Clinical Spine Surgery最新文献

{"title":"Changes in Neck Range of Motion After Laminoplasty Based on Cervical Foraminal Stenosis.","authors":"Woo-Seok Jung, Jae-Won Shin, Yung Park, Joong-Won Ha, Hak Sun Kim, Kyung-Soo Suk, Sung-Hwan Moon, Si-Young Park, Byung-Ho Lee, Ji-Won Kwon, Sung-Woo Lee","doi":"10.1097/BSD.0000000000001794","DOIUrl":"10.1097/BSD.0000000000001794","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the relationship between a number of preoperative cervical foraminal stenoses and postoperative ROM in cervical laminoplasty patients.</p><p><strong>Summary of background data: </strong>Several concerns exist, such as upper extremity palsy, kyphosis, axial neck pain, and ROM changes after laminoplasty. Preoperative foraminal stenosis is a known risk factor for upper extremity palsy and kyphosis after laminoplasty.</p><p><strong>Methods: </strong>Open-door laminoplasty patients with cervical myelopathy between January 2007 and September 2021 were included. Foraminal stenosis was evaluated using MRI T2-weighted images of the axial cut. The number of foraminal stenoses was counted among 10 foramina from C3/C4 to C7/T1, and the study population was divided into 2 groups based on the number of foraminal stenoses. Groups A and B comprised individuals with <4 and 4 or more foraminal stenoses, respectively. ROM was measured through flexion and extension view plain lateral radiography using Cobb method. NDI and VAS scores were used to assess clinical symptoms. Cervical spondylosis was assessed with Cervical Degenerative Index (CDI) factor scoring system. Statistical analyses were performed using 2-sample t test, χ 2 test, and linear mixed model.</p><p><strong>Results: </strong>Sixty-three patients (group A, 27; group B, 36) were analyzed. NDI score after 1 year was 18.33 and 19.29 in groups A and B ( P =0.027). Regarding neck pain, VAS score after 3 years of surgery was 1.55 in group A and 3.94 in group B ( P =0.043). Flexion and total ROM in group A, 3 years post-surgery were 24.59 and 36.2 degrees, and group B had values of 16.04 and 24.98 degrees, respectively ( P =0.014). Three years after surgery, ROM preservation ratio was 89% in group A and 66% in group B ( P =0.013). On the basis of the CDI factor scoring system, difference of average between groups was 1.02 ( P =0.081).</p><p><strong>Conclusions: </strong>A greater number of foraminal stenoses results in a reduction in ROM after laminoplasty.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Laminectomy and Lateral Mass Screw Fixation With 1-2 Levels Laminoplasty for the Treatment of Cervical Spondylotic Myelopathy.","authors":"Chuang Li, Jingfeng Li, Qixin Zheng","doi":"10.1097/BSD.0000000000001878","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001878","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, observational study.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical efficacy of cervical posterior laminectomy with lateral mass screw internal fixation combined with 1-2 levels of laminoplasty in patients with severe complex cervical spondylotic myelopathy.</p><p><strong>Summary of background data: </strong>In this single-center retrospective observational study, data collected from 15 patients who underwent modified cervical posterior laminectomy with lateral mass screw internal fixation (modified PLF group) were compared with those from 45 patients who underwent standard cervical posterior laminectomy with lateral mass screw internal fixation (PLF group) during the same period.</p><p><strong>Methods: </strong>The cervical curvature, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), Odom's grade, and development of C5 nerve palsy were compared preoperatively and postoperatively. A power analysis was conducted to determine the sample size required to detect clinically significant differences between the groups. Based on an expected effect size of 0.5, a significance level (α) of 0.05, and a power (1-β) of 80%, the analysis indicated that a minimum of 60 patients per group would be needed. The mean follow-up period was 3.5 years.</p><p><strong>Results: </strong>A significant reduction in the extent of cervical kyphosis (P<0.05) was observed at the last follow-up in both groups. There were no significant differences in the JOA score, VAS, and NDI, all of which significantly improved in both groups. The rates of excellent and good Odom's grading (100% and 88.89% in the modified PLF and PLF groups, respectively) and the incidence of C5 nerve palsy (0% and 11.11% in the modified PLF and PLF groups, respectively) were significantly different between the 2 groups (P<0.05). The power analysis confirmed that the study was adequately powered to detect significant differences in cervical curvature and clinical outcomes, although the smaller sample size of the modified PLF group (n=15) may have limited the ability to detect smaller but clinically meaningful differences in secondary outcomes.</p><p><strong>Conclusions: </strong>Modified cervical posterior laminectomy with lateral mass screw internal fixation achieved improved clinical outcomes after medium-to-long-term follow-up in patients with severe and complex cervical spondylotic myelopathy. It can stabilize the cervical spine, fully decompress the spinal canal, and prevent excessive backward drifting of the cervical spinal cord, thereby reducing cervical spinal cord injury and C5 nerve palsy.