Clinical Spine Surgery最新文献

{"title":"Anesthesia and Pain Management for Scoliosis Surgery: A Narrative Review.","authors":"Małgorzata Reysner, Grzegorz Kowalski, Alicja Geisler-Wojciechowska, Tomasz Resyner, Katarzyna Wieczorowska-Tobis","doi":"10.1097/BSD.0000000000001758","DOIUrl":"10.1097/BSD.0000000000001758","url":null,"abstract":"<p><strong>Study design: </strong>This was a narrative review.</p><p><strong>Objective: </strong>The objective of this review was to summarize the current evidence and knowledge gaps regarding anesthesia and pain management for scoliosis surgery, including multimodal analgesia, and identify the best anesthetic approach to scoliosis surgery that ensures patient safety and pain relief even in the postoperative period, with minimal influence on SSEP monitoring.</p><p><strong>Summary of background data: </strong>Spinal surgeries and fusions for scoliosis are associated with high pain levels. Inadequate analgesia can cause patient dissatisfaction, delay recovery, and increase the risk of chronic pain. Despite serious side effects, opioids are the mainstay of pain medication after scoliosis surgery. However, increasing emphasis on minimizing opioids and accelerating recovery has increased the adoption of multimodal analgesic therapy.</p><p><strong>Materials and methods: </strong>The literature review was performed on standards of care, a pain management protocol, current therapeutic options, and innovative treatment options for patients undergoing scoliosis surgery. The literature was reviewed through 4 electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase.</p><p><strong>Results: </strong>The initial search yielded 994 articles. Forty-seven relevant articles were selected based on relevance, recentness, search quality, and citations. Ten studies described the influence of different methods of anesthesia on neuromonitoring. Twenty-one researchers studied the effect of analgesics and coanalgesics on pain relief protocol. Nine studies treated regional anesthesia and its influence on pain management.</p><p><strong>Conclusions: </strong>The most suitable anesthetic approach that does not disturb the neuromonitoring is obtained by combining total intravenous anesthesia (TIVA) with remifentanil and propofol with regional anesthesia, particularly erector spinae plane block (ESPB), as a part of a multimodal analgesia protocol.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"259-265"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920974","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":"Cervical Degenerative Myelopathy Is an Unexpected Risk Factor for Hip Fractures.","authors":"Nicolas Plais, Adoración Garzón-Alfaro, Carlos José Carrasco Jiménez, Maria Isabel Almagro Gil, Enrique Jiménez-Herrero, Rafael Carlos Gómez Sánchez, José Luis Martín Roldán, Virginie Lafage, Frank Schwab","doi":"10.1097/BSD.0000000000001742","DOIUrl":"10.1097/BSD.0000000000001742","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>To assess the potential role of degenerative myelopathy as a risk factor for major fragility fractures in older patients.</p><p><strong>Background: </strong>Degenerative cervical myelopathy (DCM) stands as the foremost spinal disorder affecting adults, significantly impacting patients' quality of life. However, it is often underdiagnosed, with its prevalence traditionally considered low (0.06%-0.112%). Despite the rising prevalence of hip fractures with an aging population and the identification of numerous risk factors, DCM is not typically regarded as a primary risk factor for such fractures. In 2015, an American study revealed an unexpectedly high rate of 18% of undiagnosed DCM in patients with hip fractures within a small cohort. We sought to replicate this study in a larger cohort of a European population.</p><p><strong>Materials and methods: </strong>Our cross-sectional study targeted patients older than 65 years with hip fractures and aimed to identify cases of DCM at the time of fracture. Exclusions were made for patients with preexisting DCM diagnoses, neurological disorders, prior cervical surgeries, and instances of high-energy trauma. Comprehensive demographic, clinical, and radiologic data were collected, followed by descriptive and statistical analysis.</p><p><strong>Results: </strong>In our study, 147 patients (mean age: 82.9 y) were included. Through a combination of clinical assessment and physical examination, 23 patients (15.6%) were identified as indicative of myelopathy. Confirmation through magnetic resonance imaging led to an estimated overall prevalence of DCM at 10.5%. Logistic regression analysis revealed that the presence of hypertonic reflexes, cervical pain, or cervicobrachialgia were specific and valuable indicators for diagnosing myelopathy.</p><p><strong>Conclusion: </strong>This study marks the first investigation of its kind in a European population, highlighting the notably high prevalence of undiagnosed DCM among older patients who have experienced hip fractures. This underscores DCM as a potential risk factor for hip fractures in the elderly, despite its underdiagnosis and undertreatment.