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Study Design Retrospective cohort study. Objectives This study aimed to examine whether the use of intravenous TXA in elective spine surgery is associated with reduced perioperative massive hemorrhage requiring transfusion. Methods We extracted all patients who underwent decompression with or without fusion surgery for the cervical, thoracic, and lumbar spine between April 2012 and March 2019. The primary outcome was the occurrence of massive hemorrhage requiring transfusion, defined as at least 560 mL of blood transfusion within 2 days of spine surgery or the requirement of additional blood transfusion from 3-7 days postoperatively. Secondary outcomes were the occurrence of thrombotic complications (pulmonary embolism, acute coronary syndrome, and stroke) and postoperative hematoma requiring additional surgery. Results We identified 83,821 eligible patients, with 9747 (12%) patients in the TXA group. Overall, massive hemorrhage requiring transfusion occurred in 781 (.9%) patients. Propensity score matching yielded 8394 pairs. In the matched cohort, the TXA group had a lower proportion of massive hemorrhage requiring transfusion than the control group (.7% vs 1.1%; P = .002). There was no significant difference in the occurrence of thrombotic complications and postoperative hematoma requiring additional surgery between both groups. The multivariable regression analysis also showed that the use of TXA was associated with significantly lower proportions of massive hemorrhage requiring transfusion (odds ratio, .62; 95% confidence interval, .43-.90; P = .012). Conclusions In this analysis using real-world data, TXA use in elective spinal surgery was associated with reduced perioperative massive hemorrhage requiring transfusion without increasing thrombotic complications. Level of evidence Prognostic Level Ⅲ

This study aimed to determine the association of preoperative malnutrition with an increased risk of cervical kyphosis after laminoplasty in geriatric patients with cervical spondylotic myelopathy (CSM).Geriatric patients who underwent cervical laminoplasty were included. Malnutrition was defined as a geriatric nutritional risk index 98 before surgery. The C2-7 angle and the global alignment parameters were analyzed on standing radiographs. The postoperative kyphosis was defined as a C2-7 angle 0° during a 2-year follow-up.Ninety patients without preoperative kyphotic alignment were enrolled (mean age, 73.5 years old; 41.1% female). Twenty-one patients (23.3%) had malnutrition status (74.2 years old). Preoperatively, the global alignment parameters were comparable between the malnutrition and normal nutrition groups (SVA, 43.3 mm vs. 42.4 mm; T1S, 29.7° vs. 28.4°; TPA, 21.4° vs. 17.8°), with no significant difference in the C2-7 angle (15.1° vs. 15.2°). At 2 years postoperatively, the malnutrition group showed a significantly lower C2-7 angle than the normal nutrition group (9.3° vs. 15.8°, P = 0.03). Postoperative kyphosis was more prevalent in the malnutrition group (33.3% vs. 7.2%, P = 0.005). The preoperative nutritional status and C2-7 angle were independent predictors of postoperative kyphosis. The predictive C2-7 angles differed by preoperative nutritional status (malnutrition group, 11°; normal nutrition group, 7°).Among geriatric CSM patients, preoperative malnutrition was closely associated with the increased occurrence of cervical kyphosis after laminoplasty. Our results underscore the importance of preoperative nutritional assessment and management in geriatric populations undergoing cervical spine surgery, as malnutrition is a perioperative modifiable risk factor.

Background: To investigate the prevalence and risk factors for vertebral fractures in patients with rheumatoid arthritis (RA) during an era of tight management.Methods: We retrospectively reviewed 426 RA patients who had visited our outpatient RA clinic between July 2017 and June 2020. Among them, we included 107 patients (19 males and 88 females) who had undergone lateral X-ray of the thoracolumbar spine and dual-energy X-ray absorption spectroscopy for the assessment of osteoporosis. We assessed the disease activity score for 28 joints (DAS28), the history of medication for RA and osteoporosis, the number and location of vertebral fractures, and the bone mineral density (BMD). Two board-certified specialists determined osteoporotic vertebral fractures on a lateral X-ray of the thoracolumbar spine.Results: The mean age, average disease duration, and average DAS28 of the analyzed patients were 67.9 years, 14.9 years, and 2.8, respectively. Vertebral fractures were found in 33 patients (30.8%). In this population, 84.8% of patients with vertebral fractures and 59.5% of those without vertebral fractures were treated for osteoporosis with active vitamin D3, bisphosphonate, and/or denosumab. RA patients with vertebral fractures had significantly higher DAS28 values, a higher rate of patients with a history of glucocorticoid use, and lower BMD in comparison to those than without vertebral fractures (p = 0.009, p = 0.004, and p = 0.01, respectively). Logistic regression analysis showed DAS28 (p = 0.038) and BMD (p = 0.004) were independent factors associated with the presence of vertebral fractures. The ordered logistic regression analysis also showed DAS28 (p = 0.043) and BMD (p = 0.024) were independent factors that explained the number of vertebral fractures.Conclusions: Vertebral fractures were frequently observed in RA patients, even when patients were treated the recommended anti-osteoporotic agents. A high disease activity score and low BMD were associated with the presence and number of vertebral fractures in patients with RA.

