Clinical Spine Surgery最新文献

{"title":"Anxiety but not Depression Is Associated With Increased Health Care Utilization Following Lumbar Fusion.","authors":"Darren Z Nin, Ya-Wen Chen, Raymond W Hwang, Ruijia Niu, Andrew Powers, David C Chang, David H Kim","doi":"10.1097/BSD.0000000000001783","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001783","url":null,"abstract":"<p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to describe the association between 3 prevalent mental health comorbidities and 1-year health care utilization after lumbar fusion surgery.</p><p><strong>Summary of background data: </strong>The volume of lumbar fusion procedures in the United States is increasing, leading to a substantial postoperative health care burden. Postoperative costs associated with these procedures may be driven by a number of factors, including patient comorbidities.</p><p><strong>Methods: </strong>A large national commercial claims database (MarketScan, Merative) was analyzed. Patients who underwent a single-level lumbar fusion from January 1, 2018, to December 31, 2018, were included in the study. Patients were categorized based on the presence of a prior diagnosis of opioid dependence, anxiety, or depression. The main outcome was the total cost for postoperative interventions in the 1-year period after lumbar fusion. Interventions examined in this study included: (i) physical therapy, (ii) injections, (iii) pain medication, (iv) imaging, (v) clinic visits, and (vi) subsequent spine surgeries.</p><p><strong>Results: </strong>The study population included 4245 patients (anxiety, 19.2%; depression; 19.2%; opioid dependence, 2.6%). The average total 1-year postoperative cost per patient was $8641 ± 19,661. Higher-cost patients were more likely to be those with a prior diagnosis of anxiety (OR 1.41, 95% CI 1.18-1.69, P<0.001) or opioid dependence (OR 1.82, 95% CI 1.23-2.69, P<0.01). Anxiety was found to be associated with the largest relative increases in total costs compared with patients without this diagnosis (+$2,272, P=0.003). The cost of pain medication was 4.2 times higher (P<0.001) among patients with a prior diagnosis of opioid dependence.</p><p><strong>Conclusions: </strong>Patients undergoing single-level lumbar fusion have varying levels of health care utilization, with a prior diagnosis of anxiety likely to drive higher costs.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119129","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":"Utility of Preoperative Whole-Body Imaging in Candidates for Lumbar Spine Surgery: The Impact of Concomitant Lower Extremity Osteoarthritis.","authors":"Omri Maayan, Bo Zhang, Anthony Pajak, Pratyush Shahi, Tejas Subramanian, Troy B Amen, Tomoyuki Asada, Nishtha Singh, Kasra Araghi, Maximillian K Korsun, Sumedha Singh, Olivia C Tuma, Evan D Sheha, James E Dowdell, Sravisht Iyer, Sheeraz A Qureshi, Francis C Lovecchio","doi":"10.1097/BSD.0000000000001828","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001828","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess the utility of whole-body imaging in diagnosing lower extremity osteoarthritis (LEOA), evaluate the association of LEOA with radiculopathy, and determine the impact of LEOA on postoperative recovery.</p><p><strong>Summary of background data: </strong>Whole-body imaging offers rapid, low-radiation assessment of both spinal and lower extremity pathology. This modality may be pivotal in helping clinicians better understand how lower extremity pathology influences clinical presentation and recovery among patients with degenerative lumbar conditions.</p><p><strong>Methods: </strong>Patients with preoperative whole-body imaging who underwent lumbar spine surgery for degenerative conditions between 2017 and 2022 were included. The Kellgren and Lawrence (KL) score was implemented to grade joint osteoarthritis (OA) as mild (KL ≤2) or severe (KL ≥3). Length of stay (LOS) and side of radiculopathy were assessed. The Oswestry disability index (ODI), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS), visual analog scale (VAS), and Short Form-12 (SF-12) Physical/Mental Component Scales (PCS/MCS) were recorded at preoperative, early-postoperative (2, 6, 12 weeks), and late-postoperative (6, 12, 24 months) timepoints. The association of HOA/KOA with PROMs and minimum clinically important difference (MCID) was evaluated.