記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most effective combinations. Methods: The retrospective cohort study analyzed 656 patients who visited the hospital for spinal diseases between 1 January 2004 and 31 March 2021; a total of 76 were diagnosed with pyogenic spondylitis. Blood samples were analyzed for serum albumin (Alb), total protein (TP), globulin (Glb), C-reactive protein (CRP), platelet count, white blood cell count, neutrophil count, lymphocyte count, and monocyte count. Combination markers, including albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), CRP-AGR (CAGR), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), were also evaluated. Receiver operating characteristic curves were used to determine each marker's diagnostic performance. Furthermore, multivariate analysis was performed to examine the odds ratios. Results: Patients with pyogenic spondylitis showed significantly different levels in Alb (p < 0.0001), Glb (p < 0.0001), CRP (p < 0.0001), platelet count (p < 0.0001), WBC count (p < 0.0006), neutrophil count (p = 0.0019), lymphocyte count (p = 0.0085), AGR (p < 0.0001), CAR (p < 0.0001), CAGR (p < 0.0001), NLR (p < 0.0001), and PLR (p < 0.0001). CRP (AUC = 0.80) showed good diagnostic accuracy, while combination markers CAR (AUC = 0.82) and CAGR (AUC = 0.83) had the highest areas under the curve (AUC). Multivariate analysis indicated that decreased age and the presence of comorbidities (including chronic kidney disease, chronic liver disease, malignancy, or diabetes), were independent predictors of early pyogenic spondylitis (OR_age = 0.93, OR_comorbidities = 16.98, p_age = 0.0005, and p_comorbidities = 0.0001). In patients with low-inflammatory pyogenic spondylitis, significant differences were observed in TP (p = 0.0293), Glb (p = 0.0012), CRP (p = 0.0023), platelet count (p = 0.0108), AGR (p = 0.0044), CAR (p = 0.0006), CAGR (p = 0.0004), PLR (p = 0.0192), and NLR (p = 0.0027), with CAGR showing the highest AUC (AUC = 0.70) among them. Conclusions: Serum combination markers (AGR, CAGR, CAR, PLR, and NLR) showed diagnostic value for pyogenic spondylitis, with CAGR achieving the highest accuracy. In low-inflammatory pyogenic spondylitis patients (CRP ≤ 1.0 mg/dL), these markers may aid diagnosis.

DOI： 10.3390/jcm14176001

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: Multicenter retrospective observational study. OBJECTIVE: To quantitatively evaluate spinal cord pulsatile motion during anterior cervical decompression and fusion (ACDF) and identify factors affecting spinal cord dynamics. BACKGROUND: Intraoperative ultrasonography is useful to assess neural decompression during cervical spinal surgery. While spinal cord pulsation has been qualitatively evaluated, detailed quantitative analyses of three-dimensional spinal cord motion are lacking. METHODS: 109 intervertebral spaces of 50 patients (32 men and 18 women; mean age 66.9±11.6 years) who underwent ACDF were evaluated. Two-dimensional video measurement software was used to quantify anteroposterior pulsation and craniocaudal sliding motion of the spinal cord in intraoperative ultrasound recordings. Additionally, correlations between cervical alignment parameters (C2-7 and O-C2 angles) and spinal cord pulsation characteristics were analyzed. RESULTS: Craniocaudal sliding motion was significantly greater than anteroposterior pulsation in both amplitude (1.09±0.93 vs. 0.34±0.21 mm, P<0.001) and velocity (16.75±11.12 vs. 5.39±4.26 mm/s, P<0.001). Directional analysis revealed greater velocities from posterior to anterior than from anterior to posterior (5.30±5.12 vs. 4.47±4.12 mm/s, P=0.00489) and from cranial to caudal than from caudal to cranial (16.53±11.10 vs. 11.59±7.71 mm/s, P<0.001). The maximum anteroposterior amplitude was significantly greater at the C4/5 level than at the C3/4 or C6/7 level (P=0.0027). The C2-7 angle showed a moderate positive correlation with craniocaudal sliding parameters (amplitude: r=0.467, P<0.001; velocity: r=0.41, P<0.001) and a weak positive correlation with anteroposterior pulsatile parameters. CONCLUSION: This first quantitative three-dimensional analysis of spinal cord motion during ACDF revealed that craniocaudal sliding motion exceeded anteroposterior pulsation. The preferential direction from cranial to caudal indicated the brain pulsation to be the major origin. The C4/5 level exhibited maximum anteroposterior motion, which may be related to C5 palsy pathophysiology. Increased cervical lordosis promoted both types of motion, particularly craniocaudal sliding. These findings may guide intraoperative neural assessments during cervical decompression procedures.

DOI： 10.1097/BRS.0000000000005473

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Surgical site infection (SSI) following spinal surgery, although rare, is a serious complication that affects patient outcomes. Identifying risk factors such as patient background, preoperative serum markers, and surgical factors is essential for effective screening and prevention measures. Therefore, this study aimed to verify whether preoperative patient conditions serve as predictors of post-spinal surgery infections and to determine the association between preoperative serum markers and infecting pathogen species. METHODS: This single center retrospective study analyzed 427 patients who underwent spinal surgery at our hospital between November 2019 and September 2022. Data on patient demographics, comorbidities, preoperative blood tests, surgical factors, SSI occurrence, and causative organisms were collected. Logistic regression analysis was performed to identify independent predictors of SSI, and a subgroup analysis compared preoperative serum markers between superficial and intra-abdominal bacterial infections. RESULTS: SSI occurred in 33 patients (7.7 %). Several factors showed significant differences between the SSI and non-SSI groups, including albumin (ALB), Albumin-Globulin Ratio (AGR), Prognostic Nutritional Index (PNI), C-Reactive Protein (CRP), CAR, D-dimer, and blood loss. Logistic regression analysis identified ALB as the only independent predictor of SSI (OR = 0.23, 95 % CI: 0.11-0.48, P < 0.001), with a cutoff value of <4.0 g/dL. Among SSI cases with identified pathogens, 17 were caused by skin commensal bacteria, while 7 were attributed to intra-abdominal comm-ensal bacteria. Subgroup analysis revealed that AGR and Lympocyte to Monocyte Ratio (LMR) were significantly higher in the intra-abdominal infection group than in the superficial infection group (P = 0.028 and P = 0.045, respectively). CONCLUSION: Preoperative ALB levels serve as a crucial predictor of postoperative SSI in spinal surgery, with a cutoff value of <4.0 g/dL. Additionally, the type of bacterial infection (superficial vs. intra-abdominal) may be influenced by preoperative patient factors.

DOI： 10.1016/j.jos.2025.03.012

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.34371/jspineres.2022-0062

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02317&link_issn=&doc_id=20200520060008&doc_link_id=10.11477%2Fmf.5002201423&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.5002201423&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

開催年月日： 2023年4月

記述言語：日本語  

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開催年月日： 2023年3月

記述言語：日本語  

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開催年月日： 2022年4月

記述言語：日本語  

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開催年月日： 2022年3月

記述言語：日本語  

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開催年月日： 2021年8月

記述言語：日本語  

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