Clinical Spine Surgery最新文献

{"title":"Do Superficial Drains Make a Difference After Lumbar Fusion Surgery? A Prospective, Randomized Trial.","authors":"Cailin A Cruess, Hyun Song, Charles C Edwards","doi":"10.1097/BSD.0000000000001784","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001784","url":null,"abstract":"<p><strong>Study design: </strong>A prospective, randomized study.</p><p><strong>Objective: </strong>The goal of this study was to evaluate the impact that subcutaneous drains have on patient satisfaction and postoperative recovery after a lumbar fusion surgery.</p><p><strong>Summary of background data: </strong>The use of drains following lumbar fusion surgery is controversial. Current literature shows that there are both benefits and drawbacks to using deep drains, however, there are no reports on the utility of superficial drains.</p><p><strong>Methods: </strong>One hundred ten patients undergoing a 1 to 3-level fusion by a single surgeon were randomly selected to receive either a subcutaneous drain (55 patients) or no drain (55 patients). Drain output was collected 1, 3, and 5 days after the procedure. Drains were removed 5 days after the surgery so long as the output was <50 ccs in a 24-hour period. Patient demographics, drain outputs, and questionnaire data from 10, 30, and 60 days after the procedure were compared.</p><p><strong>Results: </strong>Patients receiving a superficial drain were significantly less likely to have incisional drainage (P<0.01) and tended to be less anxious about their wound healing (P=0.06). There was no difference between drain and no drain groups in terms of postoperative complications, wound care satisfaction, level of independence, or need for outside medical assistance. Body mass index (BMI) and wound thickness did not impact the volume of drain output or other results.</p><p><strong>Conclusions: </strong>Subcutaneous drains significantly decrease incisional leakage and tend to decrease patient anxiety regarding wound healing. The presence of a postoperative drain does not diminish patient satisfaction with wound healing.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Semaglutide in Patients Undergoing Lumbar Fusion Does not Increase 90-Day Medical or 1-Year Implant Complications.","authors":"Abdullah Ghali, Jad Lawand, Parker Mitchell, David Momtaz, Umar Ghilzai, Eileen Phan, Jude Alawa, Lorenzo Deveza","doi":"10.1097/BSD.0000000000001800","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001800","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study of National Database.</p><p><strong>Objective: </strong>This study examines their effect on medical and mechanical complications within 90 days postlumbar spine surgery.</p><p><strong>Summary of background data: </strong>Patients undergoing spinal procedures increasingly use glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally for type 2 diabetes and now popular for weight loss. The impact of GLP-1 RAs on spinal fusion outcomes is unknown.</p><p><strong>Methods: </strong>This study used medical records from TriNetX, a national deidentified database, to examine diabetic patients undergoing lumbar spine procedures. Patients receiving GLP-1 RAs within 6 months preoperatively were compared with a propensity-matched control group. Propensity score matching (1:1) controlled for demographic factors and comorbidities, including type I and II diabetes, metformin use, and BMI. The study analyzed 90-day medical and 1-year implant complications using χ2 exact tests and univariate regression in a propensity-matched cohort.</p><p><strong>Results: </strong>The GLP-1 RA cohort and control group included 1110 and 151,440 patients, respectively. Of these, 1090 patients were propensity-matched 1:1 in each cohort. Within 90 days postoperatively, the GLP-1 RA group had higher rates of all-cause anemia (9.4% vs. 7.0%, P=0.016), renal failure (4.4% vs. 2.9%, P=0.028), opioid use (94% vs. 89%, P<0.001), emergency room visits (16% vs. 13%, P=0.013), and wound complications (0.5% vs. 0.2%, P<0.001). Other complications, such as infections, myocardial infarction, pulmonary embolism, deep vein thrombosis, hypoglycemic events, stroke, hospitalization, pneumonia, and transfusion, were similar between groups. One year postoperatively, pseudoarthrosis was less frequent in the GLP-1 RA group (12% vs. 16%, P=0.002). There were no significant differences in hospitalization, adjacent segment disease, mechanical loosening, or postlaminectomy syndrome.</p><p><strong>Conclusion: </strong>This study found that the risk of complications in patients receiving GLP-1 RAs before lumbar spine surgery is comparable to control patients, suggesting GLP-1 RAs do not increase adverse outcomes and should not exclude patients from surgery.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spine Surgery Outcomes in Patients With Limited English Proficiency.","authors":"Tejas Subramanian, Kasra Araghi, Izzet Akosman, Troy B Amen, Austin C Kaidi, Takashi Hirase, Gregory S Kazarian, Amier Hassan, Eric Mai, Omri Maayan, Chad Z Simon, Tomoyuki Asada, Pratyush Shahi, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1097/BSD.0000000000001803","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001803","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to investigate the impact of language-discordant spine care. Specifically, do non-English speakers (NES) experience (1) increased length of stay? (2) increased rates of complications (ie, intra/perioperative complications, revision surgery, reoperation)?