Clinical Spine Surgery最新文献

{"title":"Motion Capture-based 3-Dimensional Measurement of Range of Motion in Patients Undergoing Cervical Laminoplasty.","authors":"So Kato, Sayaka Fujiwara, Nozomu Ohtomo, Yukimasa Yamato, Katsuyuki Sasaki, Jim Yu, Toru Doi, Yuki Taniguchi, Yoshitaka Matsubayashi, Tomohiro Ushikubo, Toru Ogata, Sakae Tanaka, Yasushi Oshima","doi":"10.1097/BSD.0000000000001641","DOIUrl":"10.1097/BSD.0000000000001641","url":null,"abstract":"<p><strong>Study design: </strong>A prospective study.</p><p><strong>Objective: </strong>To measure 3-dimensional cervical range of motion (ROM) by noninvasive optical tracking-based motion-capture technology in patients undergoing laminoplasty, and to elucidate the postoperative effects of laminoplasty on cervical mobility.</p><p><strong>Summary of background data: </strong>Cervical laminoplasty is a motion-sparing decompression surgery for degenerative cervical myelopathy. Unlike cervical laminectomy and fusion, the true postoperative impact of laminoplasty on neck motion has not been well studied.</p><p><strong>Methods: </strong>Participants comprised 25 patients undergoing double-door cervical laminoplasty for degenerative cervical myelopathy in a single center. Maximum flexion/extension, left/right rotation, and left/right side bending were recorded using the motion-capture device preoperatively and 3 months postoperatively. ROMs in 3 orthogonal axes were calculated. Preoperative differences in C2-7 Cobb angles on lateral flexion/extension x-rays were also measured as the radiologic ROM to assess reliability. Preoperative and 1-year postoperative Japanese Orthopaedic Association score, Neck Disability Index [NDI], and Euro-QOL were recorded, and correlations with ROMs were assessed.</p><p><strong>Results: </strong>Preoperative mean (±SD) ROMs for flexion/extension, rotation, and side bending were 90±17, 107±16, and 53±17 degrees, respectively. Although radiologic sagittal ROM measurement showed a smaller range than motion capture, averaging 36±13 degrees, a moderate to strong correlation between radiologic and motion capture values was observed (R=0.57, P =0.003). Preoperative NDI showed a negative correlation with coronal ROM (rho=-0.547, P =0.02). Postoperative ROM showed a significant reduction in rotation (95±16 degrees, P =0.002) but not in flexion/extension or side bending.</p><p><strong>Conclusions: </strong>Three-dimensional motion-capture analysis allowed reliable measurement of cervical ROM. Rotational ROM was significantly reduced after laminoplasty, showing that cervical kinematics are still significantly altered.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E24-E29"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183755","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":"Worse Pain and Disability at Presentation Predicts Greater Improvement in Pain, Disability, and Mental Health in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis.","authors":"Fatima N Anwar, Andrea M Roca, Timothy J Hartman, James W Nie, Srinath S Medakkar, Alexandra C Loya, Keith R MacGregor, Omolabake O Oyetayo, Eileen Zheng, Vincent P Federico, Arash J Sayari, Gregory D Lopez, Kern Singh","doi":"10.1097/BSD.0000000000001650","DOIUrl":"10.1097/BSD.0000000000001650","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Review.</p><p><strong>Objective: </strong>To assess the impact of preoperative pain and disability on patient-reported outcome measures (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis.</p><p><strong>Summary of background data: </strong>Varying preoperative symptom severity in lumbar fusion patients alters perceptions of surgical success.</p><p><strong>Methods: </strong>Degenerative spondylolisthesis patients undergoing elective, primary, single-level MI-TLIF were stratified by preoperative symptom severity: Mild (VAS-B<7/ODI<50), Moderate (VAS-B≥7/ODI<50 or VAS-B<7/ODI≥50), and Severe (VAS-B≥7/ODI≥50). PROMs, Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), ODI, VAS-B, VAS-Leg (VAS-L), and 9-item Patient Health Questionnaire (PHQ-9) were compared at baseline, 6 weeks, and final follow-up (μ=16.3±8.8 mo). Postoperative PROMs, magnitudes of improvement, and minimal clinically important difference (MCID) achievement rates were compared between cohorts through multivariable regression.</p><p><strong>Results: </strong>A total of 177 patients were included. Acute postoperative pain and narcotic consumption were highest in the severe cohort ( P ≤0.003). All preoperative PROMs worsened from mild to severe cohorts ( P <0.001). All PROMs continued to be significantly different between cohorts at 6 weeks and final follow-up, with the worst scores in the Severe cohort ( P ≤0.003). At 6 weeks, all cohorts improved in ODI, VAS-B, VAS-L, and PHQ-9 (P≤0.003), with the Moderate cohort also improving in PROMIS-PF (P=0.017). All Cohorts improved across PROMs at the final follow-up ( P ≤0.044). Magnitudes of improvement in ODI, VAS-B, and PHQ-9 increased with worsening preoperative symptom severity ( P ≤0.042). The Moderate and Severe cohorts demonstrated higher MCID achievement in ODI, VAS-B, and PHQ-9 rates than the Mild cohort.