Clinical Spine Surgery最新文献

{"title":"Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.","authors":"Dana G Rowe, Seeley Yoo, Connor Barrett, Emily Luo, Alissa Arango, Matthew Morris, Kerri-Anne Crowell, Russel R Kahmke, C Rory Goodwin, Melissa M Erickson","doi":"10.1097/BSD.0000000000001716","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001716","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the correlation between comorbid chronic obstructive pulmonary disease (COPD), asthma, tobacco use, and the incidence of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Prior studies have identified general risk factors such as multilevel fusion and coagulopathy. However, specific coughing-related factors like COPD, asthma, and tobacco use have not been extensively investigated.</p><p><strong>Methods: </strong>Patients who underwent single or multilevel ACDF between 2011 and 2021 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver database. The primary outcome was the occurrence of postoperative hematoma requiring reoperation within 30 days. χ2 tests and t tests compared groups, and multivariable logistic regression identified predictors for postoperative hematoma.</p><p><strong>Results: </strong>Among 399,900 patients with ACDF, 901 (0.2%) developed postoperative hematoma requiring reoperation within 30 days. Patients with postoperative hematoma were older (58 vs. 55, P<0.001) and predominantly male (62.5% vs. 44.9%, P<0.001). After adjustment, tobacco use and comorbid COPD were associated with postoperative hematoma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.10-1.47; P<0.001 and OR, 1.41; 95% CI, 1.21-1.64; P<0.001, respectively). Comorbid asthma was not a significant risk factor. Additional risk factors included comorbid hypertension (OR, 1.46; 95% CI, 1.18-1.82; P<0.001), coagulopathy (OR, 1.50; 95% CI, 1.24-1.81; P<0.001), anemia (OR, 1.38; 95% CI, 1.17-1.62; P<0.05), and history of deep vein thrombosis (OR, 1.93; 95% CI, 1.44-2.54; P<0.001).</p><p><strong>Conclusion: </strong>Tobacco use and COPD were identified as novel risk factors for postoperative hematoma formation requiring reoperation after ACDF. Recognizing these modifiable factors, providers may consider postponing nonemergent ACDFs until patients undergo smoking cessation programs or receive optimal COPD management.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy.","authors":"Brian Q Hou, Andrew Croft, Hani Chanbour, Omar Zakieh, Alicia M Hymel, Jacquelyn S Pennings, Mason W Young, Mitchell F Bowers, Raymond J Gardocki, Julian G Lugo-Pico, Amir M Abtahi, Scott L Zuckerman, Byron F Stephens","doi":"10.1097/BSD.0000000000001713","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001713","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM).</p><p><strong>Background: </strong>DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression. One surgical option for cord decompression is cervical laminoplasty. Factors influencing return to work (RTW) postsurgery are unknown.</p><p><strong>Methods: </strong>This study included adult patients previously employed, undergoing primary elective laminoplasty for DCM, and with documented RTW status. Variables included demographic information, medical history, illness characteristics, and baseline patient-reported outcomes. The primary outcome of interest was RTW status at 90 days. Statistical analyses were conducted to identify predictors.</p><p><strong>Results: </strong>Forty-six patients (67.6%) returned to work within 90 days, whereas 22 (32.3%) either RTW between 90 and 365 days (n = 3) or did not RTW within 365 days (n = 19). Significantly more patients who RTW within 90 days worked full-time (90.9% vs 64.3%, P = 0.030). Patients who RTW within 90 days had significantly lower preoperative Neck Disability Index scores (23.7 ± 17.5 vs 35.6 ± 14.3, P = 0.008) and higher preoperative modified Japanese Orthopedic Association scores (13.7 ± 2.5 vs 12.2 ± 2.7, P = 0.018) compared with those who did not RTW. No differences were found in other baseline patient-reported outcomes. Patients who RTW within 90 days had significantly lower postoperative 3-month neck pain (2.0 ± 2.1 vs 3.8 ± 2.6, P = 0.007), 3-month arm pain (1.3 ± 1.9 vs 3.6 ± 2.8, P < 0.001), 12-month neck pain (1.4 ± 1.6 vs 3.1 ± 2.4, P = 0.019) and 12-month arm pain (1.1 ± 1.8 vs 2.4 ± 2.4, P = 0.048) compared with those who did not RTW within 90 days. Higher preoperative modified Japanese Orthopedic Association scores were significantly associated with truncated time to RTW (HR: 1.14, 95% CI: 1.01-1.29, P = 0.034).</p><p><strong>Conclusion: </strong>Patients with better preoperative neck and arm pain and functional scores were more likely to RTW within 90 days postlaminoplasty. Preoperative functional status plays an important role in assessing RTW postlaminoplasty. This information is valuable for preoperative patient counseling.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hangman's Fractures: A Review of Current Concepts in Evaluation and Management.","authors":"Joshua Mizels, James W Connelly, Nicholas Spina, Brandon Lawrence, Brian A Karamian","doi":"10.1097/BSD.0000000000001694","DOIUrl":"10.1097/BSD.0000000000001694","url":null,"abstract":"<p><strong>Study design: </strong>Review article.</p><p><strong>Objective: </strong>To provide a comprehensive review and update on the evaluation and management of Hangman's fractures.</p><p><strong>Summary of background data: </strong>Hangman's fractures are the second most common fracture of the C2 vertebrae, and the prevalence is increasing with our aging population. Although these injuries are associated with good clinical outcomes and low rates of neurologic injury, they must be promptly recognized and treated according to patient and fracture factors.</p><p><strong>Methods: </strong>A review of the literature.