Clinical Spine Surgery最新文献

{"title":"Recovery Trajectories of Patient-reported Outcomes After Surgery for Degenerative Cervical Myelopathy: A Bayesian Latent Class Modeling Approach.","authors":"Anjishnu Banerjee, Yushan Yang, Marjorie C Wang, Aditya Vedantam","doi":"10.1097/BSD.0000000000001662","DOIUrl":"10.1097/BSD.0000000000001662","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>The aim of this study was to identify recovery trajectory clusters after surgery for degenerative cervical myelopathy (DCM), as well as to determine clinical and imaging characteristics associated with functional recovery trajectories.</p><p><strong>Background: </strong>Accurate prediction of postsurgical neurological recovery for the individual patient with DCM is challenging due to varying patterns of functional recovery. Latent class Bayesian models can model individual patient patterns and identify groups of patients with similar phenotypes for personalized prognostication.</p><p><strong>Methods: </strong>A prospective single-center study of 70 consecutive patients with DCM undergoing elective cervical spine decompression for DCM between 2010 and 2017 was performed. Outcomes were recorded using the modified Japanese Orthopedic Association (mJOA), Neck Disability Index (NDI), and the Short Form-36 Physical Component Score (SF-36 PCS) at 3, 6, 12, and 24 months. Recovery trajectories were constructed based on unsupervised Bayesian latent class modeling. Clinical and imaging predictors of recovery trajectories were also determined.</p><p><strong>Results: </strong>Recovery after surgery for DCM showed 3 distinct recovery trajectory clusters for each outcome. The commonest recovery trajectory was sustained improvement for the mJOA (41.1%), stagnation for the NDI (60.3%), and stability for the SF-36 PCS (46.6%). Age, duration of symptoms, and baseline disability were the strongest predictors of each recovery trajectory. Degree of cord compression, neck pain, and intramedullary T2-hyperintensity were predictive of NDI and SF-36 PCS but not mJOA recovery trajectory. Sex was associated with the NDI recovery trajectory but not SF-36 PCS and mJOA recovery trajectories.</p><p><strong>Conclusion: </strong>Using prospective data and a data-driven approach, we identified 3 distinct recovery trajectory clusters and associated factors for mJOA, NDI, and SF-36 PCS in the first 24 months after surgery for DCM. Our results can enhance personalized clinical prognostication and guide patient expectations at different time points after surgery for DCM.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E69-E74"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733648","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":"Research Progress of Camptocormia in Parkinson Disease.","authors":"Yilin Lu, Xiang Zhang, Junyu Li, Weishi Li, Miao Yu","doi":"10.1097/BSD.0000000000001674","DOIUrl":"10.1097/BSD.0000000000001674","url":null,"abstract":"<p><p>Camptocormia, also known as bent spine syndrome, primarily affects individuals with Parkinson disease (PD). This review provides an overview of camptocormia in PD, covering its definition, epidemiology, causes, diagnosis, and treatment. In the epidemiology section, we delve into its prevalence, gender disparities, and ongoing genetic research. Regarding diagnosis and assessment, we discuss evolving diagnostic criteria and measurement techniques, as well as new diagnostic tools. For management and treatment, a wide array of options is available, from conservative methods such as physical therapy and botulinum toxin injections to surgical interventions such as spinal orthopedic surgery and deep brain stimulation. We stress the significance of personalized care and multidisciplinary collaboration. This comprehensive review aims to provide clinicians, researchers, and healthcare professionals with a comprehensive understanding of camptocormia in PD, highlighting its clinical features, diagnostic strategies, management approaches, and future perspectives.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"39-44"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153307","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":"Impact of Early Depressive Burden on Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Jacob C Wolf, Fatima N Anwar, Andrea M Roca, Alexandra C Loya, Srinath S Medakkar, Aayush Kaul, Ishan Khosla, Timothy J Hartman, James W Nie, Keith R MacGregor, Omolabake O Oyetayo, Eileen Zheng, Vincent P Federico, Arash J Sayari, Gregory D Lopez, Kern Singh","doi":"10.1097/BSD.0000000000001653","DOIUrl":"10.1097/BSD.0000000000001653","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To evaluate mental health influence on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) patients.