Clinical Spine Surgery最新文献

{"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}

{"title":"Ski and Snowboard-Related Spinal Trauma and Spinal Cord Injury: A Northeastern Level I Trauma Experience.","authors":"Khushdeep S Vig, Jillian Kazley, Abdul Arain, Morgan Spurgas, Hamza Murtaza, Gabriella Rivas, Robert Ravinsky, James Lawrence","doi":"10.1097/BSD.0000000000001761","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001761","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To review the traumatic spinal injuries in alpine athletes treated at a single level I trauma center.</p><p><strong>Summary of background data: </strong>Recreational and competitive skiers/snowboarders are prone to spinal injuries, and recent changes in the sport may have led to increases in the incidence and severity of spinal injuries. Currently, there is a paucity of data on the epidemiology of spinal injuries resulting from skiing and snowboarding.</p><p><strong>Methods: </strong>A review of patients admitted with traumatic spinal injuries from skiing/snowboarding, between January 2015 and March 2019. Data on demographics, spinal region of injury, mechanism of injury, fracture type, presence/absence of spinal cord injury, ASIA score, management, concomitant injuries, and involvement of other surgical services were collected.</p><p><strong>Results: </strong>Spinal injuries were distributed as 33.3% cervical, 57% thoracic, and 38.0% lumbosacral spine. Seventy-five percent patients injured a single region, 21.7% injured 2 regions, and 3.3% injured all 3. Single-level injuries occurred in 38% patients, II-level in 25%, III-level in 12%, and >3-levels in 28%. Twenty-seven percent patients suffered a spinal cord injury. Eighty-one percent of those had neurological compromise, with a 53.8% rate of full neurological resolution at the time of discharge. 65% fractures were compression-type. Management included operative treatment with decompression and fusion in 32% patients. Cervical spinal injuries were more likely to sustain an extension-distraction type fracture and concomitant spinal cord injury. Thoracic spine injuries were more likely to have multiple vertebral level (>3 vertebrae) involvement. Lumbosacral injuries were more likely to sustain compression type and transverse process fractures. Patients with trauma to all 3 spinal regions were more likely to have translational/rotational injuries, facet fractures, lamina and pedicle fractures, and traumatic anterolistheses.</p><p><strong>Conclusion: </strong>Skiing/snowboarding injuries can be devastating, potentially resulting in permanent neurological compromise and spinal instability. Surgeons and the general population can benefit from improving their understanding of the dangers of alpine sports as it pertains to spinal trauma.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540133","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 Association of Preoperative Bone Mineral Density and Outcomes After Anterior Cervical Discectomy and Fusion: A Systematic Review.","authors":"Davin C Gong, Anthony N Baumann, Aditya Muralidharan, Joshua D Piche, Paul A Anderson, Ilyas Aleem","doi":"10.1097/BSD.0000000000001656","DOIUrl":"10.1097/BSD.0000000000001656","url":null,"abstract":"<p><strong>Study design: </strong>This is a systematic review.</p><p><strong>Objective: </strong>To evaluate anterior cervical discectomy and fusion (ACDF) outcomes and complications as a function of preoperative bone mineral density (BMD).</p><p><strong>Summary of background data: </strong>Preoperative BMD optimization is commonly initiated before lumbar spinal fusion, but the effects of BMD on ACDF are less known. Consequently, it remains unclear whether preoperative BMD optimization is recommended before ACDF.</p><p><strong>Methods: </strong>This systematic review included relevant clinical articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Web of Science, SCOPUS, and MEDLINE from database inception until October 1, 2023. Eligible studies included those evaluating low BMD and outcomes after ACDF. All articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale and Critical Appraisal Skills Programme (CASP) assessment tools.</p><p><strong>Results: </strong>The initial retrieval yielded 4271 articles for which 4 articles with 671 patients were included in the final analysis. The mean patient age was 56.4 ± 3.9 years, and 331 patients (49.3%) were female. A total of 265 (39.5%) patients had low BMD (T score<-1.0) before ACDF. Preoperative low BMD was associated with cage subsidence in single-level ACDF (odds ratio (OR) 2.57; P =0.063; 95% Confidence Interval (CI): 0.95-6.95), but this result did not reach statistical significance. Osteoporosis (T score<-2.5) was associated with the development of adjacent segment disease following ACDF (OR 4.41; P <0.01; 95% CI: 1.98-9.83). Low pre-operative BMD was associated with reoperation within 2 years ( P <.05) and strongly associated with pseudarthrosis (OR: 11.01; P =0.002; 95% CI 2.4-49.9).