Daniele Vanni

Purpose To propose a pelvic incidence (PI)-based asymptomatic spine classification, quantitatively define differences among Roussouly morphotypes, and develop a morphotype-oriented algorithm to guide surgical planning. Methods A retrospective analysis of 102 asymptomatic adults undergoing full-spine EOS radiographs was performed. Patients were classified according to the original Roussouly criteria. Spinopelvic parameters were measured using validated software. Receiver operating characteristic (ROC) curve analysis assessed the discriminative capacity of sagittal variables, with optimal cutoffs determined using the Youden index. A one-versus-rest ROC approach was applied for three-group comparisons. Linear regression analysis evaluated the relationship between lumbar lordosis (LL), PI, and Roussouly type. Results Although mean PI increased across types, significant overlap was observed among Types 1–3 for PI < 50°. In the binary comparison between Types 1 and 2, L5–S1 lordosis showed the highest discriminative performance (AUC 0.92; 95% CI 0.848–0.997; p < 0.001), with a cutoff of 19° differentiating Type 2 (≤ 19°) from Type 1 (> 19°). In the three-group analysis (Types 1–3), L5–S1 remained the most discriminative parameter (Type 2 vs. rest AUC 0.85). Thoracolumbar junction morphology differed consistently: kyphotic in Type 1, neutral in Type 2, and neutral-to-lordotic in Type 3. Conclusion Sagittal alignment cannot be defined by PI alone. Integration of distal lordosis (L5–S1) and thoracolumbar morphology improves morphotype differentiation and may support more precise surgical planning.

Purpose To identify the risk factors for distal junctional failure (DJF) in women treated for adult spine deformity with fusion to L5 and to highlight the significance of preoperative assessment, surgical decision-making, and postoperative care. Methods This is a retrospective study of data collected prospectively on the local institutional spine surgery registry (2016–2021). All patients, women older than 18 years, with a diagnosis of adult spine deformity who underwent long posterior instrumentation to L5 and had a minimum of 2-years follow-up were included in the study (two groups: with or without DJF). Demographic and radiographic data, corrective strategy, preoperative level of degeneration at L5/S1 and GAP score were compared between the two groups. Results Forty-eight patients (n = 48) satisfied eligibility criteria. At two-years follow-up, nine patients (18,7%) developed a DJF that required surgical revision. Thirty-nine patients did not present distal junctional complications. Patients with or without DJF showed significant differences in terms of preoperative spinopelvic parameters (PT: 28°± 6° vs. 23°± 9°, p-value 0.05; DJF group vs. not DJF) and degeneration of L5-S1 (Pfirmann grade L5-S1 disc 3.7 ± 1.0 vs. 2.6 ± 0.8, p-value 0.001; DJF group vs. not DJF) (L5-S1 Facet joint Osteoarthritis 3.1 ± 0.8 vs.2.4 ± 0.8, p-value 0.023; DJF group vs. not DJF). Conclusion DJF following spinal deformity correction surgery is influenced by a combination of patient-related, surgical and implant-related factors. Fusion construct length, preoperative and postoperative sagittal alignment and the grade of degeneration of the distal disc have been identified as significant risk factors. Surgeons should carefully evaluate these factors and employ appropriate strategies.

Study design: A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. Background and Purpose: The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. Methods: A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. Results: A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. Conclusion: Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.

Purpose This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. Methods This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case–control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. Results A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. Conclusion The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. Level of Evidence I.

Purpose To investigate the role of depressive symptoms on clinical outcomes in patients undergoing spinal surgery up to 2-year follow-up. Methods The study used data from an institutional spine surgery registry (January 2016, through March 2022) to identify patients (> 18 years) undergoing spine surgery. Patients with Oswestry Disability Index (ODI) < 20/100 at baseline or undergoing surgery on the cervical spine or for idiopathic spinal deformity and trauma patients were excluded. The patients were divided into two groups based on the pre-operative Mental Component Summary (MCS) score of the SF-36: depression group (MCS ≤ 35) or non-depression group (MCS > 35). The ODI and MCS scores trajectory were wined over the 24-month post-surgery between groups. Additionally, a secondary subgroup analysis was conducted comparing outcomes between those with depressive symptoms (persistent-depression subgroup) and those without depressive symptoms (never-depression subgroup) at 3 months after surgery. Results A total of 2164 patients who underwent spine surgery were included. The pre-operative depression group reported higher ODI total scores and lower MCS than the pre-operative non-depression group at all time points (P < 0.001). The persistent-depression subgroup reported higher ODI total scores and lower MCS than the never-depression subgroup at all follow-ups (P < 0.001). Conclusion Functional disability and mental health status improve in patients with depression symptoms undergoing spinal surgery. Despite this improvement, they do not reach the values of non-depressed subjects. Over the 2-year follow-up time, patients with depression show a different trajectory of ODI and MCS. Caregivers should be aware of these results to counsel patients with depression symptoms.

Actions to improve occupational health and safety arose from the need to protect employees working in European industries, such as nuclear power plants or large-scale chemical industries, from accidents. Today, the field has evolved in many directions, with the prevention and management of musculoskeletal disorders (MSDs) being one of its main lines of action. MSDs are the main reason for workers to take time off work. Specifically, the prevalence of MSDs represents more than 1.3 billion people and a loss of more than 100 million years of life due to disability; they are a common cause of disability and sick leave. Historically, the workplace approach to MSDs has focused on adopting ergonomic measures, which has been positive in some cases. However, despite ergonomic and biomechanical measures being widely implemented in the workplace, the increasing prevalence of MSDs globally indicates that they are not sufficient measures on their own. Therefore, new holistic approaches that take biological, psychological, and social aspects are needed to address them. The European Prevent4Work Alliance for innovative measures to prevent MSDs in the workplace has developed this document as a guide based on the most recent and relevant scientific knowledge. Both companies and their employees can benefit from the recommendations of this guide

Las acciones dirigidas a la mejora de la seguridad y de la salud laboral surgieron de la necesidad de proteger frente a los accidentes a los empleados que trabajaban en industrias europeas; como en centrales nucleares o en industrias químicas de gran escala. Actualmente, este campo ha evolucionado en multitud de direcciones, siendo la prevención y el manejo de los trastornos musculoesqueléticos (TME) una de sus principales líneas de actuación, debido a que son el principal motivo de baja laboral en los trabajadores. Concretamente, la prevalencia de los TME representa más de 1,3 mil millones de personas y una pérdida de más de 100 millones de años de vida por incapacidad; siendo una causa común de incapacidad y de bajas laborales. Históricamente, el abordaje de los TME desde el lugar de trabajo se ha focalizado en la adopción de medidas ergonómicas, lo que ha sido positivo en algunos casos. Sin embargo, a pesar de las ergonómicas y biomecánicas llevadas de manera generalizada en los puestos de trabajo, el aumento de la prevalencia de los TME a escala global indica que no son medidas suficientes por si solas., Por lo tanto, nuevos enfoques holísticos que tengan en cuenta aspectos biológicos, psicológicos y sociales para su abordaje son necesarios. Desde la Alianza Europea Prevent4Work para la prevención de los TME en el ámbito laboral, se ha elaborado este documento en forma de guía en base al conocimiento científico más reciente y relevante. Tanto las empresas como sus trabajadores se pueden beneficiar de las recomendaciones de esta guía.