</p><p><strong>Conclusions: </strong>Despite preoperative pain and disability severity, patients undergoing MI-TLIF for degenerative spondylolisthesis report significant improvement in physical function, pain, disability, and mental health postoperatively. Patients with increasing symptom severity continued to report worse severity postoperatively compared with those with milder symptoms preoperatively but were more likely to report larger improvements and achieve clinically meaningful improvement in disability, pain, and mental health.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"11-17"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466676","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":"Cervical Disc Arthroplasty Device Failure Causing Progressive Cervical Myelopathy and Requiring Revision Cervical Corpectomy.","authors":"Jonathan Parish, Steve H Monk, Matthew O'Brien, Ummey Hani, Domagoj Coric, Christopher M Holland","doi":"10.1097/BSD.0000000000001691","DOIUrl":"10.1097/BSD.0000000000001691","url":null,"abstract":"<p><strong>Background: </strong>Cervical disc arthroplasty is a well-established alternative to anterior cervical fusion but requires precise placement for optimal outcomes. We present the case of a 2-level cervical disc arthroplasty with suboptimal implantation of the interbody devices, requiring revision corpectomy. Supplemental video, Supplemental Digital Content 1 ( http://links.lww.com/CLINSPINE/A358 ) content of the revision surgery is also provided. This report highlights the importance of proper implant sizing and position and reviews the nuances of surgical revision.</p><p><strong>Methods: </strong>A retrospective review of the clinical and radiographic data was performed from prior to the index operation through the 3-month postoperative period after the surgical revision.</p><p><strong>Results: </strong>The patient presented approximately 2 years post-cervical arthroplasty with increasing neck pain and early cervical myelopathy. An imaging workup revealed severe cervical stenosis at the caudal level with cord compression and concern for device failure. Intraoperatively, the core of the caudal device was found to have ejected into the spinal canal. A cervical corpectomy of the intervening vertebra with the removal of both devices was performed. The patient had a complete neurologic recovery.</p><p><strong>Conclusion: </strong>Although failure of a cervical disc arthroplasty device is rare, the likelihood can be significantly increased with poor sizing (over or under sizing), asymmetric placement, endplate violation, or poor patient selection. In the case presented herein, early device failure was unrecognized, and the patient went on to develop progressive cervical myelopathy requiring revision corpectomy.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"18-25"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153306","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":"Unrecognized Provider Burden During Hospital EMR Introduction.","authors":"Kornelis Poelstra, Lara Cooper","doi":"10.1097/BSD.0000000000001740","DOIUrl":"10.1097/BSD.0000000000001740","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of-or the transition to-a new electronic health record system (EHR) places an unrecognized burden on health care providers in our ever-changing health care environment of increased mandates, increased overhead, and reduced reimbursement to practice medicine.</p><p><strong>Purpose: </strong>The purpose of this study was to track the non-reimbursed time investment required for 6 providers from an independent spine surgery practice after a hospital system independently decided to transition to a new EHR system.</p><p><strong>Results: </strong>Between the 6 providers of the practice, 266 hours of required classroom time, in-person training, and video and phone call teaching sessions had to be completed to become \"proficient\" so that clinical utilization of the system for in-patient care was certified by the hospital trainers and the EHR company.</p><p><strong>Conclusions: </strong>The burdens associated with the introduction of mandatory EHRs are putting tremendous pressure on providers from a time commitment perspective. This detracts from patient care during that time and deserves to be compensated for by the EHR companies that extract billions of dollars from both federal and private insurers' health care budgets.