Journal of neurosurgery. Spine最新文献

{"title":"A propensity score-matched comparison between single-stage and multistage anterior/posterior lumbar fusion surgery: a Michigan Spine Surgery Improvement Collaborative study.","authors":"Anisse N Chaker, Michael Melhem, Dheeraj Kagithala, Edvin Telemi, Tarek R Mansour, Leticia Simo, Kylie Springer, Lonni Schultz, Kari Jarabek, Anneliese F Rademacher, Matthew Brennan, Enoch Kim, David R Nerenz, Jad G Khalil, Richard Easton, Miguelangelo Perez-Cruet, Ilyas Aleem, Paul Park, Teck Soo, Doris Tong, Muwaffak Abdulhak, Jason M Schwalb, Victor Chang","doi":"10.3171/2024.8.SPINE24423","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24423","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing anterior/posterior lumbar fusion surgery can undergo either a single-stage or multistage operation, depending on surgeon preference. The goal of this study was to assess different patient outcomes between single-stage and multistage lumbar fusion procedures in a multicenter setting.</p><p><strong>Methods: </strong>The Michigan Spine Surgery Improvement Collaborative database was queried for anterior/posterior lumbar fusion surgeries between July 2018 and January 2022. Patients who underwent either single-stage or multistage procedures were included. For multistage procedures, the first surgery included both anterior lumbar interbody fusions and lateral lumbar interbody fusions. Primary outcomes included postoperative complications and improvement in patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Physical Function, EQ-5D, and satisfaction. The two cohorts were propensity score matched, while Poisson generalized estimating equation models were used for multivariate analyses.</p><p><strong>Results: </strong>After one-to-one propensity score matching, 355 patients were identified in the single-stage and multistage cohorts. Single-stage procedures were associated with a lower risk of complications (p = 0.024), fewer emergency department visits (p = 0.029), and higher patient satisfaction after 1 year (p = 0.026) and 2 years (p = 0.007), compared with multistage procedures. After adjusting for baseline patient and operative characteristics, patients undergoing multistage procedures had a higher risk of complications (relative risk [RR] 1.17, 95% CI 1.02-1.34; p = 0.026), were less likely to be satisfied after 1 year (RR 0.83, 95% CI 0.74-0.93; p < 0.001), and were less likely to experience improvement in back pain after 90 days (RR 0.86, 95% CI 0.75-0.99; p = 0.039) and 2 years (RR 0.76, 95% CI 0.60-0.96; p = 0.023).</p><p><strong>Conclusions: </strong>The authors observed that patients who undergo lumbar fusion surgery using a multistage approach have higher postoperative complication rates and are less likely to report satisfaction compared with a matched, single-stage procedure cohort.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the prognostic impact of body composition phenotypes on surgical outcomes and survival in patients with spinal metastasis: a deep learning approach to preoperative CT analysis.","authors":"Syed I Khalid, Elie Massaad, John H Shin","doi":"10.3171/2024.8.SPINE24722","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24722","url":null,"abstract":"<p><strong>Objective: </strong>The prognostic significance of body composition phenotypes for survival in patients undergoing surgical intervention for spinal metastases has not yet been elucidated. This study aimed to elucidate the impact of body composition phenotypes on surgical outcomes and 5-year survival.</p><p><strong>Methods: </strong>The records of patients treated surgically for spinal metastases between 2010 and 2020 were retrospectively evaluated. A deep learning pipeline assessed preoperative CT scans obtained within 3 months of surgery and identified muscle and fat content and composition. These data were used to categorize patients into 4 body composition phenotypic groups: 1) not sarcopenic, not obese; 2) sarcopenia alone; 3) obesity alone; and 4) sarcopenic obesity (SO). The groups were matched using a comprehensive propensity-matching procedure. Rates of postoperative outcomes and survival were evaluated. Cox proportional hazard models were used to evaluate the influence of body composition phenotypes on 5-year survival. Kaplan-Meier plots were used to evaluate survival probability further.