Global Spine Journal最新文献

{"title":"The Safety of Spinal Surgery in Patients over 80 Years of Age: Propensity Score Matching Study.","authors":"Chungwon Bang, Kihyun Kwon, Joonghyun Ahn, Young-Hoon Kim","doi":"10.1177/21925682241304332","DOIUrl":"10.1177/21925682241304332","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Using propensity match score to remove those confounding bias and focuses on age factor to compare clinical outcomes and perioperative complications following spinal surgery in cohort of Korean octogenarians treated at a single tertiary hospital.</p><p><strong>Methods: </strong>We classified patients of 80s as the octogenarian group (group O), those 65 and older, and under 80 as the elderly group (group E). We strategically employed the Propensity Score Matching (PSM) analysis as a method to counteract potential confounding variables. 1: 1 nearest-neighbor PSM for fusion level, estimated blood loss (EBL), transfusion, body mass index (BMI), American society of anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI) surgical method and operation time was performed. After PSM, 98 patients are categorized each group evenly (group O, n = 49 vs group E, n = 49). Demographics, clinical, radiologic and postoperative complications were analyzed.</p><p><strong>Results: </strong>The clinical outcomes showed no significant differences in the VAS and ODI preoperatively or postoperatively. And most of hospitalization related factors shows no differences between 2 groups. However, follow-up period was longer in group E (1053.37 ± 684.14 days) than group O (640.29 ± 496.68, <i>P</i> = 0.001) and group O has higher incidences of medical complication (38.77% vs 16.32%, <i>P</i> = 0.013), especially in delirium (34.69% vs 6.12%, <i>P</i> = 0.001) than group E.</p><p><strong>Conclusions: </strong>With the preparation for the prevention and treatment of postoperative delirium, age itself should not be a reason to hesitate in performing the spinal surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241304332"},"PeriodicalIF":2.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692885","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":"Is Cervical Disc Degeneration a Compensatory Mechanism in Hirayama Disease? A Retrospective Case‒Control Study.","authors":"Zhaoxuan Wang, Jianhua Ren, Hengrui Chang, Rui Xue, Guzhen Liang, Junkai Kou, Xianzhong Meng","doi":"10.1177/21925682241302329","DOIUrl":"10.1177/21925682241302329","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>This study aimed to explore the association between cervical disc degeneration and disease progression in patients with Hirayama disease, with a particular focus on changes in the cervical intervertebral disc space height and potential compensatory mechanisms.</p><p><strong>Methods: </strong>This retrospective study included 35 patients diagnosed with Hirayama disease (HD), who were compared with 35 healthy control subjects matched for age and sex. This study focused on collecting and analyzing cervical disc grades and intervertebral space heights from C2 to C7, aiming to assess the extent of cervical disc degeneration between HD patients and the control group. The analysis used independent sample t tests and Mann‒Whitney U tests for demographic data and Spearman's correlation coefficient to explore the relationship between disc degeneration and age.</p><p><strong>Results: </strong>Compared with the control group, patients with Hirayama disease presented significant reductions in intervertebral disc height (<i>P</i> < .01) and increased disc degeneration. Within the HD group, most patients displayed multisegment degeneration (30 out of 35), and more than half presented with full-segment disc degeneration (20 out of 35), which was significantly different from the normal population (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>Patients with Hirayama disease exhibit disc degeneration and reduced intervertebral space height, which may represent a compensatory response.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241302329"},"PeriodicalIF":2.