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"37-38"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766679","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 Preoperative Motor Weakness on Postoperative Clinical Outcomes in Patients Undergoing Cervical Disk Replacement.","authors":"Andrea M Roca, Fatima N Anwar, Srinath S Medakkar, Alexandra C Loya, Aayush Kaul, Jacob C Wolf, Vincent P Federico, Arash J Sayari, Gregory D Lopez, Kern Singh","doi":"10.1097/BSD.0000000000001651","DOIUrl":"10.1097/BSD.0000000000001651","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective review.</p><p><strong>Objective: </strong>To examine the effect of preoperative motor weakness on clinical outcomes in patients undergoing cervical disk replacement (CDR).</p><p><strong>Summary of background data: </strong>Studies examining the effect of preoperative motor weakness on postoperative clinical outcomes in CDR are limited.</p><p><strong>Methods: </strong>Patient cohorts were based on documented upper-extremity motor weakness on physical exam versus no motor weakness. Demographics, perioperative characteristics, and preoperative patient-reported outcome measures (PROMs) were compared using univariate inferential statistics. PROMs consisted of Visual Analog Pain Scale-Neck (VAS-N), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), VAS-Arm (VAS-A), 12-Item Short Form (SF-12) Physical Component Score (PCS), Oswestry Neck Disability Index (NDI), and SF-12 Mental Component Score (MCS). Postoperative PROMs were collected at the 6-week, 12-week, 6-month, and final follow-up up to 1-yeartime points, and intercohort minimum clinically important difference (MCID) achievement was compared through multivariable linear logistic regression adjusting for significant differences in preoperative characteristics.</p><p><strong>Results: </strong>A total of 118 patients formed cohorts based on documented upper-extremity weakness (n=73) versus no weakness (n=45). The average time to postoperative follow-up was 9.7±7.0 mo. The differences in insurance type between the 2 cohorts were significant ( P <0.042). Perioperative diagnosis of foraminal stenosis was significantly more common in the motor weakness cohort ( P <0.013). There were no differences in reported PROMs between cohorts. Patients with motor weakness reported significant MCID achievement for PROMIS-PF at 6-/12-weeks ( P <0.012, P <0.041 respectively), SF-12 PCS at 6-months ( P <0.042), VAS-N at final follow-up ( P <0.021), and NDI at final follow-up ( P <0.013).</p><p><strong>Conclusions: </strong>CDR patients with preoperative muscle weakness achieved MCID across several PROMs compared with patients without muscle weakness. Patients with motor weakness reported greater improvement in mental health, pain, and disability as early as 6 weeks and up to 1 year after CDR. This information serves to inform physicians that motor weakness may not indicate a negative overall outcome.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"6-10"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466638","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":"Precision and Sensitivity: A Surrogate for Quality of Literature Search in Systematic Reviews.","authors":"Vishal Kumar, Sitanshu Barik, Vikash Raj, Sheshadri Reddy Varikasuvu","doi":"10.1097/BSD.0000000000001738","DOIUrl":"10.1097/BSD.0000000000001738","url":null,"abstract":"<p><p>The adequacy of the literature search is one of the critical domains that affect the quality of the systematic review. The aim of a literature search in the systematic review should be to obtain thorough, comprehensive, transparent, and reproducible results. Precision (also called \"positive predictive value\") and sensitivity (also called \"recall\") have been postulated as 2 markers for rating the quality of literature search in systematic reviews. The reporting of such measures shall help in improving the relevance, transparency, reproducibility, and comprehensibility of the search. A search strategy that maximizes sensitivity with reasonable precision shall improve the quality of the review.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"34-36"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945905","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":"Ligamentous Augmentation to Prevent Proximal Junctional Kyphosis and Failure: A Biomechanical Cadaveric Study.","authors":"Chong Weng, Thomas Niemeier, Zuhair J Mohammed, Alan Eberhardt, Steven M Theiss, Sakthivel R Rajaram Manoharan","doi":"10.1097/BSD.0000000000001632","DOIUrl":"10.1097/BSD.0000000000001632","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical cadaveric study (level V).</p><p><strong>Objective: </strong>To evaluate the effectiveness of polyethylene bands looped around the supra-adjacent spinous process (SP) or spinal lamina (SL) in providing strength to the cephalad unfused segment and reducing junctional stress.