Journal of neurosurgery. Spine最新文献

{"title":"Clinical outcomes and patient-reported outcome measures among patients undergoing posterior lumbar fusion procedures with varying insurance payor status: a propensity score-matching study.","authors":"Aaryan Shah, Ethan Schonfeld, Ghani Haider, Neelan J Marianayagam, Sina Sadeghzadeh, Martin N Stienen, Anand Veeravagu","doi":"10.3171/2024.9.SPINE231403","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE231403","url":null,"abstract":"<p><strong>Objective: </strong>Posterior lumbar fusion (PLF) is a routinely used procedure for treatment of spinal pathology. Several studies have highlighted disparities in reoperation and postoperative complications and demonstrated associations between differing insurance providers, complication rates, and hospital resource utilization in spine surgery. Previous studies have examined broad spinal procedures but have not extended to uninsured patients, or adjusted for sociodemographic factors or comorbidity history. Understanding relationships between payor status and outcomes following fusion procedures is vital to promoting healthcare equity. The objective of this study was to assess whether patients' insurance impacts postoperative outcomes and patient satisfaction following PLF procedures.</p><p><strong>Methods: </strong>The Stanford University Medical Center inpatient registry was used to retrospectively analyze patients who underwent PLF procedures between 2016 and 2022. Propensity score matching was used to compare privately insured with Medicaid patients, as well as comparing uninsured patients with Medicaid patients based on age, sex, and comorbidities. Outcomes data, including 90-day postoperative complications, reoperation, and patient-reported outcome measures scores (Oswestry Disability Index and Patient Health Questionnaire) were collected.</p><p><strong>Results: </strong>A total of 1904 patients fulfilled the inclusion criteria. In unmatched comparisons, statistically significant differences existed within specific types of complications including altered mental status, delirium, neurological complications, and pulmonary complications. A total of 292 privately insured patients were matched to 292 Medicaid patients. Within matched patient groups, the Medicaid group had higher rates of altered mental status (6.2% vs 2.7%, p = 0.042); delirium (9.9% vs 5.1%, p = 0.035); renal dysfunction (6.9% vs 4.1%, p = 0.020); and pulmonary complications (8.9% vs 3.8%, p = 0.049) compared to privately insured patients. Privately insured patients had lower postoperative Oswestry Disability Index scores (30.2 vs 34.4, p = 0.018) compared to Medicaid patients. Following propensity score matching of 88 Medicaid patients to 88 uninsured patients, large but not statistically significant differences existed for neurological complications (12.5% vs 5.7%, p = 0.165) and 5-year revision rates (3.4% vs 1.1%, p = 0.353).</p><p><strong>Conclusions: </strong>The findings indicate that the treatment outcomes, care quality, and patient satisfaction following PLF procedures differ between Medicaid and privately insured patients. Further investigation is warranted to explore relationships between insurance payor status and clinical outcomes in multicenter populations.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070955","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":"Surgical versus conservative management of spinal cord cavernous malformations: a systematic review and comparative meta-analysis.","authors":"Jorge Rios-Zermeno, Abdul Karim Ghaith, Juan Pablo Navarro-Garcia de Llano, Victor Gabriel El-Hajj, Omar R Ortega-Ruiz, Elena Greco, Anshit Goyal, Krishnan Ravindran, Jeyan S Kumar, Lindsy N Williams, Mohamad Bydon, Rabih G Tawk","doi":"10.3171/2024.10.SPINE24432","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24432","url":null,"abstract":"<p><strong>Objective: </strong>Spinal cord cavernous malformations (SCCMs) are rare vascular malformations with a capricious prognosis. Given the eloquent nature of the spinal cord, considerable surgical morbidity may be encountered. Therefore, conservative management has emerged as a valid alternative, especially for incidental lesions diagnosed on ubiquitous imaging. The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of surgical versus conservative management of SCCMs.</p><p><strong>Methods: </strong>Following PRISMA guidelines, this study included articles published in full-text form comparing the outcomes following conservative and surgical management of SCCMs. Collected variables included the total number of patients, spine level, resection, myelotomy, follow-up duration, bleeding, motor weakness, pain, bladder and/or bowel dysfunction, and neurological improvement or deterioration after discharge. The primary outcome of interest was long-term functional outcome.