</p><p><strong>Results: </strong>Neurologic injuries are uncommon in typical Hangman's fractures but are more of a concern in atypical Hangman's fractures due to lack of dissociation of the posterior ring of C2. The nonoperative treatment of stable type I, II, and atypical fractures with external immobilization leads to excellent long-term outcomes as does the operative treatment of unstable type IIa, III, and atypical fractures.</p><p><strong>Conclusions: </strong>Stable injury patterns can be treated with immobilization alone, whereas unstable injury patterns necessitate surgical treatment. Prompt diagnosis and treatment Hangman's fractures is paramount, and when managed properly, patients can have excellent clinical and neurologic outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enabling Technologies in the Management of Cervical Spine Trauma.","authors":"Arjun K Menta, Antony A Fuleihan, Marvin Li, Tej D Azad, Timothy F Witham","doi":"10.1097/BSD.0000000000001709","DOIUrl":"10.1097/BSD.0000000000001709","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>The objective of this study is to explore and evaluate the role of novel technologies in enhancing the diagnosis, surgical precision, and rehabilitation of cervical spine trauma, and to discuss their potential impact on clinical outcomes.</p><p><strong>Summary of background data: </strong>Traumatic cervical spine injuries are challenging to manage due to their complex anatomy, the potential for long-term disability, and severe neurological deficits. Traditional management approaches are being supplemented by emerging technologies that promise to improve patient care and outcomes.</p><p><strong>Methods: </strong>A literature review was conducted to identify and analyze advancements in imaging, navigation, robotics, and wearable technologies in the context of cervical spine trauma. The review focuses on the potential of these technologies to improve early detection, surgical accuracy, and postoperative recovery.</p><p><strong>Results: </strong>Technological innovations, including advanced imaging techniques, machine learning for diagnostics, augmented reality, and robotic-assisted surgery, are transforming the management of cervical spine trauma. These tools contribute to more efficient, accurate, and personalized treatment approaches, potentially improving clinical outcomes and reducing patient care burdens.</p><p><strong>Conclusions: </strong>Although these technologies hold great promise, challenges such as implementation costs and the need for specialized training must be addressed. With continued research and interdisciplinary collaboration, these advancements can significantly enhance the management of cervical spine trauma, improving patient recovery and quality of life.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Cervical Facet Fractures and Dislocations.","authors":"Jesse Wang, Abhishek Kumar, Adam L Shimer, Brian W Su","doi":"10.1097/BSD.0000000000001706","DOIUrl":"10.1097/BSD.0000000000001706","url":null,"abstract":"<p><p>Cervical facet injuries, though less common than other spinal injuries, represent a subset of subaxial cervical spine injuries and can present significant challenges in terms of diagnosis, management, and outcomes. A major concern with cervical facet fracture is identifying instability patterns that may necessitate surgical stabilization. Particularly in cases of cervical facet fracture dislocations, there remains controversy regarding requirements for closed reduction, timing, surgical approach, need for preoperative MRI, and method of fixation. This review article aims to provide a thorough understanding of the etiology, clinical presentation, diagnostic techniques, treatment options, and prognostic factors associated with cervical facet fractures.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Methadone in Spine Surgery ERAS Protocols: A Systematic Review of the Literature.","authors":"Christian Rajkovic, Sima Vazquez, Zach Thomas, Eris Spirollari, Bridget Nolan, Cameron Marshall, Nitin Sekhri, Ammar Siddiqui, Merritt D Kinon, John V Wainwright","doi":"10.1097/BSD.0000000000001726","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001726","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To systematically review the use of intraoperative methadone in spine surgery and examine its effects on postoperative opioid use, pain, length of stay, and operative time.</p><p><strong>Summary of background data: </strong>Spine surgery patients commonly have a history of chronic pain and opioid use, and as a result, they are at an increased risk of severe postoperative pain. While pure mu opioids remain the standard for acute surgical pain management, they are associated with significant short-term and long-term adverse events. Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery.</p><p><strong>Results: </strong>Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. However, one study observed that intraoperative methadone used in a multimodal analgesia regimen strategy with ketamine resulted in a shortened LOS compared with the use of intraoperative methadone alone. Differences in operating time between cases that used intraoperative methadone and cases that used comparator analgesics were not statistically significant among included studies.</p><p><strong>Conclusion: </strong>Methadone may present an alternative option for both intraoperative and postoperative analgesia in spine surgery recovery protocols and may reduce postoperative pain, opioid use, and LOS while maintaining consistent operating time and reduced side effects of pure mu opioids.