</p><p><strong>Background: </strong>Proximal junctional kyphosis (PJK) is a pathologic kyphotic deformity adjacent to posterior spinal instrumentation after fusion constructs. Recent studies demonstrate a mismatch in stiffness between the instrumented construct and nonfused adjacent levels to be a causative factor in the development of PJK and proximal junction failure. To our knowledge, no biomechanical studies have addressed the effect of different methods of polyethylene band placement at the proximal junction.</p><p><strong>Materials and methods: </strong>Twelve fresh frozen cadavers were divided into 3 groups of 4: pedicle screw-based instrumentation from T10 to L5 (\"control\"), T10-L5 instrumentation with a polyethylene band to the T9 \"SP,\" T10-L5 instrumentation with 2 polyethylene bands to the T9 \"SL.\" Specimens were tested with an eccentric (10 mm anterior) load at 5 mm/min for 15 mm or until failure occurred. Failure was defined by the inflection point on the load versus deformation curves. Linear regression was utilized to evaluate the effect of augmentation on the load-to-failure. Significance was set at 0.05.</p><p><strong>Results: </strong>Fractures occurred in all specimens tested. The mean peak load to failure was 2148 N (974-3322) for the SP group, and 1248 N (742-1754) for the control group ( P > 0.05) and 1390 N (1080-2004) for the SL group. No difference existed between the control group and the SP group in terms of fracture level ( P > 0.05). Net kyphotic angulation shows no differences among these 3 groups ( P > 0.05).</p><p><strong>Conclusion: </strong>Although statistical significance was not achieved, ligament augmentation to the SP increased mean peak load-to-failure in a cadaveric PJK model.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E12-E17"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897482","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":"Preoperative Cervical Epidural Steroid Injections: Utilization and Postoperative Complications in ACDF, PCDF, and Decompression.","authors":"Husni Alasadi, Joydeep Baidya, Yazan Alasadi, Zakaria Chakrani, Michael M Herrera, Nicole Zubizarreta, Brocha Z Stern, Jashvant Poeran, Saad B Chaudhary","doi":"10.1097/BSD.0000000000001645","DOIUrl":"10.1097/BSD.0000000000001645","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Identify factors associated with cervical epidural steroid injection (CESI) receipt before anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), or decompression; evaluate the association between CESI receipt and 90-day postoperative complications; and determine characteristics of CESI associated with complications.</p><p><strong>Summary of background data: </strong>Previous literature has suggested that a preoperative CESI may increase the risk of postoperative complications. However, these studies were limited in the procedures and complications they evaluated.</p><p><strong>Methods: </strong>The IBM MarketScan database was queried for patients aged 18 years or older who underwent ACDF, PCDF, or cervical decompression for disc herniation, stenosis, radiculopathy, myelopathy, and/or spondylosis without myelopathy between January 1, 2014 and September 30, 2020. CESI receipt within 12 months preoperatively, injection characteristics, and postoperative complications were extracted. Multivariable logistic regression models were used to investigate associations between patient characteristics and receipt of CESI, receipt of a CESI and each 90-day postoperative complication, and CESI characteristics and each 90-day complication.</p><p><strong>Results: </strong>Among the unique patients who underwent each procedure, 20,371 ACDF patients (30.93%), 1259 (22.24%) PCDF patients, and 3349 (36.30%) decompression patients received a preoperative CESI. In all 3 cohorts, increasing age, increasing comorbidity burden, smoker status, and diagnosis of myelopathy were associated with decreased odds of preoperative CESI receipt, while female sex and diagnosis of radiculopathy and spondylosis without myelopathy were associated with increased odds. There were no meaningful between-group comparisons or significant associations between preoperative CESI receipt and any 90-day postoperative complications in multivariable models (all P >0.05).</p><p><strong>Conclusions: </strong>This study elucidated the main determinants of CESI receipt and found no differences in the odds of developing 90-day postoperative complications, but did identify differential outcomes with regard to some injection characteristics.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E53-E60"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283184","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":"Stopping at C2 Versus C3/4 in Elective Posterior Cervical Decompression and Fusion: A 5-Year Follow-up Study.","authors":"Connor C Long, John E Dugan, Hani Chanbour, Jeffrey W Chen, Iyan Younus, Soren Jonzzon, Inamullah Khan, Douglas P Terry, Jacqueline S Pennings, Julian Lugo-Pico, Raymond J Gardocki, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1097/BSD.0000000000001646","DOIUrl":"10.1097/BSD.0000000000001646","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective cohort study.