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Ramanathan S, Rapp A, Perez-Cruet M, Fahim DK. Long-Term Reoperation Rates After Open versus Minimally Invasive Spine Surgery for Degenerative Lumbar Disease: Five Year Follow-Up of 2130 Patients. World Neurosurg 2023; 171:e126-e136. [PMID: 36442783 DOI: 10.1016/j.wneu.2022.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally Invasive Spine Surgery (MISS) is a growing alternative to Open Spine Surgery (OSS). The preservation of musculature and minimization of iatrogenic injury is hypothesized to decrease the need for reoperation by preserving normal anatomy. Our objective is to compare the relative long-term reoperation rates after MISS and OSS for the treatment of degenerative disease of the lumbar spine. METHODS This retrospective analysis compares the long-term reoperation rates after MISS and OSS. Eligible patients were adults with a primary lumbar intervention carried out between 5/1/2004 and 1/31/2014 to allow for at least 5 years of follow up. Patients without sufficient descriptive metrics or follow-up data were excluded. The primary outcome was the rate of lumbar spine reoperation. RESULTS A total of 2130 patients met the inclusion criteria-1895 underwent OSS and 235 underwent MISS. On average and across all surgery types (decompression and decompression with fusion), 28% of OSS patients required reoperation during the minimum 5-year follow up period while only 14% of MISS patients required reoperation (P = 0.001). The MISS group was statistically identical to the OSS group in all categories except that the MISS group was on average 1.8 years older (62.25 vs. 60.45, P = 0.039) and had a higher incidence of diabetes (26% vs. 17%, P = 0.000), but had a lower average body mass index than the OSS group (28.35 vs. 29.60, P = 0.002). CONCLUSIONS In the setting of degenerative lumbar spine disease, MISS has the potential to reduce the long-term need for reoperation when compared with OSS.
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Affiliation(s)
- Siddharth Ramanathan
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA
| | - Aaron Rapp
- Department of Neurosurgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Mick Perez-Cruet
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA; Department of Neurosurgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Daniel K Fahim
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, USA; Department of Neurosurgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA; Spine & Brain Surgery Specialists, Royal Oak, Michigan, USA.
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Quan H, Zuo X, Huan Y, Wang X, Yao Z, Wang C, Ren F, Wang H, Qin H, Hu X. A systematic morphology study on the effect of high glucose on intervertebral disc endplate degeneration in mice. Heliyon 2023; 9:e13295. [PMID: 36816302 PMCID: PMC9932476 DOI: 10.1016/j.heliyon.2023.e13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
To explore the relationship between diabetes and intervertebral disc degeneration in mice and the associated underlying mechanism. Four-week-old male Kunming mice were used to model diabetes using a high-fat diet combined with streptozotocin injection. After 6 months, morphological and pathological changes in L4-L6 intervertebral discs were detected by magnetic resonance imaging, micro-CT and histological staining. Immunostaining of CD31, F4/80 and CD16/32 receptors was used to detect vascular invasion and inflammatory infiltration in endplates; the exact changes were then explored by the transmission electron microscopy. The nucleus pulposus of the control and the diabetic group had a clear boundary and regular shape without collapse, while endplate calcification and chondrocyte abnormality in the diabetic group were more obvious. Immunofluorescence confirmed that compared to control, expression levels of CD31 (vascular endothelial marker) and F4/80 (monocyte/macrophage marker) in the diabetic group were significantly increased (P < 0.05), with an elevated number of F4/80 (+)/CD16/32 (+) cells (P < 0.05). The morphology of endplates was observed by transmission electron microscopy, which showed monocytes/macrophage accumulation in the endplate of the diabetic group, accompanied by increased vascular density, collagen fiber distortion and chondrocyte abnormality. In a conclusion, diabetes promotes endplate degeneration with vascular invasion, monocyte/macrophage infiltration and inflammation in mice.
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Affiliation(s)
- Huilin Quan
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Xiaoshuang Zuo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Yu Huan
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Xuankang Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Zhou Yao
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Chunmei Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Fang Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China
| | - Hongyan Qin
- State Key Laboratory of Cancer Biology, Department of Medical Genetics and Developmental Biology, Fourth Military Medical University, Xi'an, 710032 Shaanxi China,Corresponding author.
| | - Xueyu Hu
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032 Shaanxi China,Corresponding author.
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