Clinical Spine Surgery最新文献

{"title":"Comparison Between Short-Term and 1-Year Patient-Reported Outcome Measures After Anterior Cervical Discectomy and Fusion.","authors":"Jonathan Dalton, Robert J Oris, Omar Tarawneh, Alec M Giakas, Yasmine Eichbaum, William A Green, Rajkishen Narayanan, Nicholas B Pohl, Michael A McCurdy, Keyur Patel, Evgeniy V Uvarov, Stephan Aynaszyan, Dominic Finan, Ian D Kaye, Jeffrey A Rihn, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1097/BSD.0000000000002072","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002072","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study of adult patients who underwent 1-4 level primary elective ACDF at a tertiary care center (2014-2022).</p><p><strong>Objective: </strong>This study's purpose was to evaluate the timing of patient-reported outcome measure (PROM) changes up to a year after anterior cervical discectomy and fusion (ACDF) and to identify any plateaus in improvement within this time period. The goal was to provide information for patients/providers and minimize unnecessary extended PROM collection.</p><p><strong>Summary of background data: </strong>ACDF is a largely successful procedure, but there is minimal literature evaluating the optimal time frame for PROM collection after ACDF, despite increasing emphasis on PROMs to evaluate outcomes and determine reimbursement.</p><p><strong>Methods: </strong>Demographics, including age, sex, BMI, insurance, and distressed community index, were collected. Outcomes included 30- and 90-day readmissions, revisions, and PROMs (preoperative and at 3, 6, and 12 months postoperative). PROMs included modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) Neck/Arm, Physical Component Summary (PCS-12), and Mental Component Summary (MCS-12) scores. The percentage of patients achieving minimum clinically important differences (MCID) was calculated for VAS Neck/Arm and mJOA.</p><p><strong>Results: </strong>Seven hundred sixty-eight patients (49.1% female, mean age: 56.5 y) underwent ACDF (49% 1-2-level, 23.3% 3-level, and 6.77% 4-level). Ninety-day readmission and 1-year revision rates were 0.91% and 3.52%, respectively. Across all PROMs, patients improved significantly from baseline to 3 months (P<0.001). However, no differences were noted across PROMs in the 3-6 and 6-12 months intervals postoperatively. Pairwise comparison of MCID achievement between the different postoperative timepoints showed no differences after 3 months.</p><p><strong>Conclusions: </strong>This study showed that PROM values and the likelihood of MCID achievement plateau 3 months after ACDF, challenging the necessity of PROM follow-up up to a year. Reassessing the utility of long-term PROM collection may lead to more inclusive and cost-efficient investigations in spine surgery outcomes, without compromising data quality.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834332","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":"Barriers to Care Among Elderly Patients Diagnosed With Degenerative Conditions of the Lumbar Spine.","authors":"Barnabas Obeng-Gyasi, Ethan D L Brown, Daniel Schneider, Max Ward, Anoop Chinthala, Greer M Williams, Gordon Mao, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1097/BSD.0000000000002075","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002075","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional survey.</p><p><strong>Objectives: </strong>This study aimed to assess how advanced age (≥65 y) influences perceived barriers to care and surgical utilization among adults with degenerative lumbar spinal conditions (DLSCs), along with any accompanying racial and ethnic disparities within the elderly populations.</p><p><strong>Summary of background data: </strong>While social determinants of health such as age have been previously identified as predictors of surgical utilization in patients with DLSCs, investigation of specific barriers to care among geriatric patients remains limited.</p><p><strong>Methods: </strong>Using the All of Us Research Program database, we conducted a cross-sectional analysis of adults diagnosed with DLSC who completed the Health Care Access & Utilization survey. Barriers to care were analyzed using a demographic-adjusted binomial logistic regression model. Subgroup analyses evaluated racial disparities specifically among elderly patients, stratified by age: 18-64 (nonelderly), 65-72, 73-79, and 80+ years.</p><p><strong>Results: </strong>Among 28,683 DLSC patients, 15,286 (53.3%) were elderly. Surgical utilization increased with age (3.8% in <65 vs. 6.5% in 80+, P<0.001). Older age was associated with a stepwise reduction in barriers, including provider background concerns (AORs: 0.43 in 65-72, 0.30 in 73-79, and 0.25 in 80+) and co-pay costs (AORs: 0.44, 0.18, and 0.11, all P<0.001). Among elderly patients, transportation delays (AOR 1.76 in 65-72, P=0.015) and challenges acquiring time off work (AOR 2.25 in 73-79, P=0.049) were associated with increased odds of surgery.