</p><p><strong>Conclusions: </strong>Patients with low BMD who undergo ACDF have higher rates of subsidence, adjacent segment disease, and pseudarthrosis than those with normal BMD. Given the individual and system-wide burdens associated with these complications, some patients may benefit from preoperative BMD screening and optimization before undergoing ACDF.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"85-93"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747581","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":"Operative Time Associated With Increased Length of Stay After Single-level Cervical Disk Arthroplasty: An Analysis of 3681 Surgeries.","authors":"Mitchell K Ng, Olivia Tracey, Nikhil Vasireddi, Ahmed Emara, Aaron Lam, Ian J Wellington, Brian Ford, Nicholas U Ahn, John K Houten, Ahmed Saleh, Afshin E Razi","doi":"10.1097/BSD.0000000000001652","DOIUrl":"10.1097/BSD.0000000000001652","url":null,"abstract":"<p><strong>Study design: </strong>Level III evidence-retrospective cohort.</p><p><strong>Objective: </strong>The purpose of this study was to (1) determine whether longer CDA operative time increases the risk of 30-day postoperative complications, (2) analyze the association between operative time and subsequent health care utilization, and (3) discharge disposition.</p><p><strong>Background: </strong>Cervical disk arthroplasty (CDA) most commonly serves as an alternative to anterior cervical discectomy and fusion (ACDF) to treat cervical spine disease, however, with only 1600 CDAs performed annually relative to 132,000 ACDFs, it is a relatively novel procedure.</p><p><strong>Methods: </strong>A retrospective query was performed identifying patients who underwent single-level CDA between January 2012 and December 2018 using a nationwide database. Differences in baseline patient demographics were identified through univariate analysis. Multivariate logistic regression was performed to identify associations between operative time (reference: 81-100 min), medical/surgical complications, and health care utilization.</p><p><strong>Results: </strong>A total of 3681 cases were performed, with a mean patient age of 45.52 years and operative time of 107.72±49.6 minutes. Higher odds of length of stay were demonstrated starting with operative time category 101-120 minutes (odds ratio: 2.164, 95% CI: 1.247-3.754, P =0.006); however, not among discharge destination, 30-day unplanned readmission, or reoperation. Operative time <40 minutes was associated with 10.7x odds of nonhome discharge, while >240 minutes was associated with 4.4 times higher odds of LOS>2 days ( P <0.01). Increased operative time was not associated with higher odds of wound complication/infection, pulmonary embolism, deep venous thrombosis, or urinary tract infections.</p><p><strong>Conclusions: </strong>Prolonged CDA operative time above the reference 81-100 minutes is independently associated with increased length of stay, but not other significant health care utilization parameters, including discharge disposition, readmission, or reoperation. There was no association between prolonged operative time and 30-day medical/surgical complications, including wound complications, infections, pulmonary embolism, or urinary tract infection.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"45-50"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305632","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":"Screw Motion Used in Semiconstrained Rotational Plate Systems for Anterior Cervical Discectomy and Fusion.","authors":"Yasunori Tatara, Takanori Niimura, Akira Sakaguchi, Hiroki Katayama, Yoshinari Miyaoka, Hisanori Mihara","doi":"10.1097/BSD.0000000000001665","DOIUrl":"10.1097/BSD.0000000000001665","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>To scrutinize screw motion used in semiconstrained rotational plate systems for anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Semiconstrained rotational plate systems are supposed to control graft subsidence and facilitate lordosis acquisition and maintenance by toggling the instrumented vertebrae via variable-angle screws. However, their benefits may be unrealized if the screws move within the vertebrae.