</p><p><strong>Results: </strong>Totally, 207 patients were included (HOA: n=130 mild, n=62 severe; KOA: n=141 mild, n=53 severe). Patients with severe OA were significantly older compared with patients with mild OA (P<0.05). OA laterality was not associated with side of radiculopathy. After controlling for age, LOS was ∼50% greater for severe HOA (P=0.031) and severe KOA (P=0.013) compared with mild OA. Severe KOA exhibited worse PROMIS at the early-postoperative timepoint (P=0.013), and worse PROMIS (P=0.049), VAS-back (P=0.009), and SF-12-PCS (P=0.025) at the late-postoperative timepoint. Severe HOA and KOA reduced the likelihood of achieving MCID for SF-12-PCS (OR: 0.44; P=0.049) and PROMIS (OR: 0.37; P=0.027), respectively.</p><p><strong>Conclusions: </strong>Whole-body imaging may help improve patient-specific counseling on expectations after lumbar spine surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076538","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":"Race, Region, and Reimbursement: Sociodemographic Variations in Medicare Payments for Spine Surgery in the United States, 2014-2022.","authors":"Daniel Schneider, Ethan D L Brown, Harshal A Shah, Sheng-Fu L Lo, Daniel M Sciubba","doi":"10.1097/BSD.0000000000001834","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001834","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective.</p><p><strong>Objective: </strong>Assess whether Medicare adjustments adequately correct for systemic population-level payment variations.</p><p><strong>Summary of background data: </strong>Medicare currently uses payment adjustments for spine surgery, including clinical risk, geography, and socioeconomic status.</p><p><strong>Methods: </strong>Using Medicare fee-for-service claims from 2014 to 2022, we conducted a retrospective cohort study of spine-related diagnosis-related groups (459 state-year observations). Multivariable regression models examined associations between payments and sociodemographic factors, controlling for existing Medicare adjustments.</p><p><strong>Results: </strong>Significant disparities persisted despite adjustment. Each percentage-point increase in Black beneficiaries was associated with $172 higher payments (95% CI: $111-$232, P<0.001), while Hispanic population increases showed the opposite effect (-$174 per point; 95% CI: -$252 to -$96, P<0.001). Areas with above-median female proportions had $1596 higher payments (95% CI: $580-$2611, P=0.002). Regional variations were notable: payments were higher in the West ($11,060), Northeast ($5762), and Midwest ($3210) than in the South (all P<0.001).</p><p><strong>Conclusions: </strong>Medicare payments for inpatient spine care demonstrate persistent demographic disparities unaddressed by current risk-adjustment models. Future research should determine whether these variations indicate appropriate adjustments for care needs or systematic underpayment or overpayment for the treatment of particular populations.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985411","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 Role of the Glymphatic System in Cervical Spondylotic Myelopathy: Insights From Advanced Imaging.","authors":"Justin K Zhang, Saad Javeed, Jacob K Greenberg, Salim Yakdan, Sama Noroozi Gilandehi, Lubdha M Shah, Rajiv R Iyer, Andrew T Dailey, Erica F Bisson, Mark A Mahan, Marcus D Mazur, Sheng-Kwei Song, Wilson Z Ray","doi":"10.1097/BSD.0000000000001763","DOIUrl":"10.1097/BSD.0000000000001763","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Objective: </strong>To provide a primer of the glymphatic system, discuss its potential relevance in evaluating spinal diseases like cervical spondylotic myelopathy (CSM), and describe possible imaging markers of the glymphatic system derived from advanced diffusion-weighted imaging (dMRI), namely diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI).</p><p><strong>Summary of background data: </strong>The glymphatic system is a recently described physiological process that plays an integral role in macroscopic waste clearance in the CNS through cerebrospinal fluid (CSF)-interstitial fluid (ISF) exchange. Chronic spinal cord compression in CSM leads to pathophysiological consequences that theoretically affect the glymphatic system, and advanced dMRI may be well positioned to characterize these changes.</p><p><strong>Methods: </strong>This single-center study enrolled participants (control and CSM) from 2018 through 2020. All participants underwent clinical assessments and dMRI, followed by DTI and DBSI analyses, preoperatively and 2 years postoperatively. CSF flow was characterized by DTI-derived apparent diffusion coefficient (ADC) and ISF flow by DBSI-derived extra-axonal axial diffusivity (EA-AD) and radial diffusivity (EA-RD). Imaging parameters were compared among participants.