.852),plate(OR=2.188,95％CI:1.413-3.175)and revision surgery(OR=2.687,95％CI:2.316-3.119)were related to dysphagia after ACSS,while smoking(OR=1.323,95％CI:0.852-2.056),hypertension(OR=1.006,95％CI:0.591-1.713),body mass index(BMI)(OR=1.037,95％CI:0.929-1.159),cervical disc arthroplasty(OR=0.577,95％CI:0.085-3.943)and difference between postoperative and preoperative C2-7 angles(dC2-7)＞5°(OR=1.716,95％CI:0.925-3.183)were not.Conclusions:Patients who are female,old aged,with long preoperative disease duration and diabetes mellitus,undergoing double or multi-level surgery,upper cervical spine surgery,and revision surgery,prolonged operation time,and use of plate,are prone to have dysphagia after ACSS.

Improvement in anesthesia method for lumbar spine surgery: esketamine-based anesthesia / 中华麻醉学杂志

Objective:To evaluate the efficacy of esketamine-based anesthesia in lumbar spine surgery.Methods:Ninety-four patients of both sexes, aged 18-64 yr, with body mass index of 18.5-29.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification ⅠorⅡ, scheduled for elective lumbar posterior decompression bone grafting fusion internal fixation under general anesthesia from June 2022 to December 2022, were divided into control group(group C) and esketamine group(group K) using a random number table method, with 47 cases in each group. Midazolamm, sufentanil, etomidate and cisatracurium were intravenously injected for anesthesia induction in both groups, and esketamine 0.5 mg/kg was intravenously injected on this basis in group K. Propofol and remifentanil were intravenously infused to maintain anesthesia, and cisatracurium besylate was intermittently injected to maintain muscle relaxation in both groups, and esketamine 0.25 mg·kg -1·h -1 was intravenously infused on this basis in group K. The patients were connected to an analgesic pump for patient-controlled intravenous analgesia at 10 min before the end of surgery, and flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia when the numeric rating scale score >4. The time of first pressing the analgesia pump, effective pressing times of the analgesia pump within 48 h after operation and requirement for rescue analgesia were recorded. The initial dose of remifentanil, cumulative amount of remifentanil used during operation, time of tracheal extubation, and adverse reactions within 48 h after surgery were recorded. Results:Compared with group C, the cumulative use of remifentanil during operation was significantly reduced, the time of first pressing the self-control button of the analgesia pump after surgery was prolonged, the pressing times of the analgesia pumps were decreased( P<0.05), and no significant change was found in terms of the initial dose of intraoperative remifentanil, rate of postoperative rescue analgesia, time of extubation, and incidence of adverse reactions after surgery in group K( P>0.05). Conclusions:Esketamine-based anesthesia can reduce the amount of intraoperative opioids, delay the time of postoperative pain and reduce the early postoperative pain when used for lumbar spine surgery.

Analysis of major adverse cardiac events and risk factors during perioperative period of cervical spine surgery / 中国综合临床