</p><p><strong>Methods: </strong>We reviewed medical records of 119 patients who underwent 1-level, 2-level, 3-level, or 4-level ACDF, divided them into the short-segment (n=62, 1-level or 2-level ACDF) and long-segment (n=59, 3- level or 4-level ACDF) groups, and investigated their immediate and 1-year postoperative lateral radiographs. We measured the fused segmental angle, screw angles at the upper-instrumented vertebra (UIV) and lower-instrumented vertebra (LIV), distance from the screw base to the endplate of UIV/LIV (SBE), and distance from the screw tip to the endplate of UIV/LIV (STE) to analyze the screw motion used in these plate systems. The differences between the immediate and 1-year postoperative values were statistically analyzed. The nonunion level was also investigated.</p><p><strong>Results: </strong>Screw angle and SBE at the LIV significantly decreased in the long-segment group (-14.5±9.8 degrees and -2.8±1.8 mm, respectively) compared with those in the short-segment group (-4.6±6.0 degrees and -1.0±1.5 mm, respectively). Thus, the long-segment group could not maintain the immediate-postoperative segmental angle. Overall, 27 patients developed nonunion, with 19 (70.4%) in the long-segment group and 21 (77.8%) at the lowest fused level.</p><p><strong>Conclusions: </strong>Semiconstrained rotational plate systems provide only vertical forces to the fused segment rather than toggling the instrumented vertebrae. Postoperatively in multilevel ACDF, LIV screws migrate caudally, suggesting that these plate systems are not always effective in maintaining lordosis. Moreover, LIV screws and the anterior wall of the LIV are subject to overloading, resulting in a high rate of nonunion at the lowest fused level.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"58-63"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757549","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":"No Increased Risk of All-cause Revision up to 10 Years in Patients Who Underwent Bariatric Surgery Before Single-level Lumbar Fusion.","authors":"Emile-Victor Kuyl, Arnav Gupta, Philip M Parel, Theodore Quan, Tushar Ch Patel, Addisu Mesfin","doi":"10.1097/BSD.0000000000001669","DOIUrl":"10.1097/BSD.0000000000001669","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to assess whether prior bariatric surgery (BS) is associated with higher 10-year surgical complication and revision rates in lumbar spine fusion compared with the general population and morbidly obese patients.</p><p><strong>Background: </strong>Obesity accelerates degenerative spine processes, often necessitating lumbar fusion for functional improvement. BS is explored for weight loss in lumbar spine cases, but its impact on fusion outcomes remains unclear. Existing literature on BS before lumbar fusion yields conflicting results, with a limited investigation into long-term spine complications.</p><p><strong>Methods: </strong>Utilizing the PearlDiver database, we examined patients undergoing elective primary single-level lumbar fusion, categorizing them by prior BS. Propensity score matching created cohorts from (1) the general population without BS history and (2) morbidly obese patients without BS history. Using Kaplan-Meier and Cox proportional hazard modeling, we compared 10-year cumulative incidence rates and hazard ratios (HRs) for all-cause revision and specific revision indications.</p><p><strong>Results: </strong>Patients who underwent BS exhibited a higher cumulative incidence and risk of decompressive laminectomy and irrigation & debridement (I&D) within 10 years postlumbar fusion compared with matched controls from the general population [decompressive laminectomy: HR = 1.32; I&D: HR = 1.35]. Compared with matched controls from a morbidly obese population, patients who underwent BS were associated with lower rates of adjacent segment disease (HR = 0.31) and I&D (HR = 0.64). However, the risk of all-cause revision within 10 years did not increase for patients who underwent BS compared with matched or unmatched controls from the general population or morbidly obese patients ( P > 0.05).</p><p><strong>Conclusions: </strong>Prior BS did not elevate the 10-year all-cause revision risk in lumbar fusion compared with the general population or morbidly obese patients. However, patients who underwent BS were associated with a lower 10-year risk of I&D when compared with morbidly obese patients without BS. Our study indicates comparable long-term surgical complication rates between patients who underwent BS and these control groups, with an associated reduction in risk of infectious complications when compared with morbidly obese patients. Although BS may address medical comorbidities, its impact on long-term lumbar fusion revision outcomes is limited.