Clinical Spine Surgery最新文献

{"title":"Establishment of Scoring to Predict Severe Complication After Pyogenic Spondylodiscitis Surgery.","authors":"Yuichiro Ukon, Shota Takenaka, Hiromasa Hirai, Tsuyoshi Sugiura, Yusuke Sakai, Takahito Fujimori, Masayuki Furuya, Yuya Kanie, Seiji Okada, Takashi Kaito","doi":"10.1097/BSD.0000000000001756","DOIUrl":"10.1097/BSD.0000000000001756","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study using prospective database.</p><p><strong>Objective: </strong>This study aimed to establish a risk-scoring system for predicting severe complications after pyogenic spondylodiscitis surgery.</p><p><strong>Summary of background data: </strong>Pyogenic spondylodiscitis surgery can cause severe complications.</p><p><strong>Methods: </strong>Grades III, IV, and V complications in the CD classification were defined as severe complications. A predictive scoring system for severe complications was developed using 7 risk factors identified from a cohort of 143 PS surgery patients from January 2013 to December 2017 described in a previous study. External validation used a separate cohort of 70 patients from 9 institutions identified from January 2018 to December 2021.</p><p><strong>Results: </strong>This first study proposed a risk predictive scoring system for severe complications [updated Charlson comorbidity index (≥3), 2; chronic pulmonary disease, 3; diabetes, 1; Gram-negative bacteria, 3; pyogenic osteoarthritis, 3; preoperative white blood count (≥1.0×10 4 /μL), 2; preoperative platelet count (≤2.4×10 5 /μL), 2]. The scoring system could well predict severe complications [area under the receiver operating curve (AUROC) value of 0.851]. There was classification into 3 risk groups: low-moderate risk (≤4), high risk (5 or 6), and very high risk (≥7), further simplified by the scoring system. Complication rates were 5.2% (low-moderate), 40.1% (high), and 84.2% (very high). In addition, external validation showed a very good AUROC value of 0.820.</p><p><strong>Conclusions: </strong>We developed a simple, externally validated scoring system for predicting severe complications after pyogenic spondylodiscitis surgery that will be helpful for clinicians involved in informed consent and intensive care unit management of high-risk patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"353-359"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058289","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":"Inpatient Multimodal Pain Regimens Do Not Impact Hospital Length of Stay or Long-term Postoperative Opioid Use Following 1 and 2-Level Lumbar Fusion.","authors":"Michael Carter, Rajkishen Narayanan, Gregory Toci, Yunsoo Lee, Sebastian Fras, Emma Hammelef, Shiraz Mumtaz, Tasha Garayo, Mark Kurd, Ian David Kaye, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder","doi":"10.1097/BSD.0000000000001753","DOIUrl":"10.1097/BSD.0000000000001753","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine hospital length of stay (LOS) and long-term opioid consumption among patients who received inpatient multimodal analgesia following lumbar spine surgery, as opposed to those who received opioids alone.</p><p><strong>Summary of background data: </strong>Opioids have long been the historical choice for managing postoperative pain. The use of multimodal analgesia has become more commonplace in recent years as it is thought to achieve similar levels of pain control while simultaneously diminishing opioid consumption and decreasing LOS.</p><p><strong>Materials and methods: </strong>Patients who underwent 1 or 2-level lumbar fusion from 2018 to 2019 were included. Patients who received opioids on an as-needed basis were propensity-matched to a cohort who received multimodal analgesia based on demographics, surgical approach, and levels fused. LOS was collected for each patient. One year preoperative to 2 postoperative opioid use was obtained from the Pennsylvania Prescription Drug Monitoring Program and included total prescriptions and total morphine milligram equivalents (MMEs). A subanalysis was also performed comparing preoperative, perioperative, and postoperative tramadol consumption during this time frame.</p><p><strong>Results: </strong>A total of 69 patients received an opioid-only pain regimen, while 207 patients received multimodal analgesia. Patients receiving a multimodal pain regimen consumed a higher daily tramadol MME but a comparable total in-hospital MME to patients in the opioid-only cohort. No statistically significant differences existed between cohorts with regards to LOS, preoperative, perioperative, and postoperative opioid consumption, though multimodal patients consumed more tramadol from 0 to 30 days postoperatively.