</p><p><strong>Results: </strong>Eleven articles comprising 515 patients were included, of whom 343 (66.6%) underwent resection and 172 (33.4%) were managed conservatively. Patients who underwent surgery were more likely to have preoperative motor deficits, hemorrhagic episodes, and bladder and/or bowel dysfunction, indicating increased disease severity. Resection was associated with significantly improved long-term functional outcomes (OR 3.27, 95% CI 1.72-6.24) compared with conservative management. There was no significant difference between the two groups regarding odds of long-term clinical deterioration (OR 1.03, 95% CI 0.35-3.03). However, the risk of hemorrhagic episodes during follow-up was higher in the conservative group (17.3%) compared with the surgical group (1.69%). The odds of hemorrhage during follow-up were lower in the surgical group, although not statistically significant (OR 0.24, 95% CI 0.05-1.05).</p><p><strong>Conclusions: </strong>This study highlights that while surgical management of SCCMs is associated with better long-term functional outcomes and reduced risk of recurrent hemorrhage, treatment decisions must be carefully tailored to the individual patient, particularly given the potential risks associated with surgery. Conservative management, although less invasive, carries a nonnegligible risk of hemorrhage during follow-up, warranting close monitoring. These findings parallel management strategies used for brainstem cavernomas, for which surgery is reserved for cases with low surgical risk and worsening neurological symptoms. However, the limitations of current data, including selection bias and heterogeneity in reporting, emphasize the need for a multi-institutional registry to better define the natural history of SCCMs and inform future management strategies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070957","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":"A novel posterior decompression technique (anterior sliding decompression osteotomy) for beak-type ossification of the posterior longitudinal ligament in the thoracic spine.","authors":"Jin-Sung Park, Hyun-Jun Kim, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.3171/2024.10.SPINE24941","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24941","url":null,"abstract":"<p><strong>Objective: </strong>Conventional decompression surgery for beak-type ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine, whether approached anteriorly or posteriorly, poses several challenges, including technical complexity, cerebrospinal fluid leakage, incomplete decompression, and potential neurological deterioration. Therefore, the authors introduce a novel technique, anterior sliding decompression osteotomy (ASDO), for thoracic myelopathy caused by OPLL and evaluate the efficacy and safety of this technique.</p><p><strong>Methods: </strong>Six patients (4 men and 2 women) who underwent ASDO surgery for beak-type OPLL in the thoracic spine with a follow-up period of at least 2 years were included in the cohort. Clinical and surgical outcomes, including modified Japanese Orthopaedic Association (mJOA) score, neurological recovery rate, canal occupying ratio, operation time, and blood loss, were evaluated.</p><p><strong>Results: </strong>The mean ± SD follow-up period was 26.5 ± 2.0 months. The mean mJOA score improved from 6.0 to 9.7, with the mean recovery rate reaching 63.6% at 6 weeks postoperatively to 73.9% at 2 years after surgery. Neural decompression was effective in all patients, reducing the mean canal occupying ratio from 70.8% to 29.1% without complications.</p><p><strong>Conclusions: </strong>ASDO surgery achieves sufficient spinal cord decompression for beak-type OPLL in the thoracic spine. It represents an effective, feasible technique, offering surgeons a familiar view from the conventional posterior approach.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033238","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":"Response to the AO Spine/Praxis Spinal Cord Institute guidelines for the management of acute spinal cord injury.","authors":"Jeffrey P Mullin, Luis M Tumialán, Patricia B Raksin, Ganesh M Shankar, Richard Menger, Erica F Bisson, Mohamad Bydon, Eric A Potts, Juan S Uribe","doi":"10.3171/2024.8.SPINE24612","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24612","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033253","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":"Smartphone accelerometers as tools to study the effect of socioeconomic disparities in neurosurgical outcomes: a multi-institutional retrospective analysis.","authors":"Daksh Chauhan, Hasan S Ahmad, Kristen Park, Yohannes Ghenbot, Robert Subtirelu, Ryan W Turlip, Kevin Bryan, Patrick T Wang, Malek Bashti, Dmitriy Petrov, Zarina S Ali, Ali K Ozturk, Neil Malhotra, Gregory Basil, Jang W Yoon","doi":"10.3171/2024.9.SPINE24639","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE24639","url":null,"abstract":"<p><strong>Objective: </strong>Smartphones and wearable devices can be effective tools to objectively assess patient mobility and well-being before and after spine surgery. In this retrospective observational study, the authors investigated the relationship between these longitudinal perioperative patient activity data and socioeconomic and demographic correlates, assessing whether smartphone-captured metrics may allow neurosurgeons to distinguish intergroup patterns.