</p><p><strong>Summary of background data: </strong>Poor mental health has been postulated to indicate inferior patient perceptions of surgical outcomes in spine literature. Few studies have assessed mental health as a dynamic metric throughout the perioperative period.</p><p><strong>Methods: </strong>A single-surgeon database was retrospectively searched for patients who underwent primary, elective MIS-TLIF for degenerative or isthmic spondylolisthesis. Summative depressive burden (SDB) was defined by the sum of preoperative and 6-week postoperative 9-item Patient Health Questionnaire (PHQ-9), with Lesser Burden (LB, SDB<10) and Greater Burden (GB, SDB≥10) cohorts. Patient-reported outcomes measures (PROMs) were compared preoperatively, at 6 weeks, and at final postoperative follow-up (11.4±10.9 mo), using Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Oswestry disability index (ODI), visual analog scale-back (VAS-B), VAS-leg (VAS-L), and PHQ-9. Improvements at 6-week (∆PROM-6W), final follow-up (∆PROM-FF), and minimum clinically important difference (MCID) achievement were compared.</p><p><strong>Results: </strong>The GB cohort consisted of 44 of 105 patients. Demographic variations included older age, higher Charlson comorbidity index, increased hypertension prevalence, and private insurance in the LB cohort ( P ≤0.018). The LB cohort demonstrated better baseline and 6-week PROMIS-PF/ODI/VAS-L ( P ≤0.032) and better final PROMIS-PF/ODI/VAS-L/PHQ-9 ( P ≤0.031). Both cohorts improved in all PROMs at 6 weeks and final follow-up ( P ≤0.029), except for PROMIS-PF at 6 weeks in the GB cohort. ∆PROM-6W, ∆PROM-FF, and MCID achievement rate for PHQ-9 were greater in the GB cohort ( P ≤0.001).</p><p><strong>Conclusion: </strong>On average, patients undergoing MIS-TLIF for degenerative or isthmic spondylolisthesis improved in all PROMs by final follow-up. Patients with GB suffered inferior perceptions of physical function, disability, and leg pain. MCID rates in mental health were higher for GB cohort. Surgeons are encouraged to adopt a compassionate understanding of depressive burden and educate the patient on possible consequential postoperative outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"51-57"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455727","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":"Posterior Cartilage Endplate Disruption on T1-weighted Magnetic Resonance Imaging as a Predictor for Postoperative Recurrence of Lumbar Disk Herniation.","authors":"Kazuhiro Inomata, Eiji Takasawa, Tokue Mieda, Toshiki Tsukui, Kenta Takakura, Yusuke Tomomatsu, Akira Honda, Hirotaka Chikuda","doi":"10.1097/BSD.0000000000001657","DOIUrl":"10.1097/BSD.0000000000001657","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to investigate the relationship between disruption of cartilage endplates and postoperative recurrence of lumber disk herniation (LDH) using preoperative T1-weighted magnetic resonance imaging (MRI-T1WI).</p><p><strong>Summary of background data: </strong>Recurrence of LDH is a relatively common complication after discectomy. Although several risk factors have been identified, their predictive capability remains limited. Previous histologic studies reported that cartilage endplates were present in 85% of patients with recurrent LDH.</p><p><strong>Methods: </strong>Patients with a single level of LDH who underwent open or microendoscopic discectomy were retrospectively reviewed. On the basis of preoperative sagittal MRI-T1WI, cartilage endplates were divided into anterior and posterior portions at the center of the disk and evaluated for discontinuity. Patient background characteristics, spinopelvic sagittal parameters, degrees of disk degeneration, and recurrence level were also evaluated.