Clinical Spine Surgery最新文献

{"title":"Subsidence Following Anterior-Only Anterior Cervical Corpectomy Fusion For Cervical Spondylotic Myelopathy: Systematic Review and Meta-Analysis.","authors":"Rakesh Kumar, Aiyush Bansal, Annie Luo, Kenneth Nwosu, Anirudh K Gowd, Murad Alostaz, Jean-Christophe A Leveque, Venu M Nemani, Philip K Louie","doi":"10.1097/BSD.0000000000001919","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001919","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To examine the occurrence and potential contributing factors of interbody subsidence following anterior-only ACCF performed for CSM.</p><p><strong>Summary of background data: </strong>Surgical interventions for cervical spondylotic myelopathy (CSM) frequently involve anterior approaches, such as anterior cervical discectomy/fusion (ACDF) or anterior cervical corpectomy/fusion (ACCF). Although graft subsidence is a well-established and described complication in ACDF procedures, much less has been published regarding factors related to subsidence in patients undergoing anterior-only ACCF for CSM.</p><p><strong>Methods: </strong>A systematic literature search was conducted using PubMed, Embase, and COCHRANE. The study's inclusion criteria encompassed anterior-only anterior cervical corpectomy and fusion (ACCF), surgery for the primary diagnosis of cervical spondylotic myelopathy (CSM). Qualitative analysis was performed for complications and revision rates. The data were subjected to meta-analysis to evaluate subsidence incidence rates, and meta-regression analysis was used to assess variations between different graft types.</p><p><strong>Results: </strong>Two hundred forty-five abstracts were evaluated and 34 papers met the inclusion criteria. Two thousand five patients were evaluated over a mean of 31 months (range: 6-56 mo). Pooled subsidence rates expressed as incidence per person-years based on graft type were as follows: 2% (carbon fiber), 27% (fibular strut allograft), 2% (nHAPA composite strut), 5% (PEEK), 10% (static titanium), and 2% (expandable titanium cages). The combined subsidence rate for all grafts was 7%. Notably, the expandable titanium cohort demonstrated a lower subsidence rate (2%) compared with the overall pooled cohort (7%), while other graft types showed no significant difference.</p><p><strong>Conclusion: </strong>Subsidence occurred in ∼7% of patients undergoing anterior-only ACCF procedures for CSM. Notably, the use of expandable metal cages resulted in a lower rate of subsidence compared with the broader cohort. This finding suggests that these implant options may be preferable to reduce the risk of subsidence when corpectomy is necessary without posterior fixation.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945405","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":"Clinical Utility and Patient Compliance With Mobile Applications for Home-based Rehabilitation Following Cervical Spine Fusion.","authors":"Arpitha Pamula, Katie Lee, Alex Tang, Tan Chen","doi":"10.1097/BSD.0000000000001903","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001903","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>(1) To compare patient-reported outcome measures (PROMs) between postoperative patients who were the most and least compliant in using mobile-based rehabilitation programs, (2) compare PROMs between patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical posterior decompression and instrumented fusion (PDIF), and (3) quantify the overall compliance rate.</p><p><strong>Summary of background data: </strong>Mobile applications for rehabilitation have been widely used following orthopedic procedures. There is limited data describing the utility and compliance with self-directed programs and their effects on PROMs following ACDF or PDIF.</p><p><strong>Methods: </strong>A retrospective review was performed identifying patients who underwent elective ACDF or cervical PDIF for degenerative pathology. Patient-Reported Outcomes Measurement Information System (PROMIS) and Neck Disability Index (NDI) scores were collected perioperatively and assessed longitudinally. Patients were separated into 2 study groups based on application compliance and fusion construct. Patient compliance and engagement were defined as those who downloaded the application (DL+) and set therapy session reminders (R+) on their mobile devices. Compliance rate was calculated as the difference between the number of active participants at the preoperative phase and final follow-up. Descriptive and inferential statistics were performed.</p><p><strong>Results: </strong>A total of 775 patients (ACDF, n=571; PDIF, n=204) were included. No difference was found in ∆PROMIS overall (P=0.205) or ∆NDI (P=0.441) regardless of patient compliance and engagement to the therapy program. No difference was found in the improvement of outcomes scores between ACDF or PDIF cohorts as stratified by DL+/DL- and R+/R- at any postoperative point. Overall patient compliance rate to the program at final postoperative follow-up was 71% (ACDF: 71.8%, PDIF: 69.2%).