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E358-E363"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709374","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":"Prior Antidepressant Prescription Is Associated With Greater Opioid Prescriptions and Complications in Cervical Spine Surgery: A Propensity Matched Cohort Study.","authors":"Abdullah Ghali, Jad Lawand, Aaron Singh, Alexander Mihas, Meghana Jami, Anthony Farhat, Lorenzo Deveza","doi":"10.1097/BSD.0000000000001730","DOIUrl":"10.1097/BSD.0000000000001730","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of national database.</p><p><strong>Objective: </strong>This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.</p><p><strong>Summary of background data: </strong>Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.</p><p><strong>Methods: </strong>Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.</p><p><strong>Results: </strong>In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P <0.0001), 6 months (OR 1.36, P <0.0001), 12 months (OR 1.36, P <0.0001), and 24 months (OR 1.33, P <0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P =0.0082) and 24 months (OR 1.083, P =0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P =0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P =0.0013) and 24 months (OR 1.18, P <0.0001). Adjacent segment disease (OR 1.54, P <0.0001 at 24 mo), hardware failure (OR 1.42, P =0.013 at 24 mo), and pseudarthrosis (OR 1.48, P <0.0001 at 24 mo) were also significantly higher in the ADP group.</p><p><strong>Conclusions: </strong>Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E327-E333"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945907","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":"Lower Incidence of ASP Requiring Surgery With Minimally Invasive TLIF Than With Open PLIF: A Long-term Analysis of Adjacent Segment Survival.","authors":"Young-Ho Roh, Jaewan Soh, Jae Chul Lee, Hae-Dong Jang, Sung-Woo Choi, Byung-Joon Shin","doi":"10.1097/BSD.0000000000001741","DOIUrl":"10.1097/BSD.0000000000001741","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To assess the incidence of and risk factors for adjacent segment pathology (ASP) requiring surgery among patients previously treated with spinal fusion. Survival of the adjacent segment was compared in patients undergoing open posterior lumbar interbody fusion (O-PLIF) versus minimally invasive transforaminal interbody fusion (MI-TLIF).</p><p><strong>Summary of background data: </strong>Compared with O-PLIF, MI-TLIF may reduce ASP in the long term by preserving more of the paraspinal muscle and ligamentous structures connected to adjacent segments.</p><p><strong>Methods: </strong>The study population consisted of 740 consecutive patients who had undergone lumbar spinal fusion of 3 or fewer segments. O-PLIF was performed in 564 patients, and MI-TLIF in 176 patients. The incidence and prevalence of revision surgery for ASP were calculated using the Kaplan-Meier method. A risk factor analysis was performed using the log-rank test and a Cox regression analysis.</p><p><strong>Results: </strong>After index spinal fusion, 26 patients (3.5%) underwent additional surgery for ASP. Kaplan-Meier analysis predicted a disease-free survival rate of adjacent segments in 87.2% at 10 years after the index operation. The incidence of ASP requiring surgery within 10 years was 16.4% after O-PLIF and 6.1% after MI-TLIF ( P =0.045). This result was supported by the Cox regression analysis, which showed a significant difference between MI-TLIF and O-PLIF ( P =0.034). The hazard ratio of revision surgery was about 3 times higher with O-PLIF than with MI-TLIF. Patients 65 years or older at the time of the index operation were 2.9 times more likely to undergo revision surgery than those younger than 65 years ( P =0.015).</p><p><strong>Conclusions: </strong>MI-TLIF results in less ASP requiring surgery than O-PLIF. 65 years or older is an independent risk factor for ASP. By preserving the soft tissues, MI-TLIF may result in a lower incidence of ASP than the open technique.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E340-E348"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726451","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":"Toward Identifying and Resolving the Challenges to the Prognostic Validation of the Classifications for Thoracolumbar Burst Fractures: A Narrative Review.","authors":"Mohamed M Aly, Mohammad El-Sharkawi, Andrei F Joaquim, Javier Pizones, Xavier A Santander Espinoza, Eugen C Popescu, Abdulaziz Bin Shebree N, Paul Gerdhem, Cumhur F Öner","doi":"10.1097/BSD.0000000000001764","DOIUrl":"10.1097/BSD.0000000000001764","url":null,"abstract":"<p><strong>Objective: </strong>To review the historical thoracolumbar burst fractures (TLBFs) classifications and discuss the probable gaps for their clinical validation.</p><p><strong>Summary of background data: </strong>Despite multiple classification schemes, the treatment decisions for TLBFs in neurologically intact patients remain controversial. There are gaps between the current classifications and their predictive validation.</p><p><strong>Methods: </strong>A narrative literature review.