BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation...BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.展开更多
结局测量工具(OMI)是评估患者感受或健康状况的重要工具,但其质量参差不齐。选择健康测量工具的共识标准(COSMIN)为遴选高质量的OMI提供了方法学指导,得到广泛认可。近年来,基于COSMIN开展的OMI系统评价数量激增,然而许多已发表的相关...结局测量工具(OMI)是评估患者感受或健康状况的重要工具,但其质量参差不齐。选择健康测量工具的共识标准(COSMIN)为遴选高质量的OMI提供了方法学指导,得到广泛认可。近年来,基于COSMIN开展的OMI系统评价数量激增,然而许多已发表的相关系统评价常未能充分报告关键信息,严重影响了OMI系统评价的可重复性和可解释性,从而影响其结果的推广应用。鉴于PRISMA 2020未包含报告此类系统评价的所有必要信息,有关学者在前者基础上制订了新的报告规范“PRISMA-COSMIN for OMIs 2024”,以帮助研究人员以清晰、详细和透明的方式撰写和报告OMI系统评价。本文结合实例对该规范进行了介绍和解读,旨在帮助国内学者深入理解并有效应用该指南,提高国内OMI系统评价进行全面地的整体质量。展开更多
基金Supported by AI For Spinal Surgery Planning and Results Assessment Project under the“Priority 2030”Academic Leadership Initiative,No.6.18-01/240724-15.
文摘BACKGROUND Pedicle screw fixation is frequently used to treat unstable thoracolumbar injuries;however,the rate of instrumentation failure remains considerable.The primary contributing factor leading to instrumentation failure is poor bone quality.On the other hand,some evidence suggests that surgical tactics can influence long-term instrumentation stability.AIM To assess factors that influence the stability of spinal instrumentation in patients with thoracolumbar injuries.METHODS This study is a non-randomized single center ambispective evaluation of 204 consecutive patients(117 men;87 women)with unstable thoracolumbar injuries.All patients underwent either stand-alone or combined with anterior column reconstruction instrumentation.In cases with spinal cord and nerve root injuries,either posterior or anterior decompression were performed.Patients with pedicle screw loosening were identified via computed tomography imaging.Out of those,cases with clinically significant instrumentation failure were registered.RESULTS The rate of pedicle screw loosening detected by computed tomography was inversely correlated with bone radiodensity figures and an increased association with the number of instrumented levels,residual kyphotic deformity,laminectomy,and lumbosacral fixation.Intermediate screws and anterior reconstruction were associated with a clinically relevant decreased risk of pedicle screw loosening development.Either complete or partial posterior fusion within instrumented levels was capable of decreasing instrumentation failure risk,while extensive decompression with laminectomy and at least one-level total facetectomy were associated with an increased risk of instrumentation failure.Anterior decompression does not have a negative impact on instrumentation stability.CONCLUSION Intermediate screws,anterior reconstruction and posterior tension band preservation are associated with decreased rates of instrumentation instability development.Posterior fusion is beneficial in terms of instrumentation failure prevention.
文摘结局测量工具(OMI)是评估患者感受或健康状况的重要工具,但其质量参差不齐。选择健康测量工具的共识标准(COSMIN)为遴选高质量的OMI提供了方法学指导,得到广泛认可。近年来,基于COSMIN开展的OMI系统评价数量激增,然而许多已发表的相关系统评价常未能充分报告关键信息,严重影响了OMI系统评价的可重复性和可解释性,从而影响其结果的推广应用。鉴于PRISMA 2020未包含报告此类系统评价的所有必要信息,有关学者在前者基础上制订了新的报告规范“PRISMA-COSMIN for OMIs 2024”,以帮助研究人员以清晰、详细和透明的方式撰写和报告OMI系统评价。本文结合实例对该规范进行了介绍和解读,旨在帮助国内学者深入理解并有效应用该指南,提高国内OMI系统评价进行全面地的整体质量。
