Clinical Spine Surgery最新文献

{"title":"Evaluating the Association Between Physical Therapy Variables and Outcomes After Lumbar Fusion.","authors":"Jeremy C Heard, Teeto Ezeonu, Yunsoo Lee, Rajkishen Narayanan, Alec Kellish, Yoni Dulitzki, Dylan Resnick, Jeffrey Zucker, Alexander Shaer, Jose A Canseco, Jeffrey A Rihn, Barrett Woods, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BSD.0000000000001671","DOIUrl":"10.1097/BSD.0000000000001671","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study was to investigate how inpatient physical therapy variables impact (1) inpatient complications, (2) 90-day readmissions, (3) 1-year reoperation rates, and (4) length of stay after posterior lumbar decompression and fusion.</p><p><strong>Summary of background data: </strong>Previous studies have emphasized the role of early ambulation in postoperative spine patients as an effective method for improving pain and decreasing length of stay, but few studies have evaluated the efficacy of inpatient physical therapy.</p><p><strong>Methods: </strong>Patients 18 years of age or older who underwent primary 1-level or 2-level posterior lumbar decompression and fusion from 2019 to 2020 were retrospectively identified. Physical therapy data, including time to first inpatient PT session, gait trial distance achieved, post-treatment pain rating, and Activity Measure for Post-Acute Care (Activity Measure for Post-Acute Care [AM-PAC]) scores were collected using manual chart review. Surgical outcome variables included length of stay, inpatient complications, 90-day readmissions, and reoperations within 1 year of primary surgery.</p><p><strong>Results: </strong>Overall, 425 patients were identified. There was no difference in hours to PT or total gait trial distance achieved between patients who experienced a complication and those that did not. Patients in the noncomplication group had higher AM-PAC scores than patients in the complication group. There was no difference with regards to time to PT, AM-PAC score, or gait trial distance achieved between readmitted patients and nonreadmitted patients or revision patients and nonrevision patients. Stepwise logistic regression showed that having a physical therapy session within 6 hours of surgery was predictive of a decreased length of stay both in all patients.</p><p><strong>Conclusions: </strong>While inpatient physical therapy within 6 hours of surgery does not appear to impact readmissions, complications, or reoperations, surgeons should encourage early ambulation postoperatively to decrease extended hospital stays. Future investigation should seek to identify factors that delay inpatient PT in the 6 hours after surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":"38 2","pages":"E129-E134"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental and Validation of Machine Learning Model for Prediction Complication After Cervical Spine Metastases Surgery.","authors":"Borriwat Santipas, Siravich Suvithayasiri, Warayos Trathitephun, Sirichai Wilartratsami, Panya Luksanapruksa","doi":"10.1097/BSD.0000000000001659","DOIUrl":"10.1097/BSD.0000000000001659","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective cohort study utilizing machine learning to predict postoperative complications in cervical spine metastases surgery.</p><p><strong>Objectives: </strong>The main objective is to develop a machine learning model that accurately predicts complications following cervical spine metastases surgery.</p><p><strong>Summary of background data: </strong>Cervical spine metastases surgery can enhance quality of life but carries a risk of complications influenced by various factors. Existing scoring systems may not include all predictive factors. Machine learning offers the potential for a more accurate predictive model by analyzing a broader range of variables.</p><p><strong>Methods: </strong>Data from January 2012 to December 2020 were retrospectively collected from medical databases. Predictive models were developed using Gradient Boosting, Logistic Regression, and Decision Tree Classifier algorithms. Variables included patient demographics, disease characteristics, and laboratory investigations. SMOTE was used to balance the dataset, and the models were assessed using AUC, F1-score, precision, recall, and SHAP values.</p><p><strong>Results: </strong>The study included 72 patients, with a 29.17% postoperative complication rate. The Gradient Boosting model had the best performance with an AUC of 0.94, indicating excellent predictive capability. Albumin level, platelet count, and tumor histology were identified as top predictors of complications.