</p><p><strong>Results: </strong>The potential barriers to establishing the predictive value of the current classifications of TLBFs could be connected to validation studies' flaws such as nonvalidated outcome measures and challenges of randomization. It could also be related to limited interobserver reliability in diagnosing A3/A4 fractures. Finally, it might be attributed to the inability to incorporate all prognostic variables, such as computed tomography (CT) parameters, patient-related factors, and traumatic disc injury, may result in failed validation.</p><p><strong>Conclusion: </strong>AOSpine Patient and Clinical Reported Outcome Spine Trauma (PROST) and a recently proposed natural experiment observational study hold promise for mitigating methodological challenges. A structured approach for distinguishing A3/A4 fractures and standardized CT criteria for PLC injury is critical to improving reliability. Finally, a treatment algorithm incorporating all potential prognostic variables, independent of the morphologic classification, may improve the predictive value of the classification. Machine learning techniques could be helpful in this context.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"266-277"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691440","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":"Smoking Does Not Negatively Impact Outcomes Following Cervical Laminoplasty: A Quality Outcomes Database Study.","authors":"Brian Q Hou, Andrew Croft, Hani Chanbour, Omar Zakieh, Hui Nian, Jacquelyn S Pennings, Mitchell Bowers, Mason W Young, William H Waddell, Amir M Abtahi, Raymond J Gardocki, Julian G Lugo-Pico, Scott L Zuckerman, Byron F Stephens","doi":"10.1097/BSD.0000000000001732","DOIUrl":"10.1097/BSD.0000000000001732","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess the impact of smoking on outcomes following elective cervical laminoplasty for degenerative cervical myelopathy (DCM).</p><p><strong>Summary of background data: </strong>The detrimental effect of cigarette smoking on cervical spinal fusion surgery outcomes is well documented. However, the impact of smoking on outcomes following nonfusion cervical spine procedures is unknown. One commonly utilized nonfusion technique for cervical decompression is laminoplasty.</p><p><strong>Methods: </strong>Adult smokers or nonsmokers who underwent primary elective laminoplasty for DCM were included. The propensity score (PS) was constructed for being a current smoker based on covariates. Only patients contained in the PS overlapped region were included in the analysis set. Patient-reported outcomes (PROs) at baseline and 12 months postoperation included Visual Analog Scale (VAS) neck and arm pain, neck disability index (NDI)%, EuroQol-5 Dimension (EQ-5D), and modified Japanese Orthopedic Association (mJOA) scores. Other outcomes included perioperative complications, 3-month readmissions/reoperations, and patient satisfaction. Wilcoxon and Pearson tests were used to compare outcomes between smokers and nonsmokers.</p><p><strong>Results: </strong>The study included 132 patients: 30 were smokers (22.7%) and 102 were nonsmokers (77.3%). No significant differences were found at baseline between groups in demographics or medical history. Smokers had significantly worse baseline VAS neck pain (5.7±3.2 vs. 4.4±3.04, P =0.028) and arm pain (5.7±3.5 vs. 4.3±3.2, P =0.045) scores, but all other baseline PROs were not statistically different between groups. No differences were found between smokers and nonsmokers in any 12-month PRO, or in rates of perioperative complications, 3-month readmissions, or 3-month reoperations. On multivariable logistic regression analysis, smoking had no significant impact on any outcome of interest.</p><p><strong>Conclusion: </strong>Clinical and PROs following elective laminoplasty for DCM are not significantly different between smokers and nonsmokers. Laminoplasty should be considered a good surgical option in smokers presenting with DCM.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E316-E321"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681059","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":"Utilization of Neuromonitoring in Surgical Cervical Spondylosis Patients With the Presence or Absence of Myelopathy: Is It Standard?","authors":"Glenn A Gonzalez, Katherine Corso, Guilherme Porto, Jill Ruppenkamp, Jingya Miao, Daniel Franco, Kevin Hines, Matthew O'Leary, Sara Thalheimer, James Harrop","doi":"10.1097/BSD.0000000000001739","DOIUrl":"10.1097/BSD.0000000000001739","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional, observational study.</p><p><strong>Objective: </strong>Investigate the frequency of intraoperative neuromonitoring (IONM) utilization among Medicare patients diagnosed with cervical spondylosis (CS), both with and without myelopathy.</p><p><strong>Background: </strong>IONM is widely used as a tool in spine surgery. However, the overall prevalence of neuromonitoring utilization among CS undergoing surgical intervention is not well characterized.