</p><p><strong>Results: </strong>Forty-two patients with CSM [23 (55%) mild, 9 (24%) moderate, 10 (21%) severe] and 20 control patients were included. Preoperatively, ADC was significantly lower in CSM (2.59±0.4 µm 2 /ms) than control (3.08±0.34 µm 2 /ms) patients ( P <0.01). Conversely, EA-AD and EA-RD were significantly higher in CSM (2.53±0.33; 0.48±0.13 µm 2 /ms) compared with control (2.27±0.2; 0.40±0.04 µm 2 /ms) patients (both P <0.01). Two years postoperatively, only EA-RD significantly decreased for CSM patients (Δ-0.04±0.12 µm 2 /ms, P <0.01). More severe CSM preoperatively was associated with lower baseline ADC (ρ=0.49, P <0.001) and higher baseline EA-RD (ρ=-0.35, P =0.005).</p><p><strong>Conclusions: </strong>The pathophysiology of CSM may affect the glymphatic system because of chronic spinal cord compression that decreases CSF bulk flow, leading to compensatory increases in ISF flow. Although research in this topic remains nascent, greater glymphatic system function observed on dMRI may correspond with greater disease burden. Future studies examining the role of the glymphatic system in spinal cord pathology are critical to better understanding how these noninvasive imaging biomarkers can improve patient outcomes in CSM.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"204-212"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Cervical Laminoplasty Incidence in the United States: A Comparison of Commercial Insurance, Medicare, and Device Manufacturer Databases.","authors":"Prashant V Rajan, Kevin Heo, John G Heller, Sangwook Tim Yoon","doi":"10.1097/BSD.0000000000001729","DOIUrl":"10.1097/BSD.0000000000001729","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective database study.</p><p><strong>Objective: </strong>To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).</p><p><strong>Summary of background data: </strong>With purported benefits of motion preservation and lower complication rates than fusion, cervical laminoplasty is an important surgical technique. However, current commercial database studies suggest that laminoplasty adoption in the United States has been slow.</p><p><strong>Methods: </strong>The primary outcome was the total volume of laminoplasty procedures performed in the United States per year. Truven, a large commercial insurance claims database, was used to estimate laminoplasty volume from 2009 to 2019. Volume estimates for posterior cervical fusions were also generated as a comparator. Reimbursement data for laminoplasty adjusted for inflation were also generated. Trends in national procedural volumes and reimbursement over time were assessed with the Pearson correlation test. CMS Part B national summary statistics from 2000 to 2022 and market data from laminoplasty device manufacturers from 2017 to 2024 were qualitatively compared with volume estimates from Truven.</p><p><strong>Results: </strong>Truven volume of laminoplasty remained stable throughout the study period with an estimated annual volume of 944-1590 cases. Posterior cervical fusion volume was much higher, ranging from 7930 to 11,874 cases with increased trend. When compared qualitatively, Truven volume estimates were similar to those from CMS data, although industry volume estimates were comparatively higher (estimated total volume of 8352-11,428 cases). There was no statistically significant trend in Truven reimbursement values for laminoplasty from 2009 to 2019.</p><p><strong>Conclusions: </strong>Industry market data suggest more laminoplasty procedures are being performed nationally than what is estimated by commercial/CMS databases. This suggests possible growth in laminoplasty usage, given purported advantages to fusion in the properly indicated patient, and possibly calls into question the epidemiological accuracy of commercial claims databases.</p><p><strong>Level of evidence: </strong>IV-Retrospective study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"161-168"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945862","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":"Are Postoperative Neck Pain and Kyphotic Change After Laminoplasty Affected by Degree of Facet Joint Degeneration?","authors":"Gumin Jeong, Sehan Park, San Kim, Chang Ju Hwang, Jae Hwan Cho, Dong-Ho Lee","doi":"10.1097/BSD.0000000000001760","DOIUrl":"10.1097/BSD.0000000000001760","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>To date, the association between postlaminoplasty neck pain or kyphosis and facet joint degeneration (FJD) remains unknown. Therefore, this study aimed to determine whether FJD affects postlaminoplasty neck pain or kyphosis.</p><p><strong>Summary of background data: </strong>FJD can cause medial branch irritation leading to postlaminoplasty neck pain. Cervical lordosis is a prerequisite for laminoplasty as it achieves cord decompression through posterior shifting.