Clinical Spine Surgery最新文献

{"title":"First In Vivo Electromyographic Analysis of Mechanical Load Scenarios of the Cervicothoracic Junction During Daily Activities as a Basis for Future Postoperative Behavioral Instructions.","authors":"Bennet Mathis Schröder, Heiko Koller, Emmanouil Liodakis, Stephan Sehmisch, Sonja Körner, Sebastian Decker","doi":"10.1097/BSD.0000000000001655","DOIUrl":"10.1097/BSD.0000000000001655","url":null,"abstract":"<p><strong>Study design: </strong>Clinical Research.</p><p><strong>Objectives: </strong>Study participants were twenty- eigth healty volunteers.</p><p><strong>Background: </strong>Soft tissue complications after posterior cervicothoracic fusion surgery occur frequently. Postoperative myofascial dehiscence (PMD) can cause disability and pain. So far, it is unknown whether patients can affect PMD development through behavioral adjustment. Consequently, this study aimed to analyze how much mechanical stress daily activities exert on the posterior muscles and fascia at the cervicothoracic junction.</p><p><strong>Materials and methods: </strong>Surface electromyography was applied next to the upper thoracic spine at the trapezius muscle. All volunteers performed 22 different daily activities, such as tooth brushing, dressing, standing up, and different horizontal positions. During the exercises, the electromyographic activity was measured. For each volunteer, root mean square values were determined. All exercises were then repeated with the use of a clavicular bandage to unload the shoulder and cervicothoracic muscles. Afterwards, the rankings were statistically compared interindividually.</p><p><strong>Results: </strong>Among the different tasks, significant differences in regard to the root mean square values were noted. For instance, horizontal positions caused significantly lower muscle activation compared with all other exercises ( P ≤ 0.001). Notably, no relevant electromyographic differences were detected between the tasks with and without a clavicular bandage.</p><p><strong>Conclusions: </strong>This in vivo electromyographic analysis of cervicothoracic muscle activity during daily activities demonstrates that myofascial strain differs among various daily activities. Data indicate that potential postoperative mobilization protocols and behavioral instructions may have the potential to reduce the biomechanical load and consequently the risk of PMD and, therefore, may reduce the risk for surgical wound-related complications, disability, and need for revision surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E100-E107"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874352","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 Role of the Glymphatic System in Cervical Spondylotic Myelopathy: Insights From Advanced Imaging.","authors":"Justin K Zhang, Saad Javeed, Jacob K Greenberg, Salim Yakdan, Sama Noroozi Gilandehi, Lubdha M Shah, Rajiv R Iyer, Andrew T Dailey, Erica F Bisson, Mark A Mahan, Marcus D Mazur, Sheng-Kwei Song, Wilson Z Ray","doi":"10.1097/BSD.0000000000001763","DOIUrl":"10.1097/BSD.0000000000001763","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Objective: </strong>To provide a primer of the glymphatic system, discuss its potential relevance in evaluating spinal diseases like cervical spondylotic myelopathy (CSM), and describe possible imaging markers of the glymphatic system derived from advanced diffusion-weighted imaging (dMRI), namely diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI).</p><p><strong>Summary of background data: </strong>The glymphatic system is a recently described physiological process that plays an integral role in macroscopic waste clearance in the CNS through cerebrospinal fluid (CSF)-interstitial fluid (ISF) exchange. Chronic spinal cord compression in CSM leads to pathophysiological consequences that theoretically affect the glymphatic system, and advanced dMRI may be well positioned to characterize these changes.</p><p><strong>Methods: </strong>This single-center study enrolled participants (control and CSM) from 2018 through 2020. All participants underwent clinical assessments and dMRI, followed by DTI and DBSI analyses, preoperatively and 2 years postoperatively. CSF flow was characterized by DTI-derived apparent diffusion coefficient (ADC) and ISF flow by DBSI-derived extra-axonal axial diffusivity (EA-AD) and radial diffusivity (EA-RD). Imaging parameters were compared among participants.