Clinical Spine Surgery最新文献

{"title":"Health Care Outcomes and Costs Associated With Cervical and Lumbar Spinal Fusion Surgeries in the United States: A Retrospective Claims Database Study.","authors":"Daryll C Dykes, Jill W Ruppenkamp, Katherine A Corso, Caroline E Smith, Michelle Costa","doi":"10.1097/BSD.0000000000001880","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001880","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive, retrospective cohort study.</p><p><strong>Objective: </strong>To descriptively evaluate the 2-year health care burden post cervical and lumbar fusion surgeries using real-world data.</p><p><strong>Summary of background data: </strong>Reoperation, infection, and pseudarthrosis are common adverse events after cervical and lumbar fusion procedures.</p><p><strong>Methods: </strong>This was a descriptive, retrospective cohort study using Merative™ MarketScan® Commercial Claims Database (October 1, 2015 to October 31, 2022). International Classification of Diseases-Tenth Revision (ICD-10) codes were used to identify and study outcomes of adults who underwent cervical-only (N=28,674) or lumbar-only (N=14,527) fusion surgery. The outcomes included incidence and cost of reoperations, pseudarthrosis, and infection post cervical and lumbar spinal fusion surgery.</p><p><strong>Results: </strong>At 2-year follow-up, cervical and lumbar reoperations were performed in 11.6% and 11.0% of cases. A third of cervical and 57% of lumbar reoperation cases had spinal complications identified within the 90 days before and including the reoperation admission. Following cervical and lumbar fusion index surgeries, 2-year pseudarthrosis was reported in 3.9% and 5.6%, and infection in 2.2% and 4.3% of cases, respectively. ​Two-year postoperative health care costs associated with pseudarthrosis or infection following cervical fusion averaged $33,055 and $108,173, and those following lumbar fusion averaged $32,303 and $80,539, respectively. ​For patients with reoperations, the 2-year postoperative health care costs associated with cervical and lumbar fusion were $49,354 and $73,604, respectively.​.</p><p><strong>Conclusions: </strong>Using modern real-world data, our descriptive study suggested significant increased health care costs associated with adverse outcomes after cervical and lumbar fusion surgery. Innovative technologies that mitigate the risk of adverse outcomes after spine fusion have the potential to reduce costs postsurgeries.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642008","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":"Factors Associated With Postoperative Kyphosis and Loss of Range of Motion After Cervical Disc Replacement.","authors":"Abel De Varona-Cocero, Stephane Owusu-Sarpong, Juan Rodriguez-Rivera, Fares Ani, Camryn Myers, Constance Maglaras, Tina Raman, Themistocles Protopsaltis","doi":"10.1097/BSD.0000000000001869","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001869","url":null,"abstract":"<p><strong>Study design: </strong>Single-center retrospective study.</p><p><strong>Objective: </strong>To evaluate the risks associated with postoperative kyphosis and loss of range of motion after cervical disc replacement (CDR).</p><p><strong>Summary of background data: </strong>One of the main benefits of CDR is that it maintains physiological range of motion (ROM) and lordosis while achieving decompression. However, some patients experience loss in segmental ROM or postoperative segmental kyphosis. This study analyzes the radiographic outcomes of these patients.</p><p><strong>Methods: </strong>Adult patients who underwent CDR were included. The cohort was divided into patients with poor x-ray outcomes (PXR) and successful x-ray outcomes (SXR). The PXR group was defined as patients who had a loss in segmental ROM (≥11 degress decrease in Δ segmental ROM) after CDR and/or postoperative segmental kyphosis at the operative level at 2-year follow-up. Sagittal alignment and other measures were compared.</p><p><strong>Results: </strong>A total of 151 (PXR=47; SXR=104) patients met the inclusion criteria. Pre- and postoperative segmental lateral Cobb angles were more kyphotic in the PXR group (3.5 vs. -1.4 degress, P<0.001; 2.6 vs. -5.6 degress, P<0.001). There was a larger Δ in segmental lateral Cobb angle in the SXR group (-4.2 vs. -0.9 degress, P<0.001). The PXR group had more flexion and less extension (11.3 degress vs. 6.5 degress, P<0.001; -2.2 vs. -6.1 degress, P=0.049). Segmental ROM loss was significant in the PXR group (-5.7 degress vs. 1.5 degress, P<0.001). Pre- and postoperative C2-C7 lateral Cobb angles were more kyphotic in the PXR group (-1.2 vs. -9.4 degress, P<0.001; -2.9 vs. -13.9 degress, P<0.001). Pre- and postoperative cSVA were larger in the PXR group (29.6 vs. 25.3 mm, P=0.047; 30.1 vs. 22.8 mm, P=0.004). Multiple variable regressions showed higher preoperative segmental lateral Cobb angle increased odds of SXR (OR=1.217, 95% CI: 1.083-1.369, P<0.001), while larger preoperative C2-C7 ROM decreased them (OR=0.970, 95% CI: 0.994-0.996, P=0.024). No significant differences in postoperative complications were observed.