Objective:To understand the occurrence of major adverse cardiac events (MACE) during the perioperative period of cervical spine surgery and analyze its risk factors.Methods:A retrospective analysis of 426 cervical spine surgery patients admitted to the from March 2017 to March 2021. The basic information of the patients, including gender, age, body mass index (BMI), underlying diseases, and the Charlson comorbidity index (CCI) was calculated based on the underlying diseases.The preoperative serum cardiac troponin I(cTnI) level and the operation-related indicators were collected,including the type of cervical spine surgery, surgical procedure, approach, duration of surgery, duration of anesthesia, intraoperative bleeding, postoperative pain visual analogue scale (VAS), and electrolyte disturbances. Count data were expressed as cases (%), and comparisons between groups were made using the χ 2 test; logistic regression models were applied to perform a multifactorial analysis of the factors influencing the perioperative occurrence of MACE in patients undergoing cervical spine surgery. Results:Among the 426 patients, 54 (12.68%) experienced MACE during the perioperative period, including 4 cases of unstable angina (7.41%), 4 cases of acute myocardial infarction (7.41%), 33 cases of severe arrhythmia (61.11%), and 13 cases of acute heart failure (24.07%). The results of multivariate logistic regression analysis showed that the older the age group (50-59 years old: odds ratio=1.34, 95% confidence interval: 1.14-1.78; 60-69 years old: odds ratio=1.48, 95% confidence interval: 1.20-1.86; 70-79 years old: odds ratio=1.71, 95% confidence interval: 1.34-2.57; 80-89 years old: odds ratio=1.95, 95% confidence interval: 1.46-2.85), as well as females, CCI scores>3, and preoperative cTnI>0.04 μg/L, postoperative VAS score>5, and electrolyte disorders are all influencing factors for the occurrence of MACE in cervical spine surgery patients during the perioperative period (odds ratios of 1.84, 2.12, 2.34, 2.57, 2.20, 95% confidence intervals of 1.34-2.68, 1.50-3.41, 1.63-3.72, 1.53-4.01, 1.43-3.69, all P<0.05). Conclusions:The incidence of MACE in the perioperative period of cervical spine surgery is relatively high. Elderly age, female, high CCI score, high preoperative serum cTnI, postoperative pain and electrolyte disturbance are independent risk factors for the perioperative period of cervical spine surgery.

Study on the effect of ultrasound intermediate frequency acupoint drug guiding technology on the recovery of gastrointestinal function in patients undergoing lumbar spine surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound intermediate frequency acupoint targeted drug guiding technology on the recovery of gastrointestinal function and serum gastrin levels in elderly patients after lumbar spine surgery under general anesthesia.Methods:This study used prospective research methods.A total of 90 elderly patients undergoing lumbar spine surgery after general anesthesia in the orthopaedic ward of Beijing Geriatrics Hospital from June 2019 to June 2021 were randomly divided into blank control group, drug control group, and drug-guided treatment group, with 30 cases each group. After the operation, no intervention was given to the blank control group, the drug control group received oral mosapride citrate tablets, the drug-guided treatment group used the D patch to guide the medicine at the two acupoints of Zusanli and Zhongwan with ultrasound medium frequency guided medicine instrument for 1 week each. The serum gastrin levels of the patients in each group were detected 1 d before operation, 3 d after operation, and 1 week after operation, and the time of first exhaust and first defecation after operation were recorded.Results:The results showed that the level of serum gastrin preoperativein the three groups was not significantly different ( P>0.05). On the third day after operation, the levelof serum gastrin in the drug guide treatment group, drug control group and blank control group were lower than those at 1 d before operation: (66.51 ± 5.34) ng/L vs. (69.36 ± 6.50) ng/L, (58.34 ± 5.71) ng/L vs. (68.75 ± 5.13) ng/L, (55.76 ± 6.23) ng/L vs. (70.20 ± 6.71) ng/L, the differences were statistically significant ( P<0.05), and showed a decreasing trend in turn. Among them, the level of serum gastrin in the drug guide treatment group was higher than that in the drug control group and blank control group, the difference was statistically significant ( P<0.05). One week after operation, the level of serum gastrin in the three groups increased compared with the third day after operation ( P<0.05), and the drug guiding treatment group was higher than the drug control group and the blank control group: (72.38 ± 6.78) ng/L vs. (67.15 ± 6.27) ng/L, (63.52 ± 5.38) ng/L, the differences were statistically significant ( P<0.05). The time of first exhaust and defecation after the operation of the three groups of patients, the drug-guided treatment group was significantly shorter than the drug control group and the blank control group: (15.25 ± 3.10) h vs. (20.38 ± 4.21) h and (28.52 ± 3.69) h, (24.14 ± 3.53) h vs. (36.15 ± 3.54) h and (49.51 ± 4.37) h, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound intermediate frequency acupoint drug guiding technology can increase the patient′s serum gastrin level and promote the recovery of gastrointestinal function in elderly patients with lumbar spine surgery after general anesthesia.