</p><p><strong>Results: </strong>Forty-two patients with CSM [23 (55%) mild, 9 (24%) moderate, 10 (21%) severe] and 20 control patients were included. Preoperatively, ADC was significantly lower in CSM (2.59±0.4 µm2/ms) than control (3.08±0.34 µm2/ms) patients (P<0.01). Conversely, EA-AD and EA-RD were significantly higher in CSM (2.53±0.33; 0.48±0.13 µm2/ms) compared with control (2.27±0.2; 0.40±0.04 µm2/ms) patients (both P<0.01). Two years postoperatively, only EA-RD significantly decreased for CSM patients (Δ-0.04±0.12 µm2/ms, P<0.01). More severe CSM preoperatively was associated with lower baseline ADC (ρ=0.49, P<0.001) and higher baseline EA-RD (ρ=-0.35, P=0.005).</p><p><strong>Conclusions: </strong>The pathophysiology of CSM may affect the glymphatic system because of chronic spinal cord compression that decreases CSF bulk flow, leading to compensatory increases in ISF flow. Although research in this topic remains nascent, greater glymphatic system function observed on dMRI may correspond with greater disease burden. Future studies examining the role of the glymphatic system in spinal cord pathology are critical to better understanding how these noninvasive imaging biomarkers can improve patient outcomes in CSM.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522793","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":"Effect of Lumbar Erector Spinae Plane Blocks After Lumbar Fusion Surgery: A Randomized Control Trial.","authors":"Brendan Holderread, Ishaq Syed, Caleb Shin, Leonide Toussaint, Andrew Lewis, David Botros, Ioannis Avramis, James Rizkalla","doi":"10.1097/BSD.0000000000001767","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001767","url":null,"abstract":"<p><strong>Study design: </strong>Randomized control trial.</p><p><strong>Objective: </strong>To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.</p><p><strong>Summary of background data: </strong>Pain management is a key aspect of a patient's care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.</p><p><strong>Methods: </strong>A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.</p><p><strong>Results: </strong>Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P= 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days (P< 0.0001).</p><p><strong>Conclusions: </strong>The patient population that received the erector spinae block had significantly lower pain scores on days 1-3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522771","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 Comprehensive Analysis Between Disk Geometry and Posterior Muscle Characteristics Among Degenerative Spine Patients: An Internal Retrospective Review.","authors":"Bongseok Jung, Joshua Mathew, Alshabab Basel Sheikh, Jonathan Elysee, Priya Duvvuri, John Fallon, Anas Abbas, Austen Katz, Junho Song, Adam Strigenz, Luke Zappia, Renaud Lafage, David Essig, Virginie Lafage, Sohrab Virk","doi":"10.1097/BSD.0000000000001773","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001773","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective Cohort Study.</p><p><strong>Objective: </strong>The aim of this study is to investigate the associations between posterior muscle health characteristics and disk geometry parameters between L1 and S1.</p><p><strong>Summary of background data: </strong>Paralumbar muscle changes have been associated with clinical outcomes. However, the relationship between disk geometry and paralumbar muscle changes has not been defined.</p><p><strong>Methods: </strong>Axial T2 MRI was analyzed for paralumbar muscle measurements, and lateral radiographs were analyzed for disk geometry parameters in patients with disk degeneration. Associations between disk shape and muscle health at each individual lumbar level were evaluated using a partial correlation controlling for age and sex. Demographic data were compared between the listhesis groups, and an ANCOVA analysis controlling for significant demographic parameters was conducted to evaluate differences in muscle characteristics.</p><p><strong>Results: </strong>In all, 435 patients were included (age: 55.6±15, BMI: 29.5±6, 60.9% female, 41.3% White). Muscle health median characteristics were CSA/BMI=140, LIV=13, and Goutallier Classification of 1. Partial correlations between focal disk parameters and muscle health controlling for age and sex showed moderate significant positive associations between focal lordosis and lumbar indentation value (LIV) at every level L1-S1 (mean r=0.264 between L1 and L5, P<0.001), weak positive association between focal lordosis and CSA/BMI (mean r=0.113 at L2-L5, P <0.03), and weak negative associations between disk height and Goutallier Classification (mean r=0.158 at L1-L5, P<0.03). Listhesis at L4-S1 was stratified, and ANCOVA controlling for sex and age demonstrated no significant association between S and R groups and CSA/BMI, LIV, or Goutallier classification (P>0.1).