Clinical Spine Surgery最新文献

{"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}

{"title":"Does Interbody Height and Material Influence Radiographic Pseudarthrosis in ACDF? Insights From a Single-Institution Study.","authors":"Brian Hou, Hani Chanbour, Omar Zakieh, Andrew Croft, D Campbell Liles, Iyan Younus, Raymond J Gardocki, Amir M Abtahi, Scott L Zuckerman, Byron F Stephens, Julian G Lugo-Pico","doi":"10.1097/BSD.0000000000001797","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001797","url":null,"abstract":"<p><strong>Study design: </strong>Single-institution retrospective cohort study.</p><p><strong>Objective: </strong>Determine the impact of graft height and material on radiographic pseudarthrosis, pseudarthrosis requiring reoperation, and patient-reported outcome measures (PROMs).</p><p><strong>Summary of background data: </strong>The success of an anterior cervical discectomy and fusion (ACDF) depends on obtaining solid bony fusion to achieve stability and restore disc height. While various interbody graft options exist, the impact of graft height and material on fusion rate remains an area of ongoing investigation.</p><p><strong>Methods: </strong>Patients who underwent 1-3 level primary ACDF between 2010 and 2021 were studied. Graft height and material (structural allograft vs. prosthetics) were the primary independent variables. The primary outcome was pseudarthrosis, defined as interspinous motion >2 mm on flexion-extension lateral x-rays at 1-year postoperatively. PROMs included Numeric Rating Scale-Arm/Neck and Neck Disability Index. Multivariable logistic regression was performed. A subanalysis was conducted for prosthetic submaterial (PEEK vs. titanium).</p><p><strong>Results: </strong>One hundred fifty-three patients were included (mean age: 51.8±11.0 y; 42.5% male). Most patients had 1-2 levels operated on and 33.3% had structural allograft as the interbody implant. Prosthetic implants were used in 66.7% of patients, with PEEK being the most common (80.4%). At 1-year postoperatively, 11.1% of patients developed pseudarthrosis, and 2.0% underwent reoperation. There were no significant differences in graft height, material, or prosthetic submaterial between patients with and without pseudarthrosis. Multivariable logistic regression also did not show any significant associations between graft height, material, or prosthetic submaterial with pseudarthrosis, reoperation, or PROMs (all P>0.05).</p><p><strong>Conclusion: </strong>This study found that graft height and material did not significantly affect pseudarthrosis, reoperation, or PROMs in patients undergoing primary ACDF. While graft height and composition alone may not be critical determinants for fusion success in ACDF, Other factors, such as patient-specific characteristics and surgical technique may contribute to the risk of pseudarthrosis and should be explored in future studies.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603521","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 and Radiologic Outcomes of Unilateral Biportal Endoscopic Lumbar Interbody Fusion Compared With Conventional Posterior Lumbar Interbody Fusion on the Treatment of Single-segment Lumbar Spinal Stenosis With Instability, a 2-year Follow-up Study.","authors":"Heqing Zhang, Chengyan Dong, Jingjie Wang, Ding Yan, Leisheng Wang, Xiaoguang Fan","doi":"10.1097/BSD.0000000000001781","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001781","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the clinical and radiologic outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) for single-segment lumbar spinal stenosis with instability.</p><p><strong>Background: </strong>Unilateral biportal endoscopic technology has developed rapidly, and ULIF is a new type of minimally invasive fusion surgery. However, there remains a lack of sufficient evidence regarding its clinical efficacy. By comparing it with posterior lumbar interbody fusion (PLIF) surgery, its clinical efficacy can be evaluated.</p><p><strong>Materials and methods: </strong>In total, 110 (ULIF group, 54; PLIF group, 56) patients were included. Perioperative indicators were compared between the groups. Clinical efficacy, Visual Analog Scale (VAS) scores for back and leg pain, and Oswestry Disability Index scores were compared. Surgical complications, intraoperative dural tears, nerve root injury, surgical hematoma, and reoperation were assessed. The postoperative clinical test indicators were white blood cell count and C-reactive protein, procalcitonin, and interleukin-6 levels. Imaging results, cage loosening, screw loosening, and intervertebral fusion rate were evaluated.