</p><p><strong>Conclusions: </strong>Although elderly patients generally report fewer barriers to care and higher surgical utilization rates than younger patients, disparities persist within the elderly population. These findings suggest that age-specific interventions addressing barriers to care should consider the intersectionality of age and race/ethnicity to effectively improve access to care for elderly DLSC patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833838","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":"Application and Short-Term Clinical Outcomes of Neurophysiological Monitoring in Hemivertebra Resection for Pediatric Patients With Congenital Scoliosis.","authors":"Jiang Cao, Song Yu, Jianmei Wu, Xin Lv","doi":"10.1097/BSD.0000000000002073","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002073","url":null,"abstract":"<p><strong>Study design: </strong>This study retrospectively analyzed clinical data from 82 pediatric patients with congenital scoliosis who underwent hemivertebra resection.</p><p><strong>Objective: </strong>To analyze the application and short-term clinical outcomes of neurophysiological monitoring in hemivertebra resection for pediatric patients with congenital scoliosis.</p><p><strong>Summary of background data: </strong>All pediatric patients underwent a posterior approach for spinal pedicle screw insertion, hemivertebra resection, and corrective surgery under neurophysiological monitoring.</p><p><strong>Materials and methods: </strong>Preoperative and postoperative surgery-related indicators and complications in pediatric patients were compared, and preoperative and postoperative functional indicators, radiographic parameters in the spinal coronal and sagittal planes, stress responses, and quality of life changes were observed.</p><p><strong>Results: </strong>Among 82 pediatric patients, the MEP elicitation rate was 95.12% (78/82), with 4 patients where the amplitude was not normally elicited, weighing <15 kg, and the SEP elicitation rate was 100.00% (82/82). In MEP monitoring, 6 patients showed gradual declines in amplitude exceeding the warning criterion after a hemivertebra resection, but the amplitude normalized upon temporarily halting the procedure, without any abnormal neurological symptoms. In SEP monitoring, 3 patients exhibited a unilateral decrease in amplitude exceeding the warning criterion, yet no acroparesthesias were observed. At 6 months postoperatively, JOA scores were significantly higher than preoperative values, while VAS scores, total scoliosis angles, segmental scoliosis angles, cephalic and caudal compensatory curves, and segmental kyphosis were all significantly decreased compared with preoperative levels (P < 0.05). At 6 months postoperatively, the PedsQL 4.0 scale scores were significantly higher than preoperative scores (P<0.05). The overall complication rate was 2.4% (2/82). Postoperatively, the VAS scores in the IONM alarm group were significantly higher than those in the non-alarm IONM group (P< 0.05).</p><p><strong>Conclusions: </strong>Neurophysiological monitoring during hemivertebra resection for pediatric congenital scoliosis is feasible, providing real-time neurological function information and prompting timely adjustments to surgical procedures when abnormalities are detected.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834591","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":"Increased Cumulative Incidence of 10-Year Reoperation and Surgical Complications Following Anterior Cervical Discectomy and Fusion Compared With Cervical Disc Arthroplasty.","authors":"Philip M Parel, John G Parel, Theodore Quan, Jeremy Clements, Adrianna Kowblansky, Abbas Saeed, Joseph E Manzi, Sabrina Gill, Tushar Ch Patel, Addisu Mesfin","doi":"10.1097/BSD.0000000000002090","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002090","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare 10-year survivorship, secondary cervical procedure rates, and surgical complications between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>ACDF is the traditional gold-standard treatment for cervical spine degeneration but alters adjacent segment motion, potentially accelerating degeneration. CDA has emerged as a motion-preserving alternative that may reduce adjacent segment disease. While short- and mid-term studies suggest comparable outcomes, limited data exist on long-term complications and survivorship beyond 10 years.</p><p><strong>Methods: </strong>Patients undergoing primary single-level CDA and ACDF between 2010 and 2022 were identified from a national claims database. CDA patients were propensity-score matched 1:1 to ACDF patients by age, sex, and Charlson Comorbidity Index. Kaplan-Meier survival analysis was used to determine the 10-year cumulative incidence of secondary cervical procedures, including ACDF, CDA, cervical decompression, and posterior fusion. Complications such as all-cause revision, hardware removal, spinal complications, nerve root compression, dural tear, dysphonia, dysphagia, drainage and evacuation, and mechanical failure were analyzed. Cox proportional hazards models estimated hazard ratios (HR) with 95% CIs.