Journal of neurosurgery. Spine最新文献

{"title":"Different nuances between patient- and surgeon-reported outcomes in intramedullary ependymoma surgery.","authors":"Ho Sung Myeong, Jungbo Sim, Hangeul Park, Woo Jin Kim, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, John M Rhee, Chi Heon Kim","doi":"10.3171/2025.4.SPINE241657","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE241657","url":null,"abstract":"<p><strong>Objective: </strong>With regard to intramedullary ependymoma surgery, most studies have presented surgeon-reported outcomes (SROs) such as McCormick grade, but few have evaluated patient-reported outcomes (PROs) using quality-of-life questionnaires. This retrospective study of patients who underwent surgery for intramedullary ependymoma was performed to analyze PROs and compare them with SROs.</p><p><strong>Methods: </strong>PROs were assessed using EQ-5D-5L (5-level version of the 5-dimension EuroQoL questionnaire) data collected preoperatively and at least 6 months postoperatively from patients with histologically confirmed ependymoma treated with surgery between September 2016 and December 2023. Pre- and postoperative EQ-5D-5L indices, along with changes across the 5 dimensions of the instrument, were analyzed. A favorable PRO required a postoperative EQ-5D-5L index ≥ the preoperative EQ-5D-5L index and a postoperative EQ-5D-5L index ≥ the linear regression line between pre- and postoperative EQ-5D-5L indices. A favorable SRO was defined as modified McCormick Scale grade I and was compared to a favorable PRO. Prognostic factors for attaining favorable outcomes on both measures were also evaluated.</p><p><strong>Results: </strong>Among 76 patients included in this analysis, the mean follow-up was 34.7 ± 22.4 months. Among the dimensions of the EQ-5D-5L, mobility worsened postoperatively and pain/discomfort remained the dimension with a severe problem. A favorable PRO was attained by 33% (n = 25) of the patients and a favorable SRO by 38% (n = 29), with only 52% (n = 15) overlap between the two. The pain/discomfort dimension of the EQ-5D-5L was the key factor contributing to the discrepancy between PRO and SRO. Younger age was identified as a significant prognostic factor for attaining favorable outcomes on both measures.</p><p><strong>Conclusions: </strong>There was a discrepancy between PRO and SRO primarily due to the inadequate reflection of patient pain/discomfort on the SRO. This discrepancy highlights the importance of considering both perspectives in patient counseling and management.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715139","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":"The impact of durotomy on short-term morbidity and long-term outcomes in adult spinal deformity surgery: a multicenter propensity score-matched observational study.","authors":"Joshua L Golubovsky, Mert Marcel Dagli, Ben Jiahe Gu, Yohannes Ghenbot, John D Arena, William C Welch, Jang W Yoon, David S Casper, Vincent Arlet, Ali K Ozturk","doi":"10.3171/2025.4.SPINE241319","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE241319","url":null,"abstract":"<p><strong>Objective: </strong>Incidental durotomy is a common complication in adult spinal deformity (ASD) correction, but its long-term impact remains unclear. This study aimed to evaluate the long-term outcomes associated with incidental durotomy in ASD surgery, focusing on hospital length of stay (LOS), thromboembolic events, and patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study using data from their institutional spine deformity registry, including ASD surgeries from January 1, 2013, to December 13, 2021. Adult patients who underwent elective thoracolumbosacral posterior spinal fusion involving ≥ 6 vertebrae were included. Primary outcomes were hospital LOS, postoperative thromboembolic events, 30-day readmission rate, reoperation rate, and PROMs. Secondary outcomes involved preoperative risk factors, surgical details, and perioperative complications and outcomes. Unadjusted and adjusted analyses were performed. Propensity scores were calculated using logistic regression, adjusting for relevant covariates, and propensity score matching (PSM) with an attempted 1:5 ratio was applied. The p values were adjusted using the Benjamini-Hochberg correction.