</p><p><strong>Methods: </strong>This study observed neuromonitoring usage in CS patients who had cervical spinal procedures from 2012 to 2020, using a 5% random sample of Medicare data. Logistic regression compared patient characteristics between those who received neuromonitoring and those who did not. The model included age, sex, region, Elixhauser Comorbidity Index score, year of surgery, elective status, and procedure type. Odds ratios with a 95% CI were generated for each covariate.</p><p><strong>Results: </strong>Of the 6224 patients who underwent cervical procedures for CS, 4053 were included in the study, with 2845 having myelopathy and 1208 without. Myelopathy patients had a higher number of hospitalizations (2884) compared with non-myelopathy patients (1229). Among myelopathy patients, the prevalence of neuromonitoring increased from 49.2% in 2012 to 56.5% in 2020. The range of utilization for each type of monitoring was: 96.4%-100% for somatosensory evoked potential, 73.2%-86.1% for electromyography, 70.0%-86.1% for motor evoked potential, and 17.6%-33.6% for other modalities. For non-myelopathy patients, neuromonitoring prevalence increased from 33.1% in 2012 to 43.3% in 2020. The range of utilization for each type of monitoring was: 93.0%-100% for somatosensory evoked potential, 68.9%-89.7% for electromyography, 55.8%-77.4% for motor evoked potential, and 17.8%-36.4% for other modalities.</p><p><strong>Conclusions: </strong>This study investigates the utilization of IONM during cervical spinal surgeries in Medicare patients with cervical spondylotic myelopathy or CS between 2012 and 2020. Although IONM is employed in cervical spine procedures, its adoption and standardization appear to vary across the country and different health care settings.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E349-E357"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709384","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":"Revisiting the Consistency of Financial Disclosure Reporting by Authors at Annual Spine Conferences Shows Inconsistent Improvements After 14 Years.","authors":"Lucas Y Kim, Jonathan N Grauer","doi":"10.1097/BSD.0000000000001736","DOIUrl":"10.1097/BSD.0000000000001736","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study of presenter disclosures from the 2022 North American Spine Society (NASS), Scoliosis Research Society (SRS), and Cervical Spine Research Society (CSRS) annual research conferences.</p><p><strong>Objective: </strong>The current study aimed to evaluate the consistency of financial disclosures for authors presenting at multiple 2022 spine conferences and compared results to those previously reported in 2008.</p><p><strong>Summary of background data: </strong>Transparent reporting of financial relationships between physicians and industry is seen as an important way to limit/address potential bias. Thus, many research conferences require authors to disclose such relationships. Despite these requirements, variability in the financial disclosure reporting for matched speakers at 2008 major spine conferences was previously reported. Since then, the Sunshine Act mandated public financial relationships, potentially furthering attention and leading to improvements in financial disclosures.</p><p><strong>Methods: </strong>Disclosures of authors presenting at >1 of the three 2022 spine conferences were compiled from conference websites, and discrepancies were determined based on conference disclosure policies. For comparisons where both conferences required disclosure of all relationships, the discrepancy was identified if there was not a match. For comparisons where 1 conference required paper-specific relationships, and the other required all relationships, discrepancy was identified if the first was not a subset of the other. Results were compared with those reported from 2008.</p><p><strong>Results: </strong>NASS and SRS both required disclosure of all relationships, had 208 overlapping authors, and had 36.5% discrepancies. SRS and CSRS required all and paper-specific disclosures, had 37 overlapping authors, and had 29.7% discrepancies. NASS and CSRS required all and paper-specific disclosures, had 81 overlapping authors, and had 29.6% discrepancies. Overall, the average discrepancy for pairs of conferences in 2008 was 26%, and for 2022 was 32%, indicating a lack of improvement. Compared with 2008, discrepancies decreased more when disclosure requirements were the same for both conferences being considered.</p><p><strong>Conclusions: </strong>These findings demonstrate that significant variability remains in the reporting of financial conflicts of interest by authors presenting at 3 major spine conferences last year, despite previous scrutiny and the evolution of the Sunshine Act. These discrepancies may reflect the ambiguity caused by different disclosure policies and further attention is needed for this topic.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E334-E339"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945910","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":"Removal or Nonremoval of the Rib During a Direct Lateral Interbody Fusion Relative to Postoperative Pain.","authors":"Zane Littell, Elizabeth Ablah, Hayrettin Okut, Joey Dean, Camden Whitaker","doi":"10.1097/BSD.0000000000001731","DOIUrl":"10.1097/BSD.0000000000001731","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>To determine whether there was a difference in postoperative pain among patients undergoing direct lateral interbody fusion (DLIF) who had rib removal compared with those who did not.