</p><p><strong>Results: </strong>A total of 18,192 CDA patients were matched to 18,192 ACDF patients. At 10 years, the cumulative incidence of secondary procedures was lower for CDA (8.7%) compared with ACDF (11.4%), with ACDF patients more likely to undergo reoperation (HR: 1.12, P=0.005). ACDF patients also demonstrated higher risks of spinal complications (4.73), nerve root compression (HR: 2.61), drainage and evacuation (HR: 2.01), and mechanical failure (HR: 1.36), all statistically significant (P<0.05).</p><p><strong>Conclusions: </strong>CDA demonstrated superior long-term outcomes compared with ACDF by reducing secondary procedures and complication rates over 10 years. These findings suggest motion preservation with CDA translates into sustained clinical benefit. Surgeons should incorporate this evidence when counseling patients regarding surgical options for single-level cervical degeneration.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834301","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":"Awake Endoscopic Radiofrequency Ablation for Lateral Atlantoaxial Joint Pain.","authors":"Borriwat Santipas, Piya Chavalparit, Jin-Sung Kim","doi":"10.1097/BSD.0000000000002076","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002076","url":null,"abstract":"<p><p>Chronic pain originating from the lateral atlantoaxial (C1-C2) joint is a challenging condition with limited long-term treatment options. Conventional radiofrequency ablation (RFA) techniques rely on indirect guidance, which can lead to incomplete nerve denervation and variable outcomes. This report introduces awake endoscopic radiofrequency ablation (ERFA) as a novel, minimally invasive treatment, complemented by advanced diagnostic imaging. We present the case of a 67-year-old male with intractable occipital and posterior neck pain refractory to previous surgeries. Single-photon emission computed tomography (SPECT/CT) was crucial in identifying active inflammation localized to the left C1-C2 facet joint as the primary pain generator. The patient then underwent an awake ERFA procedure targeting the C1-C2 and C2-C3 facet joints. The endoscopic approach provided direct visualization of the target areas, allowing for precise and thorough ablation. The awake setting enabled real-time patient feedback, confirming immediate symptom relief of 80% upon completion. This case highlights that the combination of SPECT/CT for accurate diagnosis and awake ERFA for precise, visually-confirmed denervation presents a promising and effective modality for managing this condition, potentially offering more durable relief than conventional techniques.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833756","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":"BIS-Guided Sedation Protocol for Awake Endoscopic Lumbar Surgery: Balancing Airway Safety and Neural Feedback Without General Anesthesia.","authors":"Vignessh Kumar, Adam S Levy, Seth S Tigchelaar, Adham M Khalafallah, Michael Y Wang","doi":"10.1097/BSD.0000000000002081","DOIUrl":"10.1097/BSD.0000000000002081","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, case-matched cohort.</p><p><strong>Objective: </strong>Define a reproducible anesthetic protocol with bispectral index (BIS) targets that maintain airway safety and enable real-time dorsal root ganglion (DRG) feedback during awake endoscopic lumbar surgery without general endotracheal anesthesia (GETA).</p><p><strong>Summary of background data: </strong>Innovation has driven rapid growth in the field of endoscopic spine surgery, yet concern regarding dorsal root ganglion (DRG) injury continues to slow widespread adoption of spinal endoscopy. Awake surgery without GETA leverages real-time patient feedback for DRG monitoring, avoiding the consequences of general anesthesia. Maintaining the appropriate level of sedation is critical to awake surgery in order to prevent airway compromise from oversedation and patient movement or discomfort from undersedation.</p><p><strong>Methods: </strong>Consecutive patients undergoing 1- or 2-level awake endoscopic transforaminal lumbar interbody fusion (TLIF) or discectomy were case-matched to patients undergoing minimally invasive (MIS) TLIF or microdiscectomy under GETA. Demographic, operative, anesthesia, and BIS data were analyzed.</p><p><strong>Results: </strong>Thirty-three awake and 32 GETA cases were included. No awake cases converted to GETA. Propofol and opioid requirements were significantly lower with awake anesthesia. A BIS target window of 65±8 for awake endoscopic TLIF and of 70±4 for awake endoscopic discectomy was correlated with maintaining an optimal level of sedation and airway patency while minimizing discomfort and movement.</p><p><strong>Conclusion: </strong>The presented anesthetic protocol, coupled with BIS monitoring to titrate anesthesia, provides a reproducible framework for performing awake endoscopic spine surgery without GETA. The BIS thresholds we report are descriptive observations from a single-surgeon experience and should be interpreted as exploratory guidance. These findings are hypothesis-generating and highlight the need for prospective, multi-institutional validation.