</p><p><strong>Conclusions: </strong>The Gradient Boosting machine learning model showed superior performance in predicting postoperative complications in cervical spine metastases surgery. With continuous data updating and model training, machine learning can become a vital tool in clinical decision-making, potentially improving patient outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E81-E88"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative Value Unit (RVU) and Medicare Severity Diagnosis-related Group (MS-DRG) Reimbursement in Cervical Spinal Fusion: A 2011-2023 Trends Report.","authors":"Shravan Asthana, Pranav M Bajaj, Jacob R Staub, Connor D Workman, Samuel G Reyes, Matthew A Follett, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi","doi":"10.1097/BSD.0000000000001660","DOIUrl":"10.1097/BSD.0000000000001660","url":null,"abstract":"<p><strong>Study design: </strong>Level 3 retrospective database study.</p><p><strong>Objective: </strong>This study aims to compare work RVU (wRVU), practice expense RVU (peRVU), malpractice RVU (mpRVU), and inflation-adjusted facility price alongside MS-DRG relative weight length of stay (LOS) for cervical spine fusions between 2011 and 2023.</p><p><strong>Summary of background data: </strong>Both RVU and MS-DRG reimbursement have been studied in various surgical subspecialties; however, little investigation has centered on cervical spine fusions. To the best of our knowledge, this is the first study to investigate trends in RVU and MS-DRG reimbursement in cervical spine fusion throughout the COVID-19 pandemic.</p><p><strong>Methods: </strong>Center for Medicaid and Medicare Services (CMS) physician fee schedule was queried between 2011 and 2023 for RVU and facility reimbursement using common single and multilevel anterior and posterior cervical fusion codes. RVU facility prices were inflation adjusted to 2023. MS-DRG reimbursement data from 2011 to 2022 were compiled for cervical spinal fusion procedures with major complication or comorbidity (MCC) 471, complication or comorbidity (CC) 472, and without CC/MCC 473. Compound annual growth rates (CAGRs), Mean Annual Change, and yearly percent changes were calculated.</p><p><strong>Results: </strong>No changes in wRVU were seen for all cervical CPT codes; however, the CAGR of peRVU (-0.51%±0.60%) and mpRVU (0.69%±0.41%) demonstrated marginal fluctuations. Every CPT code displayed an inflation-adjusted facility price decrease (-2.18%±0.24%). When assessing MS-DRG, there were marginal changes in geometric mean LOS (0.17%±0.45%), arithmetic mean LOS (-0.15%±0.84%), and relative weight (1.09%±0.68%). Unlike RVU reimbursement, the yearly percent change differs between each MS-DRG code.</p><p><strong>Conclusions: </strong>Inflation-adjusted RVU reimbursement facility prices demonstrated a consistent decrease, while DRG code reimbursement stayed relatively consistent over the study period. This data may help surgeons and hospitals become cognizant of temporal variations in reimbursement patterns as it may affect their personal practice.</p><p><strong>Level of evidence: </strong>Level III retrospective study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E75-E80"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Estimate the Minimal Clinically Important Difference: An Overview.","authors":"Hernan Roca, Gretchen Maughan, Brian Karamian","doi":"10.1097/BSD.0000000000001735","DOIUrl":"10.1097/BSD.0000000000001735","url":null,"abstract":"<p><p>The minimal clinically important difference (MCID) is a threshold above which a score change would represent a change in symptoms that is noticeable by patients, and it has become a standard approach in the interpretation of clinical relevance of changes in PROMs at a population level. Given the lack of a methodological gold standard, high variability is the main limitation of MCID. Reporting both anchor and distribution-based MCID estimates is a strategy that guarantees both patient-perceived clinical relevance and statistical significance.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"94-96"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Column Release: With Great Lordosis Comes Great Risk of Complications-A Case Series.","authors":"Elliot Pressman, Molly Monsour, Hannah Goldman, Jay I Kumar, Mohammad Hassan A Noureldine, Puya Alikhani","doi":"10.1097/BSD.0000000000001664","DOIUrl":"10.1097/BSD.0000000000001664","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>We sought to characterize complications associated with anterior column release (ACR).