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759340","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":"Race, Region, and Reimbursement: Sociodemographic Variations in Medicare Payments for Spine Surgery in the United States, 2014-2022.","authors":"Daniel Schneider, Ethan D L Brown, Harshal A Shah, Sheng-Fu L Lo, Daniel M Sciubba","doi":"10.1097/BSD.0000000000001834","DOIUrl":"10.1097/BSD.0000000000001834","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective.</p><p><strong>Objective: </strong>Assess whether Medicare adjustments adequately correct for systemic population-level payment variations.</p><p><strong>Summary of background data: </strong>Medicare currently uses payment adjustments for spine surgery, including clinical risk, geography, and socioeconomic status.</p><p><strong>Methods: </strong>Using Medicare fee-for-service claims from 2014 to 2022, we conducted a retrospective cohort study of spine-related diagnosis-related groups (459 state-year observations). Multivariable regression models examined associations between payments and sociodemographic factors, controlling for existing Medicare adjustments.</p><p><strong>Results: </strong>Significant disparities persisted despite adjustment. Each percentage-point increase in Black beneficiaries was associated with $172 higher payments (95% CI: $111-$232, P <0.001), while Hispanic population increases showed the opposite effect (-$174 per point; 95% CI: -$252 to -$96, P <0.001). Areas with above-median female proportions had $1596 higher payments (95% CI: $580-$2611, P =0.002). Regional variations were notable: payments were higher in the West ($11,060), Northeast ($5762), and Midwest ($3210) than in the South (all P <0.001).</p><p><strong>Conclusions: </strong>Medicare payments for inpatient spine care demonstrate persistent demographic disparities unaddressed by current risk-adjustment models. Future research should determine whether these variations indicate appropriate adjustments for care needs or systematic underpayment or overpayment for the treatment of particular populations.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"345-351"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985411","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":"Role of Altmetric Attention Scores in Evaluating the Influence of Spine Surgery Research.","authors":"Omar Tarawneh, Rajkishen Narayanan, Jonathan Dalton, Robert J Oris, Parker Brush, Olivia Opara, Delano Trenchfield, Yunsoo Lee, Amar Vadhera, Abbey Glover, Nathaniel Pineda, Pranav Jain, Andrew Kim, Mark F Kurd, Ian D Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BSD.0000000000001751","DOIUrl":"10.1097/BSD.0000000000001751","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To analyze the annual trends in the most prevalent topics, journals, and geographic regions of the top 100 spine surgery articles, as determined by altmetric attention scores (AASs). We also describe the relationship between AAS and traditional article metrics.</p><p><strong>Background: </strong>The rapid growth of social media has transformed how medical literature is disseminated and perceived, including within the field of spine surgery. AAS is a metric that characterizes an article's reach and impact in various online sources.</p><p><strong>Materials and methods: </strong>We reviewed the Altmetric database to identify the top 100 spine surgery articles by AAS from 2015 to 2020 across 8 leading spine journals. Article topics, geographic origins, and publishing journals were analyzed. Correlation analyses were performed between AAS and traditional metrics.</p><p><strong>Results: </strong>Five hundred forty-one studies met the inclusion criteria. The majority were published in Spine (34.4%), TheSpine Journal (25.7%), European Spine Journal (15.0%), and Journal of Neurosurgery: Spine (14.2%). North America and Europe were the predominant regions of origin. The most common topics were injections (12.2%), diagnostics (11.8%), and complications (11.3%). A weak correlation was found between AAS and traditional metrics such as impact factor (Pearson coefficient = 0.041), total citations (0.051), and citations per year (0.048).</p><p><strong>Conclusions: </strong>Although AAS provides insights into the public and online engagement of articles, it shows only a weak correlation with traditional metrics. Therefore, AAS should be considered a complementary metric for gauging the impact of research. In the era of social media, authors should continue to promote their research to broaden readership, however further investigation into characterizing article impact is warranted.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E412-E418"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892616","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":"Previous Hip or Knee Arthroplasty Is Associated With Less Favorable Patient-reported Outcomes of Lumbar Surgery.","authors":"Roland Duculan, Carol A Mancuso, Jan Hambrecht, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi","doi":"10.1097/BSD.0000000000001744","DOIUrl":"10.1097/BSD.0000000000001744","url":null,"abstract":"<p><strong>Study design: </strong>Review of cohort studies.