</p><p><strong>Methods: </strong>A multi-institutional retrospective study of patients who underwent spinal decompression with and without fusion between 2017 and 2021 was conducted. Patients' home zip codes were used to determine each patient's Area Deprivation Index (ADI)-an independently validated composite measure of the socioeconomic health of a specific neighborhood relative to the entire United States. Activity data, including steps-taken-per-day across a 2-year perioperative period, were extracted from patient smartphones and statistically normalized to enable interpatient comparisons. Multivariate regression was performed to identify relationships between ADI and patient mobility, while controlling for confounders including age and obesity.</p><p><strong>Results: </strong>The study included 49 patients. The preoperative activity level of patients living in neighborhoods with an ADI score below the 80th percentile nationally was significantly greater than that of patients living in neighborhoods above the 80th percentile (p = 0.011). A direct positive correlation existed between patients' ADI scores and the number of days with below-average steps-taken-per-day during the preoperative period (adjusted r2 = 0.822, p = 0.049). Postoperatively, patients with ADI scores above the 80th percentile had significantly greater documented activity levels (p = 0.031).</p><p><strong>Conclusions: </strong>The authors' study demonstrates that individuals living in neighborhoods with an ADI score below the 80th percentile had higher preoperative activity than patients in neighborhoods above the 80th percentile; this disparity diminishes after spine surgery. Though these findings are not generalizable, the authors hypothesized that the relatively faster postoperative recovery of patients living in wealthier neighborhoods is likely multifactorial, possibly due to sustained activity in the preoperative and likely symptomatic period of patients in lower-income neighborhoods, as well as enhanced access to postoperative care for patients in higher-income neighborhoods. Overall, the findings from the authors' study demonstrate that smartphone-captured activity may be utilized as a metric to study socioeconomic disparities in surgical outcomes. Future studies must specifically isolate socioeconomic variables as potential causal factors to inform improvements in healthcare delivery after surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033260","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":"Development of a unified and comprehensive definition of successful spinal fusion: a systematic review.","authors":"Parshva A Sanghvi, Joshua M Wiener, Seth M Meade, Lauren M Boden, Michael D Shost, Michael P Steinmetz","doi":"10.3171/2024.9.SPINE2465","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE2465","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Spinal fusion is a commonly performed surgical procedure used to relieve pain, deformity, and instability of various spinal pathologies. Although there have been attempts to standardize spinal fusion assessment radiologically, there is currently no unified definition that also considers clinical symptomology. This review attempts to create a more holistic and standardized definition of spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review of the current literature on cervical, thoracic, and lumbar spinal fusion was conducted using the PubMed, Google Scholar, and EBSCO databases adhering to PRISMA guidelines. Data were collected and analyzed from more than 20 publications that contained pertinent information on the efficacy of different imaging modalities, classification systems, clinical presentations, and the normal course of healing in relation to spinal fusion. The mean methodological index for nonrandomized studies score was 18 ± 2.5. Furthermore, industry experts and board-certified spinal surgeons were consulted in the development of a proposed definition of successful spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 20 studies evaluating 1324 spinal fusion procedures were included in the final analysis. Based on the available literature, a clinical algorithm that physicians can implement in their practice to determine whether a spinal fusion procedure may be deemed successful was created. The algorithm begins broadly by stratifying patients as either symptomatic or asymptomatic. Asymptomatic patients can be considered as having successful fusions after 12 months. If patients are symptomatic, the imaging modality and healing characteristics are based on the quality of pain experienced. For radicular pain, fusion evaluation includes a flexion/extension (F/E) radiograph to assess for foraminal compression, trabecular bridging, minimal angular rotation, minimal translational movement, and minimal halo