</p><p><strong>Conclusions: </strong>Patients with postoperative kyphosis or loss of ROM were more likely to have less segmental and regional C2-7 lordosis and a larger cSVA. Surgeons should consider these preoperative parameters when indicating CDR and counseling patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636449","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":"Decreasing Rates of Patients With Low Back Pain Presenting to Emergency Departments: An Age and Sex-Specific Review of National Injury Data From 2014 to 2023.","authors":"Charu Jain, Luca M Valdivia, Niklas H Koehne, Jennifer Yu, Nikan K Namiri, Junho Song, Robert L Parisien, Andrew C Hecht","doi":"10.1097/BSD.0000000000001883","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001883","url":null,"abstract":"<p><strong>Objective: </strong>To analyze trends in low back pain presentations to US emergency departments (EDs) and identify associated risk factors and barriers to care.</p><p><strong>Study design: </strong>Retrospective analysis using data from the National Electronic Injury Surveillance System (NEISS) from 2014 to 2023.</p><p><strong>Summary of background data: </strong>Low back pain is one of the most common reasons for seeking medical care in the United States. Post-COVID-19, many older adults seem to defer care. Understanding trends in low back pain incidence can highlight potential improvements in prevention and gaps in health care access.</p><p><strong>Methods: </strong>NEISS data from January 1, 2014, to December 31, 2023, were queried for lower trunk injuries coded as strain/sprain. Narratives consistent with low back pain were included. Demographic and injury-related data were analyzed to estimate trends and outcomes.</p><p><strong>Results: </strong>The query identified 48,829 cases of low back pain, corresponding to a national estimate (NE) of 2,001,384 cases. Low back pain incidence decreased significantly over the study period [P<0.001, β=-0.967, 95% CI: (-25216.56, -16296.58)]. Most cases involved patients aged 46-65 (29.8%) and 31-45 (28.8%). Common causes of injury included stairs (8.8%) and flooring (7%), with 51.3% occurring at home. Males and females accounted for 50.8% and 49.2% of cases, respectively. Hospitalization rates averaged 1.2%, peaking at 2.4% in 2022.</p><p><strong>Conclusions: </strong>Low back pain incidence in US EDs has declined over the past decade, possibly reflecting better prevention or alternative care pathways. However, steady hospitalization rates suggest injury severity remains unchanged. Further research is needed to assess care-seeking patterns, risk factors, and prevention strategies to address the burden of low back pain.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636448","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":"Tremor Impacts Posterior Lumbar Interbody Fusion Outcomes.","authors":"Maryam N Shahin, Adeline L Fecker, Josiah N Orina, Jonathan A Kark, Travis C Philipp, Jung U Yoo, Won Hyung A Ryu","doi":"10.1097/BSD.0000000000001873","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001873","url":null,"abstract":"<p><strong>Study design: </strong>We performed a retrospective study of adult patients who underwent posterior lumbar fusion with interbody devices between 2016 and 2019 using the PearlDiver Claims Database.</p><p><strong>Objective: </strong>This study examined the outcomes of patients who underwent posterior lumbar fusion with comorbid diagnoses of tremor.</p><p><strong>Summary of background data: </strong>Prior studies have found high rates of spine surgery complications in Parkinson disease (PD) patients. There is a paucity of literature investigating other movement disorders.</p><p><strong>Methods: </strong>Patient demographics and outcomes, including short-term opioid use (ceased within 90 d after surgery) and long-term opioid use (continued use beyond 365 d) were extracted. Univariate analysis was performed before and after propensity score matching of tremor patients and nontremor patients.</p><p><strong>Results: </strong>The study included 54,231 nontremor patients, 1265 PD patients, and 2828 tremor patients. Tremor patients had the highest Charlson Comorbidity Index (2.8) and significantly higher long-term opioid use, medical complications (5.0%), emergency room visits (30.5%), 90-day readmissions (7.7%), and revision surgery (5.8%). The PD group had a higher rate of ICU admission (2.0%) and longer mean length of stay (10 d). Propensity score matching of nontremor patients and tremor patients demonstrated higher rates of medical complications (5.0%, P=0.002), revision (7.7%, P=0.001), 90-day admission (7.7%, P=0.007), and emergency room visits (30.5%, P<0.0001) for tremor patients.