Study on the application effects of the mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice" in the teaching of spinal surgery / 中华医学教育探索杂志

Objective:To explore the application effects of the mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice" in the teaching of spinal surgery.Methods:A total of 64 eight-year program clinical medical students who practiced in Peking Union Medical College Hospital in 2021 were taken as research objects and randomly divided into experimental group ( n=33) and control group ( n=31). The experimental group received the new teaching mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice", and the control group received regular teaching mode. At the end of teaching, the teaching effects were evaluated from several aspects, including the scores of theoretical examinations, anatomical marks identification tests, and anonymous questionnaires. SPSS 22.0 software was used for paired t-test and two independent-samples t-test. Results:The theoretical test scores [(51.25±6.99) points] and anatomical structure identification scores [(37.56±1.83) points] of the experimental group were higher than those of the control group [(42.46±6.13) points and (30.37±3.46) points], and the differences were statistically significant ( P<0.001). The effective recovery rate of the questionnaire was 100%. The results of the questionnaire showed that the experimental group was significantly higher than the control group in terms of teaching attractiveness, attention, learning interest, learning efficiency, anatomical identification ability, problem-finding and problem-solving ability and overall teaching method satisfaction ( P<0.05). Conclusion:The teaching mode of "Multidisciplinary integration, Doctors & patients co-teaching, Simulated practice" can effectively improve students' theoretical knowledge, learning interest, learning efficiency, operation proficiency and problem-finding and problem-solving ability, which is worth promoting.

Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients / 中南大学学报(医学版)

OBJECTIVES@#With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques.@*METHODS@#A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups.@*RESULTS@#A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05).@*CONCLUSIONS@#Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Study on application of ultrasonic bone curette in anterior cervical spine surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery.@*METHODS@#A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators.@*RESULTS@#Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank.@*CONCLUSION@#Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.

What is the degree of variability in formal training for pediatric orthopedic surgeons performing scoliosis surgery? / ¿Cuál es el grado de variabilidad en la educación formal de los cirujanos ortopédicos pediátricos que realizan intervenciones quirúrgicas de escoliosis?

Abstract: Introduction: although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability. Material and methods: in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI. Results: 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005). Conclusions: results show significant differences in training and performance of scoliosis procedures between societies.

Resumen: Introducción: aunque muchos cirujanos ortopédicos pediátricos alrededor del mundo realizan cirugías para la escoliosis, el entrenamiento es variable y poco conocido. A través de encuestar a la Sociedad Europea de Ortopedia Pediátrica (EPOS) y a la Sociedad Latinoamericana de Ortopedia (SLAOTI) queremos caracterizar esta variabilidad. Material y métodos: distribuimos un cuestionario anónimo en 2021 a los miembros de EPOS y SLAOTI. Resultados: realizan las cirugías de escoliosis 43% de EPOS, en comparación con 22% de SLAOTI (p < 0.05); 18% de EPOS realizó > 35 cirugías al año, en comparación con 2% de SLAOTI (p < 0.05); 70% de EPOS y 27% de SLAOTI recibieron capacitación formal en cirugía de deformidades de la columna (p < 0.005). Conclusiones: los resultados de este estudio subrayan las diferencias en el entrenamiento de las cirugías de escoliosis entre diferentes sociedades.

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial

Abstract Background Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated. Objectives The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries. Methods In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test. Results Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications. Conclusion Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.