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686794","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":"Coin Test: A Complementary Examination for Assessing Upper Extremity Function in Cervical Myelopathy.","authors":"Xudong J Li, Lawal Labaran, Vishal Talla, Zach Donato, Milos Lesevic, Benjamin Wang, Francis Shen, Adam Shimer, Stephen Lockey, Anuj Singla, Shawn Russell, Wendy Novicoff, Li Jin","doi":"10.1177/21925682241301687","DOIUrl":"10.1177/21925682241301687","url":null,"abstract":"<p><strong>Study design: </strong>A prospective observational study.</p><p><strong>Objectives: </strong>To explore the potential utility of the Coin Test as a valuable tool for assessing and diagnosing cervical spondylotic myelopathy (CSM).</p><p><strong>Methods: </strong>In the first cohort, 36 patients with balance issues were assessed for CSM using the new Coin Test. In the second cohort, the Coin Test and mJOA scores were compared in 36 CSM patients before and 6 weeks after surgery.</p><p><strong>Results: </strong>Among the 36 patients with balance problems who failed tandem gait test, 15 out of 16 (94%) CSM patients failed the Coin Test. The other 20 patients (56%) without CSM completed the Coin Test successfully but failed the tandem gait test for various reasons. The Coin Test demonstrated high specificity (100%) and sensitivity (94%) for diagnosing CSM in patients who failed tandem gait test. In the second cohort, the mJOA score improved significantly from 12 to 15 6 weeks postoperatively, and the Coin Test completion time decreased from 29.5 seconds to 16.4 seconds postoperatively (<i>P</i> < 0.0001). Higher mJOA scores correlate with better performance (shorter time) on the Coin Test, both at baseline and 6 weeks post-surgery.</p><p><strong>Conclusion: </strong>The Coin Test is a useful tool for evaluating hand fine motor and sensory function in CSM patients with high specificity. It also can serve as a tool for assessing surgical outcomes in patients with CSM.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241301687"},"PeriodicalIF":2.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681558","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":"Despite a Multifactorial Etiology, Rates of Distal Junctional Kyphosis After Adult Cervical Deformity Corrective Surgery Can be Dramatically Diminished by Optimizing Age Specific Radiographic Improvement.","authors":"Jamshaid M Mir, Oluwatobi O Onafowokan, Pawel P Jankowski, Oscar Krol, Tyler Williamson, Ankita Das, Zach Thomas, Benjamin Padon, Andrew J Schoenfeld, Muhammad Burhan Janjua, Peter G Passias","doi":"10.1177/21925682241303103","DOIUrl":"10.1177/21925682241303103","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of a prospectively collected single-center database.</p><p><strong>Objective: </strong>Distal Junctional Kyphosis (DJK) is one of the most common complications in adult cervical deformity (ACD) correction. The utility of radiographic alignment alone in predicting and minimizing DJK occurrence warrants further study. To investigate the impact of post-operative radiographic alignment on development of DJK in ACD patients.</p><p><strong>Methods: </strong>ACD patients (≥18 yrs) with complete baseline (BL) and two-year (2Y) radiographic data were included. DJF was defined as DJK greater than 15° (Passias et al) or DJK with reop. Multivariable logistic regression (MVA) identified 3-month predictors of DJK. Conditional inference tree (CIT) machine learning analysis determined threshold cutoffs. Radiographic predictors were combined in a model to determine predictive value using area under the curve (AUC) methodology. \"Match\" refers to ideal age-adjusted alignment.</p><p><strong>Results: </strong>140 cervical deformity patients met inclusion criteria (61.3 yrs, 67% F, BMI: 29 kg/m², CCI: 0.96 ± 1.3). Surgically, 51.3% had osteotomies, 47.1% had a posterior approach, 34.5% combined approach, 18.5% anterior approach, with an average 7.6 ± 3.8 levels fused and EBL of 824 mL. Overall, 33 patients (23.6%) developed DJK, and 11 patients (9%) developed DJF. MVA controlling for age, and baseline deformity, followed by CIT found 3M cSVA <3.7 cm (OR: .2, 95% CI:.06-.6), and TK T4-T12 <50 (OR:.17, 95% CI:.05-.5, both <i>P</i> < .05) were significant predictors of a lower likelihood of DJK. Receiver operator curve AUC using age, T1S match, TS-CL match, LL-TK match, cSVA <3.7 cm, and T4-T12 <50 predicted DJK with an AUC of .91 for DJK by 2Y, and .88 for DJF by 2Y.