</p><p><strong>Conclusions: </strong>Tremor patients may have a higher rate of complications and long-term opioid use after lumbar fusion compared with patients without movement disorders. Tremor is often considered benign; however, this study suggests it is a significant comorbidity impacting multiple spine surgery outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625422","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":"Impact of Preoperative Cervical Listhesis on Outcomes Following Unilateral Open-Door Cervical Laminoplasty.","authors":"Alejandro Perez-Albela, Charles Furlong, Ishan Shah, Timothy Jeng, Samuel Bara, Bryce A Basques","doi":"10.1097/BSD.0000000000001879","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001879","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the impact of preoperative cervical spondylolisthesis, defined as ≥2 mm of translation at any cervical level, on postoperative outcomes following unilateral open-door cervical laminoplasty.</p><p><strong>Background: </strong>Cervical laminoplasty is a motion-preserving procedure for cervical spondylotic myelopathy (CSM). The effect of preoperative cervical listhesis on laminoplasty outcomes remains unclear, with mixed findings in the literature regarding its influence on pain relief, alignment, and complications.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 104 patients who underwent unilateral open-door laminoplasty for CSM from 2017 to 2023 with at least 1 year of follow-up. Patients were grouped by presence (n = 43) or absence (n = 61) of preoperative listhesis. Demographics, radiographic parameters [eg, Torg-Pavlov ratio (TPR), C2 to C7 Cobb angle], and clinical outcomes (eg, VAS scores, complications) were compared. Multivariate logistic regression was used to assess whether listhesis predicted adverse outcomes.</p><p><strong>Results: </strong>Both groups experienced significant postoperative VAS improvement, with no differences in pain relief, reoperation rates, hardware complications, or sagittal alignment. The listhesis group had a lower TPR (0.70 ± 0.112) than the no listhesis group (0.76 ± 0.115, P = 0.0043). Listhesis progression was minimal and not significant. At 1 year, there were no significant differences in reoperation (9.8% vs 2.3%, P = 0.132), screw backout (8.2% vs 0%, P = 0.054), or loss of lordosis ≥10 degrees (34.4% vs 39.5%, P = 0.594). Preoperative listhesis was not a predictor of adverse outcomes on multivariate analysis.</p><p><strong>Conclusions: </strong>Preoperative cervical listhesis was not associated with inferior outcomes following unilateral open-door laminoplasty. Both groups showed comparable improvements in pain and maintained spinal alignment, suggesting that mild to moderate listhesis may not be a significant determinant of surgical outcomes in this population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625419","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":"Prevalence of Complications of Patients Treated With Steroids for Acute Subaxial Cervical Spinal Cord Injuries.","authors":"David Kowalski, Ellen Lutnick, Emily K Vallee, Waleed Abdelfattah, Zachary Troiani, Maxwell M Scott, Christopher Lucasti, M Nadir Haider, Lindsey Clark, Joseph Kowalski","doi":"10.1097/BSD.0000000000001884","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001884","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>To evaluate the prevalence of complications in traumatic spinal cord injury (SCI) patients treated with a modified dose of methylprednisolone (MP) at our institution.</p><p><strong>Summary of background data: </strong>Treatment concerning the use of corticosteroids for SCI remains controversial. High-dose MP initially was shown to aid neurologic recovery in SCI if administered acutely; however, reports of complications, including gastrointestinal (GI) hemorrhage, urinary tract infection, upper respiratory infections, and sacral decubitus ulcers, changed recommendations. These complications may also result due to the injury itself, or the ICU-related care these patients typically require.</p><p><strong>Methods: </strong>Adult patients with SCI from January 1, 2015 to April 25, 2023 using ICD-10 codes at our ACS level 1 institution were retrospectively reviewed. Patients with concurrent head trauma or gastrointestinal injuries were excluded. Demographic and clinical data were collected, and complication rates were analyzed. Predictive factors for complications occurring >10% were assessed using χ2 for categorical data and Mann-Whitney for continuous data. P ≤ 0.05 and 95% CI for significance value.</p><p><strong>Results: </strong>Ninety-six patients were included (age 57.42 ± 17.40 y; 72 males, 24 females). Average hospital stay was 17.27 ± 15.17 days, and ICU stay 9.36 ± 13.36 days. The most common complications were pneumonia, anemia, dysphagia, and leukocytosis. GI hemorrhage occurred in 4.2% of patients, with transfusion as the only predictor (P < 0.001).</p><p><strong>Conclusions: </strong>ICU length of stay was predictive of 4 of the 5 most commonly occurring complications in our cohort. GI hemorrhage, often cited as a deterrent for MP use, was observed in only 4.2% of cases.