Spine
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Neurogenic bladder (NB) is a group of bladder and/or urethral dysfunctions caused by neurological lesions, commonly seen in patients with lumbar spine diseases, manifesting as urinary storage and voiding dysfunction, significantly affecting patients’ quality of life.
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Degenerative changes or trauma to the lumbar spine can lead to narrowing of the dural sac, compressing the sacral nerve roots, cauda equina or blood vessels, causing bladder dysfunction and leading to NB.
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Diagnostic methods for NB include history taking, physical examination and noninvasive and invasive tests, such as urodynamic testing and cystoscopy.
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The treatment goals for NB are to protect upper urinary tract function, restore or partially restore lower urinary tract function, improve urinary control, reduce residual urine volume, prevent urinary tract infections and improve patients’ quality of life.
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Treatment methods include conservative treatment, pharmacological treatment, catheterization, neuromodulation and surgical treatment, which should be sequentially administered based on the patient’s specific condition.
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Foraminal and extraforaminal lumbar disc herniations are common sources of pain and disability. Classic surgical treatments, such as open approach through Witsel technique, often involve resection of the superior articular process to decompress the foraminal space.
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Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive alternative, providing enhanced visualization and precision while minimizing soft tissue damage.
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The extraforaminal approach using UBE offers a more effective solution for extraforaminal herniations, requiring less bone resection, reducing the risk of pars fracture and enhancing visualization.
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This article presents a comprehensive methodology for the extraforaminal approach, supported by an illustrated guide, surgical tips and highlights of UBE’s advantages over traditional techniques.
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Esophageal perforation is a rare but serious complication that can occur post-cervical spine surgery. This case report presents the clinical course, diagnostic challenges and management strategies of a patient who had a late-diagnosis esophageal perforation after anterior cervical spine surgery (ACSS).
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A woman in her 50s underwent ACSS for cervical spondylosis. Three months postoperatively, she experienced persistent right neck and shoulder pain. Despite multiple consultations, an esophageal perforation was only diagnosed 10 years later when a neck mass ruptured, discharging food debris. Surgical management included removing the anterior cervical plate and reconstruction with a sternocleidomastoid muscle flap. Postoperatively, she faced wound complications, and the perforation failed to heal despite multiple debridement and stent placements. Ultimately, complete excision of the diverticulum, repair of the perforation and muscle flap reconstruction led to her recovery, with no recurrence over an 8-year follow-up.
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We reviewed the literature on cases with esophageal perforation occurring more than 10 years after anterior cervical surgery and summarized the treatment experiences.
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This case underscores the diagnostic challenges and delayed presentation of esophageal perforation post-ACSS. Early recognition and multidisciplinary management are essential. In cases of late perforation, hardware removal, diverticulum excision and a muscle flap are critical to achieving successful closure of the esophageal lesion, preventing recurrence and ensuring comprehensive repair. Addressing esophageal diverticula during perforation treatment is crucial to prevent recurrence and ensure thorough repair. This highlights the need for high clinical suspicion and a coordinated surgical approach to improve patient outcomes.
Guangxi Academy of Medical Sciences, Nanning, China
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Guangxi Academy of Medical Sciences, Nanning, China
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Guangxi Academy of Medical Sciences, Nanning, China
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Guangxi Academy of Medical Sciences, Nanning, China
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Purpose
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This study employed meta-analysis to evaluate whether the application of intraoperative wound irrigation (IOWI) with povidone-iodine (PI) in spine surgery effectively reduces the incidence of postoperative surgical site infection (SSI).
Methods
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The present study was conducted strictly following the methodological guidance provided by the Cochrane Handbook. The protocol of this work was registered with PROSPERO. Two researchers independently conducted electronic searches in Medline via PubMed, Embase, Cochrane Library, and Web of Science. The bias risk of each included study was evaluated by two assessors. We performed statistical analysis on the dataset using STATA software.
Results
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Fourteen studies involving a total of 6777 patients were included in the present work. The risk of bias of six included randomized controlled trials (RCTs) was considered as low-to-moderate risk, and the quality scores of the eight included retrospective cohort studies were rated as high quality. The results of this meta-analysis indicated a significant difference in the incidence of postoperative SSI between the two groups (RR = 0.29, 95% CI: (0.18, 0.47)). Moreover, patients who underwent IOWI with PI had lower rates of deep and superficial infections after spine surgery compared with the controlled group (superficial infection: RR = 0.28, 95%CI: (0.14, 0.54); Deep infection: RR = 0.24, 95%CI: (0.10, 0.60)). The sensitivity analysis results indicated good robustness and high evidence strength after data consolidation in the overall rate of postoperative SSI and the incidence of deep/superficial infection.
Conclusions
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IOWI with PI solution during spinal surgery can effectively reduce the incidence of postoperative SSI.
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Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Background
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Over the past two decades, modern spine surgery has become increasingly intellectualized and minimally invasive. However, whether using robots in spine surgery results in more accurate pedicle screw placement remains a topic of debate. This study aimed to evaluate the certainty and quality of the available evidence on the efficacy of robot-assisted pedicle screw placement.
