European Spine Journal最新文献

{"title":"Fusion maturation over time in operated on adolescent idipathic scoliosis - a low dose CT study up to 5 years.","authors":"Fredrik Strömqvist, Irina Vasilescu, Acke Ohlin, Anders Möller, Kasim Abul-Kasim","doi":"10.1007/s00586-025-08767-3","DOIUrl":"https://doi.org/10.1007/s00586-025-08767-3","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate bony fusion with Low Dose CT (LDCT) over time following posterior scoliosis surgery in an all screw construct in patients with AIS with special focus on whether the spinal fusion process continue to develop beyond 2 years after scoliosis surgery and to evaluate if LDCT is an adequate radiological method to assess fusion maturation.</p><p><strong>Methods: </strong>Twenty five consecutive patients with mean age 17 (range 13-24) were operated on during 2009-2010 with index diagnosis AIS. Two neuroradiologists used a LDCT protocol to independently evaluate the occurrence and degree of bony fusion at 2 years and 5 years after surgery (ankylosed facet joints). The instrumented spine was divided in an upper, a middle and a lower third on each side in the 25 patients, leaving 150 regions to be assessed. Fusion in each region was classified based on the status of the facet joints as total, partial or non-fusion.</p><p><strong>Results: </strong>Progression of fusion degree between 2 years and 5 years postoperatively occurred in 18 patients (72%). At 5 years follow-up, 60% showed evidence of total fusion and none showed non-fusion. The interobserver agreement in the classification of bony fusion 2 years postoperatively was almost perfect with a Kappa coefficient of 0.94 and between 2 and 5 years postoperatively a Kappa Coefficient of 0.90.</p><p><strong>Conclusions: </strong>The fusion maturation progress continues beyond two years following posterior scoliosis surgery in AIS. LDCT is a reliable radiological method to reveal bony fusion maturation over time after posterior scoliosis surgery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting postoperative pelvic incidence reduction following surgery for adult spinal deformity.","authors":"Nobuki Tanaka, Tetsuro Ohba, Kotaro Oda, Hayato Takei, Kai Mizukami, Goto Go, Hirotaka Haro","doi":"10.1007/s00586-025-08769-1","DOIUrl":"https://doi.org/10.1007/s00586-025-08769-1","url":null,"abstract":"<p><strong>Purpose: </strong>The present study aimed to analyze the preoperative degeneration of the sacroiliac joint (SIJ) and its involvement in postoperative pelvic incidence (PI) change.</p><p><strong>Methods: </strong>Data from consecutive patients who underwent corrective surgery for adult spinal deformity (ASD) were included in this study. Pre- and early postoperative full-standing radiographs and preoperative pelvic computed tomography (CT) images were examined. Spinopelvic parameters were measured from full-standing radiographs, whereas SIJ degeneration was evaluated from pelvic CT images. We then compared preoperative and postoperative spinopelvic parameters, focusing on PI change, and investigated whether spinopelvic parameters and SIJ degeneration affected PI change.</p><p><strong>Results: </strong>Data from 122 patients (mean age, 71.8 years) were analyzed, with the mean number of fixed vertebrae being 10.2. Postoperative PI decreased significantly by 3.2° (from 50.8° to 47.6°; P < 0.0001). After confirming the presence of SIJ degeneration based on preoperative CT, we found that 39, 38, 49, 98, and 54 patients had osteophytes, sclerosis, bridging bone, articular gas, and SIJ subluxation, respectively. No significant association was observed between sclerosis, osteophyte formation, bony bridging, or articular gas and postoperative PI change, although a significantly greater decrease in postoperative PI was observed among those with SIJ subluxation (P = 0.0035). PI change only correlated with preoperative PI (P < 0.001, R = - 0.56).</p><p><strong>Conclusion: </strong>PI decreased significantly after ASD surgery. We found that several patients showed SIJ subluxation before ASD surgery. PI change after ASD surgery was significantly associated with preoperative PI value and SIJ subluxation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early revision rate after posterior spinal fusion surgery increases with every additional BMI point.","authors":"Alexander Hammer, Achim Götz, Denis Rappert, Olga Cheremina, Thomas Eibl, Thomas Tischer, Björn Lembcke, Klaus John Schnake","doi":"10.1007/s00586-025-08726-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08726-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Revision surgery has a profound impact on patient outcomes and is a crucial consideration in the