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E115-E121"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916290","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":"Evaluating the Association Between Physical Therapy Variables and Outcomes After Lumbar Fusion.","authors":"Jeremy C Heard, Teeto Ezeonu, Yunsoo Lee, Rajkishen Narayanan, Alec Kellish, Yoni Dulitzki, Dylan Resnick, Jeffrey Zucker, Alexander Shaer, Jose A Canseco, Jeffrey A Rihn, Barrett Woods, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BSD.0000000000001671","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001671","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study was to investigate how inpatient physical therapy variables impact (1) inpatient complications, (2) 90-day readmissions, (3) 1-year reoperation rates, and (4) length of stay after posterior lumbar decompression and fusion.</p><p><strong>Summary of background data: </strong>Previous studies have emphasized the role of early ambulation in postoperative spine patients as an effective method for improving pain and decreasing length of stay, but few studies have evaluated the efficacy of inpatient physical therapy.</p><p><strong>Methods: </strong>Patients 18 years of age or older who underwent primary 1-level or 2-level posterior lumbar decompression and fusion from 2019 to 2020 were retrospectively identified. Physical therapy data, including time to first inpatient PT session, gait trial distance achieved, post-treatment pain rating, and Activity Measure for Post-Acute Care (Activity Measure for Post-Acute Care [AM-PAC]) scores were collected using manual chart review. Surgical outcome variables included length of stay, inpatient complications, 90-day readmissions, and reoperations within 1 year of primary surgery.</p><p><strong>Results: </strong>Overall, 425 patients were identified. There was no difference in hours to PT or total gait trial distance achieved between patients who experienced a complication and those that did not. Patients in the noncomplication group had higher AM-PAC scores than patients in the complication group. There was no difference with regards to time to PT, AM-PAC score, or gait trial distance achieved between readmitted patients and nonreadmitted patients or revision patients and nonrevision patients. Stepwise logistic regression showed that having a physical therapy session within 6 hours of surgery was predictive of a decreased length of stay both in all patients.</p><p><strong>Conclusions: </strong>While inpatient physical therapy within 6 hours of surgery does not appear to impact readmissions, complications, or reoperations, surgeons should encourage early ambulation postoperatively to decrease extended hospital stays. Future investigation should seek to identify factors that delay inpatient PT in the 6 hours after surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":"38 2","pages":"E129-E134"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491200","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":"Developmental and Validation of Machine Learning Model for Prediction Complication After Cervical Spine Metastases Surgery.","authors":"Borriwat Santipas, Siravich Suvithayasiri, Warayos Trathitephun, Sirichai Wilartratsami, Panya Luksanapruksa","doi":"10.1097/BSD.0000000000001659","DOIUrl":"10.1097/BSD.0000000000001659","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective cohort study utilizing machine learning to predict postoperative complications in cervical spine metastases surgery.</p><p><strong>Objectives: </strong>The main objective is to develop a machine learning model that accurately predicts complications following cervical spine metastases surgery.</p><p><strong>Summary of background data: </strong>Cervical spine metastases surgery can enhance quality of life but carries a risk of complications influenced by various factors. Existing scoring systems may not include all predictive factors. Machine learning offers the potential for a more accurate predictive model by analyzing a broader range of variables.</p><p><strong>Methods: </strong>Data from January 2012 to December 2020 were retrospectively collected from medical databases. Predictive models were developed using Gradient Boosting, Logistic Regression, and Decision Tree Classifier algorithms. Variables included patient demographics, disease characteristics, and laboratory investigations. SMOTE was used to balance the dataset, and the models were assessed using AUC, F1-score, precision, recall, and SHAP values.