</p><p><strong>Results: </strong>Following a propensity-matching procedure, 102 matched patient records were identified (not sarcopenic, not obese, n = 24; sarcopenia alone, n = 27; obesity alone, n = 37; and SO, n = 14). SO was found to be associated with a significantly increased mortality risk within 60 months (HR 3.27, 95% CI 1.43-7.48). Kaplan-Meier plots demonstrate evident divergence in survival probability within 5 years among patients in the SO group compared to the others (log-rank test, p = 0.022). Additionally, time to death was also lower in patients with SO (p = 0.018). Significant differences in postoperative ambulation rates were noted among patients with SO (p = 0.048), whereas no preoperative difference existed (p = 0.12). No significant differences in postoperative disposition, length of hospital stay, wound-related complications, or inpatient medical complications were otherwise noted (p > 0.05).</p><p><strong>Conclusions: </strong>This study identifies SO as a distinct prognostic factor for increased mortality risk in patients undergoing surgery for spinal metastases, highlighting the complex interplay between body composition and patient outcomes. These findings advocate for integrating body composition analysis into preoperative assessment and tailored postoperative care strategies, promoting personalized treatment plans to improve survival and quality of life for this vulnerable patient population.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to play in professional football players following traumatic cervical spine injury: expert opinions from the National Football League spine surgeons.","authors":"Michael D White, Andrew M Hersh, Carly Weber-Levine, Kelly Jiang, A Daniel Davidar, Victoria Bergstein, Vikas N Vattipally, Scott L Zuckerman, Allen K Sills, Randall W Porter, Nicholas Theodore","doi":"10.3171/2024.8.SPINE24421","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24421","url":null,"abstract":"<p><strong>Objective: </strong>There is a paucity of high-quality return-to-play (RTP) data following treatment of cervical spine injuries in contact sports. In this study, the authors gathered insights from National Football League (NFL) team spine surgeon consultants to highlight current practices in treating cervical spine injuries and report decision-making regarding RTP in professional American football players.</p><p><strong>Methods: </strong>A cross-sectional, online survey was distributed to all NFL consulting physicians specializing in the management of spine injuries. The survey covered the following five clinical vignettes of cervical spine injuries: 1) radiculopathy, 2) myelopathy, 3) unilateral facet fracture, 4) unilateral facet dislocation, and 5) neck pain with MRI showing a ligamentous STIR signal. Participants were asked about management options and criteria to clear players for RTP using a combination of multiple-choice and open-ended answers.</p><p><strong>Results: </strong>A total of 26 physicians from 21 of 32 (66%) teams responded. Anterior surgery was most commonly recommended for cervical disc herniation causing radiculopathy or myelopathy (73% and 88%, respectively). A rigid cervical orthosis was preferred by 68% of experts for initial management of nondisplaced unilateral facet fracture, but single-level anterior fusion was preferred by 56% for a unilateral facet dislocation. Common criteria to clear players for RTP with cervical disc herniation causing radiculopathy included a normal examination (85%), radiographic fusion postoperatively (58%), and pain-free range of motion (50%). Contraindications for RTP included persistent stenosis (35%), instability (31%), multilevel fusion (27%), and persistent cord signal change (23%). Additional criteria for RTP in players with facet fractures or dislocations included radiographic evidence of fracture healing (32% and 24%, respectively) and normal flexion/extension radiographs (24% and 32%, respectively). Finally, for players with isolated ligamentous STIR signal changes, resolution of MRI findings was required by 36% of responding physicians prior to RTP.</p><p><strong>Conclusions: </strong>Decision-making regarding RTP after cervical spine injuries in professional football players is complex and influenced by improvement of symptoms, pain-free range of motion, and radiographic evidence of fusion or fracture healing. Respondents preferred anterior cervical discectomy and fusion for disc herniations causing cervical radiculopathy and myelopathy, rigid orthosis for unilateral facet fractures, and surgery for unilateral facet dislocations. The results of this study provide insight into how surgeons serving as consultants to professional football teams may counsel players who sustain cervical spine injuries.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation, management, and outcome of traumatic spine injuries in Africa: a systematic review and meta-analysis.","authors":"Kwadwo Darko, Ishav Shukla, Taimur Hassan, Mohammad Mirahmadi Eraghi, Muhammad Ammar Haider, Mina Guirguis, Michael Farid, Peace Odiase, Umaru Barrie, Salah G Aoun, Mabel Banson, Teddy Totimeh","doi":"10.3171/2024.8.SPINE24614","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24614","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic spinal injury (TSI) involves diverse etiologies, posing different risks among patient populations worldwide. Discrepancies in TSI treatment and outcomes between high-income countries and low- and middle-income countries highlight the critical necessity for tailored management approaches for this global challenge. This study delves into the presentation, management, and outcomes of TSI in Africa.