</p><p><strong>Methods: </strong>This study included 126 consecutive patients who underwent laminoplasty and were followed up for a minimum of 2 years. The radiographic cervical sagittal parameters, neck pain visual analog scale (VAS), arm pain VAS, neck disability index (NDI), and Japanese Orthopedic Association score were evaluated. A comparison was made between patients with moderate-to-severe neck pain (neck pain VAS ≥4; severe neck pain group) and those with mild or no neck pain (neck pain VAS <4; mild neck pain group) at the 2-year follow-up. Furthermore, patients who experienced postlaminoplasty kyphosis of C2-C7 (kyphotic group) were compared with those who did not develop kyphosis (nonkyphotic group).</p><p><strong>Results: </strong>The mild and severe neck pain groups included 99 (78.6%) and 27 (21.4%) patients, respectively. The preoperative degree of FJD was significantly higher in the severe neck pain group ( P =0.040). The cervical sagittal parameters and demographics did not exhibit significant intergroup differences. Multivariate logistic regression analysis revealed that higher preoperative FJD grade was associated with postoperative severe neck pain ( P =0.046). In addition, lesser preoperative C2-C7 extension capacity was identified as a factor influencing postoperative kyphosis ( P =0.027).</p><p><strong>Conclusions: </strong>This study demonstrates that patients with higher preoperative FJD are more likely to experience postoperative severe neck pain. However, it did not find an association between FJD and postlaminoplasty kyphosis, indicating that FJD does not influence cervical alignment aggravation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"174-181"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751489","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":"Fusion Outcomes of GLP-1 Agonist Therapy in Multilevel Cervical Spinal Fusion: A Propensity-Matched Analysis.","authors":"Sohrab K Vatsia, Michael F Levidy, Nicholas D Rowe, Andrew S Meister, Jesse E Bible","doi":"10.1097/BSD.0000000000001775","DOIUrl":"10.1097/BSD.0000000000001775","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effects of GLP-1 agonist therapy upon the incidence of pseudarthrosis in patients undergoing multilevel cervical spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of background data: &lt;/strong&gt;The rising prevalence of obesity and diabetes mellitus has rendered the usage of glucagon-like peptide-1 receptor (GLP-1) agonists increasingly commonplace since their introduction in 2005. However, there is a dearth of evidence to suggest whether outcomes of multilevel cervical spinal fusion differ in patients treated with GLP-1 agonists. This study assesses rates of pseudarthrosis in patients who underwent multilevel cervical spine fusion with and without concurrent GLP-1 agonist therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The TriNetX, LLC Diamond Network database was queried utilizing CPT codes for patients undergoing both anterior and posterior multilevel cervical spinal fusion from 2005 to 2024. Patients prescribed liraglutide, pramlintide, tirzepatide, semaglutide, lixisenatide, or dulaglutide within 1 year of surgery were propensity matched to patients without GLP-1 agonist prescriptions. Cohort balancing was achieved categorically according to age at procedure, race, sex, and nicotine dependence. Cohort balancing was performed continuously to account for body mass index and hemoglobin A1C at the time of procedure. CPT diagnosis codes for pseudarthrosis after attempted fusion were concomitantly utilized to assess pseudarthrosis rates at 6-months, 1-year, and 2-years postoperatively using the Fisher exact test. Statistical significance was set at P &lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In consideration of anterior multilevel cervical fusion, 1204 patients utilized GLP-1 agonist therapy, while 1204 patients did not use GLP-1 agonists. With respect to posterior multilevel cervical fusion, 1378 patients utilized GLP-1 agonist therapy, and 1378 patients did not have a GLP-1 agonist prescription. Anterior postoperative pseudarthrosis rates were significantly decreased in the GLP-1 agonist cohort versus the non-GLP-1 agonist cohort at 6-months (10.71% vs. 17.61%; P &lt;0.001), 1-year (12.04% vs. 18.52%; P &lt;0.001), and 2-years (12.87% vs. 19.19%; P &lt;0.001). Posterior postoperative pseudarthrosis rates were also significantly decreased in the GLP-1 agonist cohort versus the non-GLP-1 agonist cohort at 6-months (13.21% vs. 22.28%; P &lt;0.001), 1-year (14.37% vs. 24.45%; P &lt;0.001), and 2-years (16.87% vs. 24.43%; P &lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings demonstrate a statistically significant lower incidence of pseudarthrosis among patients treated with GLP-1 agonist therapy at all timepoints within this study-from 6-months to 2-years postoperatively, suggesting a potentially beneficial effect of GLP-1 agonist therapy in promoting fusion success in multilevel cervical spine surgery. Fundamentally, this aligns with the pharmacodynamic nature of GLP-1 agonists","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"213-216"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555966","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":"Do Patients With High ASA Grades Benefit From CSM Surgery?: A Report From the Quality Outcomes Database.","authors":"Vardhaan S Ambati, Arati Patel, Abraham Dada, Mohamed Macki, Andrew K Chan, Dean Chou, Erica Bisson, Mohamad Bydon, Anthony Asher, Domagoj Coric, Eric Potts, Kevin Foley, Michael Wang, Kai-Ming Fu, Michael Virk, John Knightly, Scott Meyer, Paul Park, Cheerag Upadhyaya, Luis Tumialán, Jay Turner, Juan Uribe, Oren Gottfried, Christopher Shaffrey, Regis W Haid, Anthony DiGiorgio, Praveen V Mummaneni","doi":"10.1097/BSD.0000000000001774","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001774","url":null,"abstract":"<p><strong>Study design: </strong>Analysis of prospectively collected data.</p><p><strong>Objective: </strong>To assess if systemic illness severity affects cervical spondylotic myelopathy (CSM) surgery outcomes.</p><p><strong>Summary of background data: </strong>It remains unclear if CSM patients with poor physical status/severe systemic illness benefit as much from surgery as those in good condition.</p><p><strong>Methods: </strong>Using the Quality Outcomes Database CSM cohort and the American Association of Anesthesiology (ASA) grade as a surrogate for illness burden, we compared patients with (ASA 3-4) and without (ASA 1-2) severe systemic illness, including rates of readmission and 24-month minimal clinically important differences (MCID) achievement for patient-reported outcomes (PROs)-numerical rating score (NRS) arm and neck pain, neck pain-related disability (NDI), and quality of life (EQ-5D).</p><p><strong>Results: </strong>Of 1141 CSM patients, 1062 had ASA grades recorded. Of these 1062 patients, 70.2% had a 2-year follow-up for mJOA, and 81%-84% had a follow-up for NRS arm and neck, NDI, and EQ-5D. Five hundred twenty-one patients (49.1%) had mild (ASA 1-2) and 541 (50.9%) had severe systemic illness (ASA 3-4). The severe disease cohort was older (63.3±11.0 vs. 57.4±11.7), had higher BMI (31.4±7.0 vs. 28.9±5.6), had more comorbidities (diabetes, coronary artery disease, depression), and had less independent ambulation (71.3% vs. 90.6%) ( P <0.05). At baseline, severe disease patients had worse NRS arm (5.2±3.5 vs. 4.7±3.4) and neck (5.5±3.2 vs. 5.1±3.3) pain, NDI (40.5±20.1 vs. 36.8±21.0), and EQ-5D (0.53±0.22 vs. 0.59±0.22) scores ( P <0.05). Perioperatively, the severe disease cohort had longer hospitalizations (2.4±2.6 vs. 1.7±2.0 days) and increased nonhome discharges (17% vs. 5%) ( P <0.05).The severe disease cohort had higher 90-day readmissions (7.6% vs. 2.5%), including surgery-related (3.7% vs. 1.5%) and non-surgery-related reasons (3.9% vs. 1.0%) ( P <0.05). On multivariate analysis, increased ASA grade was significantly associated with 90-day readmissions (OR: 2.55 per 1-grade increase, 95% CI: 1.38-4.83). However, both severe and mild disease cohorts had similarly high rates of achieving 2-year MCID for mJOA (67.5% vs. 66.0%), NRS arm (72.0% vs. 74.1%), neck (69.5% vs. 69.4%) pain, NDI (63.1% vs. 68.1%), and EQ-5D (67.9% vs. 66.9%) ( P >0.05).</p><p><strong>Conclusion: </strong>Patients with severe systemic illness (higher ASA) have worse baseline PROs and higher 90-day readmissions. However, they achieve similar MCID rates for mJOA and all measured PROs 2 years postoperatively.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":"38 4","pages":"197-203"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966802","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":"Comparing Spinopelvic Angles and Magnification on Supine MRI With Standing Radiographs in Lumbar Spinal Stenosis.","authors":"Aryan Banitalebi, Ivar Rossvoll, Hasan Banitalebi, Tor Åge Myklebust, Erland Hermansen","doi":"10.1097/BSD.0000000000001814","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001814","url":null,"abstract":"<p><strong>Study design: </strong>Radiologic cross-sectional study based on a prospective cohort study (level III).