</p><p><strong>Results: </strong>A total of 646 patients were included, with 53 (8.2%) experiencing durotomy and 593 controls. After PSM, 51 patients with durotomy and 242 controls were well balanced across baseline characteristics. The durotomy group had significantly longer hospital LOS (9.1 ± 5.0 days vs 7.0 ± 3.4 days; median difference 2 days, 95% CI 0.6-3.5 days; p = 0.044) and increased thromboembolic events (10 [19.6%] vs 13 [5.4%]; proportion difference 14.2%, 95% CI 3.0%-25.5%; p = 0.022) compared with the control group. No significant differences were found in 30-day readmissions, reoperation rates, and PROMs. Surgical details revealed increased operative time (median difference 64.2 minutes, 95% CI 25.7-102.8 minutes, p = 0.012), estimated blood loss (median difference 300 mL, 95% CI 60-800 mL, p = 0.035), and intraoperative total red blood cell transfusion volume (median difference 250 mL, 95% CI 25-775 mL, p = 0.035) in the durotomy group.</p><p><strong>Conclusions: </strong>Incidental durotomy was associated with increased hospital LOS and higher thromboembolic event rates in ASD surgery, but did not significantly affect long-term patient-reported outcomes or reoperation rates. These findings suggest that while durotomy may increase short-term morbidity, it does not worsen long-term outcomes. Future studies should explore strategies for minimizing in-hospital complications in this patient population.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715140","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":"Ultra-early postoperative ambulation in spine surgery: a Michigan Spine Surgery Improvement Collaborative study.","authors":"Anisse N Chaker, Kylie Springer, Kari Jarabek, Yousif Jafar, Saleh Al-Juburi, Alexander Hayes, Heegook Yeo, Jianhui Hu, Lonni Schultz, Dheeraj Kagithala, Jawad Saad, Edvin Telemi, Tarek R Mansour, Muwaffak Abdulhak, David R Nerenz, Kenneth Easton, Kevin Taliaferro, Noojan Kazemi, Miguelangelo Perez-Cruet, Ilyas Aleem, Richard Easton, Jad G Khalil, Victor Chang","doi":"10.3171/2025.5.SPINE25314","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25314","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies have demonstrated the benefit of early ambulation in patients who have undergone elective spine surgery. However, there are limited data on how early patients can feasibly move about in the postoperative period and whether there is further benefit in an ultra-early postoperative ambulation time frame. Current Michigan protocols aim for 80% of all patients ambulating within 8 hours of surgery end time. The goal of this retrospective study was to determine whether patients who ambulate within 4 hours of surgery have any greater benefit than those who ambulate 4-8 hours after surgery.</p><p><strong>Methods: </strong>The Michigan Spine Surgery Improvement Collaborative database was queried for patients who had undergone elective spine surgery between January 2020 and May 2024. Patients were categorized into two groups based on the time to ambulation: < 4 hours postoperatively (ultra-early) and 4-8 hours postoperatively. Patients who had 4 or more levels altered, a durotomy, or CSF leakage were excluded from analysis. Primary outcomes were the presence of any complication and hospital length of stay. Secondary outcomes included patient-reported outcomes. A multivariate analysis was conducted to adjust for potential confounders.</p><p><strong>Results: </strong>A total of 21,725 patients were included in the study. Compared to the ultra-early cohort, the patients who ambulated 4-8 hours postoperatively were more likely to have complications (RR 1.14, 95% CI 1.04-1.26, p = 0.005), more likely to be readmitted after surgery (RR 1.18, 95% CI 1.03-1.35, p = 0.020), less likely to be discharged to home (RR 0.99, 95% CI 0.98-1.00, p = 0.005), and less likely to reach a minimal clinically important difference in back pain 1 year after surgery (RR 0.96, 95% CI 0.93-0.99, p = 0.022). The ultra-early ambulation cohort had a 0.47-day shorter length of stay (95% CI 0.34-0.6, p < 0.001) relative to the 4- to 8-hour cohort.</p><p><strong>Conclusions: </strong>Ambulating patients in an ultra-early manner, that is, < 4 hours after spine surgery, is feasible and demonstrates a potential benefit in the outcomes of elective spine surgery. The benefits appear to be a lower risk of complications and lower likelihood of readmission.