</p><p><strong>Conclusions: </strong>Patients who received a multimodal pain regimen consumed comparable quantities of opioids to those who received opioids alone and did not have a longer LOS following 1 and 2-level lumbar fusion.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"368-373"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945864","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":"Enhancing Recovery in Severe Adolescent Idiopathic Scoliosis (AIS) Patients With Cobb Angle ≥90 Degrees Undergoing Single-staged Posterior Spinal Fusion (PSF): Evaluating the Feasibility of Rapid Recovery Protocol (RRP).","authors":"Saturveithan Chandirasegaran, Chris Yin Wei Chan, Chee Kidd Chiu, Siti Mariam Mohamad, Mohd Shahnaz Hasan, Mun Keong Kwan","doi":"10.1097/BSD.0000000000001755","DOIUrl":"10.1097/BSD.0000000000001755","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To assess the feasibility and outcome of rapid recovery protocol (RRP) in severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥90 degrees underwent single-staged posterior spinal fusion (PSF).</p><p><strong>Summary of background data: </strong>Corrective surgeries in severe AIS patients entail a higher risk of prolonged operation, excessive bleeding, extended hospital stay, and higher complication rates compared with non-severe AIS patients. Implementation of RRP among severe AIS patients has not been reported.</p><p><strong>Methods: </strong>Thirty-seven severe AIS patients who underwent single-staged PSF surgery from 2019 to 2022 were recruited. The RRP consisted of a preoperative regime and counselling, intraoperative strategies to reduce operation duration and blood loss and an accelerated postoperative rehabilitation pathway. Outcome measures were operative time, blood loss, postoperative pain scores, patient-controlled analgesia (PCA) morphine usage, length of hospital stay, and recovery milestones. Descriptive statistics were reported in mean (SD) for numerical data, whereas categorical data were presented in n (%).</p><p><strong>Results: </strong>The mean operation duration was 173.5±39.4 minutes, and the mean blood loss was 1064.6±473.3 mL. The average postoperative hospital stay was 3.2±0.6 days. Twelve hours post-operation pain score was 4.0±2.0 and reduced to 3.9±1.6 at 48 hours. 78.4% of patients discontinued their PCA at 48 hours. First liquid intake was at 6.3±8.5 hours, whereas solid food consumption was initiated at 23.4±14.2 hours. The urinary catheter was removed at 17.8±7.6 hours. Patients started ambulation at 24±12.7 hours, first passed flatus at 37.7±20.4 hours and had their first bowel movement at 122.1±41.7 hours. Three complications (8.1%) were reported, which included superficial surgical site infection, proximal wound stitch abscess and superficial thermal injury due to forced air-warming blanket.</p><p><strong>Conclusion: </strong>The implementation of the RRP after PSF in severe AIS patients was feasible and resulted in a short postoperative hospital stay of 3.2 days without increasing the risk of major complications, readmissions, and reoperations.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"360-367"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920975","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":"Perseverance of Optimal Realignment is Associated With Improved Cost-utility in Adult Cervical Deformity Surgery.","authors":"Peter G Passias, Tyler K Williamson, Jordan Lebovic, Andrew Eck, Andrew J Schoenfeld, Claudia Bennett-Caso, Stephane Owusu-Sarpong, Heiko Koller, Lee Tan, Robert Eastlack, Thomas Buell, Renaud Lafage, Virginie Lafage","doi":"10.1097/BSD.0000000000001759","DOIUrl":"10.1097/BSD.0000000000001759","url":null,"abstract":"<p><strong>Background: </strong>Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction.</p><p><strong>Objective: </strong>Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>ACD patients with 2-year data included. Outcomes: distal junctional failure (DJF), good clinical outcome (GCO):[Meeting 2 of 3: (1) NDI>20 or meeting MCID, (2) mJOA≥14, (3)NRS-Neck improved≥2]. Ideal Outcome defined as GCO without DJF or reoperation. Patient groups were stratified by correction to 'Optimal radiographic outcome', defined by cSVA 9 (<40 mm) AND TS-CL (<15 deg) upon correction. Cost calculated by CMS.com definitions, and cost-per-QALY was calculated by converting NDI to SF-6D. Multivariable analysis controlling for age, baseline T1-slope, cSVA, disability, and frailty, was used to assess complication rates, clinical outcomes, and cost-utility based on meeting optimal radiographic outcome.