</p><p><strong>Background: </strong>To provide the best care, there exists a growing focus on understanding which patient groups may be at greater risk for poorer outcomes. In the current body of orthopedic and spine literature, there is little data regarding outcomes for patients where there is language discordance between the physician and patient.</p><p><strong>Patients and methods: </strong>This is a retrospective cohort study. Patients who underwent spine surgery at a single institution between 2017 and 2023 were included. Translator usage was used as a proxy for poor English language proficiency. Patient demographic and outcome data were collected from the electronic medical record. Patients were matched on surgical and demographic factors and analyzed for outcome variables. Multivariable logistic regressions were run to assess variables associated with poor outcomes.</p><p><strong>Results: </strong>A total of 214 NES and 9217 English speakers (ES) were reviewed. The final matched cohort resulted in 158 NES and 313 ES with no differences in demographic data. NES patients had significantly more postoperative visits (2.19 vs 1.73; P < 0.001) and increased readmission rates (0.96% vs 4.43%; P = 0.033). On multivariable analysis, NES were predictive of readmission (OR = 4.22; P = 0.039).</p><p><strong>Conclusion: </strong>Patients with low English proficiency experienced significantly higher rates of readmissions following spine surgery. These patients may benefit from increased and more effective preoperative and postoperative communication.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623856","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":"Correlation Between Clinical Improvement and Dural Sac Cross-Sectional Area Expansion in Biportal Endoscopic Lumbar Decompression.","authors":"Ju-Eun Kim, Daniel K Park, Eugene J Park","doi":"10.1097/BSD.0000000000001789","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001789","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To correlate the changes in the dural area on MRI and clinical outcome after unilateral biportal endoscopic (UBE) decompression.</p><p><strong>Summary of background data: </strong>Clinical outcomes after UBE decompression have been published for up to 2 years for patients with isolated spinal stenosis at 1 level. Serial dural expansion after UBE decompression has not been published as well as correlation to clinical outcomes.</p><p><strong>Method: </strong>We retrospectively reviewed the clinical and radiologic outcomes of 86 patients who underwent UBE decompression for spinal stenosis. Preoperative and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were analyzed, and MRI was used for radiologic evaluation before surgery, 3 days after surgery, and 2 years after surgery. The correlation of dural spinal area CSA (preoperative-final) and difference of clinical outcome (preoperative-final) were analyzed.</p><p><strong>Result: </strong>None of the 86 patients had permanent neurological complications. Back VAS, leg VAS, and ODI showed improvement in symptoms postoperatively and 2 years postoperatively. The postoperative CSA of the dural sac on MRI was statistically significantly increased after surgery at all time points. VAS leg was moderately correlated with change in CSA, while ODI and VAS back were weakly correlated. Correlations were all statistically significant.</p><p><strong>Conclusion: </strong>UBE decompression showed good clinical outcomes similar to previous studies, and the CSA of ​​the dural sac on MRI significantly increased in the late postoperative phase compared with the early postoperative phase. This technique is viable option to achieve radiographic dural expansion and improvement in clinical outcomes in degenerative lumbar spinal stenosis. However, there is at best only a moderate correlation with change in CSA and clinical outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656292","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":"Comparison of Anterior Surgery Versus Posterior Surgery for the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis.","authors":"Xiaoming Bao, Kun Ren, Weidong Guo, Xiaoping Zhang, Xin Dong, Kang Yan, Huanhuan Qiao, Haien Zhao, Bo Liao","doi":"10.1097/BSD.0000000000001778","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001778","url":null,"abstract":"<p><strong>Study design: </strong>A meta-analysis.</p><p><strong>Objective: </strong>To evaluate the impact of anterior versus posterior surgical approaches on outcomes in MCSM.</p><p><strong>Background: </strong>Multilevel cervical spondylotic myelopathy (MCSM) is the most common cause of spinal cord dysfunction, and the clinical effectiveness of anterior versus posterior surgical approaches remains elusive.