Purpose To compare in-hospital mortality of three procedures in the treatment of elderly patients with isolated C2 odontoid fracture: halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF). Methods We extracted data for elderly patients who were admitted with C2 odontoid fracture and treated with at least one of the three procedures (halo-vest immobilization, ASF, or PSF) during hospitalization. We conducted a generalized propensity score-based matching weight analysis to compare in-hospital mortality among the three procedures. We further investigated independent risk factors for in-hospital death. Results The study involved 891 patients (halo-vest, n = 463; ASF, n = 74; and PSF, n = 354) with a mean age of 78 years. In-hospital death occurred in 45 (5.1%) patients. Treatment type was not significantly associated with in-hospital mortality. Male sex (odds ratio, 2.98; 95% confidence interval, 1.32–6.73; p = 0.009) and a Charlson comorbidity index of ≥ 3 (odds ratio, 9.18; 95% confidence interval, 3.25–25.92; p

Introduction Primary epidural extra-osseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is a rare entity included in the Ewing sarcoma family of tumors (ESFTs) that is associated with an unfavorable prognosis. Methods We described the case of a patient with primary epidural extra-osseous ES/pPNET of the cervical spine, and reviewed the relevant literature for reports on this rare malignant tumor. Our research yielded 24 articles describing 40 patients. We analyzed these reports to identify factors associated with long-term survival. Results A 30-year-old woman presented with pain and numbness in the right scapula and right upper limb. Cervical MRI showed an epidural mass extending into the right C6-7 foramina. We performed gross total resection of the mass; the histological diagnosis was ES/pPNET. We also performed adjuvant chemoradiotherapy after the operation. No recurrence has been observed for 10 years. Based on the review of the literature, we conducted a Kaplan-Meier analysis of 36 patients who underwent surgery. The analysis showed that the median survival time in patients treated with adjuvant chemotherapy was significantly longer than that in patients treated without adjuvant chemotherapy (25 months vs. 18 months, p = 0.002, log-rank test), whereas neither the mode of resection nor the performance of adjuvant radiotherapy significantly influenced survival. Conclusions Long-term survival (>10 years) was obtained by gross total resection and adjuvant chemoradiotherapy. Adjuvant chemotherapy was associated with a long median survival time in a patient with epidural extra-osseous ES/pPNET of the cervical spine.

Study Design: Case series study. Objective: We aimed to clarify the prevalence of rotator cuff tear (RCT), and the association between RCT and the severity and prognosis in patients with proximal type cervical spondylotic amyotrophy (CSA). Methods: We retrospectively analyzed 35 proximal type CSA patients who were treated conservatively. The following data was collected: age, rotator cuff status on MRI, manual muscle test (MMT) score of shoulder abductor and biceps brachii muscles both at the first visit and final follow-up. We investigated the prevalence of RCT and the association between the rotator cuff status, and the severity and recovery of upper extremity weakness in patients with proximal type CSA. Results: Of the 35 patients, 21 had an RCT on MRI, indicating that the prevalence of RCT in patients with proximal type CSA was 60%. An age-adjusted analysis showed that the presence of RCT was significantly associated with the MMT score of the shoulder abductor muscles both at the first visit and at the final follow-up. The presence of RCT was significantly associated with the recovery of the shoulder abductor muscles. The size of the RCT was negatively correlated with the MMT score of the shoulder abductor muscles at the final follow-up. The size of the RCT was independently correlated with the change of the MMT score of the shoulder abductor muscles. Conclusion: RCT was detected in >50% in patients with proximal type CSA, and the presence and severity of RCT can be used as prognostic factors for proximal type CSA patients who are treated conservatively.