Global Spine Journal最新文献

{"title":"Evaluating Dysphagia Duration and Severity After ACDF in Patients With Underlying Dysphagia - A Prospective, Multicenter Study.","authors":"Aditya Mazmudar, Taylor Paziuk, Khoa S Tran, Tyler Henry, Samuel Oh, Caroline Purtill, Daniel Habbal, Goutham Yalla, Quinlin Harrill, Brandon Sherrod, Erica Bisson, Darrel Brodke, Christopher Kepler, Gregory Schroeder, Alexander Vaccaro, Alan Hilibrand, Jeffrey A Rihn","doi":"10.1177/21925682231201249","DOIUrl":"10.1177/21925682231201249","url":null,"abstract":"<p><strong>Study design: </strong>Prospective Cohort Study.</p><p><strong>Objectives: </strong>The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions.</p><p><strong>Methods: </strong>After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these dysphagia surveys were repeated immediately postoperatively, at two weeks and again at six, 12, and 24 weeks postoperatively. Patients were stratified into three subgroups based on dysphagia status preoperatively and immediately postoperatively and compared using ANOVA tests or Kruskal-Wallis tests for continuous variables and Pearson chi-square analysis or Fisher's Exact test for categorical variables.</p><p><strong>Results: </strong>A total of 168 patients (23 with preoperative dysphagia, 145 without preoperative dysphagia) met study criteria and were enrolled in the study. Patients with preoperative dysphagia had less frequent alcohol consumption (23.8% vs 53.7%, <i>P</i> = .0210), and higher rates of dysphagia at 2-weeks (77.8% vs 38.7%, <i>P</i> = .004) and 24-weeks (43.8% vs 14.8%, <i>P</i> = .010) postoperatively. These patients also had higher severity scores for dysphagia on the Bazaz (<i>P</i> = .001), DSQ (<i>P</i> = .012), EAT10 (<i>P</i> = .022) questionnaires at the 2-week follow-up period, higher DSQ scores (<i>P</i> = .036) at the 6-week follow-up period, higher EAT-10 scores (<i>P</i> = .009) at the 12-week follow-up period, and higher Bazaz (<i>P</i> = .001), DSQ (<i>P</i> = .002), and EAT-10 (<i>P</i> = .005) scores at the 24-week follow-up period. There were no differences in demographic, medical history, surgical variables, rates of ENT consultation, length of stay, or other in-hospital events between groups.</p><p><strong>Conclusions: </strong>Patients undergoing ACDF who had preoperative dysphagia have prolonged postoperative dysphagia and greater dysphagia severity. Surgeons should be aware of the risk of prolonged dysphagia severity that may persist past 24 weeks after surgery when discussing clinical decisions with patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"571-579"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10159770","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":"Interobserver Agreement and Satisfaction With the use of Telemedicine for Evaluating low Back Pain: A Primary, Observational, Cross-Sectional, Analytical Study.","authors":"Jair Moreira Dias, Adriano Fernando Mendes, Eduardo Pestana de Aguiar, Luan Costa Silveira, Maria Fernanda Noel Dias, Nádia Rezende Barbosa Raposo","doi":"10.1177/21925682231194453","DOIUrl":"10.1177/21925682231194453","url":null,"abstract":"<p><strong>Study design: </strong>A primary, observational, cross-sectional, analytical study.</p><p><strong>Objective: </strong>The development of a framework for systematic telemedicine (TM) for orthopedic physicians in frequent clinical care may increase agreement in diagnosis and satisfaction among users of TM. Therefore, this study aimed to estimate the agreement in the diagnosis of low back pain (LBP) between TM, systematized by a self-completed digital questionnaire, and face-to-face (FF) care in patients with LBP.</p><p><strong>Methods: </strong>This study included adults up to 75 years of age with LBP for more than 6 weeks. They were evaluated at 2 independent time points (TM and FF) by different orthopedists with 3 different levels of expertise. Professionals evaluated the sample without prior knowledge of the diagnosis, and each orthopedist provided a diagnosis. Diagnostic agreement was the primary outcome. Secondary outcomes were the duration of the visit and satisfaction among healthcare professionals.</p><p><strong>Results: </strong>A total of 168 participants were eligible, of whom 126 sought care through TM and 122 sought FF care (mean age, 47 years [range, 18-75 years]; 66.4% women). The agreement among professionals regarding the diagnosis was moderate (kappa = .585, <i>P</i> = .001). TM was faster than FF (11.9 minutes (standard deviation = 4.1) vs 18.6 (SD = 6.9), <i>P</i> < .001). Professional satisfaction was higher among spine specialists than among orthopedic residents and orthopedists who were not specialists in spine surgery.</p><p><strong>Conclusion: </strong>Agreement in diagnosis was moderate for TM, with a 30% shorter visit duration than FF. Satisfaction varied by professional expertise and was higher among spine specialists than among professionals with other expertise.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"482-489"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10367368","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 Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study.","authors":"Yogin Patel, Karthik Ramachandran, Ajoy Prasad Shetty, Sekar Chelliah, Balavenkat Subramanian, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan","doi":"10.1177/21925682231203653","DOIUrl":"10.1177/21925682231203653","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomized controlled double-blinded study.