</p><p><strong>Methods: </strong>A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles describing spine trauma in Africa.</p><p><strong>Results: </strong>In total, 105 articles comprising 74 retrospective/prospective studies and 31 case reports/series with 11,639 patients from 16 African countries were included. Among retrospective/prospective studies, most patients were male (8543/10,538 [81.1%]) with an estimated mean (95% CI) age of 34.5 (32.6-36.3) years. Mechanism of injury included road traffic accidents (RTAs) (mean [95% CI] 49.5% [42.9%-56.0%]) followed by falls (23.2% [18.21%-28.3%]), with most injuries occurring at the cervical spine level (51.6% [44.3%-58.9%]). Regionally, cervical, thoracic, and lumbar injuries were predominant in West (mean [95% CI] 58.6% [45.3%-70.9%]), Southern (54.4% [44.3%-63.9%]), and East (23.0% [11.9%-34.8%]) Africa, respectively. Mean (95% CI) time from injury to presentation was 60.8 (23.0-98.6) hours, and the mean distance to a healthcare facility was 272.6 (220.8-324.4) km (5 articles). Of the 48 articles detailing management approaches, approximately 31.9% (95% CI 21.7%-42.2%) opted for surgery, whereas 64.1% (53.7%-74.4%) pursued conservative treatment. Overall, clinical improvement was reported in 34.1% (95% CI 26.6%-41.6%) (44 articles) of patients at last follow-up, with an estimated mortality rate of 12.1% (9.3%-15.0%) (55 articles). Regionally, clinical improvement in patients was highest in Southern Africa (39.1% [95% CI] 23.2%-55.0%), whereas West Africa had the highest mortality rate (16.9% [10.7%-23.1%]).</p><p><strong>Conclusions: </strong>The authors' review reveals that TSI in Africa is primarily caused by RTA. Significant challenges exist such as delays in access to care and surgical capacity. Regional differences in injury mechanisms, management, and outcomes exist and addressing these disparities through targeted interventions is pivotal to enhancing patient outcomes and reducing the burden of TSI in Africa.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Patient satisfaction after surgery for cervical spondylotic myelopathy.","authors":"Guanyu Yang","doi":"10.3171/2024.9.SPINE241120","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE241120","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of contrast administration and CT reconstruction plane on Hounsfield units for assessing underlying bone quality in the lumbar spine.","authors":"Abdelrahman M Hamouda, Zach Pennington, Maria Astudillo Potes, Mahnoor Shafi, Anthony L Mikula, Nikita Lakomkin, Michael L Martini, Mohamad Bydon, Kurt A Kennel, Matthew T Drake, Brett A Freedman, Arjun S Sebastian, Ahmad Nassr, Jeremy L Fogelson, Benjamin D Elder","doi":"10.3171/2024.8.SPINE24732","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24732","url":null,"abstract":"<p><strong>Objective: </strong>Hounsfield units (HUs) may better predict biomechanical complications of instrumented fusion than conventional bone quality measures. Typically, noncontrast axial slices are used. This study aims to address the influence of reconstruction plane and contrast administration on measured HUs in patients undergoing lumbar spine imaging.</p><p><strong>Methods: </strong>Patients without prior spine surgery, infection, or tumor were identified for 3 groups: 1) 150 patients with high-resolution noncontrast lumbar CT, 2) 109 patients with noncontrast and contrast-enhanced lumbar CT, and 3) 100 patients with noncontrast lumbar CT and lumbar CT myelograms. Noncontrast HU measures in group 1 were compared between axial, sagittal, and coronal reconstructions. HU measures for groups 2 and 3 were compared on axial slice averages. HU measures between groups were compared using the Wilcoxon signed-rank test to investigate the presence of a statistically significant difference between groups (α = 0.05). Linear regression was also used to determine the degree of correlation between HU measures on noncontrast axial CT slices and HU measures on other sequences.