</p><p><strong>Conclusions: </strong>Posterior muscle health was significantly associated with disk shape, especially disk height and disk lordosis, with larger and more lordotic disks being associated with better muscle health. Disk listhesis was not significantly associated with muscle quality when controlling for demographic characteristics, and no differences in muscle health parameters were observed in patients with spondylolisthesis versus retrolisthesis. Overall, the results highlight important associations between lumbar compensation, disk geometry, and posterior muscle health.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514868","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":"Indirect Spinal Decompression in Thoracolumbar Burst Fractures: Efficacy of Combined Modified Percutaneous Posterior Short-segment Fixation and Intraoperative CT Assistance.","authors":"Hou-Tsung Chen, Re-Wen Wu, Fu-Shine Yang, Cheh-Yung Chang, Chieh-Cheng Hsu, Sung-Hsiung Chen, Meng-Ling Lu","doi":"10.1097/BSD.0000000000001772","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001772","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the combined modified percutaneous short-segment posterior instrumentation technique by reducing and fixating the thoracolumbar burst fracture and checking the efficacy of indirect spinal decompression using intraoperative CT. This study aims to (1) demonstrate that using modified percutaneous short-segment posterior instrumentation is enough to rebuild spinal stability and decompress the spinal stenosis for thoracolumbar burst fracture and (2) prove the effects of spinal canal decompression by intraoperative portable CT with the surgical technique.</p><p><strong>Summary of background data: </strong>Various posterior instrumentation methods have been used to treat thoracolumbar burst fractures and decompress retropulsed bony fragments through ligamentotaxis, but no studies have assessed the efficacy of combining percutaneous short-segment posterior instrumentation with intraoperative CT.</p><p><strong>Methods: </strong>Using modified percutaneous short-segment posterior instrumentation to rebuild the spinal stability and ligamentotaxis effect to indirect decompression of the spinal stenosis without laminectomy and check parameters immediately after surgery by real-time intraoperative portable CT.</p><p><strong>Results: </strong>Fifty-seven patients with thoracolumbar burst fractures underwent modified percutaneous short-segment posterior instrumentation from 2018 to 2023 at a single medical center. Mean injured vertebral canal dimension increased from 90.8±26.3 to 122.1±30.3 mm2 (P<0.05) and mean canal encroachment index decreased from 44.8±9.5% to 25.6±4.8% (P<0.05), the anterior body height increased from 13.9±3.8 to 25.9±3.9 mm (P<0.01) and kyphotic angle decreased from 27.3±3.2 to 8.6±2.1 degrees (P<0.01). Neurological function was improved by at least 1 Frankel grade in neurological deficit patients. No significant difference in kyphotic angle between post-op and 6-month follow-up.</p><p><strong>Conclusions: </strong>Indirect decompression of the spinal canal with modified percutaneous short-segment fixation without laminectomy was an effective treatment for thoracolumbar burst fracture, even in selected incomplete neurological deficits patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448445","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 Provides the Best Value for Your Time in Spine Surgery? An Analysis of Relative Value Units.","authors":"Muhammad B Tariq, Trevor Simcox, Jacob Becker, Anthony Petrizzo, Shuriz Hishmeh","doi":"10.1097/BSD.0000000000001771","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001771","url":null,"abstract":"<p><strong>Design: </strong>Retrospective database analysis.</p><p><strong>Objective: </strong>This study aims to assess the RVU compensation model for the most common spine surgeries.</p><p><strong>Background: </strong>Physician work is commonly valued by utilizing the relative value unit (RVU) model for compensation. Our aim in this study was to assess RVU and RVU per minute valuations of the most common spine procedures comparing cervical versus lumbar and fusion versus non-fusion cases.