</p><p><strong>Objective: </strong>To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia.</p><p><strong>Methods: </strong>81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded.</p><p><strong>Results: </strong>The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; <i>P</i> < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29 mg; <i>P</i> < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03 mL, 380.74 ± 77.80 mL) than the control group (498.89 ± 71.22 mL) (<i>P</i> < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief.</p><p><strong>Conclusion: </strong>Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"639-647"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41127118","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":"Artificially Intelligent Billing in Spine Surgery: An Analysis of a Large Language Model.","authors":"Bashar Zaidat, Yash S Lahoti, Alexander Yu, Kareem S Mohamed, Samuel K Cho, Jun S Kim","doi":"10.1177/21925682231224753","DOIUrl":"10.1177/21925682231224753","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>This study assessed the effectiveness of a popular large language model, ChatGPT-4, in predicting Current Procedural Terminology (CPT) codes from surgical operative notes. By employing a combination of prompt engineering, natural language processing (NLP), and machine learning techniques on standard operative notes, the study sought to enhance billing efficiency, optimize revenue collection, and reduce coding errors.</p><p><strong>Methods: </strong>The model was given 3 different types of prompts for 50 surgical operative notes from 2 spine surgeons. The first trial was simply asking the model to generate CPT codes for a given OP note. The second trial included 3 OP notes and associated CPT codes to, and the third trial included a list of every possible CPT code in the dataset to prime the model. CPT codes generated by the model were compared to those generated by the billing department. Model evaluation was performed in the form of calculating the area under the ROC (AUROC), and area under precision-recall curves (AUPRC).</p><p><strong>Results: </strong>The trial that involved priming ChatGPT with a list of every possible CPT code performed the best, with an AUROC of .87 and an AUPRC of .67, and an AUROC of .81 and AUPRC of .76 when examining only the most common CPT codes.</p><p><strong>Conclusions: </strong>ChatGPT-4 can aid in automating CPT billing from orthopedic surgery operative notes, driving down healthcare expenditures and enhancing billing code precision as the model evolves and fine-tuning becomes available.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1113-1120"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037579","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":"Obesity Limits Utility of Vertebral Bone Quality Score for Opportunistic Osteopenia/Osteoporosis Screening in Cervical Surgery Patients.","authors":"Mingliang Shi, Cheng Ye, Baocheng Niu, Dong Xie, Qing Chen, Qi Zhao, Hao Wu, Lili Yang","doi":"10.1177/21925682251325181","DOIUrl":"10.1177/21925682251325181","url":null,"abstract":"<p><strong>Study design: </strong>Comparative study.</p><p><strong>Objective: </strong>The vertebral bone quality (VBQ) score is a validated opportunistic screening tool for bone mineral density (BMD). Obesity, often associated with hyperlipidemia and fat infiltration, may result in lower VBQ-derived BMD. However, studies have shown that dual-energy x-ray absorptiometry (DXA)-derived BMD tends to increase in obesity. Given this paradox, the aim of this study was to evaluate the effect of obesity on the utility of VBQ in opportunistic osteopenia/osteoporosis screening.</p><p><strong>Methods: </strong>A total of 310 consecutive patients with degenerative cervical myelopathy were included. Body mass index (BMI) classified patients into underweight/normal, overweight, and obesity groups. Pearson's correlation assessed the associations of BMI with VBQ score, Hounsfield unit (HU) values, and T-score. The utility of VBQ score and HU values to discriminate normal BMD from osteopenia/osteoporosis was analyzed using receiver operating characteristic curve analysis and area under the curve (AUC).</p><p><strong>Results: </strong>BMI was associated with lower VBQ score and higher T-score, but not with HU values. The correlation between VBQ score and T-score decreased with increasing BMI, eventually becoming nonsignificant in the obesity group (r = 0.241, <i>P</i> = .082). The VBQ score was not effective in identifying osteopenia/osteoporosis in the obese group (AUC = 0.59, <i>P</i> = .282). Compared with VBQ score, HU values were effective in several BMI subgroups (AUC = 0.75 to 0.88, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>The Cervical VBQ score is no longer a reliable indicator of DXA-derived BMD in obese patients. Even when the VBQ-derived BMD appears normal, it should not be solely relied upon to preclude further DXA evaluation.