</p><p><strong>Results: </strong>The mean patient age was 58.8 ± 15.9 years for group 1 (54.0% male), 65.5 ± 15.9 years for group 2 (61.5% male), and 65.2 ± 14.2 years (53.5% male) for group 3. Comparison of HU measures in group 1 showed significant differences across measurement modalities with the exception of axial average versus coronal average measures (p = 0.257) and sagittal average versus midsagittal measures (p = 0.726). There were significant differences in average axial HUs for each vertebral body between contrast and noncontrast lumbar CT and between CT myelography and noncontrast CT. Linear regression analysis demonstrated an extremely high correlation between measures for all methodologies (r2 = 0.950-0.986, all p < 0.001), and between contrast-enhanced and noncontrast studies (r2 = 0.870, p < 0.001). Measurements on CT myelography were significantly correlated with those in noncontrast studies, although to a lesser degree (r2 = 0.745, p < 0.001).</p><p><strong>Conclusions: </strong>HU measures on noncontrast CT appear similar across multiple different planes, suggesting that a simpler methodology such as single-slice measurement on midsagittal reconstruction may allow for more rapid assessment of underlying bone quality. Consistent with prior work, contrast-enhanced CT sequences appear to reliably mirror underlying bone quality, although CT myelogram measures may vary in a more unpredictable way that precludes their use to interpret underlying bone quality. HU measures on contrast-enhanced studies are on average greater, suggesting the need for higher cutoff values.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid prescribing guidelines for spine surgery patients: a multisite analysis of guideline implementation and monitoring with an automated text messaging platform.","authors":"Thilan Tudor, Anish K Agarwal, M Kit Delgado, Daniel J Lee, Jessica T Nguyen, Ruiying Xiong, Ali K Ozturk, Jang W Yoon, William C Welch, Zarina S Ali","doi":"10.3171/2024.8.SPINE24373","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24373","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to describe the effect of opioid prescribing guideline implementation for elective spine surgery cases on prescribing and consumption behaviors in a multisite academic hospital system. The effectiveness of an automated text messaging system as a tool to monitor postoperative opioid use and pain outcomes and inform guideline development and deployment is also evaluated.</p><p><strong>Methods: </strong>The authors conducted a prospective study of postoperative opioid use behaviors and patient-reported outcomes for 2101 elective spine surgery cases between December 2018 and March 2022, prior to and following the implementation of opioid-prescribing guidelines in February 2021 at three urban hospital sites within a large academic health system. Opioid-prescribing guideline development was based on patient-reported opioid consumption behaviors monitored using a two-way text messaging platform in the perioperative and postoperative settings; its implementation involved standardized indication-specific discharge pain medication dosing. Opioid prescription and consumption trends were compared between pre-guideline and post-guideline implementation cases.</p><p><strong>Results: </strong>The overall response rate to the automated text messaging system was 50.2% when evaluating all elective spine surgery cases. There were significant reductions in the mean postsurgical opioid prescription for thoracolumbar laminectomies and fusions (p < 0.001) after guideline implementation. There was no difference in mean cumulative postsurgical opioid consumption by operative procedure after guideline implementation. Prior opioid use (OR 1.81, 95% CI 1.05-3.03; p < 0.05) and the aggregate 12-week mean pain score (OR 1.20, 95% CI 1.07-1.35; p < 0.05) were significant predictors of elevated opioid use.</p><p><strong>Conclusions: </strong>Opioid-prescribing guideline development for elective spine surgery cases that is informed by patient-reported opioid behaviors using a text messaging platform might reduce opioid volume prescribed by the operative procedure.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of anterior CSF space in the cervical spine with Chicago Chiari Outcome Scale score in adult females.","authors":"Philip A Allen, Francis Loth, Dorothy Loth, Mohamad Motaz Al Samman, Richard Labuda, Christine Herrera, Jayapalli Rajiv Bapuraj, Petra M Klinge","doi":"10.3171/2024.7.SPINE24370","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24370","url":null,"abstract":"<p><strong>Objective: </strong>Craniocervical junction morphology has been associated with Chiari malformation type I (CMI) symptom severity; however, little is known about its deterministic effect on surgical outcomes in patients across age and sex differences. The goal of the present study was to assess the effects of age and sex on surgical outcomes in CMI.