Journal of neurosurgery. Spine最新文献

{"title":"Letter to the Editor. PEEK versus titanium.","authors":"Connor S Gifford, Francis Farhadi","doi":"10.3171/2024.10.SPINE241366","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE241366","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575887","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 Social Deprivation Index and lumbar spine surgery outcomes.","authors":"Claudia Hejazi-Garcia, Susanna D Howard, Addison Quinones, Neil R Malhotra, Jang W Yoon, Ali K Ozturk, James M Schuster, Dmitriy Petrov, Jesse Y Hsu, Zarina S Ali","doi":"10.3171/2024.11.SPINE241048","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE241048","url":null,"abstract":"<p><strong>Objective: </strong>The Social Deprivation Index (SDI) measures area-level social disadvantage. SDI values range from 0 (no distress/prosperous) to 100 (highest distress). This study investigated the association between SDI and lumbar spine surgery outcomes.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was performed using electronic health record data from a multihospital academic health system from 2017 to 2024. Eligible patients included adults who underwent lumbar fusion or decompression alone. The primary exposure of interest was the binary SDI (low distress [SDI < 50] vs high distress [SDI ≥ 50 and ≤ 100]). SDI was associated with the patient's zip code of residence. The associations between SDI category and pain reduction, physical function improvement, length of stay, and 30-day readmission were examined. Both unadjusted and adjusted regression models were created. Adjusted models included the following covariates: age, comorbidities, race, insurance, and surgery type. Multiple imputation by chained equations was used to impute missing values.</p><p><strong>Results: </strong>The total sample included 7598 patients with 5139 in the low-SDI group and 2459 in the high-SDI group. SDI category was not significantly associated with the likelihood of pain reduction or physical function improvement after surgery. In the adjusted model, residence in a high-SDI area was significantly associated with extended length of stay (OR 1.21, 95% CI 1.07-1.36, p = 0.002). In the unadjusted model, patients from high-SDI areas were significantly more likely to experience 30-day readmission (OR 1.35, 95% CI 1.07-1.71, p = 0.01). In the adjusted model, this association was no longer statistically significant (OR 1.00, 95% CI 0.74-1.36, p ≥ 0.99).</p><p><strong>Conclusions: </strong>Patients from high-SDI areas had similar pain and physical function outcomes compared to patients from low-SDI areas after lumbar spine surgery. High SDI was significantly associated with length of stay. This study highlights the need for interventions that address the unique needs of patients from low-resource settings to improve lumbar spine surgery outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575891","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":"Axis 4-screw technique for occipital-cervical fixation in the treatment of atlantoaxial dislocation with axis osseous deformity: a retrospective study with a minimum 1-year follow-up.","authors":"Zhihang Gan, Nanfang Xu, Shenglin Wang, Yinglun Tian, Guodong Gao, Shilin Xue, Qiyue Gao, Ye Ouyang, Renyi Liang","doi":"10.3171/2024.11.SPINE24951","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE24951","url":null,"abstract":"<p><strong>Objective: </strong>Atlantoaxial dislocation (AAD) with axis osseous deformity poses significant surgical challenges, particularly in complex anatomical cases. This study compares the efficacy of 2-screw versus 4-screw occipital-cervical fixation in improving neurological outcomes and reducing complications in patients with AAD and axis deformity.</p><p><strong>Methods: </strong>A retrospective study was conducted on 37 patients with AAD and axis osseous deformity treated at the authors' institution from 2017 to 2023. The cohort included 19 patients treated with bilateral pars screws and translaminar screws (4-screw group) and 18 patients who received traditional pedicle screw (PS) fixation (2-screw group) prior to the application of 4-screw fixation. Radiographic parameters, including atlanto-dental interval (ADI), distance from the tip of the dens above the Chamberlain line (CL), cervico-medullary angle (CMA), and clivo-axial angle (CAA), were measured using radiography, CT, and MRI. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score. Data on complications and revision surgical procedures were collected and analyzed.</p><p><strong>Results: </strong>Preoperative demographic and clinical characteristics were comparable between groups. Both techniques effectively improved CAA and CMA and reduced CL, but the 4-screw group demonstrated significantly lower ADI postoperatively (p = 0.001) and at the latest follow-up (p = 0.003). Patients in the 4-screw group also showed significantly higher JOA scores at the latest follow-up (p = 0.027), indicating better neurological recovery. The incidence of postoperative complications was lower in the 4-screw group (1 vs 6, p = 0.037), and no revision surgical procedures were required in this group, whereas 4 patients in the 2-screw group required further surgical interventions (p = 0.046).</p><p><strong>Conclusions: </strong>Four-screw occipital-cervical fixation offers improved neurological functions and fewer postoperative complications compared to 2-screw fixation in patients with AAD and axis osseous deformity. This technique is particularly beneficial in cases with complex axis anatomy, suggesting its potential as a preferred alternative to traditional fixation methods.