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715090","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 impact of high-risk committees in adult cervical deformity corrective surgery: a retrospective review of outcomes, complications, and frequency of procedures receiving preoperative multidisciplinary evaluation.","authors":"Kristen E Jones, Anthony Yung, Alyssa M Bartlett, Oluwatobi O Onafowokan, Peter S Tretiakov, Max R Fisher, Ethan Cottrill, Tyler K Williamson, Peter G Passias","doi":"10.3171/2025.5.SPINE25311","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25311","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to assess the frequency, outcomes, and impact of high-risk procedures receiving preoperative multidisciplinary review in adult cervical deformity (ACD) patients.</p><p><strong>Methods: </strong>ACD patients were stratified by whether they underwent high-risk review (HRR). High-risk patients were defined as meeting ≥ 1 of the following criteria: anterior-posterior cervical deformity fusion ≥ 3 levels; planned 3-column osteotomy, vertebral column resection, and/or anterior column refinement; deformity correction with severe baseline neurological deficit; severe baseline myelopathy (modified Japanese Orthopaedic Association score < 11); and severe osteoporosis with fusion ≥ 4 levels. Differences in demographic characteristics, radiographic outcomes, and complication rates were assessed via means comparison. Adjusting for baseline age and modified ACD frailty index, follow-up univariate 1-way ANCOVA was performed to assess postoperative outcomes. Logistic regressions assessed the impact of committee review on prediction of complications or reoperation.</p><p><strong>Results: </strong>Of 149 ACD patients (mean ± SD age 57.5 ± 10.9 years, 58.2% female, BMI 28.5 ± 7.8 kg/m2), 51.0% (n = 76) underwent committee review. At baseline, cohorts were comparable in terms of age, sex, and BMI, although patients undergoing HRR (HRR+) were frailer according to the modified ACD frailty index (p < 0.001). HRR+ patients were also significantly more likely to have a history of myocardial infarction (p = 0.045). Radiographically, HRR+ patients were more likely to have more severe deformity in terms of T1 slope minus cervical lordosis (p = 0.031) and C2-7 sagittal vertical axis (p < 0.001) compared to patients who did not undergo high-risk review (HRR-). Perioperatively, HRR- patients had significantly greater mean operative time (p < 0.001) and were more likely to undergo any osteotomy (p = 0.020) or 3-column osteotomy (p = 0.045), although total estimated blood loss, length of stay, surgical intensive care unit admissions, and discharge dispositions were comparable between groups (all p > 0.05). Rates of any complications and mortality were also comparable between groups (all p > 0.05). HRR+ patients demonstrated lower reoperation rates (p = 0.037). Yet, adjusted regression revealed that HRR was neither independently predictive of intraoperative major complications nor reoperation (all p > 0.05).</p><p><strong>Conclusions: </strong>Implementation of high-risk committees is associated with a lower frequency of high-risk procedures over time. However, the risk of complications is not necessarily diminished after the establishment of such committees.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715138","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 frailty screening tools for predicting morbidity for suboccipital decompression in adults with Chiari malformation type I.","authors":"Paul Serrato, Justice Hansen, Shaila Ghanekar, Lucas P Mitre, Michael DiLuna, Aladine A Elsamadicy","doi":"10.3171/2025.4.SPINE2597","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE2597","url":null,"abstract":"<p><strong>Objective: </strong>The revised Risk Analysis Index (RAI-rev) and modified 5-item frailty index (mFI-5) are comprehensive assessment tools of frailty that have been used to predict neurosurgical outcomes. The aim of this study was to investigate the utility of these tools to predict extended hospital length of stay (LOS), nonroutine discharge (NRD), and 30-day adverse events (AEs) among patients with Chiari malformation type I (CM-I) undergoing suboccipital decompression.