Global Spine Journal最新文献

{"title":"Relationship of T10-Pelvic Angle With Conventional Sagittal Parameters and Legacy Alignment Schemes in Adult Spinal Deformity Surgery.","authors":"Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1177/21925682251333703","DOIUrl":"https://doi.org/10.1177/21925682251333703","url":null,"abstract":"<p><p>Study DesignRetrospective analysis.ObjectiveTo investigate the relationship of T10-pelvic angle (T10PA) with conventional sagittal parameters and legacy alignment schemes.Summary of Background DataT10PA is a newly introduced sagittal parameter to predict the development of proximal junctional kyphosis (PJK). However, its relationship with conventional sagittal parameters and legacy alignment schemes remains unknown.MethodsPatients with fusion from the pelvis to the upper-instrumented vertebra at or above the T10 were included. Based on the 6-week T10PA, the patients were divided into 3 groups as follows: undercorrection, functional alignment, and overcorrection. Conventional sagittal parameters and alignment status based on the Schwab's pelvic incidence (PI)-lumbar lordosis (LL) modifiers and age-adjusted PI-LL were compared according to the T10PA groups. The PJK rates were compared among the alignment schemes.ResultsOverall, 219 patients were enrolled in this study. At 6 weeks postoperatively, 33.3%, 37.0%, and 29.7% of the patients demonstrated undercorrection, functional alignment, and overcorrection relative to the T10PA, respectively. Conventional sagittal parameters significantly differed according to the T10PA groups. Linear regression analysis revealed that T10PA was significantly affected by PI (β = .562) and LL (β = - .411). The correction statuses of the Schwab's PI-LL modifiers and age-adjusted PI-LL were significantly differentiated between the T10PA correction groups. However, only 32.9% of patients with functional alignment relative to T10PA belonged to matched correction category for the age-adjusted PI-LL. Overcorrection relative to age-adjusted PI-LL and T10PA significantly increased PJK risks.ConclusionT10PA significantly correlated with conventional sagittal parameters, particularly PI and LL. Although the T10PA correction status correlated with that of the legacy alignment schemes, a notable discrepancy in the optimal correction was observed between the T10PA and age-adjusted PI-LL schemes. Overcorrection relative to T10PA and age-adjusted PI-LL should be avoided to mitigate PJK development.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333703"},"PeriodicalIF":2.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772055","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":"Response to Letter to the Editor Regarding Rod Contour Angle and Postoperative Thoracic Kyphosis: Key Predictors of Proximal Junctional Kyphosis in Pediatric Neuromuscular Scoliosis After Spinopelvic Fusion.","authors":"Pochih Shen, Carson Keeter, Tyler Sullivan, Nancy Hadley-Miller, Mark A Erickson","doi":"10.1177/21925682251333409","DOIUrl":"https://doi.org/10.1177/21925682251333409","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333409"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772060","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":"Predictive Value of Social Determinants of Health on 90-Day Readmission and Health Utilization Following ACDF: A Comparative Analysis of XGBoost, Random Forest, Elastic-Net, SVR, and Deep Learning.","authors":"Samuel G Reyes, Pranav M Bajaj, Daniel E Herrera, Steven S Kurapaty, Austin Chen, Rushmin Khazanchi, Anitesh Bajaj, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.1177/21925682251332556","DOIUrl":"https://doi.org/10.1177/21925682251332556","url":null,"abstract":"<p><p>Study DesignRetrospective cohort.ObjectiveDespite numerous studies highlighting patient comorbidities and surgical factors in postoperative success, the role of social determinants of health (SDH) in anterior cervical discectomy and fusion (ACDF) outcomes remains unexplored. This study evaluates the predictive impact of SDH on 90-day readmission and health utilization (HU) in ACDF patients using machine learning (ML).MethodsWe analyzed 3127 ACDF patients (2003-2023) from a multisite academic center, incorporating over 35 clinical and demographic variables. SDH characteristics were assessed using the Social Vulnerability Index. Primary outcomes included 90-day readmission and postoperative HU. ML models