</p><p><strong>Conclusion: </strong>These findings suggest post-operative radiographic alignment is strongly associated with distal junctional kyphosis. When utilizing age-adjusted realignment in addition to newly developed thresholds, a suggested post-operative cSVA target of 3.7 cm and thoracic kyphosis less than 50, it is possible to substantially reduce the occurrence of distal junctional kyphosis and distal junctional failure.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241303103"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675620","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":"Outcomes and Complications After Elective Thoracic and Lumbar Spinal Fusion in Elderly Patients: A Comparison of Methods to Predict Adverse Events.","authors":"Omar Ramos, Benjamin Mueller, Amir Mehbod, Bayard Carlson","doi":"10.1177/21925682241300977","DOIUrl":"10.1177/21925682241300977","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>The current study compares the ability of the modified Frailty Index (mFI), the American Society of Anesthesiologists (ASA) classification, the modified Charleston Comorbidity Index (mCCI), the American College of Surgeons Surgical Risk Calculator (SRC), and the Fusion Risk Score (FRS) to predict perioperative outcomes.</p><p><strong>Methods: </strong>Comorbidity indices were calculated for patients undergoing elective thoracic and lumbar spinal fusion at a single institution and assessed for their discriminative ability in predicting the desired outcomes using an area under the curve (AUC) analysis.</p><p><strong>Results: </strong>393 patients met the inclusion and exclusion criteria. Patients being treated for adult spinal deformity (ASD) had the highest rate of complications (44.4%). The FRS had acceptable discrimination (AUC >0.7) and the highest ability among the methods studied to predict any adverse effects, new neurological deficit, return to OR within 90 days, and surgical site infection. It had good discrimination ability (AUC >0.8) predicting durotomy, respiratory failure (RF) requiring intubation, hemodynamic instability, and sepsis. The SRC had acceptable discrimination and highest ability to predict deep venous thrombosis (DVT). The mCCI had excellent and the highest ability to predict acute renal failure (ARF). For the other outcomes, the indices had either poor predictive ability (AUC 0.6-0.7) or no discriminative ability (AUC <0.6).</p><p><strong>Conclusions: </strong>The FRS had a better ability than the ASA, mCCI, mFI, and SRC to predict the most perioperative adverse events and reoperation. Further study is needed to develop preoperative indices with better predictive ability of postoperative outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241300977"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675624","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":"Impact of Vascularity on Spinal Disorders Outcomes, Underestimated yet Probably Crucial: The Example of a Comparative Cohort of Epidural Abscesses.","authors":"Baptiste Boukebous, Liam Petrie, Joseph F Baker","doi":"10.1177/21925682241300979","DOIUrl":"10.1177/21925682241300979","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative cohort.</p><p><strong>Objective: </strong>(1) Describe the prevalence of the basivertebral vessel (BVV) in a cohort of spinal epidural abscesses (SEA) at lumbar or thoracic (2) correlate the presence of BVV to the risk of conservative treatment failure (CTF).</p><p><strong>Methods: </strong>Twenty-six patients successfully managed without surgery were compared to 26 who required surgical management due to failed conservative management (lumbar and thoracic). Two observers sought the BVV on the sagittal T1 with contrast sequences of the initial MRI in a blinded fashion for Kappa score calculation. BVV-/BVV+: absence/presence. Demographic, radiological, and laboratory parameters, as well as functional scores, were recorded.</p><p><strong>Results: </strong>For both observers, 29/52 patients had a BVV+ (55.7%); the agreement was 84% (Kappa: 0.80 CI 95% [0.70-0.90]). 5/23 (21.7%) BVV- patients had a successful medical treatment, while the proportion was 21/29 (72%) for BVV+ (<i>P</i> = .0003). The positive predictive value for BVV+, predicting successful conservative treatment, was 81%. The negative predictive value for BVV- predicting CTF was 69%. BVV- was predictive of CTF in multivariable logistic regression: OR = 40, CI 95% [5-880], <i>P</i> = .02, for agreed observations between observers. For both observers, the proportion of dorsal abscess was the highest for BVV+ (<i>P</i> = .01).