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527837","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":"Urinary control in cervical myelopathy: does it improve postsurgery? A Quality Outcomes Database study.","authors":"Saman Shabani, Raj Swaroop Lavadi, Nitin Agarwal, Vijay Letchuman, Vivian P Le, Alysha B Jamieson, Andrew K Chan, Sarah E Johnson, Michael Y Wang, Regis W Haid, John J Knightly, Oren N Gottfried, Christopher I Shaffrey, Michael S Virk, Mark E Shaffrey, Paul Park, Kevin T Foley, Domagoj Coric, Cheerag D Upadhyaya, Eric A Potts, Juan S Uribe, Jay D Turner, Luis M Tumialán, Dean Chou, Kai-Ming G Fu, Anthony L Asher, Erica F Bisson, Mohamad Bydon, Praveen V Mummaneni","doi":"10.3171/2024.10.SPINE24338","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24338","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) can be associated with urinary dysfunction, leading to an inability or marked difficulty with micturition. This study aimed to evaluate the urinary dysfunction, long-term prognosis, and recovery in patients with CSM following surgical intervention.</p><p><strong>Methods: </strong>The CSM cases of the Quality Outcomes Database SpineCORe study group were analyzed. Urinary control was assessed using the modified Japanese Orthopaedic Association (mJOA) urinary function subscore. Improvement was defined as a minimum improvement of 1 point in the mJOA urinary function subscore at the 2-year follow-up. Univariate and multivariable analyses were conducted as appropriate.</p><p><strong>Results: </strong>Of 1141 patients, 772 (67.7%) patients were identified with a minimum 2-year follow-up mJOA score, and 249 (32.3%) of these patients reported baseline urinary dysfunction. Of those 249 patients with baseline urinary control problems, 193 (77.5%) had improvement in urinary function postoperatively, and more women than men had improved urinary control after CSM surgery (54.9% vs 45.1%, p = 0.03). Apart from sex, demographic characteristics of patients who experienced urinary function improvement versus those who did not were similar. Patients who experienced urinary function improvement had lower overall baseline mJOA scores (10.2 vs 13, p < 0.01). Both cohorts reported similar rates of postoperative satisfaction (North American Spine Society scores of 1 and 2) (89.1% vs 85.9%, p = 0.26).</p><p><strong>Conclusions: </strong>Among the one-third of patients with CSM experiencing urinary dysfunction, nearly 78% achieve improved urinary function at the 2-year postoperative follow-up. Women are more likely to experience improvement in this function. Patients with and without improvements in urinary function are equally satisfied with their surgery and report similar outcomes on long-term follow-up.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527856","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. Influencing factor for upper instrumented vertebra pedicle screw loosening.","authors":"Yafei Wang, Cheng Wang, Chenran Zhang","doi":"10.3171/2024.12.SPINE241483","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE241483","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527854","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":"Carbon fiber-reinforced PEEK implants in oncologic spine surgery: a multicenter experience on implications for postoperative patient management.","authors":"Vanessa Hubertus, Arthur Wagner, Carolin Albrecht, Darius Kalasauskas, Dragan Jankovic, Merih Turgut, Sara Lener, Raphael Gmeiner, Hannah Miller, Melanie M T Brüsseler, Güliz Acker, Nils Hecht, Julia S Onken, Stephanie E Combs, Claudius Thomé, Florian Ringel, Peter Vajkoczy, Bernhard Meyer","doi":"10.3171/2024.10.SPINE24753","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24753","url":null,"abstract":"<p><strong>Objective: </strong>Carbon fiber-reinforced polyetheretherketone (CFRP) implants have been used safely in treating spinal oncological disease and promise improved imaging follow-up and radiotherapy planning. However, data on the implant's routine use in the clinical setting with implications for postoperative management are scarce. The aim of this observational study was to provide real-world insight into the current use of CFRP instrumentations in spinal oncological disease and to define their actual relevance for postoperative imaging follow-up and adjuvant treatment planning.</p><p><strong>Methods: </strong>Datasets of patients treated between 2015 and 2022 with CFRP instrumentations due to spinal oncological disease were collected in a multicentric registry at four participating tertiary spine centers in Germany and Austria. Data on each patient's epidemiology, clinical status, surgery, adjuvant therapy, and outcome was collected retrospectively. Data management was performed using a multicentric REDCap database, and data were reviewed and analyzed descriptively.</p><p><strong>Results: </strong>A total of 457 patients were enrolled. Most patients received decompression and instrumentation (n = 308 [67%]), with additional cage implantation in 33% (n = 149). In most cases, image-guided navigated screw implantation was performed (n = 321 [70%]). The postoperative complication rate was 13% (n = 61), mostly due to surgical site infections (n = 32 [7%]). Postoperative MRI was performed in 19% (n = 87), with MRI findings prompting revision surgery in 3% (n = 15). In total, 61% of all patients (n = 278) received adjuvant radiotherapy. In those patients, MRI was performed in 6% (18 cases) for procedure planning, while this was mostly based on preinterventional CT (n = 205 [74%]). Of all patients, 27% (n = 124) received routine MRI during follow-up, where relevant local tumor recurrence was detected in 35% (n = 44) at a median follow-up of 6 months.