</p><p><strong>Results: </strong>A total of 100 patients were included in this study (mean age, 50.5 years old; 41% female). Symptomatic recurrence of LDH occurred in 15 patients (15%). There were no significant differences in patient background characteristics (age, 46.9 vs. 51.2 years old; %female, 60% vs. 38%; smoking, 33% vs. 41%; diabetes mellitus, 27% vs. 29%) or spinopelvic parameters (PI, 44.1 vs. 47.0 degrees; PT, 16.8 vs. 19.4 degrees; SS, 27.3 vs. 27.6 degrees; LL, 37.7 vs. 33.7 degrees). In the recurrence group, MRI-T1WI showed a higher rate of cartilage endplate disruption in the posterior portion than in the no-recurrence group (73% vs. 34%, P =0.01). A multivariate analysis demonstrated that the disruption of the posterior cartilage endplate remained an independent predictor of recurrence.</p><p><strong>Conclusions: </strong>Disruption in the posterior cartilage endplate on preoperative MRI-T1WI was closely associated with recurrence after LDH surgery. These results suggest that this MRI finding is a practical and useful predictor of LDH recurrence.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E96-E99"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105037","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":"First In Vivo Electromyographic Analysis of Mechanical Load Scenarios of the Cervicothoracic Junction During Daily Activities as a Basis for Future Postoperative Behavioral Instructions.","authors":"Bennet Mathis Schröder, Heiko Koller, Emmanouil Liodakis, Stephan Sehmisch, Sonja Körner, Sebastian Decker","doi":"10.1097/BSD.0000000000001655","DOIUrl":"10.1097/BSD.0000000000001655","url":null,"abstract":"<p><strong>Study design: </strong>Clinical Research.</p><p><strong>Objectives: </strong>Study participants were twenty- eigth healty volunteers.</p><p><strong>Background: </strong>Soft tissue complications after posterior cervicothoracic fusion surgery occur frequently. Postoperative myofascial dehiscence (PMD) can cause disability and pain. So far, it is unknown whether patients can affect PMD development through behavioral adjustment. Consequently, this study aimed to analyze how much mechanical stress daily activities exert on the posterior muscles and fascia at the cervicothoracic junction.</p><p><strong>Materials and methods: </strong>Surface electromyography was applied next to the upper thoracic spine at the trapezius muscle. All volunteers performed 22 different daily activities, such as tooth brushing, dressing, standing up, and different horizontal positions. During the exercises, the electromyographic activity was measured. For each volunteer, root mean square values were determined. All exercises were then repeated with the use of a clavicular bandage to unload the shoulder and cervicothoracic muscles. Afterwards, the rankings were statistically compared interindividually.</p><p><strong>Results: </strong>Among the different tasks, significant differences in regard to the root mean square values were noted. For instance, horizontal positions caused significantly lower muscle activation compared with all other exercises ( P ≤ 0.001). Notably, no relevant electromyographic differences were detected between the tasks with and without a clavicular bandage.</p><p><strong>Conclusions: </strong>This in vivo electromyographic analysis of cervicothoracic muscle activity during daily activities demonstrates that myofascial strain differs among various daily activities. Data indicate that potential postoperative mobilization protocols and behavioral instructions may have the potential to reduce the biomechanical load and consequently the risk of PMD and, therefore, may reduce the risk for surgical wound-related complications, disability, and need for revision surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E100-E107"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874352","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":"Effect of Lumbar Erector Spinae Plane Blocks After Lumbar Fusion Surgery: A Randomized Control Trial.","authors":"Brendan Holderread, Ishaq Syed, Caleb Shin, Leonide Toussaint, Andrew Lewis, David Botros, Ioannis Avramis, James Rizkalla","doi":"10.1097/BSD.0000000000001767","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001767","url":null,"abstract":"<p><strong>Study design: </strong>Randomized control trial.</p><p><strong>Objective: </strong>To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.</p><p><strong>Summary of background data: </strong>Pain management is a key aspect of a patient's care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.</p><p><strong>Methods: </strong>A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.</p><p><strong>Results: </strong>Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P= 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days (P< 0.0001).