</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study using the 2011-2022 American College of Surgeons National Surgical Quality Improvement Program database to identify adults with CM-I who underwent suboccipital decompression. Using receiver operating characteristic (ROC) curve and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI-rev, mFI-5, and patient age, with extended LOS, NRD, and 30-day AEs.</p><p><strong>Results: </strong>Among 1225 patients studied, 806 patients (65.8%) were categorized as robust, 388 (31.7%) as typical and 31 (2.5%) as frail using RAI-rev, whereas 946 (77.2%) were categorized as robust, 222 (18.1%) as typical, and 57 (4.7%) as frail according to mFI-5. Multivariable analysis revealed RAI-rev (adjusted odds ratio [aOR] 4.37, 95% CI 1.40-13.70) and mFI-5 (aOR 2.71, 95% CI 1.38-5.32) scores as significant predictors of extended LOS for frail patients. RAI-rev was also a significant predictor of NRD for patients in the typical (aOR 2.57, 95% CI 1.00-6.60) and frail (aOR 15.70, 95% CI 3.27-75.44) groups. Neither the RAI-rev nor mFI-5 score significantly predicted 30-day AEs. On ROC analysis, there were no significant differences between the RAI-rev score (area under the curve [AUC] 0.5608), mFI-5 score (AUC 0.5626), and age (AUC 0.5496) in predicting LOS. Similarly, no differences were observed between the RAI-rev score, mFI-5 score, and age in predicting 30-day AEs. Notably, the RAI-rev score (AUC 0.7234) exhibited superior performance in predicting NRD compared with the mFI-5 score (p = 0.038) and age (p = 0.016).</p><p><strong>Conclusions: </strong>The authors' findings demonstrate that while both RAI-rev- and mFI-5-defined frailty were significantly associated with extended LOS and NRD, RAI-rev outperformed mFI-5 in predicting NRD.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715137","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":"Cervical deformity correction: comparison of neurological, radiographic, and patient-reported outcome measures by three-column osteotomy level.","authors":"Anthony L Mikula, David J Mazur-Hart, Zach Pennington, Alexa M Semonche, Winward Choy, Thomas A Wozny, Jaemin Kim, Terry H Nguyen, Justin K Scheer, Aaron J Clark, Vedat Deviren, Christopher P Ames","doi":"10.3171/2025.4.SPINE241538","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE241538","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate whether level selection for a three-column osteotomy (3CO) impacts cervical deformity correction outcomes, including neurological, radiographic, and patient-reported outcomes.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent a cervical or upper thoracic 3CO for cervical deformity correction by the senior author from 2008 to 2024. Collected outcome measures included neurological outcomes, mechanical complication rates, spinopelvic alignment, and patient-reported outcomes. The minimum follow-up was 1 year.</p><p><strong>Results: </strong>One hundred fifteen patients were identified who underwent a cervical or upper thoracic 3CO for cervical deformity correction, of whom 77 met inclusion criteria for this study with a minimum follow-up of 1 year. The median age was 66 years, the median BMI was 27, and 43% of patients were male. Sixteen patients underwent a 3CO at the C7-T1 levels and 61 patients at T2-6 levels. Patients who underwent C7-T1 3CO were more likely to experience a new postoperative neurological deficit compared with those who underwent T2-6 3CO (56% vs 18%, p = 0.004), had less correction in their T1 slope (6° vs 18°, p = 0.027), had less correction in C2-T4 sagittal vertical axis (2.8 cm vs 4.9 cm, p = 0.043), and had a worse Neck Disability Index (NDI) score at 1 year compared with baseline (an increase of 7 vs a decrease of 12, p = 0.033).</p><p><strong>Conclusions: </strong>Cervical deformity patients who underwent a 3CO at C7-T1 had a higher rate of postoperative neurological deficits, less radiographic correction, and worse NDI scores at 1 year compared with patients who underwent a 3CO from T2 to T6. Although 3CO level selection is multifactorial and patient specific, surgeons should consider a 3CO level caudal to T1 when feasible.