assessment of healthcare burden following spine surgery. In this context, obesity is a significant factor influencing the rate of revision surgery. To elucidate the impact of obesity on the risk of early revision surgery after posterior fusion of the thoracic and lumbar spine, we conducted a prospective single-institution cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Over a 24-month period a total of 227 consecutive patients who underwent posterior thoracolumbar spinal fusion surgery involving up to four segments were included in the analysis. The objective was to identify factors associated with early revision surgery occurring within three months. The impact of demographic data, comorbidities, intraoperative variables, and follow-up data on the incidence of revision surgery were evaluated through univariate and multivariate statistical analysis. The revision rate was examined according to body mass index (BMI) subcategories. Receiver operating characteristic (ROC) curves were generated using the variables BMI and revision surgery, as well as their respective subcategories (hematoma, infection, implant dislocation, and dural tear).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Univariate analysis demonstrated that obesity (25.3% BMI ≥ 30 vs. 10.9% BMI &lt; 30, p = 0.005), ASA-grade (12.4% ASA grade 1 and 2 vs. 24.4% ASA grade ≥ 3, p = 0.019), and increased intraoperative blood loss (474.1 ml ± 275.3 ml vs. 587.2 ml ± 310.5 ml, p = 0.026) were statistically significant factors associated with increased revision rates. However, logistic binary regression analysis revealed that increasing BMI was the only significant independent variable (OR 1.10; 95% CI 1.02-1.19; p = 0.01). The total revision rate was 17.2% and increased significantly from 5.7% in patients with normal weight to 31.0% in extremely obese patients (BMI ≥ 35 kg/m&lt;sup&gt;2&lt;/sup&gt;) (OR 0.13; 95% CI 0.035-0.51; p = 0.0017). This increase was observed with each additional BMI point. The results of the ROC analysis indicate that the test result variable BMI has an area under the curve of 0.70 (p = 0.00013) for the total revision rate. According to the Youden Index, a cut off value of 28.2 kg/m&lt;sup&gt;2&lt;/sup&gt; was identified, while the \"closest top left\" method yielded a value of 29.5 kg/m&lt;sup&gt;2&lt;/sup&gt;. The number of treated levels did not differ significantly between obese patients (2.00 ± 0.98) and non-obese patients (2.09 ± 1.00) (p = 0.50).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Obesity is associated with an increased likelihood of requiring early revision surgery following posterior thoracolumbar spinal fusion procedures. The risk increases with each BMI point with the cutoff being around 29 kg/m&lt;sup&gt;2&lt;/sup&gt;. Patients with extreme obesity exhibit an exceedingly elevated rate of revision surgery. These results can help surgeons better assess the risk of revisions and counsel their patients a","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the prognostic role of computed tomography Hounsfield units in anticipating spinal outcomes post-instrumentation: a systematic review and meta-analysis.","authors":"Chinedu Egu, Elie Najjar, Spyridon Komaitis, Edidiong Essiet, Samuel Akintunde, Vusumuzi Sibanda, Khalid Salem, Opinder Sahota, Nasir Quraishi","doi":"10.1007/s00586-025-08737-9","DOIUrl":"https://doi.org/10.1007/s00586-025-08737-9","url":null,"abstract":"<p><strong>Purpose: </strong>The use of Hounsfield unit (HU) measurements derived from preoperative computed tomography (CT) scans has emerged as a promising surrogate for assessing bone mineral density (BMD). This systematic review aims to elucidate the role of HU in predicting spinal outcomes in patients undergoing spinal instrumentation.</p><p><strong>Methods: </strong>A comprehensive systematic review of the English-language literature was performed across multiple databases, focusing specifically on adult patients who underwent spinal instrumentation. Adhering to PRISMA guidelines, studies published between 2017 and 2024 that investigated the correlation between HU measurements and spinal outcomes were included. Data extraction and subsequent meta-analysis were conducted utilizing a random effects model. The methodological quality of the included studies was appraised using the Newcastle-Ottawa Scale, and statistical analyses were executed with R software.