were developed and validated by the area under the curve (AUC) for readmission and mean absolute error (MAE) for HU. Feature importance analysis identified key predictors.ResultsBalanced Random Forest (AUC = 0.75) best predicted 90-day readmission, with length of stay, Elixhauser score, and Medicare status as top predictors. Among SDH factors, minority status & language, household composition & disability, socioeconomic status, and housing type & transportation were influential. Support Vector Regression (MAE = 1.96) best predicted HU, with perioperative duration, socioeconomic status, and minority status & language as key predictors.ConclusionsFindings highlight SDH's role in ACDF outcomes, suggesting the value of stratifying for interventions such as targeted resource allocation, language-concordant care, and tailored follow-up. While reliance on a single healthcare system and proxy SDH measures are limitations, this is the first study to apply ML to assess SDH in ACDF patients. Further validation with direct patient-reported SDH data is needed to refine predictive models.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251332556"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772050","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":"Pelvic vs Lumbar Fusion in Neuromuscular Scoliosis - A Systematic Review.","authors":"Venla Soini, Sini Karkkola, Arimatias Raitio, Johanna Syvänen, Ilkka Helenius","doi":"10.1177/21925682251328620","DOIUrl":"https://doi.org/10.1177/21925682251328620","url":null,"abstract":"<p><p>Study DesignSystematic literature review.ObjectivesPosterior spinal fusion is the golden standard in the treatment of neuromuscular scoliosis. There are different views on whether pelvic fusion is necessary.MethodsA systematic literature review according to PRISMA guidelines was performed. A total of 628 articles were screened. Original articles of neuromuscular scoliosis patients with reference to posterior spinal fusion in the population of ≤20 years of age were included. Operative technique with lumbar pedicle screws was required. Case reports, articles with missing data on pelvic parameters or with a postoperative follow-up of less than 2 years were excluded. A final of 29 original articles were included in the review.ResultsA total of 1611 patients undergoing posterior spinal fusion for neuromuscular scoliosis were included in the analysis with a mean age of 14.0 ± 1.0 years and a mean number of 15.5 ± 0.8 levels fused. Spinal fusion was extended to the pelvis in 1222 cases, while in 389 patients had fusion limited to the lumbar spine. The percentage of main curve correction was slightly higher in pelvic fusion patients 63 ± 10% compared to 58 ± 9% in lumbar fusion group, <i>P</i> < 0.001. Pelvic obliquity correction was superior in the pelvic fusion group, 58% compared to 42% in the spinal fusion group, <i>P</i> < 0.001. Operative time, complication rate and perioperative bleeding were greater in the pelvic fusion group.ConclusionsPelvic fusion in posterior spinal fusion for neuromuscular scoliosis results in small but statistically significant differences in curve correction and pelvic obliquity but increases the risk for perioperative bleeding and other complications. The impact on quality of life should be addressed in future research.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251328620"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772042","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":"Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers.","authors":"Vadim A Byvaltsev, Andrei A Kalinin, Yurii Ya Pestryakov, Dmitriy V Hozeev, Rustem A Kundubayev, Mikhail Y Biryuchkov, K Daniel Riew","doi":"10.1177/21925682241242039","DOIUrl":"10.1177/21925682241242039","url":null,"abstract":"<p><p>Study DesignRandomized Clinical Trial.ObjectiveTo compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease.Methods83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed.ResultsAt 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (<i>P</i> < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (<i>P</i> < .05).ConclusionsThe use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1508-1516"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery.","authors":"Jae-Won Shin, Yung Park, Sung-Hoon Park, Joong Won Ha, Woo-Seok Jung, Hak-Sun Kim, Kyung-Soo Suk, Si-Young Park, Seong-Hwan Moon, Byung Ho Lee, Ji-Won Kwon, Jaeun