</p><p><strong>Results: </strong>One hundred forty-six patients included: 52 optimal radiographic realignment (O) and 94 not optimal (NO). NO group presented with higher cSVA and T1-slope. Adjusted analysis showed O group suffered similar 90-day complications ( P >0.8), but less DJK, DJF (0% vs. 18%; P <0.001) and reoperations (18% vs. 35%; P =0.02). Patients meeting optimal radiographic criteria more often met Ideal outcome [odds ratio: 2.2, (1.1-4.8); P =0.03]. Despite no differences in overall cost, O group saw greater clinical improvement, translating to a better cost-utility [mean difference: $91,000, ($49,000-$132,000); P <0.001].</p><p><strong>Conclusion: </strong>Despite similar perioperative courses, patients optimally realigned experienced less junctional failure, leading to better cost-utility compared with those sub-optimally realigned. Perioperative complication risk should not necessarily preclude optimal surgical intervention, and policy efforts might better focus on long-term outcome measures in adult cervical deformity surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"374-380"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945920","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":"Adjacent Segment Pathology After Short-Segment Posterior Lumbar Fusion: Postfusion Acceleration of Degeneration or Pre-Existing Degeneration?","authors":"Fielding Horne, Mara Louis Atherton, Rouzbeh Motiei-Langroudi","doi":"10.1097/BSD.0000000000001762","DOIUrl":"10.1097/BSD.0000000000001762","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of 363 patients who underwent posterior lumbar fusion (PLF).</p><p><strong>Objective: </strong>Adjacent segment pathology (ASP) is a major and common event in patients who have undergone PLF. The objective of this study is to determine if ASP is due to accelerated processes following fusion or to pre-existing degeneration.</p><p><strong>Summary of background data: </strong>ASP is defined as degenerative changes that occur 1-2 levels above or below the site of fusion in patients. The etiology of ASP is a topic of debate.</p><p><strong>Methods: </strong>Preoperative MRIs of 363 individuals who underwent PLF within L2-L3, L3-L4, and L4-L5 at the University of Kentucky between 2010 and 2020 were assessed for evidence of pre-existing degeneration. Measures of degeneration included Pfirrmann grade, modified Pfirrmann grade, disc height, and facet hyperintensity width. Demographic measures, including age, sex, smoking status, and BMI were also assessed.</p><p><strong>Results: </strong>Throughout the follow-up period, 30.0% of patients evaluated were found to have ASP. 83.7% of these happened at the level below and 16.3% happened at the level above the fusion. Paired sample t testing indicated that only disc height was significantly different in the adjacent levels in those who developed ASP. There was no significant difference between the 2 levels for Pfirrmann grade, modified Pfirrmann grade, and facet T2 hyperintensity. Among degenerative measures, only disc height was different (lower) in the level below PLF compared with above, before fusion. Age, sex, and smoking status were not significantly different between those who developed ASP and those who did not ( P =0.68, 0.81, 0.23, respectively).</p><p><strong>Conclusions: </strong>Analysis suggests that in patients undergoing PLF, pre-existing degeneration plays an insignificant role in the development of ASP, and that postoperative acceleration of degenerative changes still represents the primary etiology of ASP.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"381-385"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413603","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":"Ski and Snowboard-Related Spinal Trauma and Spinal Cord Injury: A Northeastern Level I Trauma Experience.","authors":"Khushdeep S Vig, Jillian Kazley, Abdul Arain, Morgan Spurgas, Hamza Murtaza, Gabriella Rivas, Robert Ravinsky, James Lawrence","doi":"10.1097/BSD.0000000000001761","DOIUrl":"10.1097/BSD.0000000000001761","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To review the traumatic spinal injuries in alpine athletes treated at a single level I trauma center.