sign. For axial pain, a helical CT scan is recommended, with characteristics of success that include trabecular bridging, lack of radiolucent shadowing, lack of visible bone or hardware fracture, lack of cystic or sclerotic changes, low subsidence level near the graft, and minimal screw-rod construct migration. Spinal fusion is considered \"unsuccessful\" if symptoms persist beyond a year postoperatively, regardless of radiographic findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The authors have constructed a systematic, standardized method for evaluating spinal fusion success that incorporates clinical symptoms, various imaging modalities, and the natural course of bone healing. A potential limitation of this algorithm is its reliance on radiographic imaging and heterogeneous data. However, the authors believe that implementation of this algorithm and a widespread unified fusion definition will lead to better postoperative evaluation, better surgical outcomes, and a standardized metric to assess d","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033251","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":"Editorial. The AO Spine/Praxis Spinal Cord Institute clinical practice guidelines for acute spinal cord injury: interpretation and implications for clinical practice.","authors":"Michael G Fehlings, Nathan Evaniew, Shekar N Kurpad, Andrea C Skelly, Lindsay A Tetreault, Brian K Kwon","doi":"10.3171/2024.9.SPINE241083","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE241083","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033252","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 pedicle screw accuracy on clinical outcomes after 1- or 2-level minimally invasive transforaminal lumbar interbody fusion.","authors":"Tejas Subramanian, Pratyush Shahi, Junho Song, Takashi Hirase, Maximilian Korsun, Austin C Kaidi, Gregory S Kazarian, Tomoyuki Asada, Eric Mai, Chad Z Simon, Izzet Akosman, Eric Zhao, Kasra Araghi, Troy B Amen, Avani Vaishnav, Cole Kwas, Olivia Tuma, Eric Kim, Nishtha Singh, Joshua Zhang, Myles Allen, Annika Bay, Evan Sheha, Francis Lovecchio, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.3171/2024.10.SPINE24692","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24692","url":null,"abstract":"<p><strong>Objective: </strong>When creating minimally invasive spine fusion constructs, accurate pedicle screw fixation is essential for biomechanical strength and avoiding complications arising from delicate surrounding structures. As research continues to analyze how to improve accuracy, long-term patient outcomes based on screw accuracy remain understudied. The objective of this study was to analyze long-term patient outcomes based on screw accuracy.</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion and were queried from a prospectively maintained multisurgeon registry. Pedicle screws were assessed for accuracy and graded as poor, acceptable, or good. Patient demographic characteristics and outcomes including complications, patient-reported outcome measures (PROMs), return to activities, and fusion rates were compared between the cohorts.</p><p><strong>Results: </strong>A total of 665 pedicle screws in 153 patients were evaluated and included in the final analysis. Of these, 20 (13.1%) patients had poor screws, 63 (41.2%) had acceptable screws, and 70 (45.7%) had good screws. All groups showed similar and significant improvements in all PROMs, although the poor screw group experienced delayed improvement in physical function. A majority of patients in all groups returned to working and driving and discontinued narcotics at similar rates. However, the poor screw group displayed significantly slower return to activities. There were no significant differences in intraoperative or postoperative complications, although the poor screw group experienced significantly lower fusion rates.</p><p><strong>Conclusions: </strong>Patients with poorly accurate pedicle screws experienced delayed return to activities and decreased fusion rates with similar long-term PROMs. Surgeons should continue to focus on placing accurate pedicle screws, and research should continue to analyze ways to ensure accurate screw placement.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007047","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":"Clinical and radiographic comparison of robot-assisted single-position versus traditional dual-position lateral lumbar interbody fusion.","authors":"Ting Li, Wenao Liao, Jiang Hu, Wei Zhang, Yang Yu, Fei Wang, Xilin Liu","doi":"10.3171/2024.10.SPINE24808","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24808","url":null,"abstract":"<p><strong>Objective: </strong>The potential of robot-assisted (RA) single-position (SP) lateral lumbar interbody fusion (LLIF) warrants further investigation. This study aimed to assess the efficacy of RA-SP-LLIF in improving both clinical and radiographic outcomes in patients undergoing lumbar spinal fusion surgery.