</p><p><strong>Results: </strong>The surgical time was significantly longer in the ULIF group than in the PLIF group. The postoperative ambulation time, length of hospital stay, and postoperative drainage volume were shorter in the ULIF group than in the PLIF group. There were no differences in the VAS scores for leg pain and Oswestry Disability Index scores, but there were statistically significant differences in the VAS scores for low back pain between the groups. The white blood cell count and C-reactive protein, procalcitonin, and interleukin-6 levels were significantly lower in the ULIF group than in the PLIF group. None of the patients showed any loosening of the fusion cage or any loosening or breakage of the screws. There was no difference in the lumbar interbody fusion rate.</p><p><strong>Conclusions: </strong>ULIF has several advantages, but its surgical time is significantly prolonged.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572333","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":"Incidence and Risk Factors for Postoperative Hip Displacement Following Spinal Fusion in Nonambulant Patients With Spastic Neuromuscular Scoliosis.","authors":"Yuki Taniguchi, Daiki Urayama, Keita Okada, Sayumi Yabuki, Ayato Nohara, Takashi Ono, Yoshitaka Matsubayashi, Hiroyuki Nakarai, Koji Nakajima, Hideki Nakamoto, So Kato, Sakae Tanaka, Yasushi Oshima","doi":"10.1097/BSD.0000000000001782","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001782","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective multicenter cohort study.</p><p><strong>Objective: </strong>To investigate the incidence and risk factors of postoperative hip displacement following spinal fusion in nonambulant patients with spastic neuromuscular scoliosis.</p><p><strong>Summary of background data: </strong>In patients with spastic neuromuscular disorders, spinal deformity, and hip displacement mutually influence each other; however, little is known about the clinical impact of spinal fusion on the incidence of hip displacement.</p><p><strong>Methods: </strong>We retrospectively analyzed nonambulant patients with spastic neuromuscular disorders undergoing primary fusion with a minimum follow-up of 1 year. The primary outcome was new postoperative hip displacement. To identify potential risk factors for postoperative hip displacement, an association analysis was conducted.</p><p><strong>Results: </strong>We identified 67 eligible patients (29 males and 38 females) with a mean age of 14.1 years and a mean follow-up period of 49.4 months. Overall, 11 cases of postoperative hip displacement (10 up hip, and 1 down hip) were identified in 11 patients (16.4%). Patients with hip displacement were significantly more skeletally immature at surgery, had a significantly larger preoperative curve magnitude (115.6 vs. 97.5 degrees), larger correction of the Cobb angle (71.0 vs. 56.8 degrees), larger preoperative pelvic obliquity (36.2 vs. 24.3 degrees), and included a significantly higher proportion of cases with pelvic fixation (P=0.03). Compared with patients with nondislocated stable up hip joints, 10 patients with new up hip displacement had a significantly higher preoperative migration percentage (MP) in the up hip (40.6 vs. 31.4, P=0.047). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the preoperative MP of the up hip for predicting postoperative displacement was 28.8 (sensitivity, 90.0%; specificity, 47.8%).</p><p><strong>Conclusions: </strong>When performing spinal fusion in patients with spastic neuromuscular disorders, especially in those with identified potential risk factors, patients and their caregivers should be informed preoperatively about the possibility of subsequent hip displacement.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566252","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 Correlation Among the Most Classic Axis Injuries Classification and the New AO Upper Cervical Spine Classification System.","authors":"Andrei F Joaquim, Rajkishen Narayan, Gregory D Schroeder, Alexander R Vaccaro","doi":"10.1097/BSD.0000000000001780","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001780","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>To establish a correlation among the classic C2 classification systems and the new AO upper cervical spine trauma classification system (UCST).</p><p><strong>Summary of background data: </strong>A multitude of classifications were historically proposed for C2 injuries, none of them with universal acceptation. The new UCST incorporated elements of these prior classifications into this new system to improve their limitations.</p><p><strong>Methods: </strong>Eight classic C2 classification systems-Anderson and D´Alonzo, Roy-Camille, Hadley et al, Grauer et al, Effendi et al, Levine and Edwards, Burke and Harris and Benzel et al were evaluated, and their injury types/subtypes were classified according to the new AO UCST.