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663956","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":"The role of posterior column osteotomies versus lumbar decompressions in improving lower extremity motor strength in adult spinal deformity patients with preoperative motor impairment.","authors":"Fthimnir M Hassan, Lawrence G Lenke, Erik Lewerenz, Peter G Passias, Eric O Klineberg, Virginie Lafage, Justin S Smith, D Kojo Hamilton, Jeffrey L Gum, Renaud Lafage, Jeffrey Mullin, Michael P Kelly, Bassel G Diebo, Thomas J Buell, Han Jo Kim, Khaled Kebaish, Robert Eastlack, Alan H Daniels, Gregory Mundis, Themistocles S Protopsaltis, Munish C Gupta, Frank J Schwab, Christopher I Shaffrey, Christopher P Ames, Shay Bess","doi":"10.3171/2025.3.SPINE241469","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE241469","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to determine if there are any specific procedural, demographic, and/or radiographic factors that are associated with an improved postoperative lower extremity (LE) motor score (LEMS) among patients with adult spinal deformity (ASD) and abnormal baseline LEMS undergoing surgical correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with ASD enrolled in an observational prospective study from 2018 to 2023 at 13 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and/or procedural inclusion criteria: pelvic incidence minus lumbar lordosis mismatch ≥ 25°, T1 pelvic angle ≥ 30°, SVA ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, global coronal malalignment ≥ 7 cm, underwent 3-column osteotomy (3CO), spinal fusion ≥ 12 levels, and/or age ≥ 65 years with ≥ 7 levels of instrumentation. Patients with a baseline abnormal LEMS were dichotomized based on whether the LEMS improved or deteriorated from baseline by the 6-week postoperative visit. Patients with a maintained LEMS by 6 weeks compared with baseline were excluded. Patient and operative characteristics were compared through bivariate analyses to assess differences in treatment. A multivariable logistic regression model was built to discern independent factors associated with improved LEMS while controlling for potential confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 121 patients (77 female, mean age 62.9 years) included in the study, 109 (90.1%) improved and 12 (9.9%) experienced further deterioration from baseline to 6 weeks. Both groups had similar baseline LEMS by laterality and per nerve root. The groups were similar in age, sex, comorbidities, baseline LEMS, BMI, surgical indication, number of instrumented levels, estimated blood loss, operating room time, and hospital length of stay (p &gt; 0.05). No differences in radiographic parameters at baseline and 6 weeks were observed aside from patients whose score had deteriorated experiencing greater change in the L1 pelvic angle (∆L1PA) (-8.0° ± 8.3° vs -1.6° ± 7.6°, p = 0.0413). Despite having similar frequencies of lumbar decompressions performed across a similar number of levels, patients whose conditions had deteriorated at 6 weeks had fewer lumbar posterior column osteotomies (PCOs) performed (50% vs 82.6%, p = 0.0169). No differences in in the frequency and number of 3COs performed were observed. Patients whose score had deteriorated experienced greater intraoperative neurophysiological monitoring (IONM) changes (41.7% vs 8.3%, p = 0.0050), all of which were motor deficits. Controlling for ∆L1PA and IONM changes revealed lumbar PCOs to be an independent driver of improved LEMS (OR 4.99 [95% CI 1.05-23.70]), with excellent model performance (p = 0.0031, area under the receiver operating characteristic curve of 0.77, Hosmer-Lemeshow goodness-of-fit test p = 0.3017).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663957","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":"Association of age-adjusted pelvic incidence minus lumbar lordosis correction with long-term radiographic and clinical outcomes in adult spinal deformity surgery.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Kyunghun Jung, Minwook Kang, Chong-Suh Lee","doi":"10.3171/2025.3.SPINE241155","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE241155","url":null,"abstract":"<p><strong>Objective: </strong>Adequate correction of sagittal spinal malalignment is crucial in adult spinal deformity (ASD) surgery. Although the age-adjusted pelvic incidence (PI)-lumbar lordosis (LL) scheme has been widely used for ideal sagittal correction, its association with long-term surgical outcomes is not well documented. Therefore, the authors aimed to evaluate the association of age-adjusted PI-LL correction with long-term radiographic and clinical outcomes.