Spring time means the beginning of trauma season. As a surgeon that takes a lot of call at a level one trauma center just outside of New York City, I see more motor vehicle accidents and recreational accidents. I figured this would be a good time to brush up on the latest in Spine trauma research. I reviewed articles on trauma in The Spine Journal, Spine, Clinical Spine Surgery and Global Spine Surgery. Unfortunately, there wasn’t much on trauma this month, but I still found some high-quality research to share below.
Lordosis and Adjacent Segment Disease
Adjacent segment disease is a problem that all spine surgeons deal with. In my experience it usually presents years after surgery. Compensatory changes in motion at the adjacent level of a fusion cause these disks/facet joints to wear out sooner rather than later. Phillip Louie’s research group from Seattle tried to tease out factors that could be identified early to implicate eventual worsening adjacent segment breakdown(1). In a study of 84 patients with lateral lumbar interbody fusions at L3-L4 and L4-L5 they found that increased lordosis at an operative segment was associated with early changes in alignment at adjacent levels within 6 months of surgery. To me, this speaks to the fact that surgeons need to be aware that non-physiologic lordosis at an operative level can lead to problems down the road at adjacent levels. I liked this article given how clinically relevant this data is for surgeons.
Proper Endoscopic Decompression Techniques
Endoscopic spine surgery continues to be a popular new topic of discussion among surgeons at all major spine conferences. I, myself just spent several slides on this surgical technique for a “What’s new in Spine Surgery” discussion at my home institution of Northwell. One technique used is a transforaminal endoscopic decompression where oftentimes a portion of a pedicle is taken down. This is important for safely entering a disc space especially at collapsed levels with smaller interpedicular distances. A cadaveric study by Farshad et al. attempted to determine the biomechanical impact of taking out 10%, 25%, 50% of a pedicle using an endoscopic technique(2). They found that once cortical bone is removed there is a substantial loss of resistance to pedicle fracture. These results are extremely relevant for any surgeon trying to utilize new endoscopic techniques. Over resection of a pedicle can lead to dangerous results of a pedicle fracture. New surgeons should be cognizant of this as they adopt this powerful new surgical technique.
New Grading System for Predicting Failure of a Decompression Surgery
Degenerative lumbar spinal stenosis is the most common clinical entity that I operate on. It is also the topic I speak about the most in the office. For the minority of patients that I offer surgery, I am often struck at how I may feel someone might benefit from a fusion although they don’t have traditional motion on a flexion/extension radiograph. Dimitriou et al attempted to quantify these factors that might lead to failure of a decompression alone procedure(3). They found that a grading system for disc degeneration, facet effusions, low back pain was able to predict failure of a decompression alone procedure.
I’ll be on the lookout for spine trauma articles next month. For now, I hope this summary of recent literature provides an overview of interesting spine topics. I’ll be attending the Lumbar Spine Research Society next month in Chicago and will provide highlights from the conference. I always enjoy LSRS, it is small and the discussions are great. Happy Spring!
1. Verst L, Drolet CE, Shen J, Leveque J-CA, Nemani VM, Varley ES, et al. What is the fate of the adjacent segmental angles 6 months after single-level L3–4 or L4–5 lateral lumbar interbody fusion? The Spine Journal.
2. Calek A-K, Tsagkaris C, Fasser M-R, Widmer J, Hagel V, Farshad M. Biomechanical limitations of partial pediculectomy in endoscopic spine surgery. The Spine Journal.
3. Dimitriou D, Winkler E, Weber S, Haupt S, Betz M, Farshad M. A Simple Preoperative Score Predicting Failure Following Decompression Surgery for Degenerative Lumbar Spinal Stenosis. Spine. 2023;48(9).