</p><p><strong>Conclusions: </strong>The patient population that received the erector spinae block had significantly lower pain scores on days 1-3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522771","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":"A Comprehensive Analysis Between Disk Geometry and Posterior Muscle Characteristics Among Degenerative Spine Patients: An Internal Retrospective Review.","authors":"Bongseok Jung, Joshua Mathew, Alshabab Basel Sheikh, Jonathan Elysee, Priya Duvvuri, John Fallon, Anas Abbas, Austen Katz, Junho Song, Adam Strigenz, Luke Zappia, Renaud Lafage, David Essig, Virginie Lafage, Sohrab Virk","doi":"10.1097/BSD.0000000000001773","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001773","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective Cohort Study.</p><p><strong>Objective: </strong>The aim of this study is to investigate the associations between posterior muscle health characteristics and disk geometry parameters between L1 and S1.</p><p><strong>Summary of background data: </strong>Paralumbar muscle changes have been associated with clinical outcomes. However, the relationship between disk geometry and paralumbar muscle changes has not been defined.</p><p><strong>Methods: </strong>Axial T2 MRI was analyzed for paralumbar muscle measurements, and lateral radiographs were analyzed for disk geometry parameters in patients with disk degeneration. Associations between disk shape and muscle health at each individual lumbar level were evaluated using a partial correlation controlling for age and sex. Demographic data were compared between the listhesis groups, and an ANCOVA analysis controlling for significant demographic parameters was conducted to evaluate differences in muscle characteristics.</p><p><strong>Results: </strong>In all, 435 patients were included (age: 55.6±15, BMI: 29.5±6, 60.9% female, 41.3% White). Muscle health median characteristics were CSA/BMI=140, LIV=13, and Goutallier Classification of 1. Partial correlations between focal disk parameters and muscle health controlling for age and sex showed moderate significant positive associations between focal lordosis and lumbar indentation value (LIV) at every level L1-S1 (mean r=0.264 between L1 and L5, P<0.001), weak positive association between focal lordosis and CSA/BMI (mean r=0.113 at L2-L5, P <0.03), and weak negative associations between disk height and Goutallier Classification (mean r=0.158 at L1-L5, P<0.03). Listhesis at L4-S1 was stratified, and ANCOVA controlling for sex and age demonstrated no significant association between S and R groups and CSA/BMI, LIV, or Goutallier classification (P>0.1).</p><p><strong>Conclusions: </strong>Posterior muscle health was significantly associated with disk shape, especially disk height and disk lordosis, with larger and more lordotic disks being associated with better muscle health. Disk listhesis was not significantly associated with muscle quality when controlling for demographic characteristics, and no differences in muscle health parameters were observed in patients with spondylolisthesis versus retrolisthesis. Overall, the results highlight important associations between lumbar compensation, disk geometry, and posterior muscle health.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514868","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":"Indirect Spinal Decompression in Thoracolumbar Burst Fractures: Efficacy of Combined Modified Percutaneous Posterior Short-segment Fixation and Intraoperative CT Assistance.","authors":"Hou-Tsung Chen, Re-Wen Wu, Fu-Shine Yang, Cheh-Yung Chang, Chieh-Cheng Hsu, Sung-Hsiung Chen, Meng-Ling Lu","doi":"10.1097/BSD.0000000000001772","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001772","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the combined modified percutaneous short-segment posterior instrumentation technique by reducing and fixating the thoracolumbar burst fracture and checking the efficacy of indirect spinal decompression using intraoperative CT. This study aims to (1) demonstrate that using modified percutaneous short-segment posterior instrumentation is enough to rebuild spinal stability and decompress the spinal stenosis for thoracolumbar burst fracture and (2) prove the effects of spinal canal decompression by intraoperative portable CT with the surgical technique.