</p><p><strong>Conclusions: </strong>Mobile applications for postoperative rehabilitation demonstrated low clinical utility following ACDF or PDIF for degenerative diseases, despite high patient compliance and growing popularity.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945146","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":"Therapeutic Opportunity Window for Surgical Management in Patients With Malignant Spinal Compression: Systematic Review And Meta-Analysis.","authors":"Jhonny A Gómez-Arévalo, Angela C Prieto-Garzón, Herney A García-Perdomo","doi":"10.1097/BSD.0000000000001915","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001915","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To determine the optimal time to perform surgery in patients with malignant cord compression.</p><p><strong>Summary of background data: </strong>Malignant cord compression (MSC) is a frequent complication of spinal metastases, being reported in about 5%-10% of all cancer patients. The sequelae caused by spinal cord compression can be devastating, causing disability, deterioration of their quality of life, and even death. Patients with malignant cord compression frequently require surgical management to preserve neurological function.</p><p><strong>Methods: </strong>This systematic review identified studies that tested different therapeutic windows for surgical decompression. The articles that met the inclusion criteria were meta-analyzed to compare the patients with early versus late decompression after the onset of neurological symptoms. The result of interest was the recovery of walking ability.</p><p><strong>Results: </strong>Out of the 1003 abstracts reviewed, 5 studies (389 patients) met the inclusion criteria. All 5 were retrospective studies that proposed surgical intervention in the first 48 hours after the onset of neurological symptoms as the necessary therapeutic window. When comparing early versus late intervention, surgery before the first 48 hours had an odds ratio of 3.92 [95% CI: 1.51-10.18] for recovering walking ability.</p><p><strong>Conclusion: </strong>Surgery in the first 48 hours after the onset of neurological symptoms in patients with malignant cord compression is associated with a greater chance of recovery of walking ability. Since the literature is scarce, studies with more evidence are needed on this topic.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945422","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":"Reoperation Rate Following Single-Level Anterior Cervical Discectomy and Fusion With Standalone Cage Versus Anterior Plating in a Large Matched Cohort.","authors":"Adeesya Gausper, Andrew M Miller, Vivien Chan, Suhas K Etigunta, Andy M Liu, David Skaggs, Tiffany Perry, Corey Walker, Alexander Tuchman","doi":"10.1097/BSD.0000000000001917","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001917","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To compare reoperation rates between single-level standalone anterior cervical discectomy and fusion (ACDF) and ACDF with anterior plating.</p><p><strong>Summary of background data: </strong>ACDF is a widely performed procedure for cervical degenerative disc disease and may utilize standalone cages or cages with anterior plating. Reoperation rate serves as a critical measure of long-term success and durability of each technique.</p><p><strong>Methods: </strong>The PearlDiver national insurance claims database was used to identify patients who underwent single-level ACDF with a standalone cage or ACDF with a plate. 1:1 matched cohorts were created based on age, sex, Elixhauser Comorbidity Index score, and year of surgery. The primary outcome was the reoperation rate at 2 years postoperatively. Secondary analyses included reoperation rate at 1-year and 5-years, reoperation stratified by surgical approach, and rate of epidural or facet injections at 2-years after index surgery. Statistical analyses included χ2 tests and Kaplan-Meier analysis to compare reoperation rates.</p><p><strong>Results: </strong>Nine thousand three hundred twenty-six patients were included in each cohort after matching. The 2-year reoperation rate was 3.26% for ACDF with plate and 3.31% for standalone ACDF (P=0.837). No significant difference was found in reoperation rates at 1-year, 2-year, and 5-year. Kaplan-Meier analysis additionally demonstrated no significant difference in reoperation-free survival over time. Patients undergoing standalone ACDF had higher rates of posterior approach reoperations within 2 years (1.22% vs. 0.84%, P=0.011). No significant differences were found in the rate of epidural or facet injections between groups.</p><p><strong>Conclusions: </strong>Standalone and plated single-level ACDF provide comparable long-term outcomes in terms of reoperation rates. This study is the largest matched cohort to date of patients who underwent single-level ACDF with and without anterior plating.