</p><p><strong>Methods: </strong>The ACS-NSQIP database was utilized to identify the most commonly performed spine procedures. RVU and RVU per minute values were calculated and compared in each group.</p><p><strong>Results: </strong>In all, 18,779 entries encompassing 28 CPT codes/code combinations were identified. Average RVUs were higher in cervical spine cases compared with lumbar cases (29 vs. 20 RVUs, respectively). Furthermore, cervical cases had significantly higher RVUs per minute compensation compared with lumbar cases (0.26 vs. 0.18 RVUs/min; P=0.01). Fusion cases also fared higher average RVUs compared with nonfusion cases (28 vs. 19 RVUs, respectively). However, when corrected for operative time, fusion cases did not differ significantly in RVUs per minute (P=0.13).</p><p><strong>Conclusions: </strong>Cervical spine surgery provides the best value for the surgeon in terms of RVUs per minute. We highlight key aspects of the compensation model in spine surgery.</p><p><strong>Level of evidence: </strong>Level III-economic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440110","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 Comparison of Inpatient Versus Ambulatory Lumbar Surgical Care Utilization Among Minority Patients.","authors":"Justin Tiao, Husni Alasadi, Michael M Herrera, Nicole Zubizarreta, Jonathan Huang, Jashvant Poeran, Saad Chaudhary","doi":"10.1097/BSD.0000000000001766","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001766","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery.</p><p><strong>Summary of background data: </strong>The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting.</p><p><strong>Materials and methods: </strong>Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients.</p><p><strong>Results: </strong>Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001.</p><p><strong>Conclusions: </strong>Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440155","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":"Trends in Operative Timing for Acute Traumatic Central Cord Syndrome: National Inpatient Sample Analysis 2013-2019.","authors":"Thomas A Gagliardi, Ilan Fleisher, Justin Lapow, Eris Spirollari, Timothy Sullivan, Alexis Carr, Kevin Berardino, Merritt Kinon, Harshadkumar Patel","doi":"10.1097/BSD.0000000000001770","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001770","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To analyze national trends in the management of acute traumatic central cord syndrome.</p><p><strong>Summary of background data: </strong>Acute traumatic central cord syndrome (ATCCS) is the most common incomplete spinal cord injury. Initial management involves decompression and stabilization of the cervical spinal cord. On the basis of mixed literature regarding operative timing for ATCCS, we aimed to evaluate trends in early, late, and delayed surgery over the last 5-10 years and compare their respective outcomes.</p><p><strong>Methods: </strong>Data were obtained from the National Inpatient Sample (NIS) using specific ICD-10 codes. Baseline demographics, comorbidities, and outcomes were evaluated. These patients were grouped based on whether central cord syndrome (CCS) operative treatment was early (within 24h of admission), late (between 24 and 48h of admission), or delayed (after 48h of admission).</p><p><strong>Results: </strong>A total of 21,265 patients underwent operative management for ATCCS; 16.7% received early operative management, 35.6% received late operative management, and 47.6% received delayed operative management. Compared with the total cohort, the delayed operative management group was more likely to contain patients with obesity (7.1% vs. 6.3%, P<0.001), chronic obstructive pulmonary disease (COPD) (12.9% vs. 11.1%, P<0.001), and diabetes mellitus (28.1% vs. 26.1%, P<0.001). Early operative management was more likely in patients with plegia (24.7% vs. 17%, P<0.001) and bowel/bladder dysfunction (14.6% vs. 9.5%, P<0.001) and was independently associated with lower rates of prolonged length of stay (LOS) (OR=0.71) and acute kidney injury (AKI) (OR=0.696).</p><p><strong>Conclusions: </strong>Our analysis of the trends in operative timing for ATCCS demonstrated an overall increase in the rate of early operative management and a decrease in the rate of delayed operative management. These findings mirror the current evolution of the literature on the topic. Nuances in early versus late outcomes should be used to help decision making related to operative timing in ATCCS.