</p><p><strong>Results and conclusions: </strong>Most of the injuries were classified as type A in accordance with the new UCST, suggesting that most of the detailed descriptions of specific bone injury patterns may not be implied in different treatment strategies, being treated non-surgical. Those with ligamentous injury (type B) were attributed to some injuries with ligamentous/disc disruption without clear dislocations (type C when dislocations were present). This correlation between the classic morphologies and the new AO UCST may improve the understanding of injury patterns and help in the decision of the best treatment.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fusion Outcomes of GLP-1 Agonist Therapy in Multilevel Cervical Spinal Fusion: A Propensity-Matched Analysis.","authors":"Sohrab K Vatsia, Michael F Levidy, Nicholas D Rowe, Andrew S Meister, Jesse E Bible","doi":"10.1097/BSD.0000000000001775","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001775","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effects of GLP-1 agonist therapy upon the incidence of pseudarthrosis in patients undergoing multilevel cervical spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of background data: &lt;/strong&gt;The rising prevalence of obesity and diabetes mellitus has rendered the usage of glucagon-like peptide-1 receptor (GLP-1) agonists increasingly commonplace since their introduction in 2005. However, there is a dearth of evidence to suggest whether outcomes of multilevel cervical spinal fusion differ in patients treated with GLP-1 agonists. This study assesses rates of pseudarthrosis in patients who underwent multilevel cervical spine fusion with and without concurrent GLP-1 agonist therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The TriNetX, LLC Diamond Network database was queried utilizing CPT codes for patients undergoing both anterior and posterior multilevel cervical spinal fusion from 2005 to 2024. Patients prescribed liraglutide, pramlintide, tirzepatide, semaglutide, lixisenatide, or dulaglutide within 1 year of surgery were propensity matched to patients without GLP-1 agonist prescriptions. Cohort balancing was achieved categorically according to age at procedure, race, sex, and nicotine dependence. Cohort balancing was performed continuously to account for body mass index and hemoglobin A1C at the time of procedure. CPT diagnosis codes for pseudarthrosis after attempted fusion were concomitantly utilized to assess pseudarthrosis rates at 6-months, 1-year, and 2-years postoperatively using the Fisher exact test. Statistical significance was set at P&lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In consideration of anterior multilevel cervical fusion, 1204 patients utilized GLP-1 agonist therapy, while 1204 patients did not use GLP-1 agonists. With respect to posterior multilevel cervical fusion, 1378 patients utilized GLP-1 agonist therapy, and 1378 patients did not have a GLP-1 agonist prescription. Anterior postoperative pseudarthrosis rates were significantly decreased in the GLP-1 agonist cohort versus the non-GLP-1 agonist cohort at 6-months (10.71% vs. 17.61%; P&lt;0.001), 1-year (12.04% vs. 18.52%; P&lt;0.001), and 2-years (12.87% vs. 19.19%; P&lt;0.001). Posterior postoperative pseudarthrosis rates were also significantly decreased in the GLP-1 agonist cohort versus the non-GLP-1 agonist cohort at 6-months (13.21% vs. 22.28%; P&lt;0.001), 1-year (14.37% vs. 24.45%; P&lt;0.001), and 2-years (16.87% vs. 24.43%; P&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings demonstrate a statistically significant lower incidence of pseudarthrosis among patients treated with GLP-1 agonist therapy at all timepoints within this study-from 6-months to 2-years postoperatively, suggesting a potentially beneficial effect of GLP-1 agonist therapy in promoting fusion success in multilevel cervical spine surgery. Fundamentally, this aligns with the pharmacodynamic nature of GLP-1 agonists: as co","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Utility of Bilateral-contralateral Decompression for Adjacent Segment Stenosis After Lumbar Interbody Fusion Using Unilateral Biportal Endoscopy.","authors":"Dong Hyun Lee, Choon Keun Park, Jae-Won Jang, Dong-Geun Lee","doi":"10.1097/BSD.0000000000001777","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001777","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series study.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of bilateral-contralateral decompression using unilateral biportal endoscopy (UBE) for treating adjacent segment disease (ASD) after lumbar interbody fusion (LIF).