</p><p><strong>Objective: </strong>Investigate whether lumbar lordosis (LL) and sacral slope (SS) differ significantly on supine magnetic resonance imaging (MRI) versus standing radiographs in nondeformity lumbar spinal stenosis (LSS). Secondly, to quantify the amount of magnification on standing lumbar radiographs.</p><p><strong>Summary of background data: </strong>Supine MRI is routinely performed when diagnosing LSS. Standing radiographs are often supplemented to measure spinopelvic angles. Little research has been done on whether LL and SS translate from standing radiographs to supine MRI. Previous studies have trended to significant changes in LL and SS; however, none have been performed exclusively in nondeformity LSS.</p><p><strong>Materials and methods: </strong>Review of preoperative standing lateral lumbar radiographs and midsagittal T2-weighted supine lumbar MRI in 211 patients with LSS without concomitant degenerative spondylolisthesis, measuring LL (L1-S1), segmental lumbar lordosis (sLL) (L4-S1) and SS, in addition to the anteroposterior diameter and height of the L3 vertebral body. We conducted a reliability study and performed a Pearson's correlation analysis. Data was presented in Bland-Altman plots.</p><p><strong>Results: </strong>Interobserver reliability was good to excellent, with ICC ranging from 0.77 to 0.94 for all parameters. Statistically significant differences were observed in LL and SS between image modalities. The mean radiographic measurements were as follows: LL 48.9 (SD: 12.8), sLL 32.3 (SD: 8.1), and SS 37.3 (SD: 8.7) degrees. The mean MRI measurements were as follows: LL 46.0 (SD: 10.5), sLL 32.3 (SD: 7.1), and SS 38.1 (SD: 7.1) degrees. Mean vertebral body magnification was between 21% and 23% for L3 anteroposterior diameter and height.</p><p><strong>Conclusions: </strong>Our results suggest that supine lumbar MRI might be a viable alternative to standing lateral lumbar radiographs for measuring LL and SS in routine follow-up for patients with LSS without concomitant spinal deformity. Standing radiographs are recommended as part of the initial investigation for LSS. Standing lumbar radiographs may yield high grades of magnification.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995655","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":"Adoption of Endoscopic Spine Surgery: A 6-Year National Utilization Analysis.","authors":"Rohan Vemu, Mohammed S Abdullah, Sachin Gupta, David Casper, Amrit Khalsa, Bijan Dehghani","doi":"10.1097/BSD.0000000000001830","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001830","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive study.</p><p><strong>Objective: </strong>To determine national trends in utilization of endoscopic spine surgery from 2017 to 2022.</p><p><strong>Summary of background data: </strong>Endoscopic spine surgery (ESS) has emerged as a potential, minimally invasive approach to treat certain symptomatic spinal pathology. The benefits of ESS have not been well established; however, small case series suggest possible improvement in postoperative complications rates, decreased length of stay, and improved outcomes in comparison to traditional techniques. Despite this, adoption of ESS is not widespread in the United States.</p><p><strong>Methods: </strong>Patients undergoing ESS were identified using the CPT code 62380 in the PearlDiver M165Ortho database from 2017 to 2022. Demographic factors extracted included: (1) age, (2) sex, (3) Elixhauser comorbidity index (ECI), (4) Charlson comorbidity index (CCI), (5) geographic region of surgery, (6) type of insurance plan (Commercial, Medicaid, Medicare), and (7) timing of the surgery.</p><p><strong>Results: </strong>A total of 1886 patients who have undergone ESS were identified from 2017 to 2022. The utilization of ESS peaked in 2018 but reached a plateau after. The largest proportion of patients receiving ESS were over the age of 70 (30%) with 51% female (n=968). In addition, the majority of ESS were performed in the South (47.8%), and most payers utilized commercial health insurance (70.9%). Comorbidity indices for ESS patients were tracked: mean ECI +/- SD: 5.04+/-3.68; median ECI: 4 and mean CCI: 2.06; median CCI: 2.</p><p><strong>Conclusions: </strong>The limited widespread adoption of ESS can be multifactorial. As with all new technologies, there is hesitation for early adoption, additionally the lack of standardized surgeon education, limited scope of procedure, and need for advanced surgical tools serve as possible reasons contributing to the trends in usage.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988053","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}