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Interventional spine procedures represent a well-known alternative to conservative management and highly debated surgical procedures in the management and relief of spinal pain. Basic Neuro-Interventional Spine Procedures allow minimally invasive treatment for both degenerative and tumor conditions, such as spine metastasis, osteoid osteoma, vertebral hemangioma, aneurysmal bone cyst, and osteoblastoma. Diagnostic imaging, both MRI—T1w, T2w, and STIR sequences—and CT, is of main importance for understanding underlying condition and planning the best therapeutic approach. Epidural steroid injection in the care of radiculopathy, oxygen-ozone therapy for the treatment of herniated disk, and percutaneous vertebroplasty in the management of vertebral body compression fracture are only few of the most used and widely accepted techniques in the setting of neuro-interventional spine interventions. In this chapter, we review the basic of anatomy and pathophysiology of spinal pain and then the current practice on neuro-interventional spinal interventions, including indications, contraindications, and complication and discuss the most used techniques in the clinical practice.

Adult spinal deformity (ASD) correction has changed considerably since the initial description of a Smith-Petersen osteotomy (SPO), including pedicle subtraction osteotomies (PSO), and more minimally invasive techniques. Here, we introduce and describe the intradiscal osteotomy (IDO), a novel variation of Schwab type 3 and 4 osteotomies allowing pedicle and vertebral body preservation, and its advantages and disadvantages. After pedicle screw placement, the posterior elements (except pedicles) are removed from the appropriate vertebrae, including the superior/inferior articulating processes, laminae, and spinous processes. An osteotome is used to remove the posterior aspect of the superior and inferior endplate, followed by the entire disc, creating more working room for eventual cage insertion. After the careful release of the annulus, an intradiscal distractor is used to distract the endplates and allow interbody cage insertion as anteriorly as possible. Pedicle and vertebral body preservation allow increased fixation and endplate cage support, which lengthens the anterior column and acts as a fulcrum when compressing posteriorly to restore lordosis. By allowing for anterior and posterior column release, the IDO technique provides a feasible, all-posterior approach for the correction of fixed or flexible kyphoscoliotic curves. This technical report introduces and describes the IDO as an alternative method for thoracic and/or lumbar ASD correction. More studies are required to fully elucidate its outcome vs. complication profile compared to other deformity correction techniques.

Spinal disc arthroplasty (SDA) has been a rising alternative to fusion for the treatment of degenerative disc disease (DDD). This review aims to provide an overview of the timeline, approvals, and limitations of SDA through analysis of U.S. Food and Drug Administration (FDA)-approved trials. Clinical studies have shown more successful outcomes when comparing cervical disc arthroplasty (CDA) with anterior cervical decompression and fusion, with the key benefits of decreased risk of nerve root compression and adjacent disc disease. CDA is currently approved by the FDA for one- and two-level disc pathologies. However, there are no approved trials for three-level or more cervical pathologies. The FDA approved its usage for the treatment of one-level lumbar disc pathologies in 2007 and recently approved two-level disc pathologies in 2020. Thoracic SDA has not been approved by the FDA, and there are no currently occurring clinical trials. While multilevel SDA has been approved in the cervical and lumbar spine, it has not been approved in more than two adjacent vertebral levels. Based on these clinical studies, future research is needed to compare the success of SDA for three-level or more disc pathologies. There have been recent publications showing promising results, though no FDA-approved clinical trials exist. Furthermore, a hybrid construct has been a recent surgical method to treat multilevel DDD. In this approach, arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels to treat two- and three-level disc disease. Hybrid arthroplasty compared with SDA is currently being studied in clinical trials. As such, long-term research with FDA-approved clinical trials is needed to understand the benefits and limitations of different approaches in the treatment of DDD.

Understanding genetic indicators is a fundamental aspect to characterizing the pathophysiology of chronic diseases such as intervertebral disc degeneration (IVDD). In our previous spinal genetics review, we characterized some more common genetic influencers in the context of IVDD. In this second part of our two-part comprehensive spinal genetics review, we characterize the more infrequently studied genes that have pathophysiological relevance. In doing so, we aim to expand upon the current gene-library for IVDD. The genes of interest include: asporin, cartilage intermediate layer protein, insulin-like growth factor 1 receptor, matrix metallopeptidase 9, and thrombospondin 2. Findings show that these genetic indicators have trends and polymorphisms that may have causal associations with the manifestation of IVDD. However, there is a narrow selection of studies that use genetic indicators to describe correlations to the severity and longevity of the pathology. Nevertheless, with the continued identification of risk genes involved with IVDD, the possibilities for refined models of gene therapies can be established for future treatment trials.