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625420","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 Effect of Perioperative Pregabalin Administration in Postoperative Pain Control After Laminectomy and Instrumented Fusion in Degenerative Lumbar Spine Disease: A Double-Blind, Randomized, Placebo-Controlled Trial.","authors":"Monchai Ruangchainikom, Borriwat Santipas, Vimolluck Sanansilp, Nantthasorn Zinboonyahgoon, Panya Luksanapruksa, Sirichai Wilartratsami","doi":"10.1097/BSD.0000000000001832","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001832","url":null,"abstract":"<p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Objectives: </strong>To evaluate the efficacy of 150 mg and 300 mg preoperative pregabalin for postoperative pain control following lumbar surgery.</p><p><strong>Summary of background data: </strong>Pregabalin has been introduced as an adjunct in the multimodal management of pre-emptive and postoperative analgesia following spinal surgery. Previous studies demonstrated its efficacy in neuropathic pain. However, pregabalin's optimal dose, frequency of administration, and efficacy for degenerative lumbar spine surgery have not been previously studied.</p><p><strong>Methods: </strong>Adult patients aged 18 years or older undergoing laminectomy and fusion for degenerative lumbar disease were randomized to receive pregabalin 150 mg, 300 mg, or a placebo presurgery and postsurgery. Metrics included 48-hour postoperative morphine intake, time to first analgesic, pain scores at various postoperative intervals, preoperative and postoperative EQ-5D-3L, and opioid-related side effects.</p><p><strong>Results: </strong>Fifty-four patients were enrolled in the study. Five patients were discontinued. There were no statistical differences in baseline characteristics of patients, except the preoperative EQ-5D, in which the patients who received 300 mg of pregabalin had a higher score than the patients who received placebo. For the primary outcome, there were no statistical differences in the accumulated morphine consumption among the 3 groups during the postoperative periods. The postoperative pain score at 24 hours was the only outcome with a statistically significant difference among the groups (1.1±1.9 for 150 mg of the pregabalin group, 1.4±1.7 for 300 mg of the pregabalin group, and 3.1±2.0 for the placebo group, P=0.007). There were no statistical differences in opioid-related adverse effects among the groups.</p><p><strong>Conclusion: </strong>Preoperative doses of 150 mg or 300 mg of pregabalin did not significantly alter opioid consumption or its side effects compared with a placebo. However, a notable reduction in pain was observed 24 hours postsurgery in the pregabalin groups.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625421","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":"Health Literacy Assessment Tools in Spine Surgery.","authors":"Elyette Lugo, Dhruv Garg, Branden Lee, Victor Cardona-Perez, Amit Jain","doi":"10.1097/BSD.0000000000001871","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001871","url":null,"abstract":"<p><strong>Study design: </strong>Scoping review.</p><p><strong>Objective: </strong>To summarize and provide existing health literacy (HL) assessment tools used in spine surgery and identify their advantages, limitations, and gaps in measuring spine-specific health literacy.</p><p><strong>Summary of background data: </strong>Health literacy plays a crucial role in patient-reported outcomes (PROs), particularly in spine surgery, where complex decisions and comprehension are required. However, the current tools used to assess HL often lack spine-specific content and fail to address the multidimensional nature of HL, such as numeracy, print, and visual comprehension.</p><p><strong>Methods: </strong>A comprehensive search was conducted across PubMed, Embase, and Cochrane Library databases in August 2024. Studies published between 2014 and 2024, involving human participants and directly assessing HL in patients with spinal conditions, were included. Data on study design, HL tools, HL dimensions, and associated sociodemographic factors were extracted and analyzed descriptively.</p><p><strong>Results: </strong>Nine studies, encompassing 2958 spine patients, met the inclusion criteria. Eight HL tools were identified, including 3 objective (LiMP, NVS, and REALM-SF) and 5 subjective methods (BRIEF, verbal and visual comprehension tasks, surveys, and single-item screening questions). The studies covered various HL dimensions, including print literacy (n=3), print and numeracy literacy (n=1), combined print, oral, and numeracy literacy (n=1), oral and visual comprehension (n=2), and a mix of print and oral literacy (n=1). Limited HL was reported in 9%-50% of patients and was associated with older age, lower education levels, non-native English speakers, and socioeconomic disparities. None of the tools specifically addressed spine-related literacy needs.