</p><p><strong>Results: </strong>A total of thirty-five retrospective studies met the inclusion criteria, encompassing a cohort of 3,927 patients. The reported rates of complications included cage subsidence at 35.5%, pedicle screw loosening at 27.9%, proximal junctional failure at 28.6%, and pseudoarthrosis at 66.7%. Notably, lower HU values were significantly associated with an increased incidence of complications across all studies. The delineated HU cutoff thresholds for predicting specific complications were as follows: 198 HU for lumbar interbody fusion cage subsidence; 116 HU and 126 HU for pedicle screw loosening in lumbar and thoracic spine fusions, respectively; 151 HU for proximal junctional failure in thoracolumbar spinal fusion; and 240-260 HU for pseudoarthrosis following anterior odontoid screw fixation. HU measurements were typically calculated as the mean HU of the vertebrae in the operational segments: cervical (C2-C7), thoracic (T1-T12), lumbar (L1-L4), or sacral (S1).</p><p><strong>Conclusion: </strong>This meta-analysis substantiates a significant correlation between reduced HU values and spinal complications following instrumentation. Specifically, thresholds of below 130 HU for thoracic and lumbar pedicle screw loosening, below 200 HU for lumbar cage subsidence, approximately 150 HU for proximal junctional failure in the thoracolumbar region, and below 260 HU for pseudoarthrosis subsequent to anterior odontoid screw fixation were identified. The mean vertebral HU of the surgical segments serves as a reliable metric for this assessment.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time video communication during percutaneous transforaminal endoscopic discectomy is beneficial to postoperative recovery: a single-center retrospective study.","authors":"Zhicheng Pan, Wangxin Liu, Qian Li, Qi Zhang, Enpeng Gu","doi":"10.1007/s00586-025-08777-1","DOIUrl":"https://doi.org/10.1007/s00586-025-08777-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of intraoperative viewing of real-time surgical video and communication among patients on postoperative recovery and satisfaction after percutaneous transforaminal endoscopic discectomy (PTED).</p><p><strong>Method: </strong>Patients admitted to our medical center from January 1, 2021 to December 1, 2023 who underwent PTED for L4/5 lumbar disc herniation were collected. We finally included 77 patients who met the inclusion and exclusion criteria. Patients were categorized into communication (CM) group (n = 39) and non-communication (NCM) group (n = 38) according to whether they had intraoperative real-time surgical video viewing and communication. Preoperative baseline data, operative time, postoperative hospitalization time, Visual Analogue Scale(VAS) score, lumbar Japanese Orthopaedic Association (JOA) score, surgical complications and patient satisfaction were compared between the two groups.</p><p><strong>Result: </strong>Patients in the CM group had less pain, faster functional recovery, shorter hospitalization, and higher satisfaction in the early postoperative period. The NCM group had a shorter operative time. However, patients in the CM group had lower VAS scores on the first day after surgery and at 1 month after surgery than those in the NCM group. And JOA scores were better in the communication group at the first week and first month after operation. There was no significant difference between the two groups in terms of VAS scores, JOA scores, and postoperative complications in the third and sixth postoperative months.</p><p><strong>Conclusion: </strong>Allowing patients to watch real-time surgical videos and engage in intraoperative communication during PTED surgery is a feasible way to reduce early postoperative pain, accelerate functional recovery, and improve patient satisfaction.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of three frailty evaluation tools in predicting postoperative adverse events in older patients undergoing lumbar fusion surgery: a prospective cohort study of 240 patients.","authors":"Di Han, Jun Li, Peng Cui, Shuai-Kang Wang, Peng Wang, Shi-Bao Lu","doi":"10.1007/s00586-025-08743-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08743-x","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the utility of the frailty phenotype (FP), the FRAIL scale, and 5-item modified Frailty Index (mFI-5) in predicting postoperative adverse events after enhanced recovery after lumbar fusion surgery in older patients.</p><p><strong>Methods: </strong>This study prospectively included older patients (> 75 years) who underwent transforaminal lumbar interbody fusion from June 2019 to August 2021. Frailty status was evaluated using FP, the FRAIL scale, and mFI-5. The study investigated the associations between these three frailty tools and total adverse events, complications, and secondary outcomes. Multivariable logistic regression analysis was performed to identify predictors of total adverse events, complications, and secondary outcomes.