Patient-reported outcome measures (PROMs) are being used increasingly in total knee arthroplasty (TKA). We conducted a systematic review aimed at identifying psychometrically sound PROMs by appraising their measurement properties. Studies concerning the development and/or evaluation of the measurement properties of PROMs used in a TKA population were systematically retrieved via PubMed, Web of Science, Embase, and Scopus. Ratings for methodological quality and measurement properties were conducted according to updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Of the 155 articles on 34 instruments included, nine PROMs met the minimum requirements for psychometric validation and can be recommended to use as measures of TKA outcome: Oxford Knee Score (OKS); OKS–Activity and Participation Questionnaire (OKS-APQ); 12-item short form Knee Injury and Osteoarthritis Outcome (KOOS-12); KOOS Physical function Short form (KOOS-PS); Western Ontario and McMaster Universities Arthritis Index-Total Knee Replacement function short form (WOMAC-TKR); Lower Extremity Functional Scale (LEFS); Forgotten Joint Score (FJS); Patient’s Knee Implant Performance (PKIP); and University of California Los Angeles (UCLA) activity score. The pain and function subscales in WOMAC, as well as the pain, function, and quality of life subscales in KOOS, were validated psychometrically as standalone subscales instead of as whole instruments. However, none of the included PROMs have been validated for all measurement properties. Thus, further studies are still warranted to evaluate those PROMs. Use of the other 25 scales and subscales should be tempered until further studies validate their measurement properties. Cite this article: Bone Joint Res 2021;10(3):203–217.

Degenerative disease of the lumbar spine commonly develops with age and can cause debilitating pain or neurologic deficits. When minimally invasive treatments and pain management interventions fail to provide relief, the traditional treatment has consisted of decompression surgery followed by the possible need for lumbar fusion. A mechanical implant device, known as a Total Posterior Spine (TOPS) System, has been introduced as a potential dynamic alternative to fusion surgery following decompression. The device is a dynamic posterior arthroplasty via pedicle screw insertion that maintains mobility, flexibility, and range of motion by providing multiaxial, three-column stabilization. While currently approved for use in Europe, the device is undergoing clinical trials in the United States to determine efficacy and potential complications. This paper provides a comprehensive narrative review of this technique's mechanism, early clinical outcomes, and considerations for patient selection. A review of the literature identified both positive results and adverse effects. While TOPS' use shows excellent potential, additional prospective trials are needed to determine this system's long-term complications.

Aims Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. Methods Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD). Results In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD –3.11; 95% confidence interval (CI) –4.98 to –1.23), the ASES score (WMD –6.50; 95% CI –10.80 to –2.19), FF (WMD –6.3°; 95% CI –9.9° to –2.6°), and abduction (WMD –9.4°; 95% CI –17.8° to –1.0°), but not for ER (WMD –0.6°; 95% CI –3.7° to 2.5°). Conclusion The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: Bone Joint J 2020;102-B(11):1438–1445.

Baastrup’s disease, known colloquially as “kissing spine disease”, is a degenerative process, most commonly occurring in the lumbar spine, in which adjacent spinous processes closely approximate or even touch (Filippiadis et al. in Insights Imaging. https://doi.org/10.1007/s13244-014-0376-7 , 2015). We present the case of an 86-year-old woman presenting with left low back, hip, and anterolateral thigh pain. Magnetic resonance imaging noted an approximation of the L2/3 spinous processes, with degeneration of the vertebral processes. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Informed consent for publication was obtained from the participant.

Introduction: Degenerative changes of the spine are common in obese cancer patients and are frequently confusing duringthe interpretation of bone scan of those patients. Aim: To investigate the influence of body weight on the frequency of degenerative spine disease in a cohort of cancer patients using technetium-99m methylene diphosphonate (Tc-99m MDP) bone scan. Methods: A prospective study of 100 cancer patients with or without back pain referred for bone scanning. Their mean age was 58.5±10.2 years and 46% were males. Tc-99m MDP bone scan was done followed by spinal magneticresonance imaging (MRI) examination. Patients were divided into two groups according to the body mass index (BMI) intogroup 1 including 60 overweight and obese (BMI ≥ 25) patients and group 2 including 40 non-obese (BMI < 25) patientsserving as a control group. Any spot of enhanced radiotracer uptake at any part of the vertebrae was considered abnormaland correlated with MRI findings. Results: A total of 168 vertebral lesions were detected by bone scan (150 in group 1 and 18 in group 2) with significant difference between both groups and between different grades of obesity in group 1. All lesions were accurately localized and proved to be of degenerative nature by MRI. The percentage of patients with back pain in group 1 was significantly higher than in group 2 (65% vs. 35%, respectively). Conclusion: Bone scintigraphy is a good technique to detect degenerative spinal disease in obese cancer patients.

Wenzhi Sun, Shibao Lu, Chao Kong, Zhongen Li, Peng Wang, Sitao Zhang Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People’s Republic of ChinaCorrespondence: Shibao Lu Email xuanwuspine@sina.comBackground and Aim: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery.Methods: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥ 3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11-variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders.Results: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P< 0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased.Conclusion: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.Keywords: frailty, degenerative spine disease, spinal surgery, elderly, clinical evaluation, complications, risk stratification

The paper presents a review of the current literature devoted to estimation of outcomes of surgical treatment for degenerative changes in the spine using scales, tests and questionnaires. The literature search in domestic and foreign bibliographic databases has been carried out, and the use of scales, tests and questionnaires in spinal surgery was analyzed. The review presents requirements for scales, tests and questionnaires, examines the evaluation of clinical and patient-reported outcomes, and describes the advantages of multifactorial outcome evaluation. The multifactorial evaluation of outcomes is illustrated by the example of degenerative changes in the cervical spine, and includes a clinical case of surgical treatment for cervical myelopathy. The limitations of scales, tests and questionnaires are also discussed.