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834071","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":"Adequacy of ChatGPT's Responses to Frequently Asked Questions for Patients With Adolescent Idiopathic Scoliosis.","authors":"Anil Özgür, Uğur Yüzügüldü, Harun Yasin Tüzün, Rifat Güveli, Ömer Erşen, Alihan Derincek, Metin Özalay","doi":"10.1097/BSD.0000000000002084","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002084","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>To evaluate whether the answers of different versions of ChatGPT to frequently asked questions about AIS compiled from patient education websites the American Academy of Orthopaedic Surgeons (AAOS) and the Scoliosis Research Society (SRS) provide appropriate and sufficient information to patients.</p><p><strong>Summary of background data: </strong>Artificial intelligence chatbots have gained popularity due to their ability to analyze substantial scientific data using machine learning techniques and generate human-like responses in medicine. These responses can guide patients and families who are seeking information online after a diagnosis of AIS.</p><p><strong>Methods: </strong>Thirty frequently asked questions, selected by expert spine surgeons, were posed to 3 versions of ChatGPT using a new internet browser window for each question, and the responses were recorded. Three orthopedic spine surgeons graded the accuracy of the responses against 2 selected expert websites using a Likert scale. Finally, the response accuracy was evaluated for patient use.</p><p><strong>Results: </strong>Median Likert scores for ChatGPT-3.5, ChatGPT-4, and ChatGPT-4o were 4 (1-5), 4 (2-5), and 4 (2-5), respectively. No significant differences were observed among versions within individual categories (all P>0.05). However, a significant difference was found in the overall response scores (P=0.004). Post hoc analysis revealed that ChatGPT-4o achieved significantly higher accuracy than ChatGPT-3.5 (P=0.005, Bonferroni-adjusted), whereas other pairwise comparisons were not significant. When the adequacy of the responses was evaluated, 26/30 (86%) of ChatGPT-3.5 responses were acceptable for patient use, whereas ChatGPT-4 and ChatGPT-4o provided appropriate responses in 29/30 (96%) of the questions.</p><p><strong>Conclusions: </strong>Successive ChatGPT versions demonstrated improved response reliability, with ChatGPT-4o showing a statistically significant advantage over ChatGPT-3.5. Given that ChatGPT-4 and ChatGPT-4o provided accurate and patient-appropriate answers in 96% of cases, these tools may assist in online patient education under clinician supervision.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834551","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":"Racial and Ethnic Disparities in Posterior Cervical Spine Surgery: An Analysis of 19,994 Cases.","authors":"Ataollah Shahbandi, Kevin Wojcik, Peter Palmer, Pegah Ghamasaee, Saman Shabani","doi":"10.1097/BSD.0000000000002082","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002082","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>This study aimed to evaluate the extent of racial and ethnic disparities in perioperative outcomes after posterior cervical spine surgeries.</p><p><strong>Summary of background data: </strong>Although racial disparities have been studied in the context of anterior cervical spine surgery, limited literature exists on outcomes after posterior cervical spine procedures.</p><p><strong>Methods: </strong>Using 2006-2023 National Surgical Quality Improvement Program database, we conducted a study of patients who underwent posterior cervical fusion or cervical laminoplasty. Patients were stratified by race [White, Black or African American (B/AA), Asian, Native Hawaiian or Pacific Islander (NH/PI), American Indian or Alaska Native (AI/AN)] and Hispanic ethnicity. The primary outcome was the incidence of postoperative complications within 30 days. Secondary outcomes included hospital length of stay and discharge disposition.</p><p><strong>Results: </strong>A total of 19,994 patients were included in the study. The majority were White (n=14,276, 71.3%), followed by B/AA (n=3473, 17.4%), Asian (n=822, 4.1%), AI/AN (n=218, 1.1%), NH/PI (n=114, 0.6%), and Hispanic (n=1091, 5.5%). After adjusting for covariates, B/AA race was independently correlated with higher risk of experiencing at least one major complication (OR: 1.264, P=0.005), a medical complication (OR: 1.234, P=0.007), cardiac arrest (OR: 2.631, P=0.001), pulmonary embolism (OR: 1.88, P=0.001), extended hospital stay (OR: 1.921, P<0.001), and non-home discharge (OR: 1.801, P<0.001). NH/PI race was independently correlated with higher odds of prolonged hospitalization (OR: 2.396, P<0.001), as was Hispanic ethnicity (OR: 1.309, P=0.001).</p><p><strong>Conclusions: </strong>Racial and ethnic minority patients were significantly more likely to experience unfavorable outcomes within 30 days after posterior cervical spine surgery, underscoring the need for interdisciplinary approaches to address inequities in surgical care.