</p><p><strong>Methods: </strong>A total of 59 patients underwent either RA-SP-LLIF (n = 31 cases) or traditional LLIF (n = 28 cases). Surgical parameters including operative duration, estimated blood loss, and fluoroscopy duration were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 36-item Short-Form Health Survey (SF-36). Radiographic parameters were also evaluated.</p><p><strong>Results: </strong>There were no significant differences between the two groups in terms of postoperative and last follow-up times, but both groups demonstrated significant improvements in VAS scores. Similarly, ODI and SF-36 scores showed comparable improvements. Radiographic parameters did not significantly differ between the groups preoperatively, postoperatively, and at last follow-up (p > 0.05). Neither group showed significant improvements in pelvic tilt and sacral slope parameters compared to baseline postoperatively and at last follow-up (p > 0.05). However, the RA-SP-LLIF group exhibited significantly greater improvements in lumbar lordosis (LL; p < 0.01), segmental lordosis (SL; p < 0.01), and pelvic incidence-LL mismatch (PI-LL; p < 0.01) immediately postoperatively compared to baseline, although these differences were not significant at subsequent evaluations. Similarly, the traditional LLIF group improved the LL, SL, and PI-LL parameters postoperatively. Importantly, there was no statistically significant difference in the Bridwell grade and complications between the two groups (p = 0.83 and p = 0.88, respectively). However, the RA-SP-LLIF group had significantly shorter operative and fluoroscopy durations compared to the traditional LLIF group (p = 0.04 and p < 0.01, respectively).</p><p><strong>Conclusions: </strong>Both RA-SP-LLIF and traditional LLIF surgeries achieved satisfactory lordotic correction. However, RA-SP-LLIF surgery demonstrated shorter operative and fluoroscopy times compared to traditional LLIF surgery. Therefore, RA-SP-LLIF is a promising technique for enhancing surgical efficiency, safety, and precision in lumbar spinal fusion procedures.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007046","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":"Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.","authors":"Daniel Zeitouni, Sarah E Johnson, Sufyan Ibrahim, Erica F Bisson, Praveen V Mummaneni, Regis W Haid, Andrew K Chan, Dean Chou, Michael Y Wang, John J Knightly, Scott Meyer, Oren N Gottfried, Christopher I Shaffrey, Michael S Virk, Kai-Ming G Fu, Mark E Shaffrey, Paul Park, Kevin T Foley, Cheerag D Upadhyaya, Eric A Potts, Jay D Turner, Juan S Uribe, Luis M Tumialán, Domagoj Coric, Mohamad Bydon, Anthony L Asher","doi":"10.3171/2024.9.SPINE24351","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE24351","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) shows varying levels of improvement after surgical treatment. While some patients improve soon after surgery, others may take months to years to show any signs of improvement. The goal of this study was to evaluate postoperative improvement, patient-reported outcomes, and patient satisfaction up to 2 years after surgical treatment for CSM, which will help optimize the current treatment strategies and effectively manage patient expectations.</p><p><strong>Methods: </strong>This was a retrospective study of prospectively collected data using the Quality Outcomes Database. The primary outcomes of interest were achievement of the minimal clinically important difference (MCID) for the numeric rating scale for neck and arm pain, modified Japanese Orthopaedic Association, Neck Disability Index, and EQ-5D scores and postoperative satisfaction (North American Spine Society scale). Early and sustained improvement was defined as MCID achievement in at least one patient-reported outcome measure (PROM) at the 3-, 12-, and 24-month follow-ups. Transient improvement was defined as MCID achievement only at the 3-month and/or 12-month follow-up but not at the 24-month follow-up. Late improvement was defined as MCID achievement in at least one PROM only at the 24-month follow-up.</p><p><strong>Results: </strong>There were 630 patients included in the comparative analysis. A total of 463 (73.5%) patients achieved early and sustained improvement, 105 (16.7%) patients experienced transient improvement with subsequent decline, 25 (4.0%) patients reported late improvement, and 37 (5.9%) patients did not report any clinically meaningful improvement after surgery. Patients with an anterior approach were more likely to be in the early and sustained improvement group. African American patients (OR 2.98, 95% CI 1.14-7.76; p = 0.03) were more likely to report late improvement when compared with White patients. The overall satisfaction rate at the 24-month follow-up was 87.8%.</p><p><strong>Conclusions: </strong>These findings indicate that 73.5% of patients achieve early and sustained improvement, and 87.8% of patients are satisfied with surgery 24 months postoperatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962181","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}