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945454","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 Accuracy and Safety of Free-Hand C7 Laminar Screw Fixation: A Clinical Study of 43 Consecutive Patients.","authors":"Jiwon Park, Jin S Yeom, Ho-Joong Kim, Jae-Young Hong, Sang-Min Park","doi":"10.1097/BSD.0000000000001912","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001912","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Background: </strong>C7 laminar screw is a feasible substitute for C7 pedicle screw with the potential to decrease neurovascular complications and minimize the requirement for intraoperative fluoroscopic guidance. Nevertheless, the clinical evidence regarding their accuracy and safety is still limited.</p><p><strong>Objective: </strong>To evaluate the accuracy and safety of free-hand placement of C7 laminar screw in a series of consecutive patients.</p><p><strong>Methods: </strong>This study included 43 patients who underwent posterior cervical fixation with C7 laminar screw using a free-hand technique. A total of 61 C7 laminar screws and their direction and degree of laminar cortical violation were evaluated for their accuracy and safety by postoperative computed tomography scan. Neurovascular complications were also evaluated.</p><p><strong>Results: </strong>Out of the 61 screws, 14 (23%) penetrated the laminar cortical wall, with 3 dorsal and 11 ventral breaches. Of those 14 screws, 11 screws (18%) experienced a breach of <50% of screw diameter, whereas 3 screws (5%) fell between 50% and 100% breach. No screws resulted in complete cortical violation. There were no instances of neurovascular complications. There was no mechanical complication requiring revision surgery.</p><p><strong>Conclusions: </strong>Free-hand C7 laminar screw fixation demonstrated acceptable accuracy and safety. Despite a frequent occurrence of laminar cortical breach (25%) with our free-hand technique, there was no clinically relevant neurovascular or mechanical complications occurred. This technique may offer a feasible option for C7 posterior fixation alternative to pedicle screw, especially in situations where advanced imaging guide is unavailable.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945412","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":"Clinical Significance of Facet Cysts in Patients Undergoing Lumbar Decompression for Degenerative Spine: A Propensity-score Matched Multicenter Analysis.","authors":"Karim Rizwan Nathani, Miles A Hudson, Aleeza Safdar, William Krauss, Maziyar Kalani, Selby G Chen, Kingsley Abode-Iyamah, Mohamad Bydon, Joshua Bakhsheshian","doi":"10.1097/BSD.0000000000001900","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001900","url":null,"abstract":"<p><strong>Study design: </strong>Cohort study.</p><p><strong>Objective: </strong>This study aimed to evaluate influence of facet cysts on outcomes in patients undergoing lumbar decompression, and the influence of spinal fusion in patients undergoing decompression for facet cysts.</p><p><strong>Summary of background data: </strong>The impact of facet cysts on outcomes following lumbar spine surgery for degenerative spine disease remains unclear.</p><p><strong>Methods: </strong>Our multicenter institutional Neurosurgery Enterprise Registry was queried for patients who underwent lumbar decompression for degenerative spine conditions. Patients were divided into 2 cohorts: those with lumbar spine facet cysts and those without. Retrospective propensity-score matching was performed using 13 baseline variables to adjust for potential confounding factors, including age, sex, race, body mass index, and comorbidities. Secondary analysis comparing outcomes in patients with facet cysts cases undergoing decompression only versus those undergoing decompression and fusion was conducted.</p><p><strong>Results: </strong>A total of 6768 patients were reviewed, of which 188 (2.8%) had facet cysts, which underwent lumbar decompression during 2019-2023. After 3:1 matching, patients with facet cysts were compared with 564 patients without it. We found no significant differences in LOS, nonroutine discharge, postoperative complications, readmissions, and reoperations. In addition, in cases with facet cysts, decompression reported no increased risk for discharge opioids, readmissions, and reoperations, whereas fusion (in a separate cohort of 127 patients with facet cysts) was associated with an increased risk for nonroutine discharge (3.7% vs. 10.2%, P=0.021), complications (2.1% vs. 7.1%, P=0.042), and longer LOS (0.89±1.69 vs. 3.74±2.03 d, P<0.001) and operative time (138.78±62.99 vs. 273.07±111.51 min, P <0.001).</p><p><strong>Conclusions: </strong>The presence of facet cysts does not significantly affect outcomes of lumbar decompression for degenerative spine disease. Decompression alone for facet cysts can have better outcomes than decompression and fusion. The need for fusion should be weighted with its higher risks of complications, longer hospital stays, and nonroutine discharges.