A correlation study of preoperative lumbar paraspinal muscle quality and L5-S1 lumbar foraminal stenosis degeneration after L4-5 TLIF.

STUDY DESIGN: This was a retrospective study. OBJECTIVES: Adjacent segment degeneration (ASD) is a major complication associated with spinal fusion. The lumbar paraspinal muscle is an essential factor influencing the occurrence of ASD. This study aimed to investigate the effect of preoperative lumbar paraspinal muscle quality on L5-S1 adjacent lumbar foraminal stenosis degeneration (ASLFSD) after L4-5 transforaminal lumbar interbody fusion (TLIF). METHODS: A total of 113 patients diagnosed with lumbar spinal stenosis at L4-5 were treated with TLIF. Lumbar paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The measurements included the total cross-sectional area of psoas (PS-tCSA), of erector spinae (ES-tCSA), and of multifidus (MF-tCSA); and fatty infiltration of psoas (PS-FI), of erector spinae (ES-FI), and of multifidus (MF-FI). Foraminal measurements, including posterior disc height (PDH), disc-to-facet distance (D-F), foraminal height (FH), and foraminal area (FA), were obtained bilaterally using a computed tomography system. The association between lumbar paraspinal muscle quality and changes in foraminal measurements was also studied. RESULTS: We observed that the FH and FA significantly reduced at 1 year postoperatively at the mean follow-up period of 41.56 ± 8.38 months (range, 43-50 months), and PDH, D-F, FH, and FA all significantly reduced at final follow-up. These changes in foraminal measurements were significantly and negatively correlated with PS-FI, ES-FI, and MF-FI. CONCLUSION: During the clinical follow-up, we found that patients with a higher degree of paraspinal muscle FI were more likely to develop L5-S1 ASLFSD after L4-5 TLIF.

Development of a Dynamic Nomogram for Predicting the Probability of Satisfactory Recovery after 6 Months for Cervical Traumatic Spinal Cord Injury.

OBJECTIVE: Cervical traumatic spinal cord injury (CTSCI) is a seriously disabling disease that severely affects the physical and mental health of patients and imposes a huge economic burden on patients and their families. Accurate identification of the prognosis of CTSCI patients helps clinicians to design individualized treatment plans for patients. For this purpose, a dynamic nomogram was developed to predict the recovery of CTSCI patients after 6 months. METHODS: We retrospectively included 475 patients with CTSCI in our institution between March 2013 and January 2022. The outcome variable of the current study was a satisfactory recovery of patients with CTSCI at 6 months. Univariate analyses and univariate logistic regression analyses were used to assess the factors affecting the prognosis of patients with CTSCI. Subsequently, variables (P < 0.05) were included in the multivariate logistic regression analysis to evaluate these factors further. Eventually, a nomogram model was constructed according to these independent risk factors. The concordance index (C-index) and the calibration curve were utilized to assess the model's predictive ability. The discriminating capacity of the prediction model was measured by the receiver operating characteristic (ROC) area under the curve (AUC). One hundred nine patients were randomly selected from 475 patients to serve as the center's internal validation test cohort. RESULTS: The multivariate logistic regression model further screened out six independent factors that impact the recovery of patients with CTSCI. Including admission to the American Spinal Injury Association Impairment Scale (AIS) grade, the length of high signal in the spinal cord, maximum spinal cord compression (MSCC), spinal segment fractured, admission time, and hormonal therapy within 8 h after injury. A nomogram prediction model was developed based on the six independent factors above. In the training cohort, the AUC of the nomogram that included these predictors was 0.879, while in the test cohort, it was 0.824. The nomogram C-index incorporating these predictors was 0.872 in the training cohort and 0.813 in the test cohort, while the calibration curves for both cohorts also indicated good consistency. Furthermore, this nomogram was converted into a Web-based calculator, which provided individual probabilities of recovery to be generated for individuals with CTSCI after 6 months and displayed in a graphical format. CONCLUSION: The nomogram, including ASIA grade, the length of high signal in the spinal cord, MSCC, spinal segment fractured, admission time, and hormonal therapy within 8 h after injury, is a promising model to predict the probability of content recovery in patients with CTSCI. This nomogram assists clinicians in stratifying patients with CTSCI, enhancing evidence-based decision-making, and individualizing the most appropriate treatment.

Construction and verification of a nomogram predicting the risk of preoperative deep vein thrombosis progression after elective spine surgery.