</p><p><strong>Methods: </strong>A comprehensive search was conducted across electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, to evaluate the effects of anterior surgery versus posterior surgery on outcomes, such as Japanese Orthopedic Association (JOA) score, neck disability index (NDI) score, neck visual analog scale (VAS), blood loss, operation time, length of stay, cervical range of motion, cervical Cobb angle, and complications. The baseline characteristics of the included studies were assessed using the Newcastle-Ottawa Scale score to measure the risk of bias.</p><p><strong>Results: </strong>In this meta-analysis, 14 retrospective and 6 prospective cohort studies, involving 2712 patients, were included. The analysis indicated no significant difference between the 2 groups in preoperative JOA score, postoperative JOA score, JOA recovery rate, postoperative neck VAS score, operation time, preoperative range of motion (ROM), or SF-36 score (P=0.95, 0.15, 0.20, 0.31, 0.94, 0.33, and 0.43, respectively). However, the NDI score and blood loss were significantly lower in the anterior surgery group compared with the posterior surgery group (P<0.04, P=0.0003). The anterior surgery group was also associated with shorter length of stay (P<0.00001), while had higher rates of complications (P=0.04). C2-7 Cobb angle and postoperative ROM were significantly lower in the anterior surgery group than those in the posterior surgery group (P=0.0002 and 0.01, respectively).</p><p><strong>Conclusion: </strong>This meta-analysis found no clear advantage of 1 surgical approach over the other for MCSM in terms of neurological function recovery, as measured by JOA scores. The anterior approach was associated with improved NDI scores, lower blood loss, shorter length of stay, and better recovery of cervical lordosis, accompanied by limited postoperative mobility. Careful consideration should be given to potential complications, including dysphagia with the anterior surgery, axial pain, and C5 palsy with the posterior surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623732","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":"Elevated Body Mass Index in Patients Undergoing Stand-alone Anterior and Lateral Lumbar Interbody Fusion: Complications, Hospital Length of Stay, and Cost.","authors":"Ashley Knebel, Manjot Singh, Negin Fani, Andrew Ni, Michael Farias, Joseph E Nassar, Eren O Kuris, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BSD.0000000000001799","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001799","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aims to evaluate the impact of body mass index (BMI) on postoperative outcomes following anterior, extreme lateral, and oblique lumbar interbody fusion (A/X/OLIF).</p><p><strong>Background: </strong>Obesity is an increasingly common comorbidity among spine surgery patients, potentially leading to elevated postoperative complications. Little is known about the safety of A/X/OLIF approaches in overweight and obese patients.</p><p><strong>Materials and methods: </strong>The PearlDiver database was queried to identify all adults who underwent single-level A/X/OLIF. Patients were stratified by BMI, defined as healthy weight (≤24.9 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and morbidly obese (≥40 kg/m2). Patient demographics and comorbidities were compared before matching, and complications were compared after matching for age, sex, and Charlson Comorbidity Index (CCI).</p><p><strong>Results: </strong>Among the 36,716 A/X/OLIF included patients, 5464 (14.88%) were healthy weight, 9124 (24.85%) were overweight, 16,283 (44.35%) were obese, and 5845 (15.92%) were morbidly obese. The mean age was 54.4 years, 62.6% were females, and the mean CCI was 1.8. After matching, the mean age was 54.0 years, 70.1% were females, and the mean CCI was 1.4. At 90 days postoperatively, medical and surgical complication rates and readmission generally increased with increasing BMI (all P < 0.010). Length of stay (5.37, 5.51, 5.89, 6.69, P < 0.001) and 90-day costs ($19,326, $19,058, $19,680, $21,103, P = 0.002) also generally increased with increasing BMI. Intraoperative and 2-year complication rates were comparable across cohorts.</p><p><strong>Conclusions: </strong>Elevated BMI was associated with increased 90-day postoperative complications but not increased intraoperative or 2-year complications following A/X/OLIF. Optimization for patients with higher BMI should be performed to improve perioperative outcomes, especially in the 90-day postoperative period, and ultimately the safety of these procedures for obese patients.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623735","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":"Establishing a Threshold of Impairment to Define Preoperative Coronal Malalignment in Adult Spinal Deformity Patients.","authors":"Scott L Zuckerman, Fthimnir M Hassan, Christopher S Lai, Yong Shen, Mena Kerolus, Alex Ha, Ian Buchannan, Meghan Cerpa, Nathan J Lee, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke","doi":"10.1097/BSD.0000000000001792","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001792","url":null,"abstract":"<p><strong>Study design: </strong>Single-center retrospective analysis.