</p><p><strong>Methods: </strong>The authors included patients who underwent ≥ 5-level fusion including the sacrum for ASD between 2012 and 2023. The patients were categorized into three groups according to the correction status relative to the age-adjusted PI-LL target, as follows: undercorrection, matched correction, and overcorrection. The proximal junctional kyphosis/failure (PJK/F) rates, radiographic results, and clinical outcomes, including visual analog scale for back pain, Oswestry Disability Index (ODI), and Scoliosis Research Society (SRS)-22 scores, were compared between the PI-LL correction groups. To investigate the influence of PJK/F on the outcomes, patients with and without PJK/F were analyzed separately.</p><p><strong>Results: </strong>Altogether, 384 patients were included in the study (mean age 69.0 years, mean total fused levels 7.9 levels, and mean follow-up duration 43.1 months). At 6 weeks postoperatively, all sagittal parameters were significantly more pertinently corrected in the overcorrection group than in the undercorrection and matched correction groups. PJK/F developed more frequently in the overcorrection group than in the undercorrection and matched correction groups. Final correction status, except the sacral slope, was more robust in the overcorrection group than in the undercorrection and matched correction groups. In the overall study cohort, the final ODI and SRS-22 scores were significantly better in the matched correction group than in the undercorrection and overcorrection groups. In the subgroup analysis, the clinical outcomes were comparable between the matched correction and overcorrection groups even with the exclusion of PJK/F.</p><p><strong>Conclusions: </strong>Overcorrection relative to the age-adjusted PI-LL was associated with an increased risk of PJK/F. Clinical outcomes, such as ODI and SRS-22 scores, at the final follow-up were significantly better in the matched correction group than in the other correction groups. Even in the subgroup analysis excluding PJK/F, overcorrection did not provide any additional clinical benefit compared to matched correction.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612136","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":"Long-term functional outcomes and their relationship to nerve root sacrifice after definitive surgery for sacrococcygeal chordoma.","authors":"Yuanxuan Xia, Pritika Papali, Abdel-Hameed Al-Mistarehi, A Karim Ahmed, Landon J Hansen, Christian Meyer, John Gross, Majid Khan, Malcolm Winkle, Chetan Bettegowda, Timothy Witham, Ali Bydon, Nicholas Theodore, Jean-Paul Wolinsky, Ziya Gokaslan, Sheng-Fu Larry Lo, Daniel M Sciubba, Salih Colakoglu, Sang H Lee, Kristin J Redmond, Daniel Lubelski","doi":"10.3171/2025.3.SPINE241408","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE241408","url":null,"abstract":"<p><strong>Objective: </strong>Wide en bloc excision of sacrococcygeal chordomas often requires sacral nerve root sacrifice because of their large size and involvement of surrounding structures. In this study, the authors characterize the long-term functional outcomes of patients following definitive resection, investigate the relationship between sacrificed nerve roots and deficits, and examine predictors of postoperative neurological deficits.</p><p><strong>Methods: </strong>A retrospective study was conducted on all patients followed for sacral chordoma management at a quaternary spinal oncology center from 2003 to 2023. Data on patient demographics, clinical characteristics, pre- and perioperative treatment, and symptoms at last follow-up were collected. Nerve root sacrifices were documented and, where unilateral ligations were performed, the highest level of bilateral sacrifice was noted. The primary outcomes were pain, weakness, bowel or bladder dysfunction (BBD), and sensory deficits.