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in the Management of Type II Odontoid Fractures.","authors":"Abhiraj D Bhimani, James S Harrop, Emery Monnig, Yehia Elkersh, John K Houten","doi":"10.1097/BSD.0000000000001702","DOIUrl":"10.1097/BSD.0000000000001702","url":null,"abstract":"<p><p>The management of type II odontoid fractures in the elderly is controversial, as these patients often have numerous medical comorbidities that increase the risks of surgery, but they may also fail to achieve fracture healing with nonsurgical management. Recent changes in technology and surgeon attitudes may influence the preferred approach to both surgical and nonsurgical treatments for many clinicians. While bony fracture healing remains the goal of management, a stable fibrous union is increasingly considered a satisfactory outcome. The optimal surgical approach remains debated, with some authors raising concerns about the risk of swallowing dysfunction being particularly problematic with odontoid screw placement in the elderly. The use of BMP-2 applied either anteriorly into the fracture site or posteriorly in the interlaminar space and placement of temporary posterior fixation to be removed upon demonstration of anterior bony healing are novel surgical techniques that are presently the subject of investigation. A clearer understanding of the currently available treatment options and the associated controversies may improve clinician decision-making and potentially better patient outcomes in the management of type II odontoid fractures for the growing geriatric population.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Play After Injuries to the Cervical Spine.","authors":"Gregory S Kazarian, Sheeraz Qureshi","doi":"10.1097/BSD.0000000000001698","DOIUrl":"10.1097/BSD.0000000000001698","url":null,"abstract":"<p><p>Return to play (RTP) after sports-related traumatic injuries to the cervical spine is important for athletes and teams, especially at the elite level. While early RTP may be incentivized for athletes and organizations, treating clinicians must have a thorough understanding of cervical spine injuries, treatments, and RTP guidelines to make safe recommendations. In general, patients can RTP when asymptomatic from prior injury with no neurological deficits and a full, painless, active range of motion of the neck. However, injury diagnosis, injury symptoms and severity, history of cervical spine injuries, anatomic variants/anomalies, history of treatment/surgery, and any ongoing or persistent symptoms may modify RTP recommendations. In the current review, we summarize the common cervical spine injuries associated with contact sports and the available guidelines for RTP. It is important to note, however, that despite these guidelines, there is little consensus among treating physicians regarding these recommendations. Therefore, clinical judgment should be used to ensure conservative decisions are made and patient safety is maintained.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of Cervical Spine Trauma: Update of Techniques and Clinical Relevance.","authors":"Melissa Warstadt, Blair Winegar, Lubdha M Shah","doi":"10.1097/BSD.0000000000001677","DOIUrl":"10.1097/BSD.0000000000001677","url":null,"abstract":"<p><p>Imaging of cervical spine trauma most commonly begins with computed tomography (CT) for initial osseous and basic soft tissue evaluation, followed by magnetic resonance imaging (MRI) for complementary evaluation of the neural structures (i.e., spinal cord, nerves) and soft tissues (i.e., ligaments). Although CT and conventional MRI sequences have been the mainstay of trauma imaging for decades, there have been significant advances in CT processing, imaging sequences and techniques made possible by hardware and software development, and artificial intelligence. These advancements may provide advantages in increasing sensitivity for detection of pathology as well as in decreasing imaging and interpretation time. Unquestionably, the most important role of imaging is to provide information to help direct patient care, including diagnosis, next steps in treatment plan, and prognosis. As such, there has been a growing body of research investigating the clinical relevance of imaging findings to clinical outcomes in the setting of spinal cord injury. This article will focus on these recent advances in imaging of cervical spinal trauma.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Central Cord Syndrome.","authors":"Matthew T Carr, James S Harrop, John K Houten","doi":"10.1097/BSD.0000000000001703","DOIUrl":"10.1097/BSD.0000000000001703","url":null,"abstract":"<p><p>Central cord syndrome (CCS) is the most common form of incomplete spinal cord injury, with an increasing incidence with the aging population. This is a clinical diagnosis defined by weakness greater in the upper than lower extremities and often prominent sensory complaints in the hands. CCS is typically seen in individuals with underlying cervical canal stenosis from spondylosis who experience sudden forceful movement of the neck, especially hyperextension, resulting in contusion of the spinal cord. The prognosis in CCS is relatively favorable with improvement in neurological deficits, except for fine motor control of the hands. Neuropathic pain may persist even in those with excellent motor recovery. Nonoperative management may be appropriate in selected patients, but surgery is usually necessary in those with poor neurological recovery or further deterioration. The optimal timing of surgical intervention has not been defined, but recent evidence suggests that early surgery (≤24 h) may lead to greater neurological recovery, shorter hospital stay, and fewer inpatient complications. Management in any given patient must be considered in the context of the anatomy and location of spinal cord compression, the presence of fractures or ligamentous instability, the temporal course of signs and symptoms, as well as the patient's overall health.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}