Ahn","doi":"10.1177/21925682241260642","DOIUrl":"10.1177/21925682241260642","url":null,"abstract":"<p><p>Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1725-1732"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of One-Stage Combined Posteroanterior Procedure and Laminoplasty-Alone for Multilevel Degenerative Cervical Myelopathy With Concomitant Anterior and Posterior Compression: A Propensity Score Matching Analysis of 8-year Follow-Up.","authors":"Ruomu Qu, Yiyuan Yang, Ben Wang, Zexiang Liu, Xiumao Li, Liang Jiang, Xiaoguang Liu, Zhongjun Liu","doi":"10.1177/21925682241265878","DOIUrl":"10.1177/21925682241265878","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectiveThis study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC).MethodsConsecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8 years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications.ResultsA total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 (<i>P</i> < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively (<i>P</i> < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms (<i>P</i> = 0.081).ConclusionBoth LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1813-1822"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiological Outcomes of Intermuscular \"Raising Roof\" Modified Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Study of at Least 2 Years Follow-Up.","authors":"Xinhang Li, Haosen Wu, Liran Xu, Xueshi Tian, Gengyu Han, Yu Sun, Shengfa Pan, Yanbin Zhao, Feifei Zhou","doi":"10.1177/21925682251333285","DOIUrl":"10.1177/21925682251333285","url":null,"abstract":"<p><p>Study designRetrospective study.ObjectivesThe aim of this study was to evaluate the outcomes of a new modified laminoplasty, intermuscular \"raising roof\" laminoplasty for patients with cervical spondylotic myelopathy.Methods98 patients with cervical spondylotic myelopathy were involved into the study, including 44 patients underwent intermuscular \"raising roof\" laminoplasty (RL) and 54 patients underwent unilateral muscle-preserve laminoplasty (UL). The data, including sagittal parameters and clinical scale was collected at preoperative stage and final follow-up (at least 2 years) and compared between RL group and UL group. Multivariable liner regressions were preformed to evaluate the relationship between parameters with significant changes at the final follow-up and changes of CL, postoperative NDI and JOA. The cumulative sum (CUSUM) analysis was used for quantitative assessment of RL learning curve. All cases were divided into the learning phase and the proficiency phase according to the peak of CUSUM curve.ResultsNo significant difference was found between RL group and UL group preoperatively. At final follow-up, patients in RL group showed higher JOA scores and recovery rate (RR) but lower NDI scores. For the cervical alignment, the ROM of RL group was greater significantly than UL group, whereas the T1S of RL group was lower than UL group. For the decompression, the RL group had larger CSA of spinal canal than UL group (C4: 278.16 ± 50.40 vs 233.84 ± 42.71, <i>P</i> < .001; C5: 279.12 ± 63.88 vs 232.41 ± 48.38, <i>P</i> < .001). For the muscle-preserve effect, the CSA of left-side PM in RL group decreased significantly compared to the preoperative stage on C5 level (2.92 ± 0.66 vs 3.16 ± 1.08, <i>P</i> < .05), and RL group showed better postoperative symmetry than UL group. The regression results indicated postoperative CSA of right-side PM on C4 level had positive impact on the change of CL (positive value increasing, <i>P</i> = .023). And the postoperative symmetry of PM at C4 had positively correlation with postoperative NDI (<i>P</i> = .034). However, the ages of patients showed negative correlation (<i>P</i> = .012) with postoperative JOA. Operation time of learning phase was significantly longer than proficiency phase (166 ± 34.78 vs 120.65 ± 20.36, <i>P</i> < .001), and blood loss of learning phase was significantly higher than proficiency phase (251.90 ± 171.27 vs 148.88 ± 82.02, <i>P</i> < .001).ConclusionCompared to UL, RL showed similar recovery of neurological functions, but with better improvement of quality of life, cervical mobility and decompression effect at 2-year follow-up. It provides a new treatment approach for degeneration cervical myelopathy.