</p><p><strong>Summary of background data: </strong>Correction of positive sagittal imbalance was traditionally completed with anterior column grafts or posterior osteotomies. ACR is a minimally invasive technique for addressing sagittal plane deformity by restoring lumbar lordosis.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients who underwent ACR in a prospectively kept database at a tertiary care academic center from January 2012 to December 2018. The prespecified complications were hardware failure (rod fracture, hardware loosening, or screw fracture), proximal junctional kyphosis, ipsilateral thigh numbness, ipsilateral femoral nerve weakness, arterial injury requiring blood transfusion, bowel injury, and abdominal pseudohernia.</p><p><strong>Results: </strong>Thirty-eight patients were identified. Thirty-five patients had ACR at L3-4, 1 had ACR at L4-5, and 1 patient had ACR at L2-3 and L3-4. Eighteen patients (47.4%) had one of the prespecified complications (10 patients had multiple). Ten patients developed hardware failure (26.3%); 8 patients (21.1%) had rod fracture, 4 (10.5%) had screw fracture, and 1 (2.6%) had screw loosening. At discharge, rates of ipsilateral thigh numbness (37.8%) and hip flexor (37.8%)/quadriceps weakness (29.7%) were the highest. At follow-up, 6 patients (16.2%) had ipsilateral anterolateral thigh numbness, 5 (13.5%) suffered from ipsilateral hip flexion weakness, and 3 patients (5.4%) from ipsilateral quadriceps weakness. Arterial injury occurred in 1 patient (2.7%). Abdominal pseudohernia occurred in 1 patient (2.7%). There were no bowel injuries observed.</p><p><strong>Conclusions: </strong>ACR is associated with a higher than initially anticipated risk of neurological complications, hardware failure, and proximal junctional kyphosis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"64-70"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105035","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":"Contemporary Practice Patterns in the Treatment of Cervical Stenosis and Central Cord Syndrome: A Survey of the Cervical Spine Research Society.","authors":"Hannah A Levy, Zachariah W Pinter, Erick R Kazarian, Sonal Sodha, John M Rhee, Michael G Fehlings, Brett A Freedman, Ahmad N Nassr, Brian A Karamian, Arjun S Sebastian, Bradford Currier","doi":"10.1097/BSD.0000000000001663","DOIUrl":"10.1097/BSD.0000000000001663","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>To evaluate for areas of consensus and divergence of opinion within the spine community regarding the management of cervical spondylotic conditions and acute traumatic central cord syndrome (ATCCS) and the influence of the patient's age, disease severity, and myelomalacia.</p><p><strong>Summary of background data: </strong>There is ongoing disagreement regarding the indications for, and urgency of, operative intervention in patients with mild degenerative myelopathy, moderate to severe radiculopathy, isolated axial symptomatology with evidence of spinal cord compression, and ATCCS without myelomalacia.</p><p><strong>Methods: </strong>A survey request was sent to 330 attendees of the Cervical Spine Research Society (CSRS) 2021 Annual Meeting to assess practice patterns regarding the treatment of cervical stenosis, myelopathy, radiculopathy, and ATCCS in 16 unique clinical vignettes with associated MRIs. Operative versus nonoperative treatment consensus was defined by a management option selected by >80% of survey participants.</p><p><strong>Results: </strong>Overall, 116 meeting attendees completed the survey. Consensus supported nonoperative management for elderly patients with axial neck pain and adults with axial neck pain without myelomalacia. Operative management was indicated for adult patients with mild myelopathy and myelomalacia, adult patients with severe radiculopathy, elderly patients with severe radiculopathy and myelomalacia, and elderly ATCCS patients with pre-existing myelopathic symptoms. Treatment discrepancy in favor of nonoperative management was found for adult patients with isolated axial symptomatology and myelomalacia. Treatment discrepancy favored operative management for elderly patients with mild myelopathy, adult patients with mild myelopathy without myelomalacia, elderly patients with severe radiculopathy without myelomalacia, and elderly ATCCS patients without preceding symptoms.