Постуральные нарушения являются одной из сложнейших проблем болезни Паркинсона, так как приводят к развитию стойких спинальных деформаций и значительно снижают качество жизни пациентов. С данным заболеванием часто ассоциированы дегенеративные поражения пояснично-крестцового отдела позвоночника, что обусловлено изменением сагиттального баланса при постуральных нарушениях, формированием грудопоясничной кифотической деформации, потерей поясничного лордоза и ригидностью паравертебральных мышц. Наиболее частым постуральным нарушением в этом случае выступает камптокормия, что продемонстрировано как в научных публикациях, так и в процессе собственных клинических наблюдений пациентов с болезнью Паркинсона III стадии по Хен–Яру. Авторы отмечают, что в связи с высокой частотой возникновения вторичных осложнений и ревизионных вмешательств в отсроченном периоде планирование лечения и послеоперационное ведение пациента с болезнью Паркинсона должно осуществляться вместе с неврологом – специалистом по экстрапирамидным заболеваниям. Кроме того, послеоперационный период должен включать специальные реабилитационные программы., Postural disorders are one of the most difficult issues in Parkinson’s disease, since they lead to persistent spinal deformities and can significantly reduce patients’ quality of life. Degenerative disorders of the lumbosacral spine are often associated with this disease, resulting from violation of sagittal balance in postural disorders, development of thoracolumbar kyphotic deformity, loss of lumbar lordosis and paravertebral muscles stiffness. The most common postural disorder in these patients is camptocormia, which is established both in the available literature data and in our own clinical observations in patients with stage III Parkinson’s disease according to the Hoehn–Yahr scale. Authors note, that because of high incidence of secondary complications and revision interventions in the late postoperative period makes it necessary to thoroughly assess the patients’ condition and operative risks to predict the effectiveness of treatment in order to avoid unreasonable surgical intervention planning and postoperative management of patients with Parkinson’s disease should be carried out together with a neurologist, qualified in the field of extrapyramidal disorders, in order to form a clear program of pharmacotherapy and, if necessary, its timely correction and special rehabilitation programs.

Purpose: Recent data suggest great variability in costs for surgical hospitalization for spinal surgery. However, the magnitude of expenditures attributable to complications is unknown. The purpose of this study is to describe cost of care associated with surgical and medical complications after cervical spine surgery. Materials and Methods: A retrospective cohort study utilizing the National Inpatient Sample years 2002–2014 was conducted. A weighted sample of 901,508 adults undergoing elective cervical fusion for degenerative indications was extracted using diagnostic and procedure codes. Twelve categories of major complications were identified, and patient/hospital variables were evaluated as predictors of the overall reimbursed cost using multivariate regression. Mean differences (B) and 95% confidence intervals were reported. Results: The mean age was 52.2 ± 11.4 years, with 5.2% of patients experiencing a complication. Mean overall increase in inflation-adjusted cost associated with complication was $16,435 ± 10,358, varying significantly by type of complication, surgical approach, and number of levels fused. The most common complications and their attributed costs were dysphagia (1.6%, B = $2624 [2476–2771], P < 0.001), pulmonary complications (1.0%, B = $9334 [9110–9558], P < 0.001), and device-related complications (0.9%, B = $3125 [2927–3324], P < 0.001). The costliest complications were infection (0.1%, B = $25359 [24723–25994], P < 0.001), thromboembolism (0.1%, B = $17480 [16808–18153], P < 0.001), and neurological complications (0.2%, B = $10098 [9629–10567], P < 0.001). Conclusions: Although complications are rare after elective cervical fusion, they are associated with dramatically increase costs of care as high as $25,359 in the setting of postoperative infection. Improved understanding of the economic magnitude of complications may help guide efforts in reducing health care spending and improving perioperative care.

Ramathibodi Medical Journal, 41, 3, 013-020

Background Spondylosis leads to an overestimation of bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) but not with quantitative computed tomography (QCT). The correlation between degenerative changes of the spine and QCT-BMD was therefore investigated for the first time. Methods One hundred thirty-four patients (66 female and 68 male) with a mean age of 49.0 ± 14.6 years (range: 19–88 years) who received a CT scan and QCT-BMD measurements of spine and hip were evaluated retrospectively. The occurrence and severity of spondylosis, osteochondrosis, and spondylarthrosis and the height of the vertebral bodies were assessed. Results A negative correlation was found between spinal BMD and number of spondylophytes (ρ = −0.35; p