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945083","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 of Upper Instrumented Vertebrae and Future Cervical Spine Surgery to Patient-reported Outcomes in Adolescent Idiopathic Scoliosis Treated With Harrington Rod Instrumentation: A Minimum 40-year Follow-up.","authors":"Aron Sulovari, Adan M Omar, Jarren A Section, Noorullah Maqsoodi, Emmanuel N Menga, James O Sanders, Cindy X Wang, Paul T Rubery, Varun Puvanesarajah, Addisu Mesfin","doi":"10.1097/BSD.0000000000001913","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001913","url":null,"abstract":"<p><strong>Study design: </strong>Long-term retrospective observational study.</p><p><strong>Objective: </strong>Assess the influence of upper instrumented vertebrae (UIV) and future cervical spine surgery on patient-reported outcomes in Adolescent Idiopathic Scoliosis (AIS) treated with Harrington rod fusion.</p><p><strong>Summary of background data: </strong>Harrington rod has been largely replaced by pedicle screw fixation due to many considerations, including complications like pseudoarthrosis and implant failure. UIV and future spine surgery are known factors that affect patient-reported outcomes.</p><p><strong>Methods: </strong>We identified 318 AIS patients treated with Harrington rod instrumentation and fusion between 1961 and 1978. Patient questionnaires were completed, observing: NDI, SRS-7, PROMIS physical function (PF), PROMIS depression (D), and PROMIS pain interference (PI). Statistical analysis was used to compare outcome measures based on UIV and future cervical spine surgery.</p><p><strong>Results: </strong>In patients without cervical spine surgery, those with UIV of T5 and proximal had average NDI (P=0.14) of 10.2±11.2 and SRS-7 (P=0.73) of 22.9±3.4 compared with patients with UIV T6 and distal having NDI and SRS-7 of 14.6±11.6 and 22.8±2.6. Patients without cervical spine surgery with UIV of T5 and proximal had average PROMIS PF (P=0.17) of 45.5±2.8, PROMIS D (P=0.73) of 51.8±2.7, and PROMIS PI (P=0.43) of 53.9±1.9 compared with patients with UIV T6 and distal having PROMIS PF, D, and PI scores of 43.5±2.6, 49±3.2, and 55.6±1.9, respectively. Patients with cervical spine surgery had a mean NDI (P=0.13) of 23±1.4, SRS-7 (P=0.12) of 16, PROMIS PF (P=0.11) of 39.2±2.4, and PROMIS D (P=0.43) of 55.7±2.3 as compared with NDI of 11.9±11.5, SRS-7 of 22.8±3.1, PROMIS PF of 43.5±2.6, and PROMIS D of 49.0 ± 3.2 in patients without cervical spine surgery.</p><p><strong>Conclusion: </strong>In long-term follow-up of AIS patients who underwent Harrington rod instrumentation, patient-reported outcomes were not associated with UIV or future cervical spine surgery; patients undergoing future cervical spine surgery did report greater pain interference.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945165","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":"Lowest Instrumented Vertebra in Treatment of Adolescent Idiopathic Scoliosis Is Not Correlated With PROMIS Scores.","authors":"Katherine D Sborov, De An Zhang, Robert H Cho, Cynthia V Nguyen, Selina C Poon","doi":"10.1097/BSD.0000000000001909","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001909","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter analysis of electronic medical record (EMR) data from a national pediatric orthopedic health care system.</p><p><strong>Objective: </strong>To determine whether the lowest instrumented vertebra is associated with changes in PROMIS scores in patients with adolescent idiopathic scoliosis and to evaluate for correlations with SRS-22.</p><p><strong>Summary of background data: </strong>Appropriate selection of the lowest instrumented vertebra (LIV) is crucial to ensure positive outcomes after surgical management of patients with adolescent idiopathic scoliosis (AIS). Preservation of motion segments is believed to be beneficial for preserving motion and preventing degeneration of the unfused lumbar spine, leading to a positive impact on a patient's quality of life. Prior studies have shown moderate correlations between the Spine Research Society score (SRS-22) as well as Oswestry Disability Index (ODI) score and the lowest instrumented vertebra; however, there is limited data using the Patient-Reported Outcomes Measurement Information System (PROMIS) scores as related to LIV.</p><p><strong>Methods: </strong>A set of patients who had undergone primary posterior spinal fusion for AIS from January 2011 to January 2023 with PROMIS or SRS-22 scores documented pre-surgery and post-surgery was queried. PROMIS survey scores, SRS-22 survey scores, clinical dates, sex, and LIV were collected from the EMR.</p><p><strong>Results: </strong>The study cohort consisted of 348 patients with PROMIS data and 341 patients with SRS-22 data. Neither the PROMIS scores nor SRS scores met the threshold for clinically significant differences with LIV level.</p><p><strong>Conclusions: </strong>In this study, LIV for AIS was not correlated with PROMIS or SRS-22 scores at 2 years. Longer term follow-up will be necessary to differentiate whether patients' outcomes will be affected by LIV selection.