</p><p><strong>Background: </strong>DLIF is a minimally invasive, lateral transpsoas surgical approach for spinal fusion that has a lower 2-year pain rating when compared with an open procedure. However, the DLIF surgical approach of the L1/L2 spinal level can be obstructed by the ribs. It is unknown whether patients undergoing a DLIF with rib removal experience more pain than their counterparts without rib removal.</p><p><strong>Methods: </strong>Patients who underwent a DLIF from an individual spine surgeon at Wesley Medical Center between January 1, 2014 and December 31, 2018 were grouped by rib status: with removal versus without. Postoperative pain, measured by a 0 (no pain) to 10 (worst pain) Visual Analog Scale (VAS), was recorded on the day of discharge.</p><p><strong>Results: </strong>The analysis included data from 136 patients, 75 with removal and 61 without. Patient demographics did not differ significantly by age, sex, insurance, estimated blood loss, or length of stay. However, number of spinal levels fused was greater when rib removal occurred, 4.5 versus 3.5 ( P = 0.008). The mean baseline VAS with rib removal was 6.6 (1.7) and at discharge it was 7.6 (2.1). The mean baseline VAS without removal was 6.7 (2.0) compared with 7.8 (1.8) at discharge. The multivariate model predicting discharge VAS indicated there was no difference in pain by rib removal status ( P = 0.180). VAS at discharge was associated with positive morphine milligram equivalents; as the VAS pain score increased so did the morphine dose ( P = 0.028).</p><p><strong>Conclusion: </strong>Patients undergoing a DLIF with rib removal expressed no difference in postoperative pain compared with patients without rib removal.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E322-E326"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666983","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":"High Preoperative T1 Slope Is a Marker for Global Sagittal Malalignment.","authors":"Fares Ani, Ethan W Ayres, Diann Woo, Dennis Vasquez-Montes, Avery Brown, Haddy Alas, Edem J Abotsi, Cole Bortz, Katherine E Pierce, Tina Raman, Micheal L Smith, Yong H Kim, Aaron J Buckland, Themistocles S Protopsaltis","doi":"10.1097/BSD.0000000000001734","DOIUrl":"10.1097/BSD.0000000000001734","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To develop parameter thresholds obtainable from cervical radiographs that correlate with concomitant thoracolumbar malalignment.</p><p><strong>Summary of background data: </strong>T1 slope (T1S) is typically discussed in the context of cervical deformity and correlated with health-related quality of life outcomes. Prior research suggests that T1S is related to global alignment; however, a definition for \"high\" T1S has not been established. Most patients undergoing cervical surgery do not undergo full-spine imaging; therefore, obtaining a parameter associated with thoracolumbar malalignment from cervical radiographs would be beneficial.</p><p><strong>Methods: </strong>A database of preoperative adult spinal deformity (ASD) patients was analyzed. Measures obtained from standing lateral radiographs included T1S, thoracic kyphosis (TK), sagittal vertical axis (SVA), T1-pelvic angle (TPA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL). Decision tree analysis was then used to determine the T1S corresponding to published thresholds for high TK (40 degrees), SVA (40 mm), TPA (25 degrees), and PT (25 degrees). Alignment between high and normal T1S patients was compared.</p><p><strong>Results: </strong>Two hundred twenty-six preoperative patients were included (mean: 58±16 y 62%F). Larger T1S was correlated with greater SVA ( r =0.365), TPA ( r =0.302), TK ( r =0.606), and PT ( r =0.230) (all P <0.001). Decision tree analysis yielded a threshold of 30 degrees for high T1S, which 50% of patients had. Compared with patients with T1S <30 degrees, those with T1S >30 degrees had higher TK (41.5 vs. 25.8 degrees), SVA (78.7 vs. 33.7 mm), TPA (27.6 vs. 18.3 degrees), and PT (26.3 vs. 20.8 degrees), and PI-LL (18.2 vs. 11.7 degrees) (all P <0.05). Seventy-nine percent of patients with high T1S had high TK (T1S <30=13%), 69% had high SVA (T1S <30=38%), 66% had high TPA (T1S <30=37%), 60% had PT >25 degrees (T1S <30=42%), and 47% had PI-LL >20 degrees (T1S <30=34%) (all P <0.05).</p><p><strong>Conclusion: </strong>Higher T1S was associated with worse global alignment. T1S was most strongly associated with TK. A T1S=30 degrees corresponded to high TK, SVA, TPA, and PT thresholds. Therefore, surgeons should consider obtaining full-spine radiographs if a T1S >30 degrees is present on cervical imaging.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E306-E311"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930464","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}