</p><p><strong>Results: </strong>Correlation analysis demonstrated that frailty assessed by the FP was significantly associated with an increased incidence of complications (55.7% vs. 41.5%, p =.028) and prolonged hospital stays (29.5% vs. 16.9%, p =.021). Frailty identified using the FRAIL scale was significantly linked to prolonged hospital stays (33.7% vs. 16.2%, p =.002). Additionally, frailty assessed by the mFI-5 was associated with higher rates of 30-day readmission (18.5% vs. 6.3%, p =.003) and 30-day reoperation (7.4% vs. 0.6%, p =.007). Multivariate logistic regression revealed that an FP score of ≥ 3 was an independent risk factor for total adverse events, complications, and secondary outcomes, while a FRAIL score of ≥ 3 was an independent risk factor for secondary outcomes.</p><p><strong>Conclusion: </strong>Frailty as defined by the FP is an independent risk factor for total adverse events, complications, and secondary outcomes. Frailty as defined by the FRAIL scale is an independent risk factor for secondary outcomes. The mFI-5 has not been demonstrated to be an independent risk factor for any postoperative adverse events.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between lumbar spine kinematics and falls in patients with lumbar spinal stenosis: a cross-sectional study.","authors":"Takashi Wada, Yuki Kitsuda, Shinji Tanishima, Michihiro Osumi, Chikako Takeda, Mari Osaki, Hideki Nagashima","doi":"10.1007/s00586-025-08748-6","DOIUrl":"https://doi.org/10.1007/s00586-025-08748-6","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the present study was to quantitatively assess the characteristics of lumbar spine motor function in patients with lumbar spinal stenosis (LSS) who experienced falls and to determine the association between falls and lumbar spine motion.</p><p><strong>Methods: </strong>This cross-sectional study enrolled consecutive patients with clinically and radiologically defined LSS indicated for surgical treatment at a single center. The lumbar motion task consisted of bending forward to the maximum range of motion of the lumbar spine in the standing position, followed by a return to the upright position. The occurrence of falls in the past year was recorded. Binomial logistic regression analysis was performed to evaluate the association between falls and lumbar spine motion while using basic characteristics, general fall risk assessment, and known fall-related factors in patients with LSS as adjustment variables.</p><p><strong>Results: </strong>A total of 102 participants were analyzed; 43 participants had a history of falls. Binomial logistic regression analysis showed that delayed lumbar spine motion was significantly associated with the occurrence of falls (odds ratio, 2.56; 95% confidence interval, 1.09-6.03).</p><p><strong>Conclusion: </strong>The results of this study suggest that delayed lumbar motion is an important factor associated with falls in patients with LSS.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging small-sample machine learning for rigorous prediction of JOA recovery in cervical spondylotic myelopathy patients: insights from imaging parameters and modeling strategies.","authors":"Zhangfu Li, Zihe Feng, Honghao Yang, Yong Hai","doi":"10.1007/s00586-025-08763-7","DOIUrl":"https://doi.org/10.1007/s00586-025-08763-7","url":null,"abstract":"<p><strong>Background: </strong>This study investigated how machine learning methods can be applied to small sample sizes to enhance prediction of postoperative functional recovery, as measured by the Japanese Orthopedic Association (JOA) score, in cervical spondylotic myelopathy (CSM) patients undergoing laminoplasty, while leveraging existing research and expert knowledge.</p><p><strong>Methods: </strong>Data from 143 CSM patients who underwent laminoplasty were analyzed. Eleven key imaging parameters related to cervical alignment and paravertebral muscles were measured. Multiple machine learning algorithms were evaluated using different feature engineering approaches. Model performance was assessed through repeated random sampling and confidence intervals.</p><p><strong>Results: </strong>Increasing the number of random data splits improved stability of performance metrics. Incorporating fat infiltration parameters enhanced predictive performance. The Gaussian Naive Bayes algorithm achieved the best overall performance, with 76.90% accuracy (65.01-88.78% CI) and 75.24% AUC (59.20-91.28% CI) using the optimal feature set. Logistic regression and support vector machines also performed well. Random forests showed high specificity but low sensitivity.