</p><p><strong>Objective: </strong>To establish an empirically derived threshold to define both coronal and sagittal malalignment (CM & SM) based on preoperative patient-reported outcomes (PROs).</p><p><strong>Summary of background data: </strong>Currently, no radiographic alignment threshold defines preoperative CM in adult spinal deformity (ASD) patients based on disability. In a cohort of ASD patients undergoing corrective surgery, we sought to establish a threshold to define both CM and SM based on PRO and assess the clinical impact of CM and combined with SM.</p><p><strong>Methods: </strong>ASD patients with ≥6 level fusions were included. CVA and SVA were measured. PROs included preoperative ODI and SRS-22r scores. CVA and SVA thresholds were derived to accurately differentiate patients with ODI >40 and SRS-pain+function <5. Patients were then separated into 4 groups: (1) neutral alignment (NA); (2) CM; (3) SM; and (4) combined coronal and sagittal malalignment (CCSM).</p><p><strong>Results: </strong>Totally, 368 patients were included. Thresholds to distinguish patients with ODI ≥40 and SRS-pain/function <5 were: (1) CVA=3.96 cm (ODI) and 3.17 cm (SRS); (2) SVA=4.97 cm (ODI) and 7.52 cm (SRS). The lower numbers were chosen to define each threshold: CVA=3 cm and SVA=5 cm. Alignment breakdown was: NA=179 (48.6%), CM=66 (17.9%), SM=65 (17.7%), and CCSM=58 (15.8%). Both SM=(P=0.006) and CCSM (P<0.001) patients had significantly worse ODI scores than NA patients, and CCSM patients were significantly worse than SM alone (P=0.010). On the basis of preoperative total SRS-22r scores, only CCSM (P=0.003) patients were significantly worse than the NA group. CVA significantly correlated with 4/7 (57.1%) preoperative PROs (ODI/SRS-total/function/image), while SVA correlated with 5/7 (71.4%) preoperative PROs (ODI/SRS-total/function/image/pain). A linear relationship was seen between increasing CVA and worsening ODI (β=0.92, 95% CI: 0.37-1.48, P=0.001). A significant and slightly stronger relationship was seen between increasing SVA and worsening ODI (β=1.28, 95% CI: 1.00-1.56, P<0.001).</p><p><strong>Conclusions: </strong>CM and SM thresholds that accurately distinguished ASD patients with severe pain and disability preoperatively were 3 cm for CVA and 5 cm for SVA, respectively. Preoperative CM was significantly associated with worse ODI, SRS-22r total/function/image scores. CCSM led to more disability than SM alone.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623833","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":"Preoperative NSAID Use is Associated With a Small But Statistically Significant Increase in Blood Drainage in TLIF Procedures.","authors":"Michelle A Nakatsuka, Yong Kim, Themistocles Protopsaltis, Charla Fischer","doi":"10.1097/BSD.0000000000001795","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001795","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of retrospectively collected data.</p><p><strong>Objective: </strong>To determine the effects of preoperative nonsteroidal anti-inflammatory drug (NSAID) use on estimated blood loss (EBL) and postoperative drain output in TLIF procedures.</p><p><strong>Summary of background data: </strong>Current standards of care recommend patients prescribed NSAIDs for chronic lower back pain discontinue NSAIDs at least 1 week before spine fusion surgery. The literature surrounding the effects of preoperative NSAID use is unclear, however, with dissonant findings regarding postoperative blood loss and complications.</p><p><strong>Methods: </strong>A retrospective case review was performed on 429 cases of 1-level or 2-level TLIF, with patient NSAID use recorded within 3 days of surgery, at a single institution. Linear and logistic regressions were used to assess associations between NSAID use, patient and surgical characteristics, EBL, and drain output.</p><p><strong>Results: </strong>NSAID use was significantly positively associated with drain output (P=0.03), with an approximate increase of 21±9.7 mL/day but no significant association with any postoperative complications (P=0.77). Drain output also had significant, independent positive associations with patient age (P=0.007), male sex (P<0.001), and a number of levels fused (P<0.001), and significant negative associations with robot-assisted (P<0.001) and minimally invasive (P=0.04) procedures. No significant association was detected between NSAID use and EBL (P=0.21), though EBL had significant positive associations with operative time (P<0.001) and levels fused (P<0.001), and multiple NSAIDs had a significant positive association with EBL (P<0.001).</p><p><strong>Conclusions: </strong>NSAID use had a statistically significant, but small, effect on drain output and no detectable effect on postoperative complications within 3 days of TLIF procedures, suggesting most patients can safely continue NSAID use up until their date of surgery. Future studies should further delineate the effects of preoperative NSAID use, such that a more refined risk profile could be developed from patient and surgical characteristics and NSAID use information.