</p><p><strong>Methods: </strong>In the present study, the authors examined MRI-based morphometric data from 115 individuals diagnosed with CMI (54 adults including 39 women and 15 men, and 61 children including 24 girls and 37 boys) and correlated them with Chicago Chiari Outcome Scale (CCOS) scores obtained 1 year after posterior fossa decompression. The authors assessed 7 craniocervical junction morphology-related measures that have been associated with CMI symptom severity: McRae line length, clivus length, Wackenheim angle, anterior and posterior CSF spaces, clivo-supraoccipital angle, and tonsillar position.</p><p><strong>Results: </strong>In the pediatric cohort, none of the morphometric measures correlated with CCOS score, but both anterior and posterior CSF spaces did in adults. To further study sex and age effects, the authors used age group (children vs adults) and sex (female vs male) as independent variables and ran 3 separate ANOVA tests using CCOS score, anterior CSF space, and posterior CSF space as dependent variables, respectively. Both CCOS and anterior CSF space analyses resulted in significant interactions. Specifically, women showed lower CCOS scores and smaller anterior CSF spaces than girls, boys, or men.</p><p><strong>Conclusions: </strong>These results provide evidence that joint age and sex differences moderate the surgical outcome of CMI patients. In females, smaller anterior CSF space was associated with lower CCOS score.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Improving neurosurgical differences and recommendations for interventions by modifying the study model and covariates.","authors":"Yafei Wang, Chenran Zhang","doi":"10.3171/2024.9.SPINE241106","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE241106","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the impacts of 30-day perioperative complications on patient-reported outcome measures following multilevel anterior versus posterior cervical fusion.","authors":"Adewale A Bakare, Jesus R Varela, Jacob Mazza, Ruth Saganty, Gibson Reine, John Stathopoulos, Harel Deutsch, John E O'Toole, Ricardo B V Fontes, Richard G Fessler, Vincent C Traynelis","doi":"10.3171/2024.8.SPINE24257","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24257","url":null,"abstract":"<p><strong>Objective: </strong>Many studies have compared outcomes following anterior and posterior cervical fusion, yet the differences in the impacts of perioperative complications on outcomes have not been well studied. This study aimed to assess the differences in the effects of 30-day perioperative complications on patient-reported outcome measures (PROMs) after multilevel anterior versus posterior cervical fusion.</p><p><strong>Methods: </strong>Adult patients who underwent anterior or posterior cervical fusion at three or more levels between 2014 and 2020 were analyzed. Each group was subdivided based on the occurrence and severity of perioperative complication: no complication versus minor complication versus major complication. The study primarily compared PROMs and minimal clinically important differences (MCIDs) within and between the groups.</p><p><strong>Results: </strong>A total of 146 anterior (102 with no complications, 36 with minor complications, 8 with major complications) and 55 posterior (36 with no complications, 13 with minor complications, 6 with major complications) cervical fusion cases were analyzed. Within the anterior or posterior group, there were no significant differences in the PROM change or proportions of patients achieving the MCID. In comparing the anterior group with the posterior group, anterior patients without complications had better improvement in the 3-month Neck Disability Index (coefficient 11.2, p = 0.019), with higher odds of achieving the MCID for the modified Japanese Orthopaedic Association score at 3 months (OR 2.0, p = 0.039). Otherwise, there were no significant differences in the PROM change or proportions of patients achieving the MCID in subsets of anterior or posterior patients with minor or major complications. Furthermore, patients with major complications had higher early readmission rates regardless of the surgical approach. Major complications were also associated with longer and increased rates of intensive care unit stays after posterior fusion compared with anterior fusion.</p><p><strong>Conclusions: </strong>This study suggests that the severity of perioperative complications following anterior or posterior cervical fusion did not predict changes in PROMs or achievement of MCIDs in the anterior or posterior group. Also, PROMs may not fully differentiate the full extent of the impact of perioperative complications following anterior versus posterior cervical fusion. Otherwise, in subsets of patients without complications, anterior compared with posterior patients had improved Neck Disability Index scores at 3 months, with a significant proportion of patients achieving the MCID for the modified Japanese Orthopaedic Association score at 3 months.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}