</p><p><strong>Conclusion: </strong>The BVV is part of the epidural network. The absence of BVV was strongly correlated with an increased risk of CTF, leading to the need for subsequent surgical treatment. SEA's location pattern varied according to BVV detection. Although the spinal vascular anatomy has been well-known for over 100 years, there are still very few studies on its pathophysiological implications.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241300979"},"PeriodicalIF":2.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647327","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":"The Variability of the Cervicothoracic Inflection Point: A Cohort Analysis of the Multi-Ethnic Asymptomatic Normative Study (MEANS).","authors":"Justin L Reyes, Roy Miller, Matan Malka, Josephine Coury, Yong Shen, Natalia Czerwonka, Alexandra Dionne, Jean-Charles Le Huec, Stephane Bourret, Kazuhiro Hasegawa, Hee Kit Wong, Gabriel Liu, Hwee Weng Dennis Hey, Hend Riahi, Michael Kelly, Lawrence G Lenke, Zeeshan M Sardar","doi":"10.1177/21925682241300985","DOIUrl":"10.1177/21925682241300985","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional Cohort Study.</p><p><strong>Objective: </strong>To determine the cervicothoracic inflection point in an asymptomatic, adult population.</p><p><strong>Introduction: </strong>The cervicothoracic inflection point (CTIP) is an important sagittal marker to understand for patients with cervical deformities. We aimed to identify the CTIP and understand the relationship to other sagittal alignment markers.</p><p><strong>Methods: </strong>468 adult asymptomatic volunteers (18-80 years) from 5 countries (United States, France, Japan, Singapore, Tunisia). All volunteers underwent standing full body, low dose stereo radiographs. The CTIP was identified by measuring the cervical sagittal angle (CSA) and thoracic kyphosis maximum angle (TK_Max), using the end vertebra concept. The CTIP was defined as the vertebra or disc between the lower end vertebra of the CSA and upper end vertebra of TK_Max. A correlation matrix was utilized to identify the relationship between the CTIP and spinopelvic sagittal parameters of interest.</p><p><strong>Results: </strong>The most common CTIP value was the T1 vertebra. CTIPs ranged from C5 to T4, respectively. CTIP showed a weak positive correlation to age (r = 0.10, <i>P</i> = 0.03) and negative correlation to BMI (r = -0.11, <i>P</i> = 0.04). Additionally, CTIP had a minor positive correlation with OC2-CL, C7 slope, T1 slope, T1PA, T1-T12 TK, and T4-T12 TK, all statistically significant. Linear regression demonstrated increased cervical lordosis and increased TK was associated with more caudal CTIP segments.</p><p><strong>Conclusion: </strong>CTIP segments ranged from C5 to T4, with the most common segment being T1. Understanding the relationship of the CTIP to other sagittal variables is critical to patients with CD.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241300985"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638684","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":"Opioid Use Following Spine Surgery in Ambulatory Surgical Centers Versus Hospital Outpatient Departments.","authors":"Rodnell Busigó Torres, Husni Alasadi, Akiro H Duey, Junho Song, Jashvant Poeran, Brocha Z Stern, Saad B Chaudhary","doi":"10.1177/21925682241301684","DOIUrl":"10.1177/21925682241301684","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess the association between undergoing spine surgery in an ambulatory surgical center (ASC) vs a hospital outpatient department (HOPD) and (a) perioperative opioid prescription patterns and (b) prolonged opioid use.</p><p><strong>Methods: </strong>Data from the Merative MarketScan Database included patients aged 18-64 who underwent single-level or multilevel anterior cervical discectomy and fusion (ACDF) or lumbar decompression between January 2017 and June 2021. Primary outcomes included receipt of a perioperative opioid prescription, perioperative oral morphine milligram equivalents (MMEs), and prolonged opioid use (defined as opioid prescription 91-180 days post-surgery). Secondary outcomes included the number of perioperative opioid prescriptions filled (single/multiple) and type of initial perioperative opioid filled (potent/weak). Analysis of prolonged opioid use was limited to opioid-naive patients. Propensity score matching (1 ASC to 3 HOPD cases) and logistic regression models were used for analysis.