</p><p><strong>Summary of background data: </strong>ASD is a well-documented complication following LIF, often requiring additional surgical interventions. Traditional decompression techniques risk damaging the facet joints, potentially leading to further instability and degeneration. However, our bilateral-contralateral decompression using UBE focuses on minimizing facet joint resection and reducing the risk of postoperative instability.</p><p><strong>Methods: </strong>This study included 37 patients who underwent bilateral-contralateral UBE decompression for ASD following LIF at the L4-5 level between September 2020 and March 2022. Radiographic evaluations included measurements of vertebral range of motion (ROM), slip distance, disk height, lumbar lordosis, and facet joint preservation. Clinical assessments were performed using the visual analog scale (VAS) for back and leg pain and the Oswestry disability index (ODI).</p><p><strong>Results: </strong>The average final follow-up period was 14.5±1.9 mo. The average preoperative ROM was 3.0 degrees, which significantly increased to 4.8° at the final follow-up (P<0.05). Static structure and dynamic stability parameters, including the vertebral slip distance, lumbar lordosis, and disk height, showed no significant differences between the preoperative examination and 1-year postoperative follow-up. The facet joint preservation rate was 97.4±2.1% on average. Significant improvements in VAS scores for leg and back pain and ODI were observed. Despite improvement with conservative treatment in 7 patients with delayed instability, 2 patients required fusion surgery.</p><p><strong>Conclusions: </strong>Bilateral-contralateral decompression through UBE has proven to be an effective and safe method for treating ASD following LIF. This technique is particularly suitable for patients requiring spinal stability maintenance. The high rates of facet joint preservation and low incidence of reoperation highlight this technique as a compelling alternative treatment for spinal stenosis.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539435","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":"Prehabilitation Improves Early Outcomes in Lumbar Spinal Stenosis Surgery: A Pilot Randomized Controlled Trial.","authors":"Hiroto Takenaka, Mitsuhiro Kamiya, Junya Suzuki","doi":"10.1097/BSD.0000000000001779","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001779","url":null,"abstract":"<p><strong>Study design: </strong>A pilot randomized controlled trial.</p><p><strong>Objective: </strong>To investigate the effects of a prehabilitation program on early postoperative outcomes in Japanese patients undergoing lumbar spinal stenosis (LSS) surgery.</p><p><strong>Summary of background data: </strong>Prehabilitation has shown promise for improving postoperative outcomes in various surgical populations. However, its effectiveness in Japanese patients undergoing LSS surgery has not been previously studied.</p><p><strong>Methods: </strong>Thirty-two of 34 patients scheduled for LSS surgery (mean age: 69.3 y, 17 female) were randomly assigned to the prehabilitation group (15 patients) or control group (17 patients). The primary outcomes were the Oswestry Disability Index (ODI) and 6-minute walk distance (6MWD). The secondary endpoints were the visual analog scale (VAS) scores for back pain, leg pain, and numbness. The intervention group received a 20-30-minute educational session from a physical or occupational therapist using a pamphlet 1 month before surgery, while the control group received a pamphlet handout. Assessments were conducted 1 month before surgery (baseline); 1 day before surgery; and 1, 3, and 6 months postoperatively.</p><p><strong>Results: </strong>All patients underwent preoperative educational sessions. The prehabilitation group showed significant improvements in 6MWD at 3 months postoperatively compared with the control group (446.8±48.9 m vs. 384.3±58.3 m, P=0.01, Hedges' g=1.11). ODI scores at 1 month postoperatively were lower in the prehabilitation group (10.2±10.9 vs. 19.0±10.7, P=0.04, Hedges' g=-0.77). Low back pain VAS at 3 months postoperatively was also lower in the prehabilitation group (12.5±14.8 vs. 27.5±20.8, P=0.04, Hedges' g=0.75). No adverse events were reported in either of the groups.</p><p><strong>Conclusions: </strong>Prehabilitation may enhance postoperative recovery and outcomes in patients undergoing surgery for LSS. Further research with a larger sample size is needed to establish the effectiveness of prehabilitation in this population.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540445","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}