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945398","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":"ICD-10 Coding of Cervical Radiculopathy Underestimates Concurrent Myelopathy.","authors":"Bradley T Hammoor, David N Bernstein, Ikechukwu C Amakiri, Chierika O Ukogu, Lara L Cohen, Daniel G Tobert","doi":"10.1097/BSD.0000000000001904","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001904","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To evaluate the accuracy of ICD-10 codes in identifying isolated degenerative cervical radiculopathy versus concurrent myelopathy in surgical patients across an 11-hospital health care system (2016-2023).</p><p><strong>Summary of background data: </strong>ICD-10 codes are commonly used for patient stratification in database studies, yet their accuracy in differentiating cervical radiculopathy from concurrent myelopathy remains poorly characterized. This distinction is clinically critical as treatment approaches and outcomes differ significantly between these conditions.</p><p><strong>Methods: </strong>We reviewed 830 surgical patients identified using ICD-10 codes for cervical radiculopathy (M50.10-50.13, M54.11-M54.13, or M25.78). Patients with codes for myelopathy, traumatic, oncologic, or infectious etiologies were excluded. Primary diagnoses were determined through standardized chart review by 3 independent clinical reviewers blinded to ICD-10 codes. Patients were classified using specific criteria: radiculopathy (dermatomal symptoms, positive provocative tests, and foraminal stenosis) and myelopathy (upper motor neuron signs, gait disturbances, fine motor deficits, and cord signal changes on MRI).</p><p><strong>Results: </strong>Chart review revealed 637 patients (76.7%) had isolated cervical radiculopathy, confirming ICD-10 coding. However, 151 patients (18.2%) presented with concurrent myelopathic symptoms (myeloradiculopathy), and 35 patients (4.2%) demonstrated isolated cervical myelopathy, despite being coded only for radiculopathy. Nondegenerative etiologies comprised 0.8% of cases. The nonspecific code M25.78 showed higher error rates (26%) compared with specific codes, though M54.12 still demonstrated a 22% error rate. Code position significantly influenced accuracy, with error rates increasing from 14% (primary position) to 43% (fourth position).</p><p><strong>Conclusions: </strong>A significant proportion of patients coded for isolated cervical radiculopathy have concurrent myelopathy that goes unrecognized with ICD-10 coding alone. Code specificity and diagnostic position significantly impact accuracy. Future strategies, including decision support tools and natural language processing, may improve coding accuracy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945329","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":"Intraoperative Baseline Motor Signals as a Predictor of Recovery in Complete Spinal Cord Injury.","authors":"Yazan Shamli Oghli, Shreya Vinjamuri, Zachary Sokol, Eric Mong, Sara Thalheimer, Eugene Martin, Steven Yi, Rabiul Rafi, Saurav Sumughan, Daniel K Fahim, James Harrop","doi":"10.1097/BSD.0000000000001907","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001907","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>The purpose of the study was to investigate the association between the presence of baseline sensory and motor intraoperative neuromonitoring and follow-up functional improvement in complete SCI.</p><p><strong>Summary of background data: </strong>During surgery for complete spinal cord injury (SCI), a subset of patients may have present sensory and motor signals at baseline, suggesting that neuronal tracts may be intact as a target for novel therapeutics or even as a prognostic tool for recovery.</p><p><strong>Methods: </strong>One hundred nineteen complete SCI patients who had a decompression procedure were reviewed in this retrospective study. Intraoperative neuromonitoring signals at baseline were obtained, and the presence of motor evoked potentials (MEPs) at the level of injury and above, as well as somatosensory evoked potentials (SSEPs) at the posterior tibial (PTN) and ulnar (UN) nerves was determined. ASIA scores were collected, and grade conversions and level improvements were both considered functional improvements. Binary logistic regression was completed, with patient age, sex, race, level of injury, and all the above signals as covariates, and functional improvement as the outcome.</p><p><strong>Results: </strong>Approximately 32% of all patients had functional improvement. 17.2% of patients had MEPs present at the level of injury, whereas 49.2% had MEPs present at least one level above injury. The only significant predictor of improvement was MEPs present at the level of injury (OR=3.14, P=0.023).</p><p><strong>Conclusions: </strong>Intraoperative motor signals at the level of injury may hold prognostic value following surgery in complete SCI, which is crucial for determining patient outcomes and guiding future management and decision-making.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945374","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}