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413605","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":"Adjacent Segment Pathology After Short-Segment Posterior Lumbar Fusion: Postfusion Acceleration of Degeneration or Pre-Existing Degeneration?","authors":"Fielding Horne, Mara Louis Atherton, Rouzbeh Motiei-Langroudi","doi":"10.1097/BSD.0000000000001762","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001762","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of 363 patients who underwent posterior lumbar fusion (PLF).</p><p><strong>Objective: </strong>Adjacent segment pathology (ASP) is a major and common event in patients who have undergone PLF. The objective of this study is to determine if ASP is due to accelerated processes following fusion or to pre-existing degeneration.</p><p><strong>Summary of background data: </strong>ASP is defined as degenerative changes that occur 1-2 levels above or below the site of fusion in patients. The etiology of ASP is a topic of debate.</p><p><strong>Methods: </strong>Preoperative MRIs of 363 individuals who underwent PLF within L2-L3, L3-L4, and L4-L5 at the University of Kentucky between 2010 and 2020 were assessed for evidence of pre-existing degeneration. Measures of degeneration included Pfirrmann grade, modified Pfirrmann grade, disc height, and facet hyperintensity width. Demographic measures, including age, sex, smoking status, and BMI were also assessed.</p><p><strong>Results: </strong>Throughout the follow-up period, 30.0% of patients evaluated were found to have ASP. 83.7% of these happened at the level below and 16.3% happened at the level above the fusion. Paired sample t testing indicated that only disc height was significantly different in the adjacent levels in those who developed ASP. There was no significant difference between the 2 levels for Pfirrmann grade, modified Pfirrmann grade, and facet T2 hyperintensity. Among degenerative measures, only disc height was different (lower) in the level below PLF compared with above, before fusion. Age, sex, and smoking status were not significantly different between those who developed ASP and those who did not (P=0.68, 0.81, 0.23, respectively).</p><p><strong>Conclusions: </strong>Analysis suggests that in patients undergoing PLF, pre-existing degeneration plays an insignificant role in the development of ASP, and that postoperative acceleration of degenerative changes still represents the primary etiology of ASP.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413603","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":"Readability of Patient Education Materials for Anterior Cervical Discectomy and Fusion.","authors":"Anil Sedani, Eric Kholodovsky, Justin Trapana, Evan Trapana","doi":"10.1097/BSD.0000000000001769","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001769","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive study.</p><p><strong>Summary of background data: </strong>Patients commonly use online patient education materials (PEM) to learn about anterior cervical discectomy and fusion (ACDF).</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the readability of patient education materials on anterior cervical discectomy and fusion.</p><p><strong>Methods: </strong>The Google search engine was queried using the term \"Anterior Cervical Discectomy and Fusion patient information.\" The first 25 websites meeting inclusion criteria for this term were evaluated. Readability scores were automatically calculated by transferring the texts to http://www.readabilityformulas.com. Descriptive statistics were calculated for each measure using SPSS version 28.0.0.</p><p><strong>Results: </strong>The mean average reading level was 9.2±2.4. The mean readability score out of 100 for the FK Reading Ease Score was 55.2±8.6. The remaining scores were: Gunning Fog, 12.7±2.2; FK Grade Level, 8.9±2.0; The Coleman Liau Index, 11.0±1.7; SMOG Index, 48.1±197.0; Automated Readability Index, 8.1±3.11; Linsear Write Formula, 9.8±2.1. Only 2 of the PEMs were written at or below a sixth grade level and only 7 were written at or below an eighth grade reading level.</p><p><strong>Conclusion: </strong>Patient readability is an important component of patient care and the current readability level of ACDF PEMs is insufficient. At their current state, PEMs may not allow a significant portion of the population to understand the nature of their condition and procedure properly.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406086","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}