</p><p><strong>Conclusions: </strong>Although there is uncertainty regarding the treatment of mild myelopathy, operative intervention was favored for nonelderly patients with evidence of myelomalacia or radiculopathy and for elderly patients with ATCCS, especially if pre-injury myelopathic symptoms were present.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E61-E68"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888681","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":"Experimental Study on the Application of Bioactive Xenogeneic Porcine Cancellous Bone for Cervical Intervertebral Fusion in Goats.","authors":"Wenhao Liang, Jinlong Huang, Lingling Chen, Peng Gao, Xiaona Wu, Tao Zhang","doi":"10.1097/BSD.0000000000001658","DOIUrl":"10.1097/BSD.0000000000001658","url":null,"abstract":"<p><strong>Study design: </strong>An experimental study in a cervical intervertebral fusion goat model.</p><p><strong>Objective: </strong>To investigate the effect of bioactive xenogeneic porcine cancellous bone applied to the intervertebral fusion of goat cervical vertebrae.</p><p><strong>Summary of background data: </strong>Although autogenous bone achieves satisfied outcome in cervical intervertebral fusion, it is limited and cause several complications. The application of xenogeneic bone has potential to solve these problems.</p><p><strong>Methods: </strong>Thirty local goats were randomly divided into 3 groups: group A (12 goats): autogenous tricortical iliac bone group; group B (6 goats): polyetheretherketone (PEEK) cage with autologous bone; and group C (12 goats): PEEK cage with bioactive xenogeneic porcine cancellous bone. C3-C4 discectomy was performed in each group and the above bone graft and bone graft substitutes were implanted. Lateral cervical spine x-rays were taken at preoperative; immediately postoperative; and 4, 8, 12, and 24 weeks postoperatively every goat. Disc space heights (DSHs) were measured on lateral x-rays. CT examination was performed at 12 and 24 weeks after surgery for the fusion score. After 4 and 8 weeks after surgery, 3 goats were euthanized in both groups A and C to evaluate the immune rejection response through histology. At 12 and 24 weeks after surgery, 3 goats were euthanized in each group. The cervical implants fusion outcome was evaluated through specimen histology observation.</p><p><strong>Result: </strong>As time extended, the immune rejection of bioactive xenogeneic porcine cancellous bone gradually subsided. Radiology, specimen observation, and histology manifested that the C3-4 vertebral bodies of goats in each group gradually fused. All the goats in each group achieved bony fusion at 24 weeks after surgery. In terms of preventing intervertebral space collapse, the PEEK cage could achieve better results. There was no significant difference in the remaining experimental data ( P >0.05).</p><p><strong>Conclusions: </strong>Bioactive xenogeneic porcine cancellous bone can obtain satisfied fusion outcomes in cervical intervertebral fusion and is an ideal intervertebral fusion material in goats.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E89-E95"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757548","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":"Changes in Intramedullary Increased Signal Intensity on Axial T2-weighted MRI After Laminoplasty for Cervical Spondylotic Myelopathy: A 10-year Follow-up Study.","authors":"Tenghui Ge, Linzhen Xie, Jianing Li, Jile Jiang, Yuqing Sun","doi":"10.1097/BSD.0000000000001654","DOIUrl":"10.1097/BSD.0000000000001654","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM).</p><p><strong>Summary of background data: </strong>Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated.</p><p><strong>Patients and methods: </strong>We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification.</p><p><strong>Results: </strong>Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up.</p><p><strong>Conclusions: </strong>Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E108-E114"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757579","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":"Comparison Between Resident and Attending Surgeons as Assistants on Adolescent Idiopathic Scoliosis Surgery: No Differences in Outcomes, Complications Rate, or Pedicle Screw Placement Accuracy.","authors":"Francesca Barile, Alberto Ruffilli, Tosca Cerasoli, Marco Manzetti, Giovanni Viroli, Matteo Traversari, Antonio Mazzotti, Cesare Faldini","doi":"10.1097/BSD.0000000000001670","DOIUrl":"10.1097/BSD.0000000000001670","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The aim of the present study was to determine if the level of training of the first assistant (resident or attending surgeon) has an influence on the radiographic outcome of AIS surgery and on the accuracy rate of the pedicle screws placement.