</p><p><strong>Results: </strong>The study included 72 patients, with a 29.17% postoperative complication rate. The Gradient Boosting model had the best performance with an AUC of 0.94, indicating excellent predictive capability. Albumin level, platelet count, and tumor histology were identified as top predictors of complications.</p><p><strong>Conclusions: </strong>The Gradient Boosting machine learning model showed superior performance in predicting postoperative complications in cervical spine metastases surgery. With continuous data updating and model training, machine learning can become a vital tool in clinical decision-making, potentially improving patient outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E81-E88"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105036","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":"Relative Value Unit (RVU) and Medicare Severity Diagnosis-related Group (MS-DRG) Reimbursement in Cervical Spinal Fusion: A 2011-2023 Trends Report.","authors":"Shravan Asthana, Pranav M Bajaj, Jacob R Staub, Connor D Workman, Samuel G Reyes, Matthew A Follett, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi","doi":"10.1097/BSD.0000000000001660","DOIUrl":"10.1097/BSD.0000000000001660","url":null,"abstract":"<p><strong>Study design: </strong>Level 3 retrospective database study.</p><p><strong>Objective: </strong>This study aims to compare work RVU (wRVU), practice expense RVU (peRVU), malpractice RVU (mpRVU), and inflation-adjusted facility price alongside MS-DRG relative weight length of stay (LOS) for cervical spine fusions between 2011 and 2023.</p><p><strong>Summary of background data: </strong>Both RVU and MS-DRG reimbursement have been studied in various surgical subspecialties; however, little investigation has centered on cervical spine fusions. To the best of our knowledge, this is the first study to investigate trends in RVU and MS-DRG reimbursement in cervical spine fusion throughout the COVID-19 pandemic.</p><p><strong>Methods: </strong>Center for Medicaid and Medicare Services (CMS) physician fee schedule was queried between 2011 and 2023 for RVU and facility reimbursement using common single and multilevel anterior and posterior cervical fusion codes. RVU facility prices were inflation adjusted to 2023. MS-DRG reimbursement data from 2011 to 2022 were compiled for cervical spinal fusion procedures with major complication or comorbidity (MCC) 471, complication or comorbidity (CC) 472, and without CC/MCC 473. Compound annual growth rates (CAGRs), Mean Annual Change, and yearly percent changes were calculated.</p><p><strong>Results: </strong>No changes in wRVU were seen for all cervical CPT codes; however, the CAGR of peRVU (-0.51%±0.60%) and mpRVU (0.69%±0.41%) demonstrated marginal fluctuations. Every CPT code displayed an inflation-adjusted facility price decrease (-2.18%±0.24%). When assessing MS-DRG, there were marginal changes in geometric mean LOS (0.17%±0.45%), arithmetic mean LOS (-0.15%±0.84%), and relative weight (1.09%±0.68%). Unlike RVU reimbursement, the yearly percent change differs between each MS-DRG code.</p><p><strong>Conclusions: </strong>Inflation-adjusted RVU reimbursement facility prices demonstrated a consistent decrease, while DRG code reimbursement stayed relatively consistent over the study period. This data may help surgeons and hospitals become cognizant of temporal variations in reimbursement patterns as it may affect their personal practice.</p><p><strong>Level of evidence: </strong>Level III retrospective study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E75-E80"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079503","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":"How to Estimate the Minimal Clinically Important Difference: An Overview.","authors":"Hernan Roca, Gretchen Maughan, Brian Karamian","doi":"10.1097/BSD.0000000000001735","DOIUrl":"10.1097/BSD.0000000000001735","url":null,"abstract":"<p><p>The minimal clinically important difference (MCID) is a threshold above which a score change would represent a change in symptoms that is noticeable by patients, and it has become a standard approach in the interpretation of clinical relevance of changes in PROMs at a population level. Given the lack of a methodological gold standard, high variability is the main limitation of MCID. Reporting both anchor and distribution-based MCID estimates is a strategy that guarantees both patient-perceived clinical relevance and statistical significance.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"94-96"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709376","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}