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333285"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752378","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":"The Positive Side Effect of Anterior Cervical Decompression and Fusion on Axial Neck Pain.","authors":"Andrea Redaelli, Pablo Bellosta-López, Francesco Langella, Paolo Lepori, Francesca Barile, Riccardo Cecchinato, Domenico Compagnone, Marco Damilano, Daniele Vanni, Claudio Lamartina, Pedro Berjano","doi":"10.1177/21925682241254036","DOIUrl":"10.1177/21925682241254036","url":null,"abstract":"<p><p>Study DesignObservational Cohort Study.ObjectivesThis study aims to comprehensively assess the outcomes of anterior cervical spine surgery in patients who have undergone surgical intervention for radiculopathy or myelopathy, with a specific focus on the surgery's impact on axial neck pain.MethodsData from an institutional spine surgery registry were analyzed for patients who underwent anterior cervical spine surgery between January 2016 and March 2022. Patient demographics, clinical variables, and outcome measures, including the Neck Disability Index (NDI), numeric rating scales for neck and arm pain (NRS-Neck and NRS-Arm), and 36-Item Short Form Health Survey (SF-36) scores, were collected. Statistical analysis included paired t-tests, chi-squared tests, and multivariate linear regression.ResultsOf 257 patients, 156 met the inclusion criteria. Patients showed significant improvement in NDI, NRS-Neck, NRS-Arm, SF-36 (Physical and Mental components), and all changes exceeded the minimum clinically important difference. Multivariate regression revealed that lower preoperative physical and mental component scores and higher preoperative NRS-Neck predicted worse NDI scores at follow-up.ConclusionsThis study underscores that anterior cervical fusion not only effectively alleviates arm pain and disability but also has a positive impact on axial neck pain, which may not be the primary target of surgery. Our findings emphasize the potential benefits of surgical intervention when neck pain coexists with neurologic compression. This contribution adds to the growing body of evidence emphasizing the importance of precise diagnosis and patient selection. Future research, ideally focusing on patients with isolated neck pain, should further explore alternative surgical approaches to enhance treatment options.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1608-1613"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Elevated Mean-Arterial Pressure Lead to Better Outcomes in Degenerative Cervical Myelopathy?- A Prospective, Pilot Randomized Control Trial.","authors":"Ayush Sharma, Ajay Jaiswal, Nandan Marathe, Vijay Singh, Akash Shakya, Nilesh Mangale, Pauras Mhatre","doi":"10.1177/21925682241256350","DOIUrl":"10.1177/21925682241256350","url":null,"abstract":"<p><p>Study designRandomized Control Trial.ObjectiveDCM refers to compression of spinal cord either due to static/dynamic causes or commonly, a result of combination of both. Number of variables exist, which determine prognosis post-surgery. Role of intra-operative blood pressure has not been analyzed in depth in current literature. Elevating MAP post SCI is widely practiced and forms a recommendation of AANS/CNS Joint Committee Guidelines. This led us to investigate role played by elevated MAP during surgery for DCM, in order to optimize outcomes.MethodsThis prospective randomized comparative pilot study was conducted at a tertiary care spine centre. 84 patients were randomly divided in two groups. Group 1 had intra-operative MAP in normal range. Group 2, had intra-operative BP 20 mmHg higher than preoperative average MAP with a variation of + 5 mmHg. Outcomes were recorded at 3 months, 6 months and 1 year by mJOA, VAS and ASIA scale.ResultsNeurological improvement was documented in 19/30 (63.3%) patients of hypertensive group compared to 16/30 (53.3%) patients of normotensive group. Improvements in mJOA scores were better for hypertensive group during the 1-year follow-up. Improvement in VAS scores were comparable between two groups, but at 1-year follow-up the VAS score of hypertensive groups was significantly lower.ConclusionMAP should be individualized according to preoperative average blood pressure assessment of patient. Keeping intraoperative MAP at higher level (preoperative MAP + 20 mmHg) during surgery for DCM can result in better outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1653-1661"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}