</p><p><strong>Conclusions: </strong>This study demonstrates that machine learning can effectively predict postoperative outcomes in CSM patients using small samples when combined with expert-informed feature engineering and rigorous evaluation methods. Multiple training iterations and confidence interval reporting enhance result reliability. Machine learning's flexibility in feature selection provides advantages over traditional statistical approaches for such predictive tasks in clinical settings.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiazide diuretic use is associated with fewer hardware complications after anterior cervical discectomy and fusion.","authors":"Nikhil Dholaria, Romir Parmar, Sohail R Daulat, Ali A Baaj, Norman Chutkan","doi":"10.1007/s00586-025-08756-6","DOIUrl":"https://doi.org/10.1007/s00586-025-08756-6","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the surgical outcomes and complications of ACDF among patients taking thiazide diuretics.</p><p><strong>Methods: </strong>Cervical radiculopathy patients who underwent ACDF from 2010 to 2022 were retrospectively queried through the PearlDiver Database. Patients were included if they underwent ACDF with at least 2 years of follow-up and were on thiazide diuretics within 90 days of their procedure. A control group was created using propensity score matching based on age, gender, and Charlson Comorbidity Index. Univariate analysis using chi squared tests and student t-tests were used to compare demographics and outcomes between groups.</p><p><strong>Results: </strong>A total of 16,886 cervical radiculopathy patients (8,443 used thiazide diuretics, 8,443 controls) treated with ACDF were identified through the database. The thiazide diuretic group had significantly lower rates of hardware complications compared to the control group (1.16% vs. 2.05%; P = 0.001). Pseudarthrosis rates were not significantly different between the thiazide diuretic group and the control group (3.98% vs. 3.60%; P = 0.371). Furthermore, rates of revision (11.8% vs. 10.5%; P = 0.07) and spondylolisthesis (3.90% vs. 3.60%; P = 0.482) after ACDF were not significantly different.</p><p><strong>Conclusion: </strong>This large retrospective database study over 12 years found that lower rates of hardware complications were seen in cervical radiculopathy patients who were prescribed thiazide diuretics after ACDF surgery. However, these patients may still be at a similar risk for other postoperative surgical complications, including pseudoarthrosis, revision surgery, and spondylolisthesis.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal timing for decompression in post-operative epidural hematoma: a retrospective analysis and treatment flowchart.","authors":"Cheh-Yung Chang, Hou-Tsung Chen, Fu-Shine Yang, Chieh-Cheng Hsu, Tsung-Cheng Yin, Re-Wen Wu, Sung-Hsiung Chen, Meng-Ling Lu","doi":"10.1007/s00586-025-08775-3","DOIUrl":"https://doi.org/10.1007/s00586-025-08775-3","url":null,"abstract":"<p><strong>Purpose: </strong>Post-operative epidural hematoma is a rare but devastating complication of spine surgery. The importance of timely decompression for preserving neurologic function has been repeatedly stressed, but the acceptable timescale for decompression remains controversial. The purpose of this study was to propose a diagnosis and treatment flowchart for post-operative epidural hematoma.</p><p><strong>Methods: </strong>A retrospective chart review from the registry database of 93 patients who underwent epidural hematoma evacuation from January 2007 to December 2021 was conducted. Statistical analysis was performed to assess the correlation between recovery of neurologic function and time to decompression.</p><p><strong>Results: </strong>Sixty patients were included in the statistical analysis. Time to decompression was significantly associated with recovery of neurologic function in the overall analysis and in subgroup analysis of cases of acute post-operative epidural hematoma. As the time to decompression decreases, there is an improvement in the odds of neurological function recovery. Moreover, a critical threshold for the time to decompression was determined to be < 6 h.</p><p><strong>Conclusion: </strong>Timely decompression is strongly suggested for post-operative epidural hematoma. We proposed a flowchart as a tool to guide treatment of post-operative epidural hematoma. For acute post-operative epidural hematoma, decompression within 6 h promises better neurologic recovery, and decompression should not be delayed by imaging examination. For delayed post-operative epidural hematoma, decompression should be performed as soon as possible after a definite diagnosis is reached.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}