</p><p><strong>Objective: </strong>To ascertain if previous hip (THA) or knee (TKA) arthroplasty was associated with patients' outcomes assessments of subsequent lumbar surgery, specifically overall satisfaction, less disability due to pain, and an affective appraisal reflecting emotional assessment of results.</p><p><strong>Background: </strong>Hip, knee, and lumbar symptoms often co-exist and increasingly are managed with surgery. Whether previous total joint arthroplasty (TJA) impacts patients' perspectives of results of subsequent lumbar surgery is not known.</p><p><strong>Methods: </strong>Identical and systematically acquired preoperative and postoperative data from 3 studies assessing psychosocial characteristics and outcomes of lumbar surgery were pooled. Data obtained during interviews included preoperative demographic and clinical variables and 2-year postoperative global overall assessment (very satisfied/satisfied, neither, dissatisfied/very dissatisfied) and global affective assessment (delighted/pleased, mostly satisfied/mixed/mostly dissatisfied, unhappy/terrible). Patients completed the ODI and preoperative to postoperative change was analyzed according to an MCID (15 points). At 2 years patients also reported any untoward events since surgery (ie, fracture, infection, or repeat lumbar surgery). Associations with outcomes were assessed with multivariable logistic ordinal regression controlling for untoward events. Type of arthroplasty was evaluated in subanalyses.</p><p><strong>Results: </strong>Among 1227 patients (mean: 59 y, 50% women), 12% had arthroplasty (+TJA) and 88% did not (-TJA). In multivariable analysis, +TJA was associated with less global satisfaction (OR: 1.9, CI: 1.3-2.7, P =0.0007), worse global affective assessment (OR: 1.6, CI: 1.1-2.2, P =0.009), and not meeting MCID15 (OR: 1.5, CI: 1.0-2.3, P =0.05). Covariables associated with less favorable outcomes were not working, positive depression screen, and prior lumbar surgery. Compared with -TJA, patients with THA had worse affective assessments and patients with TKA had less satisfaction and were less likely to meet MCID15.</p><p><strong>Conclusions: </strong>Previous hip or knee arthroplasty was associated with less favorable patient-reported outcomes of lumbar surgery. Surgeons and patients should discuss differences between procedures preoperatively and during shared postoperative outcome assessment.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E388-E394"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Perioperative Factors Are Associated With High-risk Daily Morphine Milligram Equivalent Totals in Spinal Decompressions?","authors":"Eeric Truumees, Ashley Duncan, Devender Singh, Matthew J Geck, Ebubechi Adindu, John K Stokes","doi":"10.1097/BSD.0000000000001750","DOIUrl":"10.1097/BSD.0000000000001750","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective cohort analysis.</p><p><strong>Objective: </strong>To determine what factors are associated with high-risk daily morphine milligram equivalent (MME) totals in patients undergoing spinal decompression.</p><p><strong>Background: </strong>Daily dosages of ≥100 MME/d are associated with an almost 9-fold increased risk of overdose. Current general recommendations endorse the lowest effective dose and ≤50 MME/d.</p><p><strong>Materials and methods: </strong>Retrospective analysis was conducted on 260 patients who underwent spinal decompressive surgery. Average MME/d was calculated as the sum of qualifying inpatient MMEs administered divided by the sum of inpatient length of stay. Independent variables across demographic, clinical, and surgical domains were subject to comparative and logistic regression analysis.</p><p><strong>Results: </strong>Overall MME per day was 54.19 ± 39.37, with a range of 1.67-218.34 MME/d. Sixty-six patients were determined to have \"high-risk MME.\" These patients were significantly younger (58.8 ± 13.1 vs 70.53 ± 11.5; P < 0.001) and reported higher preoperative pain visual analog scale (VAS; 4.8 ± 3 vs 2.8 ± 3.3; P = 0.0021) than the patients at low risk. In addition, high-risk patients had significantly higher body mass indexes (BMIs; P < 0.05) and received ketamine as part of anesthesia ( P < 0.05). Patients who consumed high-risk dosages of MMEs in the perioperative period were more likely to have been on opioids before surgery and to report higher pain scores at 4-6 week follow-ups ( P < 0.05). The final logistics regression model identified independent risk factors to be younger age, higher BMIs and preoperative VAS, and prior use of opioids and intraoperative ketamine.