</p><p><strong>Results: </strong>Sixty-six patients were included, with a median follow-up of 5.8 (interquartile range [IQR] 3.0-8.5) years. The proportion of pain-free patients increased from 22.7% preoperatively to 54.5% after surgery, and a majority experienced improvement in pain (88.2%) and sensory deficits (83.3%). All patients who had bilateral sacrifices up to the S1-2 nerve roots and 92.9% with up to S3 bilateral nerve root sacrifice had BBD. However, motor deficits were observed in only 60.0% of those with S1 nerve root sacrifice. Additionally, 13.6% of patients had unexpected BBD and motor weakness at last follow-up. Multivariable analysis demonstrated surgical duration (odds ratio [OR] 1.003, 95% confidence interval [CI] 1.001-1.006; p = 0.020), tumor volume (OR 1.002, 95% CI 1.000-1.004; p = 0.017), and preoperative weakness (OR 37.0, 95% CI 1.3-1072.9; p = 0.036) were related to postoperative weakness. Only expected BBD due to nerve root sacrifice (OR 28.5, 95% CI 3.0-267.9; p = 0.002) was associated with postoperative BBD. Finally, preoperative sensory deficits (OR 6.6, 95% CI 1.2-36.4; p = 0.031) and surgical duration (OR 1.004, 95% CI 1.001-1.007; p = 0.003) were predictive of postoperative sensory deficits.</p><p><strong>Conclusions: </strong>En bloc excisions of sacrococcygeal chordomas require complex approaches in which surgeons must consider the long-term functional effects of nerve root sacrifice. These results provide insight into residual function following these extensive operations and suggest that preserving the S3 nerve roots is critical in minimizing BBD. Cases in which the S3 is preserved but patients continue exhibiting postoperative BBD may be related to larger tumor size and intraoperative manipulation of distal S1-3 nerves or pudendal nerves. When S1 roots are preserved, larger tumor size may predict motor weakness.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612138","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":"Intraoperative vancomycin for preventing infection after open spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Yifei Sun, Hariteja Ramapuram, Jovanna Tracz, Sasha Howell, Nicholas M B Laskay, James Mooney, Adeel Ilyas, Jakub Godzik","doi":"10.3171/2025.3.SPINE2547","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE2547","url":null,"abstract":"<p><strong>Objective: </strong>The use of prophylactic intrasite vancomycin powder in spine surgery has been described as a possible method for infection prevention. Despite clinical guidelines encouraging the use of intraoperative vancomycin for infection prophylaxis, the evidence in support of such recommendations remains unclear. The primary objective of this meta-analysis was to evaluate the effect of intrawound vancomycin on deep and superficial surgical site infections (SSIs) following open spine surgery.</p><p><strong>Methods: </strong>The PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases were searched from inception to October 2024 for randomized controlled trials that investigated the association between intrawound vancomycin use and infection following open spine surgery. The results were pooled using a restricted maximum-likelihood estimation random-effects model with inverse variance weighting and Hartung-Knapp adjustment to account for variation between studies.</p><p><strong>Results: </strong>Seven randomized controlled trials with 2235 patients met the inclusion criteria. Of these, 1095 (49%) patients were randomized to receive intrawound vancomycin during open spine surgery. The overall rate of superficial and deep SSIs in the treatment group was 3.38%, compared with 4.08% in the control group. The overall rates of deep infection were 2.5% and 1.8% in the treatment and control groups, and the overall superficial infection rates were 0.9% and 1.8% in the treatment and control groups, respectively. In a random-effects model, intraoperative vancomycin was not associated with lower rates of SSI (risk ratio [RR] 0.89, 95% CI 0.47-1.67; p = 0.6; τ2 < 0.0001, I2 = 22%). In a subanalysis of patients who underwent instrumented spine surgery, vancomycin was also not significantly associated with decreased rates of SSI (RR 0.77, 95% CI 0.38-1.57; p = 0.47; τ2 = 0.2041, I2 = 33%), superficial infections (RR 0.59, 95% CI 0.22-1.57; p = 0.45; τ2 = 0, I2 = 0%), or deep infections (RR 1.37, 95% CI 0.78-2.40; τ2 = 0, I2 = 0%), nor was it associated with an increased risk of gram-negative/culture-negative infection (RR 0.99, 95% CI 0.47-2.06; τ2 = 0.107, I2 = 20%).</p><p><strong>Conclusions: </strong>Intraoperative vancomycin may not be associated with significantly decreased rates of superficial or deep SSI in patients undergoing open spine surgery. The role of intraoperative vancomycin in open spine surgery warrants further study in larger randomized controlled trials.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612137","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}