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251325181"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531241","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":"Exploring Physical Lumbar Microvascular Geometry Through Endoscopy and Illustrations: Implications for Clinical Interpretation.","authors":"Tsung-Mu Wu, Dae-Jung Choi, Wen-Shuo Chang, Jin-Ho Hwang, Moon-Chan Kim, Dae-Geun Kim","doi":"10.1177/21925682231218729","DOIUrl":"10.1177/21925682231218729","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Study.</p><p><strong>Objectives: </strong>Minimally invasive endoscopic spinal surgery is gaining popularity, but our understanding of the lumbar spine's microvascular geometry relies heavily on cadaver studies and textbook illustrations. Additionally, inconsistent nomenclature of vessels in the literature hampers effective communication among surgeons. This study aims to improve the clarity and comprehensibility of the lumbar spinal microvascular geometry under endoscopic view.</p><p><strong>Methods: </strong>The study included 400 patients who underwent endoscopic spinal surgery for lumbar spinal canal stenosis and foraminal stenosis. The surgeries were performed by an experienced surgeon using either the interlaminar or transforaminal approach. Endoscopic video recordings were further analyzed to map the microvascular geometry and common bleeding foci. The observed results were cross-referenced with existing literature to reconstruct a comprehensive view of the vascular anatomy.</p><p><strong>Results: </strong>The transforaminal approach commonly encounters bleeding foci originating from the major branches of the segmental lumbar artery and the emissary veins within the foramen. The interlaminar approach primarily encounters bleeding foci from the muscle vessels in the dorsal lamina, which are believed to be located near the ends of the three main branches. In the intracanal region, epidural vessels form a rotary loop above the disc, which can contribute to most of the bleeding during discectomy.</p><p><strong>Conclusions: </strong>This study provides a comprehensive understanding of the microvascular anatomy in the lumbar spine during endoscopic spinal surgery. Recognizing the geometry will help surgeons anticipate and control bleeding, reducing the risk of complications. The findings contribute to the improvement of surgical techniques and patient safety in endoscopic spinal surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"969-980"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451350","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":"Are Patients With Segmental Cervical Kyphosis Appropriate Candidates for Cervical Disc Arthroplasty (CDA)? A Clinical and Radiographic Analysis Compared to Anterior Cervical Discectomy and Fusion (ACDF).","authors":"George Abdelmalek, Daniel Coban, Neil Patel, Stuart Changoor, Nikhil Sahai, Kumar Sinha, Ki Hwang, Arash Emami","doi":"10.1177/21925682241232616","DOIUrl":"10.1177/21925682241232616","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To compare the clinical and radiographic outcomes of Anterior Cervical Discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in patients with preoperative segmental kyphosis.</p><p><strong>Methods: </strong>Patients with segmental cervical kyphosis at the operative levels undergoing 1- or 2-level ACDF or CDA from 2017 to 2020 with 2 years of follow were identified. Patient demographics, perioperative data, complication rates, radiographic findings and reported outcomes were analyzed.</p><p><strong>Results: </strong>A total of 48 patients met inclusion criteria and were included in our study (ACDF: n = 24, CDA: n = 24). Patient demographic data between the 2 cohorts was similar expect for proportion of males (ACDF: 62.5% vs CDA: 33.3%, <i>P</i> = .043). There was no statistical significance in the change of segmental lordosis (ACDF: +8.09° vs CDA: +5.88°, <i>P</i> = .075) between the preoperative and final postoperative period. Additionally, the change in cervical lordosis was similar between groups (ACDF:+ 9.86° vs CDA: +7.60°, <i>P</i> = .226). VAS scores were similar between the 2 groups at every follow-up interval. NDI scores were significantly different at the 6-month, 12 month and the final follow-up. Mean improvements between preoperative and final postoperative periods were statistically superior in the CDA cohort compared to the ACDF cohort (ACDF: 22.8 vs CDA: 24.1, <i>P</i> = .0375).</p><p><strong>Conclusion: </strong>CDA was superior to ACDF in regards to NDI scores following index procedure in patients with preoperative segmental cervical kyphosis. Those in the CDA cohort had similar complication rates, revision rates and radiographic outcomes as those who underwent ACDF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1263-1269"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740805","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":"Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series.","authors":"Justin K Zhang, Jacob K Greenberg, Saad Javeed, Braeden Benedict, Kathleen S Botterbush, Christopher F Dibble, Jawad M Khalifeh, Samuel Brehm, Deeptee Jain, Ian Dorward, Paul Santiago, Camilo Molina, Brenton H Pennicooke, Wilson Z Ray","doi":"10.1177/21925682231193610","DOIUrl":"10.1177/21925682231193610","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Case-Series.</p><p><strong>Objectives: </strong>Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients.</p><p><strong>Methods: </strong>A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered \"lordosing\" if the change in postoperative SL was ≥ +4° and \"kyphosing\" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression.</p><p><strong>Results: </strong>A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, <i>P</i> < .001) and NRS-BP (3.3 ± 3 point improvement, <i>P</i> < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, <i>P</i> < .001) while LL (Δ0.17° ± 6.98°, <i>P</i> > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° <i>P</i> = .001, β = 15.06° <i>P</i> < .001, respectively).</p><p><strong>Conclusions: </strong>In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"425-437"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9895545","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":"How Does Spino-Pelvic Fixation Affect Post-Operative Compensatory Mechanisms in Adult Spinal Deformity?","authors":"Wang Zhi, Ghassan Boubez, Fidaa Al-Shakfa, Yousef Kamel, Jia Liu, Daniel Shedid, Sung Joo Yuh, Maroun Rizkallah","doi":"10.1177/21925682231200832","DOIUrl":"10.1177/21925682231200832","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-center multi-surgeon cohort study.</p><p><strong>Objectives: </strong>Compare the post-operative changes in the compensatory mechanisms of the sagittal balance according to the type of pelvic fixation: S2-Alar-iliac screws (S2AI) vs iliac screws (IS) in patients with Adult spine deformity (ASD).</p><p><strong>Methods: </strong>ASD patients who underwent spino-pelvic fixation and remained with a PI-LL >10° mismatch post-operatively were included. Pre-operative and 1-year-follow-up PI, Lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), femur obliquity angle (FOA), knee flexion angle (KFA) and ankle flexion angle (AFA) were analyzed on EOS imaging. Patients were categorized based on their pelvic fixation type (S2AI vs IS), and the pre-operative to 1-year-post-operative changes (ΔX°) in the compensatory mechanisms were compared between groups.</p><p><strong>Results: </strong>Patients with S2AI (<i>n</i> = 53) and those with IS (<i>n</i> = 26) screws were comparable at baseline. ΔSS averaged 9.87° in the S2AI compared to 13.2° in the IS (<i>P</i> = .001), whereas the ΔKFA reached 6.01° in the S2AI as opposed to 3.06° in the IS (<i>P</i> = .02). The ΔPT was comparable between both groups (6.35°[S2AI group] vs 5.21°[ISgroup], <i>P</i> = .42). ΔTK, ΔLL, ΔFOA and ΔAFA were comparable between both groups.</p><p><strong>Conclusion: </strong>The type of pelvic fixation impacts significantly the post-operative compensatory mechanisms in patients with ASD. Patients with S2AI screws are more likely to compensate their remaining post-operative PI-LL mismatch through their knees and less likely through their pelvis compared to patients with IS, despite similar changes in PT. This could be explained by an increased SI joint laxity in ASD patient and the lower resistance of the iliac connectors to the junctional mechanical stresses, allowing for sacro-iliac joint motion in patients with IS.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"548-553"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10557479","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 Duration of Symptoms Influences Outcomes After Lumbar Microdiscectomies: A Michigan Spine Surgery Improvement Collaborative.","authors":"Rafid Kasir, Philip Zakko, Sazid Hasan, Ilyas Aleem, Daniel Park, David Nerenz, Muwaffak Abdulhak, Mick Perez-Cruz, Jason Schwalb, Ehab S Saleh, Richard Easton, Jad G Khalil","doi":"10.1177/21925682231210469","DOIUrl":"10.1177/21925682231210469","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort.</p><p><strong>Objective: </strong>We investigate whether duration of symptoms a patient experiences prior to lumbar microdiscectomy affects pain, lifestyle, and return to work metrics after surgery.</p><p><strong>Methods: </strong>A retrospective review of patients with a diagnosis of lumbar radiculopathy undergoing microdiscectomy was conducted using a statewide registry. Patients were grouped based on self-reported duration of symptoms prior to surgical intervention (Group 1: symptoms less than 3 months; Group 2: symptoms between 3 months and 1 year; and Group 3: symptoms greater than 1 year). Radicular pain scores, PROMIS PF Physical Function measure (PROMIS PF), EQ-5D scores, and return to work rates at 90 days, 1 year, and 2 years after surgery were compared using univariate and multivariate analysis.</p><p><strong>Results: </strong>There were 2408 patients who underwent microdiscectomy for lumbar disc herniation for radiculopathy with 532, 910, and 955 in Groups 1, 2, and 3, respectively. Postoperative leg pain was lower for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (<i>P</i> < .05). Postoperative PROMIS PF and EQ-5D scores were higher for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>Patients with prolonged symptoms prior to surgical intervention experience smaller improvements in postoperative leg pain, PROMIS PF, and EQ-5D than those who undergo surgery earlier. Patients undergoing surgery within 3 months of symptom onset have the highest rates of return to work at 1 year after surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"759-769"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71423050","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}