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623848","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":"Efficacy and Safety of Chemical Venous Thromboembolism Prophylaxis in Spine Trauma Patients: A Systematic Review and Meta-analysis Comparing Anticoagulant Types.","authors":"Sapan D Gandhi, Sarthak Mohanty, Hanna von Riegen, Michael Akodu, Elizabeth Oginni, Diana Yeritsyan, Kaveh Momenzadeh, Anne Fladger, Mario Keko, Michael McTague, Ara Nazarian, Andrew P White, Jason L Pittman","doi":"10.1097/BSD.0000000000001790","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001790","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To determine whether venous thromboembolism (VTE) prophylaxis is necessary after spine trauma and to assess the efficacy and safety profiles of anticoagulation agents.</p><p><strong>Summary of background data: </strong>Venous stasis, endothelial disruption, hypercoagulability, and orthopedic injury in spine trauma predispose 12%-64% of patients to deep vein thrombosis (DVT). Recent guidelines provide insufficient evidence to support or oppose routine VTE prophylaxis in this population.</p><p><strong>Methods: </strong>A systematic search was conducted in Medline, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials from inception to March 2023. Controlled vocabulary, key terms, and synonyms related to spinal trauma and anticoagulation were used. Studies comparing different classes of anticoagulants or anticoagulation versus no anticoagulation were included. Four reviewers independently performed abstract screening, full-text review, and data extraction, resolving conflicts by consensus. The primary outcomes were deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality.</p><p><strong>Results: </strong>Our search yielded 2948 articles, with 103 advancing to full-text review and 16 meeting inclusion criteria. Bias assessment using MINORS for 10 retrospective studies resulted in an average score of 16.8 ± 1.6, whereas 6 prospective studies had NOS scores >6, indicating high-quality evidence. Anticoagulation was significantly associated with lower odds of DVT (OR: 0.40; P=0.0013), with low heterogeneity (I² = 2%). Low-molecular-weight heparin (LMWH) was associated with significantly lower odds of DVT (OR: 0.78; P=0.0050) and PE (OR: 0.66; P=0.0013) compared with unfractionated heparin (UH). No significant difference in major bleeding was found (OR: 0.52; P=0.1397). LMWH was linked to reduced mortality (OR: 0.43; P<0.0001).</p><p><strong>Conclusion: </strong>Chemical anticoagulants reduce DVT risk in spine trauma patients. LMWH provides superior protection against DVT, pulmonary embolism, and mortality compared with UH, with no significant increase in major bleeding.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603627","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":"Additional Operations Following Sacroiliac Joint Fusions: A Minimum 3-year Follow-up Cohort Study of Patients Operated for Chronic Sacroiliac Joint Pain.","authors":"Freyr Gauti Sigmundsson, Engelke Marie Randers, Thomas Kibsgård, Paul Gerdhem, Anders Joelson","doi":"10.1097/BSD.0000000000001791","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001791","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective analysis of prospectively collected registry data.</p><p><strong>Objective: </strong>To examine the subsequent pattern of surgeries and outcome of sacroiliac joint fusions (SJF) in patients previously operated in the lumbar spine as well as those scheduled for primary SJF.</p><p><strong>Summary of background data: </strong>Patients with SI joint pain often have a history of previous back surgery, but it is unclear how often patients require back surgery after SI-joint fusion.</p><p><strong>Methods: </strong>We obtained data from the national Swedish spine registry on all patients who underwent a SJF between 1998 and 2019 and identified previous and additional operations of any type after a SJF between 1998 and 2022. The EuroQol EQ VAS and the Oswestry disability index (ODI) were registered preoperatively and 1 year after the last undergone surgery. Satisfaction with treatment was assessed 1 year after surgery.</p><p><strong>Results: </strong>Two hundred seventy-nine patients underwent SJF between 1998 and 2019. Ninety-five of 279 patients (34%) underwent primary SJF, and 184 of 279 patients (66%) underwent SJF after spine surgery. Forty-one of 95 patients (43%) underwent additional spine or SI-joint surgery after a primary SJF. The most common additional procedure was contralateral SJF (22 of 41; 54%). The mean EQ-VAS change after primary SJF was 19 points (95% CI 12-26), whereas the corresponding value for SJF after previous lumbar spine surgery was 9 points (95% CI 2-16). The corresponding values for the mean ODI change were -14 points (95% CI -19 to -10) and -9 points (95% CI -14 to -4) respectively. Seventy-three percent (37 of 51) and 54% (34 of 63) were satisfied after SJF after primary versus secondary SJF.</p><p><strong>Conclusion: </strong>After primary SJF most additional surgeries are for contralateral symptoms and 9% required lumbar surgery after their SJF. Two-thirds of the patients with SJF have had their surgery after lumbar surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603073","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}