</p><p><strong>Summary of background data: </strong>Recreational and competitive skiers/snowboarders are prone to spinal injuries, and recent changes in the sport may have led to increases in the incidence and severity of spinal injuries. Currently, there is a paucity of data on the epidemiology of spinal injuries resulting from skiing and snowboarding.</p><p><strong>Methods: </strong>A review of patients admitted with traumatic spinal injuries from skiing/snowboarding, between January 2015 and March 2019. Data on demographics, spinal region of injury, mechanism of injury, fracture type, presence/absence of spinal cord injury, ASIA score, management, concomitant injuries, and involvement of other surgical services were collected.</p><p><strong>Results: </strong>Spinal injuries were distributed as 33.3% cervical, 57% thoracic, and 38.0% lumbosacral spine. Seventy-five percent patients injured a single region, 21.7% injured 2 regions, and 3.3% injured all 3. Single-level injuries occurred in 38% patients, II-level in 25%, III-level in 12%, and >3-levels in 28%. Twenty-seven percent patients suffered a spinal cord injury. Eighty-one percent of those had neurological compromise, with a 53.8% rate of full neurological resolution at the time of discharge. 65% fractures were compression-type. Management included operative treatment with decompression and fusion in 32% patients. Cervical spinal injuries were more likely to sustain an extension-distraction type fracture and concomitant spinal cord injury. Thoracic spine injuries were more likely to have multiple vertebral level (>3 vertebrae) involvement. Lumbosacral injuries were more likely to sustain compression type and transverse process fractures. Patients with trauma to all 3 spinal regions were more likely to have translational/rotational injuries, facet fractures, lamina and pedicle fractures, and traumatic anterolistheses.</p><p><strong>Conclusion: </strong>Skiing/snowboarding injuries can be devastating, potentially resulting in permanent neurological compromise and spinal instability. Surgeons and the general population can benefit from improving their understanding of the dangers of alpine sports as it pertains to spinal trauma.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"386-391"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540133","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":"The Use of Semaglutide in Patients Undergoing Lumbar Fusion Does not Increase 90-Day Medical or 1-Year Implant Complications.","authors":"Abdullah Ghali, Jad Lawand, Parker Mitchell, David Momtaz, Umar Ghilzai, Eileen Phan, Jude Alawa, Lorenzo Deveza","doi":"10.1097/BSD.0000000000001800","DOIUrl":"10.1097/BSD.0000000000001800","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study of National Database.</p><p><strong>Objective: </strong>This study examines their effect on medical and mechanical complications within 90 days postlumbar spine surgery.</p><p><strong>Summary of background data: </strong>Patients undergoing spinal procedures increasingly use glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally for type 2 diabetes and now popular for weight loss. The impact of GLP-1 RAs on spinal fusion outcomes is unknown.</p><p><strong>Methods: </strong>This study used medical records from TriNetX, a national deidentified database, to examine diabetic patients undergoing lumbar spine procedures. Patients receiving GLP-1 RAs within 6 months preoperatively were compared with a propensity-matched control group. Propensity score matching (1:1) controlled for demographic factors and comorbidities, including type I and II diabetes, metformin use, and BMI. The study analyzed 90-day medical and 1-year implant complications using χ 2 exact tests and univariate regression in a propensity-matched cohort.</p><p><strong>Results: </strong>The GLP-1 RA cohort and control group included 1110 and 151,440 patients, respectively. Of these, 1090 patients were propensity-matched 1:1 in each cohort. Within 90 days postoperatively, the GLP-1 RA group had higher rates of all-cause anemia (9.4% vs. 7.0%, P =0.016), renal failure (4.4% vs. 2.9%, P =0.028), opioid use (94% vs. 89%, P <0.001), emergency room visits (16% vs. 13%, P =0.013), and wound complications (0.5% vs. 0.2%, P <0.001). Other complications, such as infections, myocardial infarction, pulmonary embolism, deep vein thrombosis, hypoglycemic events, stroke, hospitalization, pneumonia, and transfusion, were similar between groups. One year postoperatively, pseudoarthrosis was less frequent in the GLP-1 RA group (12% vs. 16%, P =0.002). There were no significant differences in hospitalization, adjacent segment disease, mechanical loosening, or postlaminectomy syndrome.