</p><p><strong>Conclusions: </strong>Patients with high MME per day who underwent spinal decompression were significantly younger with higher BMIs and preoperative VAS with an increased incidence of preoperative opioid use and intraoperative ketamine. A closer look at interaction models revealed that a combination of high preoperative pain and intraoperative ketamine usage were at a significantly increased risk of higher MME consumption. Preoperative opioid risk education and mitigation strategies should be considered in patients with high MME risk, especially in younger patients already utilizing opioids before surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E395-E399"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715450","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":"Local Anesthesia With 1% Lidocaine Versus General Anesthesia for Percutaneous Endoscopic Interlaminar Discectomy at L5/S1 Disc Herniation: A Prospective Randomized Study.","authors":"Xin Wang, Junjie Shen, Zhiheng Chen, Bin Cai, Yuanyuan Chen, Guowang Zhang, Jianguang Xu, Xiaofeng Lian","doi":"10.1097/BSD.0000000000001743","DOIUrl":"10.1097/BSD.0000000000001743","url":null,"abstract":"<p><strong>Study design: </strong>A prospective randomized clinical trial.</p><p><strong>Objective: </strong>In this study, we compared local anesthesia with 1% lidocaine (LA) and general anesthesia (GA) utilized in PEID at L5/S1 disc herniation.</p><p><strong>Summary of background data: </strong>Given the anatomic characteristics of L5/S1 segment, interlaminar approach was preferred to perform endoscopic discectomy for L5/S1 disc herniation. Typically, general anesthesia was used for interlaminar approach. However, with general anesthesia, nerve damage during surgery due to being unable to monitor patient status is a main concerned for surgeons. As an alternative option, local anesthesia has been developed recently. But, the optimal type of anesthesia for PEID remains controversial.</p><p><strong>Methods: </strong>From March 2021 to March 2023, 103 consecutive patients with L5/S1 disc herniation who planned to undergo PEID in our unit were randomized to the LA group (n=53) or GA group (n=50). Both groups were followed up for at least 24 months. Surgical-related parameters, clinical outcomes, and complications were compared between the 2 groups.</p><p><strong>Results: </strong>The mean operative time and bed rest time were shorter in the LA group than in the GA group (both P <0.001). The estimated blood loss in the LA group was greater than that in the GA group ( P <0.001). The cost of hospitalization in the LA group was significantly lower than that in the GA group ( P <0.001). At every time point of follow-up, there was no significant difference between the 2 groups in terms of VAS, ODI, and modified MacNab criteria. The satisfaction surveys showed that more patients in the LA group would choose contrary anesthesia, including 6 patients who were administered extravenously injected sufentanil intraoperatively due to intensive pain. Postoperative neuropathic abnormalities were rarer in the LA group.</p><p><strong>Conclusions: </strong>Both local anesthesia using 1% lidocaine and general anesthesia are effective and safe for PEID at the L5/S1 segment. The use of local anesthesia is preferable due to its associated reductions in operative time, bed rest duration, and economic costs.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E364-E370"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799652","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":"Is Vertebral Artery Injury After Blunt Cervical Spine Trauma an Incidental Finding?","authors":"Romil Shah, Ayane Rossano, Devender Singh, Eeric Truumees","doi":"10.1097/BSD.0000000000001747","DOIUrl":"10.1097/BSD.0000000000001747","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To understand the associations between vertebral artery injury (VAI) and adverse events in patients sustaining blunt cervical spine trauma.</p><p><strong>Summary of background data: </strong>To date, the impact of VAI on adverse events, and by extension, clinical outcomes has been extracted from small patient cohorts and have not allowed definitive conclusions.</p><p><strong>Methods: </strong>Adult patients with cervical vertebral, ligamentous, or neurological trauma in the National Trauma Data Bank from 2016 to 2017 were included in the study. Demographic information (age, sex, and race), injury-specific information (mechanism, severity), patient health information, and presence of a VAI were collected as explanatory variables. Response variables included development of adverse events [DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit] length of stay (LOS) and unplanned ICU admission or surgical procedure. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse and unplanned events as well as its relationship with LOS.</p><p><strong>Results: </strong>Totally, 128,908 patients with cervical trauma were reviewed, of which 5300 had VAI. Of the patients with VAI, 187 (3.5%) patients had a MI, 156 (2.9%) had a PE/DVT, 196 (3.7%) had a stroke, 1392 (26.3%) had neurological injury, and 443 (8.4%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with a >2-fold increased risk of increased LOS and ICU LOS ( P <0.001), as well as greater than a 2-fold increased risk of MI, PE/DVT, stroke, and neurological injury ( P <0.001).</p><p><strong>Conclusions: </strong>Our study documented a higher rate of concomitant VAI in blunt cervical trauma than previously reported. VAI is a hallmark of a more severe or higher energy mechanism of injury and is associated with increased adverse events and LOS in the hospital/ICU. In addition, these data suggest that, in older patients, concomitant VAI is associated with adverse outcomes independent of mechanism of injury.