OBJECTIVE: This study aimed to construct and verify a useful nomogram that predicts the risk of preoperative deep vein thrombosis (DVT) progression after elective spine surgery. METHODS: Data of patients were collected from 366 patients with preoperative DVT who underwent elective spine surgery at our hospital between July 2017 and May 2022. The least absolute shrinkage and selection operator method combined with multivariable logistic regression analysis were applied to select features for the preoperative DVT progression risk model. The model's capability was evaluated using the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. The decision curve and bootstrapping were used to analyze the clinical value of the nomogram. RESULT: A total of 366 DVT patients were enrolled in this study. Preoperative DVT progression after elective spine surgery was 24.04% (88 cases). Among these patients, 86 patients had thrombosis extending into a proximal vein or appearing in a different branch of the vein, either ipsilateral or contralateral, and two had a symptomatic pulmonary embolism. D-dimer, lower extremity varicosities, hyperlipidemia, lower limb paralysis, and operation time were among the predictors in the nomogram. Furthermore, the C-index of the prediction nomogram was 0.805 (95％ CI: 0.754-0.856), with an interval bootstrapping validation of 0.786 and an area under the ROC curve value of 0.800. According to the calibration curves and decision curve analysis, the nomogram could accurately predict the probability of preoperative DVT progression after elective spine surgery. CONCLUSION: The advantages of the nomogram included the unique discrimination capability, clinical utility, and predictive accuracy, which was beneficial for clinicians to distinguish high-risk groups of DVT progression after elective spine surgery and formulate relevant prevention measures.

Association between visceral fat and osteoporotic vertebral compression refractures.

OBJECTIVES: The aims of this study were to examine the association between osteoporotic vertebral compression refractures (OVCRFs) and visceral fat and to identify other risk factors for OVCRFs. METHODS: We included 311 patients with OVCRs who underwent percutaneous kyphoplasties (PKPs) at our hospital between May 2016 and December 2017. The visceral fat area (VFA) at the plane of the third lumbar vertebra was assessed using preoperative computed tomography (CT) scans. The patients were divided into two groups: OVCRFs and non-OVCRFs. The perioperative variables were compared between the two groups. Univariate and multivariate analyses were used to determine independent risk factors for OVCRFs. Correlation analysis was performed to investigate the association between bone mineral density (BMD) and visceral fat. RESULTS: During the 1-y follow-up, 311 patients were included in the analysis. OVCRFs occurred in 69 patients (22.19%). High VFA was present in 163 patients (52.41%), including 52 OVCRFs and 111 non-OVCRF patients. In all the patients, high VFA (P < 0.001), older age (P = 0.022), female sex (P = 0.020), lower body mass index (BMI; P = 0.028), lower albumin levels (P < 0.001), lower hemoglobin levels (P = 0.045), lower BMD (P < 0.001), lower L3 skeletal muscle index (L3 SMI; P < 0.001), lower subcutaneous fat area (SFA; P = 0.003), higher VFA/SFA ratio (V/S ratio; P < 0.001), higher visceral fat area/muscle area (V/M) ratio (P < 0.001), and higher visceral fat index (VFI; P = 0.001) were associated with OVCRFs. Multivariate analysis revealed that patients of female sex (P < 0.001) and high VFA (P < 0.001) were independent risk predictors for OVCRFs. Higher BMD (P = 0.014) was a protective predictor of OVCRFs. Among all the overweight and obese patients (BMI ≥24 kg/m2), high VFA(P = 0.002), female sex (P = 0.044), lower albumin levels (P = 0.003), lower hemoglobin levels (P = 0.010), lower vitamin D levels (P = 0.037), lower BMD (P < 0.001), lower L3 SMI (P = 0.015), higher V/S ratios (P = 0.003), higher V/M ratios (P < 0.001), and higher VFIs (P = 0.005) were associated with OVCRFs. Multivariate analysis revealed that higher VFAs (P = 0.004) remained an independent predictor of OVCRFs in overweight and obese patients. Higher BMD (P = 0.011) was a protective predictor of OVCRFs. In the correlation analysis, a negative correlation was observed between the BMD and both the visceral fat area and V/M ratio. CONCLUSIONS: High VFA is a highly independent risk factor for OVCRFs. Other factors affecting OVCRFs include belonging to the female sex and low BMD. In overweight and obese patients, high VFA and low BMD are independent risk factors for OVCRFs.