</p><p><strong>Conclusion: </strong>This study found that the risk of complications in patients receiving GLP-1 RAs before lumbar spine surgery is comparable to control patients, suggesting GLP-1 RAs do not increase adverse outcomes and should not exclude patients from surgery.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647535","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":"Perioperative Change in Bone Quality Following Posterior Cervical Fusion and Its Effects on Postoperative Outcomes.","authors":"Hannah A Levy, Caden Messer, Tissiana Vallecillo, Zachariah W Pinter, Tyler Allen, Harold I Salmons, Sarah Townsley, Karim Nathani, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, Bradford Currier, Ahmad N Nassr, Brett A Freedman, Brian A Karamian, Arjun S Sebastian","doi":"10.1097/BSD.0000000000001922","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001922","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort analysis.</p><p><strong>Objective: </strong>To determine the effect of long-segment posterior cervical decompression and fusion (PCDF) on perioperative changes in vertebral Hounsfield Units (HUs) and the impact of these changes on radiographic outcomes and fusion status.</p><p><strong>Summary of background data: </strong>Low preoperative CT HUs have been associated with adverse outcomes after spinal fusion, including hardware complications and reoperation. No existing studies have investigated the preoperative to postoperative change in HUs after cervical spinal fusion. Stress shielding may decrease bone quality within the fusion construct. Whereas, altered junctional loading and increased segmental mobility may precipitate bony hypertrophy in the terminal and adjacent levels.</p><p><strong>Methods: </strong>All adult patients who underwent C2-T2 PCDF for myelopathy/ myeloradiculopathy at an academic center between 2013 and 2020 were retrospectively identified. Preoperative and postoperative HUs were assessed on axial CT images in the cranial, middle, and caudal C2, C6, T2, and T3 vertebral bodies, outside of the region of instrumentation and artifact by 2 independent reviewers. Paired t test compared preoperative to postoperative changes in HUs. Preoperative and long-term postoperative cervical alignment, fusion, and revision rates were assessed. Univariate and regression analysis compared patient factors and outcomes between groups with perioperative increase versus decrease in vertebral HUs.</p><p><strong>Results: </strong>One hundred patients were included. The average preoperative to postoperative change in HUs in the C2, C6, T2, and T3 vertebral bodies were -19.80 (P=0.008), -52.63 (P<0.001), 15.15 (P=0.014), and 9.41 (P=0.346), respectively. Perioperative increase in C2 HUs was predictive of increased postoperative distal junctional angle (β=3.41, P=0.048) and increased T1-T4 kyphosis (β=6.50, P=0.003). Perioperative increase in C6 HU predicted pseudoarthrosis (fusion odds ratio: 0.19, P=0.007).</p><p><strong>Conclusions: </strong>Significant perioperative decreases in C6 HUs within a long-fused construct may demonstrate stress shielding. The significant association between greater distal kyphosis and an increase in C2 HUs may be attributed to a stress riser effect.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250074","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":"Surgical Considerations and Neurological Outcomes in Ballistic Penetrating Subaxial Cervical Spine Fractures: A Retrospective Analysis.","authors":"Anudariya Batbold, Christopher Johnson, Arjang Ahmadpour, Dillon Benson, Michael Lee, Mostafa El Dafrawy, Edwin Ramos, Martin Herman","doi":"10.1097/BSD.0000000000001891","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001891","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective analysis.</p><p><strong>Objective: </strong>To understand this condition and optimize management of patients who suffer from this injury.</p><p><strong>Summary of background data: </strong>Ballistic penetrating spine injury is the third most common cause of spinal cord injury. Management strategy for penetrating injury is largely guided from data from blunt injury.</p><p><strong>Methods: </strong>In this study, we present 38 patients who suffered ballistic penetrating injury to the subaxial cervical spine at the University of Chicago Medical Center from April 2018 to July 2022. Data were retrospectively collected.