</p><p><strong>Summary of background data: </strong>Adolescent idiopathic scoliosis (AIS) surgery is a challenging procedure that requires a dedicated team of skilled professionals. Therefore, understanding the learning curve is of outstanding importance to guarantee the best outcomes and the highest safety to the patients.</p><p><strong>Methods: </strong>A retrospective analysis of patients who underwent surgery for AIS with a minimum follow-up of 2 years was conducted. All patients were operated by an experienced spine surgeon, assisted by and attending surgeon (group A) or a senior resident (group B). Radiographic outcomes were assessed. Through postoperative CT scan, accuracy of pedicle screw placement was measured (using Gertzbein-Robbins classification). Groups were then statistically compared.</p><p><strong>Results: </strong>A total of 120 patients were included (mean age 15.3±3.39 y, major curve Cobb 60.7±11.9 degrees). No difference was found between groups in terms of preoperative characteristics and postoperative radiographic (correction rate, thoracic kyphosis, screw density) outcomes or complications. Operative time and estimated blood loss were significantly higher in Group B ( P =0.045 and P =0.024, respectively). Of the 2746 pedicle screws inserted (1319 group A and 1427 group B), 2452 had a perfect intrapedicular trajectory (absolute accuracy of 89.29%) and 2697 had a breach <2 mm (relative accuracy of 97.56%). No difference was found among groups in terms of absolute or relative accuracy ( P =0.06 and P =0.23, respectively).</p><p><strong>Conclusions: </strong>AIS cases assisted by senior residents have longer operative time and higher blood loss, but this does not negatively affect the overall radiographic outcome and does not place the patient at increased risk of complications.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E122-E128"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859220","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":"Endoscopic Posterior Cervical Craniolateral Inclinatory Foraminotomy: A Novel Approach for Lamina Preservation During Tandem Decompression of Cervical Spondylotic Radiculopathy via Unilateral Biportal Endoscopic Spinal Surgery.","authors":"Tsung-Mu Wu, Jin-Ho Hwang, Moon-Chan Kim, Dae-Jung Choi","doi":"10.1097/BSD.0000000000001722","DOIUrl":"10.1097/BSD.0000000000001722","url":null,"abstract":"<p><strong>Study design: </strong>Case series.</p><p><strong>Objective: </strong>Endoscopic posterior cervical foraminotomy gains attention for cervical radiculopathy due to its feasibility, better outcomes, and lower complications than traditional approaches, enabling efficient multilevel decompression in a single operation while avoiding anterior cervical diskectomy and fusion-related issues. However, with multilevel decompression, the remnant lamina becomes thin and fragile. We propose craniolateral inclinatory foraminotomy to minimize bone removal during laminotomy, reducing the risk of iatrogenic or postoperative lamina fractures in tandem decompression.</p><p><strong>Materials and methods: </strong>From 2021 to 2022, 8 consecutive patients underwent the procedure and were followed up for at least 6 months. The VAS, NDI, and MacNab scores were recorded for clinical recovery and patient satisfaction evaluations. Preoperative and postoperative CT scans were utilized to measure the lamina preservation percentage at each level.</p><p><strong>Results: </strong>The clinical outcomes improved significantly in every patient. No postoperative neck pain, segmental instability, or lamina fracture were observed. The mean lamina preservation percentages of C5, C6, C7, and all vertebrae were 68.8%, 73.22%, 71.86%, and 72.18%, respectively.</p><p><strong>Conclusions: </strong>Ongoing technical adjustments will accompany endoscopic technique development to decrease complications and enhance benefits. Our reported technique avoids extensive laminotomy in multilevel tandem decompression, aiming to prevent lamina fractures and anticipate a reduction in postoperative neck pain.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"76-84"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544130","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}