</p><p><strong>Level of evidence: </strong>Step II-diagnostic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E371-E375"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738610","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 Impact of Proton Pump Inhibitor Use on Fusion Rates Following Single-level Anterior Cervical Discectomy and Fusion.","authors":"Yu Chang, Chih-Yuan Huang, Ming-Tsung Chuang, Kuan-Yu Chi, Junmin Song, Hong-Min Lin","doi":"10.1097/BSD.0000000000001749","DOIUrl":"10.1097/BSD.0000000000001749","url":null,"abstract":"<p><strong>Study design: </strong>Cohort study.</p><p><strong>Objective: </strong>This study explores how proton pump inhibitors (PPIs) affect fusion rates following anterior cervical discectomy and fusion (ACDF), using a large-scale data analysis.</p><p><strong>Background: </strong>ACDF is essential for treating cervical disc herniation leading to myelopathy and radiculopathy, involving disc removal and vertebral fusion, crucial for long-term stability and symptom relief. Notably, PPIs, which are commonly prescribed for acid-related disorders, have been linked to altered bone health and healing processes.</p><p><strong>Materials and methods: </strong>Utilizing the TriNetX network database spanning from 2008 to 2023, we identified patients undergoing single-level ACDF, classified into cohorts based on PPI usage following ACDF. A 1:1 propensity score matching was performed to balance demographics and comorbidities between the two groups. The study focused on the incidence of non-fusion, indicated by the International Classification of Disease-10 code M96.0, within 6 months to 2 years postoperatively.</p><p><strong>Results: </strong>The initial cohort comprised 1269 PPI users and 23,932 non-users, adjusted to 1266 per group after matching. Postmatching analysis indicated minimal differences in demographics and comorbidities between the cohorts. Our results showed that postoperative PPI users have a significantly higher risk of non-fusion following single-level ACDF surgery at 1 year (odds ratio: 1.35, 95% CI: 1.05-1.73) and 2 years (odds ratio: 1.42, 95% CI: 1.11-1.81) follow-up.</p><p><strong>Conclusions: </strong>Our study showed a significant link between postoperative PPI use and increased long-term pseudarthrosis risk after ACDF surgery. These findings suggest careful consideration of PPI use in these patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E400-E403"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766189","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":"Complications and Cost in Open Versus Endoscopic Lumbar Decompression: A Database Study.","authors":"Lauren M Boden, Susanne H Boden, Najib Muhammad, Matthew A Kanzler, David S Casper","doi":"10.1097/BSD.0000000000001745","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001745","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective database study.</p><p><strong>Objective: </strong>To compare complications and costs associated with endoscopic and open lumbar decompression on a large scale.</p><p><strong>Background: </strong>Though open lumbar decompression is considered the gold standard, endoscopic procedures are on the rise. The majority of studies comparing endoscopic to open decompression have been limited to small retrospective studies or studies in other countries.</p><p><strong>Methods: </strong>Patients who underwent single-level endoscopic or open lumbar decompression from 2017 to 2021 with a 2-year follow-up were identified in the PearlDiver database using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. Multilevel surgery, concomitant fusion, or cervical/thoracic procedures were excluded. Postoperative complications, including infection, wound dehiscence, and dural tear, were evaluated for both groups, as well as additional lumbar surgery within 2 years. Costs, complications, and rate of repeat surgery were compared between groups.</p><p><strong>Results: </strong>A total of 895 endoscopic and 102,258 open lumbar decompression cases met the inclusion criteria. The median age range was 60-64 for both groups, and the majority were low risk on the Charlson Comorbidity Index. Rates of dural tear, infection, and dehiscence were similar between groups. Total cost at 2 years was slightly higher for the endoscopic group ($20,347 vs $18,089, P = 0.03). Patients who underwent endoscopic lumbar decompression were more than twice as likely to undergo a second lumbar surgery in the following 2 years (16% vs 7%, P < 0.00001). Of the patients who underwent additional surgery, there was a higher proportion of patients undergoing reexploration in the open group (33.4% vs 13.8%, P < 0.00001) and a higher proportion undergoing endoscopic decompression in the endoscopic group (35.5% vs 0.64%, P < 0.00001).</p><p><strong>Conclusions: </strong>Cost and complication profiles are similar between endoscopic and open lumbar decompression. However, endoscopic decompression patients are more than twice as likely to undergo a second procedure within 2 years. Prospective studies are needed to determine the cause of additional surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":"38 7","pages":"E383-E387"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697809","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}