</p><p><strong>Results: </strong>The study included 11,654 ACDF and 26,486 lumbar decompression patients. For ACDF, ASCs had higher odds of an initial potent opioid prescription (OR = 1.18, 95% CI 1.08-1.30, <i>P</i> < .001) and higher total adjusted mean MMEs (+21.14, 95% CI 3.08-39.20, <i>P</i> = .02). For lumbar decompression, ASCs had increased odds of an initial potent opioid (OR = 1.23, 95% CI 1.16-1.30, <i>P</i> < .001) but lower odds of multiple opioid prescriptions (OR = 0.90, 95% CI 0.85-0.96, <i>P</i> < .001). There was no significant association between the surgery setting and prolonged opioid use.</p><p><strong>Conclusion: </strong>Differences in perioperative opioid prescribing were observed between ASCs and HOPDs, but there was no increase in prolonged opioid use in ASCs. Further research is needed to optimize postoperative pain management in different outpatient settings.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241301684"},"PeriodicalIF":2.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618655","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":"Letter re: Incremental Increase in Hospital Length of Stay due to Complications of Surgery for Adult Spinal Deformity.","authors":"Waleed Ahmad, Bilal Zaib, Abdur Rehman","doi":"10.1177/21925682241302074","DOIUrl":"10.1177/21925682241302074","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241302074"},"PeriodicalIF":2.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618654","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":"Outcomes for Degenerative Cervical Myelopathy Following Implementation of the AO Spine International Guidelines: A Single-Centre Service Evaluation.","authors":"Jamie Brannigan, Sundar K Vellaiyappan, Oliver D Mowforth, Joseph Magee, Jibin J Francis, Benjamin M Davies, Mark R Kotter","doi":"10.1177/21925682241301049","DOIUrl":"10.1177/21925682241301049","url":null,"abstract":"<p><strong>Introduction: </strong>Degenerative cervical myelopathy (DCM) is a syndrome of symptomatic cervical spinal cord compression due to degenerative spinal changes. Until recently there was no formal consensus on exactly which patients are suitable for surgical or conservative management. The AO Spine international guidelines were introduced to address this issue, based on the best available current evidence. However, their implementation into routine clinical practice has not yet been reported. The objective was to evaluate surgical outcomes following the implementation of the AO Spine guidelines at our spinal neurosurgical centre.</p><p><strong>Methods: </strong>A service evaluation was conducted using data collected from electronic healthcare records for 259 patients, with outcomes of interest including change in mJOA score and complications. Data from 193 patients were included in the final analysis.</p><p><strong>Results: </strong>There was a mean improvement of the mJOA score by 1.53 points, 1.44 point and 1.92 points at post-operative intervals of 3 months (<i>P</i> < .001), 6 months (<i>P</i> < .001) and 12 months (<i>P</i> < .001). The percentage (number) of patients whose increase in mJOA score was greater than or equal to the minimal clinically importance difference (MCID) was 41% (44/107), 34% (33/96) and 43% (49/114) at these respective time intervals. Intraoperative complications occurred in 28 patients (11.7%). No association was found between BMI and postoperative change in mJOA score.</p><p><strong>Conclusion: </strong>Our results are comparable to those from best practice data and suggest adherence to international guidelines provides a service that promotes meaningful recovery for patients with DCM. Therefore, our results offer support for implementation of the AO Spine international guidelines in clinical practice.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241301049"},"PeriodicalIF":2.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618657","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}