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834278","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":"Magnetic Resonance Imaging Before Spine Consultation Expedites Time To Surgical Intervention in Higher Acuity Spinal Conditions.","authors":"Nicholas B Pohl, Jonathan Dalton, Rachel Huang, Yulia Lee, Mitchell Ng, Rajkishen Narayanan, Robert J Oris, William A Green, Matthew H Meade, Yunsoo Lee, Mark Miller, Adam J Lencer, Omar H Tarawneh, Ryan Garemani, Brady Stallman, Matthew H Ruiz, Lauren E Haupt, Meera Kohli, Emily Berthiaume, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BSD.0000000000002086","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002086","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between MRI timing relative to spine surgery consultation and in-hospital surgical workflow timelines.</p><p><strong>Background data: </strong>Acute spinal conditions can have lasting effects on patients' and their families' quality of life. Few studies have evaluated barriers to early intervention.</p><p><strong>Methods: </strong>Patients who received an inpatient spine surgery consultation and underwent nonelective surgery during the same hospitalization were identified (2017-2022). Hospital admission timelines were evaluated, including the time from MRI completion to hospital admission, medical clearance, spine consultation, and procedure start, as well as length of stay (LOS). Patients were grouped by operative booking designation into high-acuity (levels 1-3; OR requested within 12 h) and low-acuity (level ≥4; OR requested within 24 h).</p><p><strong>Results: </strong>A total of 221 cases were included, including 82 high-acuity cases: 20 (24.4%) underwent MRI before consultation, and 62 (75.6%) did not. The most common primary diagnosis was cervical trauma (17.9%), followed by spinal epidural abscess (17.3%). High-acuity cases had shorter times from MRI to procedure (28.5 vs. 71.5 h; P<0.001) and from consult to procedure (33.2 vs. 70.9 h; P<0.001) than low-acuity cases. When high-acuity patients were stratified by MRI status before consultation, consult-to-procedure time was longer in the group without an MRI (38.4 vs. 17.2 h; P=0.002). The time from medical clearance to procedure and from admission to procedure did not differ significantly between the MRI consult timing groups. Timing variables did not differ based on weekday/weekend consult placements.</p><p><strong>Conclusion: </strong>High acuity spine cases in which MRI was obtained before consultation were associated with substantially shorter time to operative intervention compared with cases in which consultation preceded imaging. Further work to identify variables associated with high-acuity spine cases and to evaluate standardized MRI acquisition pathways may help reduce delays in operative care.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834337","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":"Incidence and Risk Factors of PJK in AIS Patients Treated With Patient-Specific Rods.","authors":"Amellal Omar, Othmane Miri, Simon Vandergugten","doi":"10.1097/BSD.0000000000002087","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002087","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the incidence and risk factors of proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) patients treated with patient-specific rods, and to assess its clinical impact using the Scoliosis Research Society-22 (SRS-22) score.</p><p><strong>Summary of background data: </strong>PJK is a frequent complication following scoliosis surgery. Patient-specific rods have been introduced to improve mechanical outcomes, but their influence on PJK incidence remains unclear.</p><p><strong>Methods: </strong>This study included 50 AIS patients who underwent posterior spinal fusion with patient-specific rods, with a minimum follow-up of 18 months. Radiographic parameters and clinical outcomes (SRS-22 scores) were assessed. PJK was defined according to Glattes criteria. Patients were grouped based on the presence or absence of PJK. Demographic, surgical, and radiographic variables were compared using t tests and χ2 tests. Logistic regression analysis was used to identify risk factors.</p><p><strong>Results: </strong>PJK was observed in 10 of 50 patients (20%) at the last follow-up. Among these, 40% developed PJK within 6 weeks postoperatively. No significant differences were found between PJK and non-PJK groups regarding age, BMI, Risser stage, curve type, spinopelvic parameters, or surgical variables (UIV, LIV, number of levels fused). However, a larger immediate postoperative proximal junctional angle (PJA) was significantly associated with PJK development. SRS-22 functional scores did not differ significantly between groups.</p><p><strong>Conclusions: </strong>The incidence of PJK in AIS patients treated with patient-specific rods was 20%. A larger immediate postoperative PJA was identified as a significant risk factor for PJK. Despite its radiographic presence, PJK did not impact short-term clinical outcomes in this cohort.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834263","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}