</p><p><strong>Objective: </strong>In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4.</p><p><strong>Summary of background data: </strong>The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear.</p><p><strong>Methods: </strong>A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from December 2010 to June 2018. The primary exposure was UIV of C2 versus C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine.</p><p><strong>Results: </strong>Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2, and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms ( P =0.743), comorbidities ( P >0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, P =0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1 mins, P <0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, P <0.001). Reoperation rate was lower in the C2 group compared with C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance ( P =0.294). Multivariable logistic regression showed increased odds of reoperation for the C3/4 group compared with the C2 group (OR=3.29, 95%CI=0.59-18.11, P =0.170), though statistical significance was not reached. Similarly, the C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, P =0.694) and adjacent segment disease/disk herniation (0% vs. 7.3%, P =0.271), though neither trend attained statistical significance.</p><p><strong>Conclusions: </strong>Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease, though neither trend was statistically significant. Despite a lack of statistical significance, whether a clinically meaningful difference exists between UIV of C2 versus C3/4 should be validated in larger samples with long-term follow-up.</p><p><strong>Level of evidence: </strong>Level-3.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E45-E52"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183788","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":"Academic Productivity at Orthopedic Spine Surgery Fellowships Is Positively Correlated With Nonresearch Lifetime Industry Earnings: A Retrospective Study.","authors":"Anthony N Baumann, Davin C Gong, Seung-Ho Bae, Kyle Hitchman, Albert T Anastasio, Kempland C Walley, Brett Rocos","doi":"10.1097/BSD.0000000000001639","DOIUrl":"10.1097/BSD.0000000000001639","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Analysis.</p><p><strong>Objective: </strong>The objective of the study was to assess the impact of academic productivity at both individual and program levels on lifetime industry earnings within US orthopedic spine fellowships.</p><p><strong>Summary of background data: </strong>Physician-industry transparency was codified by the Physician Payments Sunshine Act (PSSA) in 2010. No study has explored the relationship between academic productivity and industry earnings at the fellowship level.</p><p><strong>Methods: </strong>Inclusion criteria encompassed physicians with complete academic and industry data from orthopedic spine fellowship programs listed on the North American Spine Society (NASS) 2022-2023 fellowship directory. Academic productivity was defined via H-index on the Scopus website, and industry productivity by total lifetime earnings on the Open Payments Database (OPD).</p><p><strong>Results: </strong>This analysis included 75 orthopedic spine fellowship programs with 320 individual physicians. Median individual physician lifetime earnings were $86,852.71 (mean: $666,580.23 ± $1,887,734.64; minimum-maximum: $10.86-$27,164,431.49) and the median individual physician (n=320 physicians) H-index was 17.0 (mean: 21.82 ± 19.28; minimum-maximum: 0-109). Median combined physician H-index per fellowship (n=75 fellowships) was 65.0 (mean: 93.08 ± 85.67; minimum-maximum: 3-434) and median combined physician lifetime earnings was $927,771.60 (mean: $2,844,075.64 ± $4,942,089.56; minimum-maximum: $1,112.32-$29,983,900.69). A positive correlation was observed between academic productivity and industry productivity at an individual level ( P <0.001; Spearman's rho = 0.467). This correlation was stronger at the fellowship level ( P <0.001; Spearman's rho = 0.734). There was no significant difference in total lifetime earnings ( P =0.369) or H-index per fellowship ( P =0.232) when stratified by region of the fellowship program in the United States.</p><p><strong>Conclusion: </strong>Orthopedic spine surgery fellowship programs in the United States exhibit a positive correlation between academic productivity and nonresearch industry lifetime earnings at both individual and program levels. This correlation is stronger at the program level, and regional differences among fellowship programs do not significantly impact academic or industry productivity.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E38-E44"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893051","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}