</p><p><strong>Conclusion: </strong>Current HL tools used in spine surgery focus primarily on general literacy skills and lack spine-specific components. Developing a comprehensive, spine-focused HL tool that incorporates multiple dimensions is crucial to improving patient understanding and shared decision-making.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607713","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":"Lamina-preserving, Type II Posterior Column Osteotomies (PCOs) for Correction of Adult (Thoraco) Lumbar Scoliosis.","authors":"Andrew P Collins, Aaron J Clark, Alekos A Theologis","doi":"10.1097/BSD.0000000000001872","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001872","url":null,"abstract":"<p><strong>Study design: </strong>Operative video and supplemental manuscript.</p><p><strong>Objective: </strong>To present a step-by-step approach to performing lamina-preserving lumbar posterior column osteotomies (PCO) for correction of adult thoracolumbar scoliosis.</p><p><strong>Summary of background data: </strong>Outcomes of operations for adult thoracolumbar spinal deformities are dictated by adequate neural decompression, restoration of appropriate alignment, and achievement of fusion. A surgical strategy that optimizes attainment of all 3 of these goals is important to understand.</p><p><strong>Methods: </strong>A step-by-step approach to performing lamina-preserving lumbar PCOs is provided through a case example and surgical technique video, Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A393.</p><p><strong>Results: </strong>Lamina-preserving PCOs performed at multiple levels are a particularly useful surgical strategy to correct adult thoracolumbar scoliosis, as they provide significant mobilization of the spine and allow for wide decompression of neural elements centrally and in the lateral recess and foramen while maintaining significant central osseous surfaces for interlaminar fusion.</p><p><strong>Conclusions: </strong>Multilevel lamina-preserving PCOs allow for excellent neural decompression, powerful restoration of appropriate sagittal and coronal spinal alignment through release of the lumbar spine, and facilitate interlaminar union, all of which are critical to optimal outcomes of operations for adult thoracolumbar scoliosis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607714","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 is the Early Fate of the Adjacent Segmental Angles Following a Single-level Anterior Cervical Discectomy Fusion for Degenerative Pathology?","authors":"Rakesh Kumar, Landon Basner, Thomas Hanks, Aiyush Bansal, Murad Alostaz, Alice Sohn, Patricia Lipson, Jean-Christophe A Leveque, Venu M Nemani, Philip K Louie","doi":"10.1097/BSD.0000000000001836","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001836","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case series study.</p><p><strong>Objective: </strong>This study aims to investigate adjacent segmental angle changes postsingle-level anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Anterior cervical fusion's impact on adjacent levels and global cervical alignment remains insufficiently understood, with potential implications for surgical planning and radiographic outcomes.</p><p><strong>Methods: </strong>A single-center retrospective analysis of consecutive patients undergoing single-level ACDF for degenerative pathology was conducted. Preoperative and 12-month postoperative lateral cervical plain radiographs were evaluated. Measured parameters included pre and postoperative C2-C7 lordosis, segmental lordosis of the fusion and adjacent levels, T1-slope, occipito-C2 angle (O-C2), and C2-C7 sagittal vertical axis. Patients were stratified by operative level. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Seventy patients were included (18 C4-C5, 35 C5-C6, and 17 C6-C7 operative levels). No significant changes were observed in any of the measured parameters at the C4-C5 level. Likewise, at the C5-C6 level, there were no clinically significant changes in any parameters. At the C6-C7 level, significant alterations in segmental angles were observed. At this level, the ACDF procedure led to an overall loss of lordosis of 3.48 degrees with an associated lordotic change in the supra- and infra-adjacent levels, which preferentially favored change at the supra-adjacent level (4.83 degrees of lordosis response) compared with the infra-adjacent level (3.52 degrees of lordotic response).</p><p><strong>Conclusions: </strong>This study suggests that preoperative cervical lordosis may influence adjacent segmental angles after single-level ACDF procedures, offering crucial insights for future research and preoperative planning. Understanding these dynamics is crucial for preserving cervical lordosis and managing adjacent segment disease.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607715","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}