Methods
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We performed an overview of reviews including systematic reviews (SRs) and meta-analyses (MAs) regarding the accuracy of robot-assisted pedicle screw placement. Regarding the SRs/MAs, five electronic databases were searched from inception to 28 April 2023. There were no restrictions on the language or population. The quality and certainty of the evidence were evaluated with PRISMA, AMSTAR-2, ROBIS, Veritas plot, and GRADE tools.
Results
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Fifteen SRs/MAs were analyzed. The findings indicated that the accuracy of pedicle screw placement in the robot-assisted group was not superior to that in the freehand group. All the SRs/MAs were of low or critically low quality. The main reasons for this include missing data, lack of transparency, lack of sensitivity analysis, and measurement of heterogeneity in the included studies, registration of reporting protocols, and deficiencies in the study inclusion methods and selection criteria.
Conclusions
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While there is potential for robot-assisted pedicle screw placement to offer superior accuracy compared to conventional surgery, the current evidence is limited by methodological shortcomings. The quality of the studies analyzed was insufficient to provide a robust basis for developing clinical guidelines. Further high-quality research is necessary to confirm the benefits and establish clearer recommendations.
School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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Purpose
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Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories.
Methods
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For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8.
Results
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Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494–2.89), history of LBP (OR = 2.2–8.91), and sedentary position (OR = 0.55–3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively.
Conclusions
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Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.
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Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
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Purpose
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This study aimed to assess the effects of topical tranexamic acid (tTXA) in spinal surgery to provide reliable clinical evidence for its usefulness.
Methods
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The PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trials databases were comprehensively searched to identify randomized controlled trials and non-randomized controlled trials evaluating the effect of tTXA on blood loss during spine surgery. The observation indexes were intraoperative blood loss, total blood loss, output and duration of postoperative drainage, postoperative hematological variables, length of postoperative hospital stay, blood transfusion rate, and complication rate.
Results
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A total of 21 studies involving 1774 patients were included. Our results showed that the use of tTXA during spinal surgery significantly reduced the total blood loss, postoperative drainage volume, postoperative transfusion rate, duration of postoperative drainage, and postoperative hospital stay, and increased the serum hemoglobin concentration, thereby providing better clinical outcomes for surgical patients. However, tTXA had no effect on intraoperative blood loss and associated complications.
Conclusion
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On the basis of the available evidence, the present results provide strong clinical evidence of the clinical value of tTXA in spinal surgery and provide an important reference for future research and clinical decision-making.
School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Purpose
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In the military, neck pain is second to low back pain among musculoskeletal disorders. However, the prevalence and related factors of neck pain in military personnel have not been systematically investigated, which may lead to the lack of neck pain prevention and the generation of additional medical expenses, posing challenges to medical care. This review aimed to obtain the prevalence and related factors for neck pain in military personnel in an attempt to provide directions for prevention and intervention.
Methods
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We searched PubMed, Embase, and Cochrane databases in December 2021. Two researchers independently screened studies according to eligibility criteria and assessed study quality.
Results
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We screened titles and abstracts of 503 articles, and 17 articles met the inclusion criteria. Sixteen articles received moderate to high-quality evaluations. Neck pain is common in the military, with 1-year prevalence as high as 83% and lifetime prevalence as high as 78%. Old age (OR = 5.0), poor neck mobility (OR = 3.61), shoulder pain (OR = 4.9), low back pain (OR = 2.3), high-G pilots (OR = 1.6), longer flight time (OR = 2.53), type of aircraft (OR = 3.93), and use of helmets and night vision systems (OR = 1.9) may be associated with the prevalence of neck pain.
Conclusion
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Neck pain is highly prevalent in military personnel and exhibits a substantial lifetime prevalence rate. The high prevalence rate of neck pain in the military is related to many individual-related factors and work-related factors. The in-depth assessment and prevention of specific factors is an important direction of future research.
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SUNY Downstate Medical School, New York City, New York, USA
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Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Adolescent idiopathic scoliosis (AIS) is an abnormal coronal curvature of the spine that most commonly presents in adolescence.
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While it may be asymptomatic, AIS can cause pain, cosmetic deformity, and physical and psychological disability with curve progression.
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As adolescents with AIS enter adulthood, condition outcomes vary with some experiencing curve stabilization and others noting further curve progression, chronic pain, osteoporosis/fractures, declines in pulmonary and functional capacity, among others.
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Regular monitoring and individualized management by healthcare professionals are crucial to address the diverse challenges and provide appropriate support for a fulfilling adult life with AIS.
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This review examines the prevalence, risk factors, presenting symptoms, diagnosis, management, and complications of AIS in the adult population, informing targeted interventions by clinicians caring for adult patients with AIS.
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Purpose
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To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP).
Methods
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Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author.
Results
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Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy.
Conclusion
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VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.