</p><p><strong>Summary of background data: </strong>Various posterior instrumentation methods have been used to treat thoracolumbar burst fractures and decompress retropulsed bony fragments through ligamentotaxis, but no studies have assessed the efficacy of combining percutaneous short-segment posterior instrumentation with intraoperative CT.</p><p><strong>Methods: </strong>Using modified percutaneous short-segment posterior instrumentation to rebuild the spinal stability and ligamentotaxis effect to indirect decompression of the spinal stenosis without laminectomy and check parameters immediately after surgery by real-time intraoperative portable CT.</p><p><strong>Results: </strong>Fifty-seven patients with thoracolumbar burst fractures underwent modified percutaneous short-segment posterior instrumentation from 2018 to 2023 at a single medical center. Mean injured vertebral canal dimension increased from 90.8±26.3 to 122.1±30.3 mm2 (P<0.05) and mean canal encroachment index decreased from 44.8±9.5% to 25.6±4.8% (P<0.05), the anterior body height increased from 13.9±3.8 to 25.9±3.9 mm (P<0.01) and kyphotic angle decreased from 27.3±3.2 to 8.6±2.1 degrees (P<0.01). Neurological function was improved by at least 1 Frankel grade in neurological deficit patients. No significant difference in kyphotic angle between post-op and 6-month follow-up.</p><p><strong>Conclusions: </strong>Indirect decompression of the spinal canal with modified percutaneous short-segment fixation without laminectomy was an effective treatment for thoracolumbar burst fracture, even in selected incomplete neurological deficits patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448445","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":"What Provides the Best Value for Your Time in Spine Surgery? An Analysis of Relative Value Units.","authors":"Muhammad B Tariq, Trevor Simcox, Jacob Becker, Anthony Petrizzo, Shuriz Hishmeh","doi":"10.1097/BSD.0000000000001771","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001771","url":null,"abstract":"<p><strong>Design: </strong>Retrospective database analysis.</p><p><strong>Objective: </strong>This study aims to assess the RVU compensation model for the most common spine surgeries.</p><p><strong>Background: </strong>Physician work is commonly valued by utilizing the relative value unit (RVU) model for compensation. Our aim in this study was to assess RVU and RVU per minute valuations of the most common spine procedures comparing cervical versus lumbar and fusion versus non-fusion cases.</p><p><strong>Methods: </strong>The ACS-NSQIP database was utilized to identify the most commonly performed spine procedures. RVU and RVU per minute values were calculated and compared in each group.</p><p><strong>Results: </strong>In all, 18,779 entries encompassing 28 CPT codes/code combinations were identified. Average RVUs were higher in cervical spine cases compared with lumbar cases (29 vs. 20 RVUs, respectively). Furthermore, cervical cases had significantly higher RVUs per minute compensation compared with lumbar cases (0.26 vs. 0.18 RVUs/min; P=0.01). Fusion cases also fared higher average RVUs compared with nonfusion cases (28 vs. 19 RVUs, respectively). However, when corrected for operative time, fusion cases did not differ significantly in RVUs per minute (P=0.13).</p><p><strong>Conclusions: </strong>Cervical spine surgery provides the best value for the surgeon in terms of RVUs per minute. We highlight key aspects of the compensation model in spine surgery.</p><p><strong>Level of evidence: </strong>Level III-economic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440110","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":"A Comparison of Inpatient Versus Ambulatory Lumbar Surgical Care Utilization Among Minority Patients.","authors":"Justin Tiao, Husni Alasadi, Michael M Herrera, Nicole Zubizarreta, Jonathan Huang, Jashvant Poeran, Saad Chaudhary","doi":"10.1097/BSD.0000000000001766","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001766","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery.</p><p><strong>Summary of background data: </strong>The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting.</p><p><strong>Materials and methods: </strong>Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients.</p><p><strong>Results: </strong>Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001.</p><p><strong>Conclusions: </strong>Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440155","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}