</p><p><strong>Results: </strong>The average age was 30 years old. A total of 92% were male. A total of 84% were African American. A total of 5% were Caucasian and 11% were others. A total of 95% were male and 5% were female. Patients presented with neurological deficits were more likely to have the following: intracanal air (P=0.004), transcanal trajectory (P=0.018), epidural hematoma (P=0.018), intracanal bone (P=0.000), intracanal metal (P=0.018), laminar fracture (P=0.000), vertebral body fracture (P=0.026), pedicle fracture (P=0.001), facet fracture (P=0.002), and involvement of the C5 level (P=0.026). Four patients had full comminuted vertebral body fracture and all 4 had surgery. Eight patients (16.67%) had spinal surgical intervention: 4 patients out of 7 who had improvement in neurological exam had surgical intervention. Surgical treatment of ballistic cervical spine fractures was not associated with an improvement in neurological exam [OR=4 std 3.83 CI (0.61; 26.12) with P=0.148].</p><p><strong>Conclusions: </strong>Those with fully comminuted vertebral body fractures, in our experience, are more likely to collapse and be treated surgically. Our data suggests that surgery may have a benefit in improving neurological outcome in ballistic spinal cord injury, which stands in contrast to prior literature. In this population, we strongly consider surgical intervention in patients with active neuro-compressive pathology, structural instability, or severe kyphosis, though each patient must be considered in the context of their overall outlook and health status.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190999","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":"Patterns of Outpatient Multimodal Analgesic Use Among Postoperative Marijuana Users Undergoing ACDF and Lumbar Fusion.","authors":"Rajkishen Narayanan, Michael Carter, Gregory Toci, Rachel Huang, Jonathan Dalton, Yulia Lee, Michael McCurdy, Yunsoo Lee, Nathaniel Pineda, Shiraz Mumtaz, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BSD.0000000000001818","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001818","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To describe patterns of postoperative analgesia use (opioids, antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines) among postoperative marijuana users after anterior cervical discectomy and fusion (ACDF) and lumbar fusion.</p><p><strong>Summary of background data: </strong>The use of marijuana for pain management is a controversial topic that lacks extensive research. As social and legal acceptance of marijuana increases, questions have arisen about its therapeutic potential alongside prescription analgesic pharmaceutical agents, necessitating further studies on this topic.</p><p><strong>Methods: </strong>Adult patients who underwent either ACDF or lumbar fusion surgery and used marijuana postoperatively were identified. A 1:1 propensity match incorporating patient demographics and levels fused was conducted to compare postoperative marijuana users to nonmarijuana users. One year preoperative and 1 year postoperative opioid use was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Preoperative and postoperative utilization of antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines was obtained from patient chart review and PDMP.</p><p><strong>Results: </strong>Of the 126 included patients, 63 (50%) used marijuana postoperatively. A greater proportion of marijuana users undergoing lumbar fusion used opioids preoperatively compared with nonmarijuana users (P=0.048). No significant differences in preoperative opioid use were demonstrated among ACDF patients. In both ACDF and lumbar fusion cohorts, no differences in postoperative opioid consumption were observed between marijuana and nonmarijuana users. Marijuana usage was associated with higher utilization of serotonin-norepinephrine reuptake inhibitors (SNRIs), specifically duloxetine, in the ACDF cohort (P=0.024). No significant differences in rates of utilization of tricyclic antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines were observed in patients who consumed marijuana compared with nonmarijuana users.</p><p><strong>Conclusions: </strong>Postoperative marijuana use was significantly associated with preoperative opioid use in lumbar fusion patients and duloxetine use in ACDF patients. Postoperative marijuana use was not significantly associated with gabapentinoid, muscle relaxant, or benzodiazepine use.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136650","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}