Estudio bibliométrico de las publicaciones en cirugía de columna en México / Publications on spine surgery in Mexico: a bibliometric study

Resumen: Introducción: el análisis bi-bliométrico es una forma útil de evaluar el pasado, el pre-sente y el futuro de las publicaciones relacionadas con un área determinada de forma cualitativa y cuantitativa. Objetivo: determinar las características de la productividad nacional en investigación escrita por autores mexicanos en el campo de cirugía de columna a través del tiempo. Material y métodos: se realizó una búsqueda exhaustiva en línea en Octubre de 2021 utilizando la base de datos Scopus desarrollada por Elsevier. La información de las publicaciones recolectadas fue la siguiente: año, título, acceso, idioma, revista, tipo de artículo, tema, objetivo, citas, autores e instituciones de afiliación. Resultados: se identificó un total de 404 publicaciones entre 1973 y 2021. El número de publicaciones entre la década 1991-2000 y 2011-2021 incrementó 68.28 veces. La mayoría de las publicaciones se realizaron en instituciones de la región centro-sur de México (66.16%), seguida de la región occidente (15.03%) y noreste (8.27%). El índice H más alto encontrado fue de revistas de origen estadounidense (102). La mayor parte de las publicaciones se realizó en la revista Coluna/Columna (15.53%), seguida de Cirugía y Cirujanos (10.52%) y de Acta Ortopédica Mexicana (8.52%). La institución con la más alta productividad fue el Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra¼ (17.57%), seguida del Centro Médico Nacional de Occidente del IMSS (6.67%) y del Centro Médico ABC (5.44%). Conclusiones: el número de artículos publicados en el campo de cirugía de columna ha incrementado rápidamente en los últimos 15 años. Las publicaciones escritas en inglés son las más citadas. La distribución geográfica de la investigación en este campo en México está centralizada, realizándose la mayor parte de las publicaciones en la región centro-sur del país (66.16%).

Abstract: Introduction: bibliometric analysis is a useful way of assessing the past, present and future publications related to a given area in a qualitative and quantitative way. Objective: to determine characteristics of national authors productivity in the field of spine surgery research across the time. Material and methods: an online research was performed using the Elsevier´s database Scopus in October, 2021. All studies were assessed for the following parameters: year, title, access, language, journal, type of article, focus of research, objective of research, cites, authors and institutions. Results: a total of 404 publications were identified between 1973 and 2021. Between 1991-2000 decade to 2011-2021 decade the number of published articles tended to increase by 68.28 times. The largest number of articles was from South-Central Region (66.16%), followed by Western (15.03%) and Northwest (8.27%). The highest h-index was found for USA journals (102). The highest number of articles was published in Coluna/Columna (15.53%), followed by Cirugía y Cirujanos (10.52%) and Acta Ortopédica Mexicana (8.52%). Instituto Nacional de Rehabilitación published the largest number of articles (17.57%), followed by Centro Médico Nacional de Occidente del IMSS (6.67%) and Centro Médico ABC (5.44%). Conclusions: the number of articles published in the field of spine surgery in Mexico has increased rapidly in the past 15 years. In terms of quality, publications written in English are the most cited. The geographical distribution of research in Mexico is centralized, the largest number of publications was from South-Central Region of Mexico.

Near-miss Thoracic Spine Solitary Plasmacytoma with Neurological Deficit during Pregnancy: A Case Report

@#Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a twomonth period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.

From TMISS to DMISS: The history and prospect of minimally invasive spine surgery in China / 西安交通大学学报(医学版)

In the last twenty years， the progress in minimally invasive spine surgery has been remarkable. An increasing number of spine surgeons have adopted and performed minimally invasive spine surgery， which is beneficial to patients with spinal diseases. Furthermore， the exploration and development of the surgery continues to flourish. In China minimally invasive spine surgery has been leaping from traditional minimally invasive spine surgery （T-MISS） to digital minimally invasive spine surgery （D-MISS）. This paper reviews the development history of minimally invasive spine surgery in China in the last two decades and looks forward to its development prospect in future.

Clinical application and research progress of OLIF / 西安交通大学学报(医学版)

Oblique lumbar interbody fusion （OLIF） is an internationally popular and innovative technique for treating various lumbar diseases. Introduced to China in 2014， it has been widely used to treat lumbar spine diseases. Advances in biomechanical theory and new instruments have broadened the indications for OLIF surgery and reduced its learning curve. The development of standalone OLIF makes OLIF more minimally invasive. The improvement of localized surgical methods based on Chinese anatomical studies makes OLIF more suitable for Chinese patients. The development of L5/S1 OLIF technology has expanded the application range of OLIF. This paper reviews the clinical application and research progress of OLIF.

Progress and future prospects of endoscopic spine surgery / 西安交通大学学报(医学版)

Spinal endoscopic surgery is a minimally invasive technique that has developed rapidly in recent years.As spinal endoscopic techniques continue to develop， their indications are expanding and they are beginning to gradually replace traditional open spine surgery.This article compares the differences between various spinal endoscopic procedures and other open and minimally invasive spine procedures， summarizes the current state of development of the main common techniques of spinal endoscopic surgery， and provides an overview of the advantages， disadvantages， and future developments of this technique.

Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations

ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.

Percutaneous endoscopic lumbar interbody fusion: results over 47 months of follow-up / Artrodese lombar intersomática endoscópica percutânea: resultados depois de 47 meses de acompanhamento

ABSTRACT Introduction This study aims to investigate the clinical-functional results of a new surgical technique, Percutaneous Endoscopic Lumbar Interbody Fusion (PELIF), in patients with a clinical diagnosis of low back or sciatic pain and segmental instability who were submitted to surgery using this technique assisted by the attending physician. Materials and methods Patients completed a consent form and were clinically and radiographically re-assessed by independent evaluators using the visual analog scale (VAS) for pain, the Oswestry Disability Index (ODI), and the SF-36 Quality of Life Score in the pre- and postoperative periods. Their medical records were also reviewed for surgical time, length of hospital stay, need for blood transfusion, return to work, and radiographic fusion evaluation. Results In the group of 19 patients with 33 levels operated, VAS and ODI decreased from 10.0 and 64% to 2.0 and 28%, respectively. The SF-36 showed significantly higher scores in 5 of its 7 domains at the end of the follow-up as compared to the preoperative period scores. Only 1 case of pseudoarthrosis was diagnosed radiographically. Conclusions Percutaneous Endoscopic Lumbar Interbody Fusion (PELIF) has been shown to be a safe and efficient technique for the treatment of patients with segmental instability associated with low back or sciatic pain. Level of Evidence VI; Therapeutic Study; Case Series.

RESUMO Introdução Este estudo tem como objetivo investigar os resultados clínico-funcionais de uma nova técnica cirúrgica, artrodese lombar endoscópica percutânea (PELIF) em pacientes com diagnóstico clínico de dor lombar ou ciática e instabilidade segmentar, submetidos à referida técnica pelo médico responsável. Materiais e métodos Os pacientes preencheram um termo de consentimento livre e esclarecido e foram reavaliados clínica e radiograficamente por avaliadores independentes que usaram a Escala Visual Analógica (EVA) para dor, Índice de Incapacidade de Oswestry (ODI) e o Short Form Health Questionnaire SF-36 nos períodos pré e pós-operatório. Foram também pesquisados nos prontuários médicos tempo de cirurgia, tempo de internação hospitalar, necessidade de transfusão de sangue, retorno ao trabalho e avaliação radiográfica da fusão. Resultados Na amostra final de 19 pacientes com 33 níveis operados, EVA e ODI diminuíram de 10,0% e 64% para 2,0% e 28%, respectivamente. O SF-36 mostrou escores significativamente maiores em 5 de seus 7 domínios no final do acompanhamento, em comparação com o período pré-operatório. Somente 1 caso de pseudoartrose foi diagnosticado por radiografia. Conclusões A artrodese lombar endoscópica percutânea (PELIF) tem se mostrado uma técnica segura e eficiente para o tratamento dos pacientes com instabilidade segmentar associada a lombalgia ou ciatalgia. Nível de Evidência IV; Estudos Terapêuticos; Série de Casos.