</p><p><strong>Conclusions: </strong>Low overall complication and low surgical revision rates were reported. Because of the possibility of higher quality MRI follow-up due to CFRP implants, complications or relevant tumor recurrence during follow-up were detected safely and at a high rate in cases where MRI was performed. However, consequent MRI follow-up was not homogeneously performed, and adjuvant radiotherapy was handled rather heterogeneously. These findings lead to the conclusion that until homogeneous adjuvant follow-up and treatment standards are established, the potential benefits available through the use of CFRP implants are not exhausted, and the decision for the use of CFRP implants in comparison to standard titanium implants remains case-to-case based.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472583","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 minimally invasive surgical technique for posttraumatic syringomyelia: subarachnoid-subarachnoid bypass.","authors":"Chenghua Yuan, Can Zhang, Jiachen Wang, Hao Wu, Zan Chen, Fengzeng Jian, Jian Guan","doi":"10.3171/2024.10.SPINE24987","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24987","url":null,"abstract":"<p><strong>Objective: </strong>Current treatment options for posttraumatic syringomyelia (PTS) lack clear standardization and often result in common complications. This study aims to introduce a novel minimally invasive technique for a modified subarachnoid-subarachnoid (S-S) bypass procedure for PTS.</p><p><strong>Methods: </strong>The study included 20 consecutive patients with symptomatic PTS who underwent the modified S-S bypass. The surgical technique of modified S-S bypass involved two-laminae fenestration based on preoperative MRI and myelography results showing normal subarachnoid space above and below the injury site. A passer was used to create a subcutaneous tunnel, and two medical-grade silicone tubes were inserted into the normal subarachnoid space at the cranial and caudal ends. Bypass tubes were placed in the subcutaneous tunnel, and dural closure was achieved using 6-0 nonabsorbable sutures. The mean follow-up period was 14.9 (range 12-18) months, with neurological function assessed using a standard grading system and MRI used to evaluate the change in syrinx size.</p><p><strong>Results: </strong>Seventeen patients demonstrated clinical improvement, while 3 remained stable. The mean preoperative syrinx length on MRI was 16.9 spinal levels, with a mean Syringomyelia Tension Index (STI) of 58.1%. The postoperative mean STI was 28.4%, significantly lower than preoperative values (p < 0.05).</p><p><strong>Conclusions: </strong>Modified S-S bypass, which can be performed without myelotomy and without the bypass tubes interfering with the adhesion, was not only a safe and effective surgical technique, but may also be a physiologically better way of treating PTS.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-12"},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472580","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":"Does smoking status affect baseline symptom severity and patient-reported outcomes and satisfaction in patients with cervical myelopathy at 24 months? A Quality Outcomes Database study.","authors":"Christine Park, Deb Bhowmick, Christopher I Shaffrey, Raj Swaroop Lavadi, Sarah E Johnson, Erica F Bisson, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Paul Park, Michael Y Wang, Kai-Ming Fu, Michael S Virk, John J Knightly, Scott Meyer, Cheerag D Upadhyaya, Mark E Shaffrey, Alexander J Schupper, Juan S Uribe, Luis M Tumialán, Jay D Turner, Andrew K Chan, Dean Chou, Regis W Haid, Praveen V Mummaneni, Mohamad Bydon, Oren N Gottfried","doi":"10.3171/2024.10.SPINE24744","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24744","url":null,"abstract":"<p><strong>Objective: </strong>It is not clear whether smoking impacts patient-reported outcomes (PROs) in patients with cervical spondylotic myelopathy (CSM). The aim of this study was to explore the impact of smoking status on baseline symptom severity and the rate of achieving satisfaction and the minimal clinically important differences (MCIDs) for PROs in patients with CSM.</p><p><strong>Methods: </strong>This study was an analysis of the prospective Quality Outcomes Database CSM module. Patients aged ≥ 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (visual analog scale [VAS] neck and arm pain, Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA], and EQ-5D scores and North American Spine Society [NASS] patient satisfaction) were collected at baseline and 24 months of follow-up.</p><p><strong>Results: </strong>Of the 1141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were nonsmokers. Compared with the nonsmokers, smokers were younger (56.3 ± 11.3 years vs 61.5 ± 11.7 years, p < 0.01) and had a lower BMI (29.3 ± 6.8 vs 30.3 ± 6.3, p = 0.04). A higher proportion of smokers had depression, anxiety, and chronic obstructive pulmonary disease (all p < 0.01). At baseline, smokers had worse pain (VAS neck pain score: 6.0 ± 3.2 vs 5.1 ± 3.3; VAS arm pain score: 5.7 ± 3.2 vs 4.7 ± 3.5), disability (NDI score: 45.2 ± 20.0 vs 37.1 ± 20.6), myelopathy (mJOA score: 11.5 ± 2.9 vs 12.2 ± 2.8), and quality of life (EQ-5D score: 0.51 ± 0.23 vs 0.57 ± 0.22) (all p < 0.01). At the 24-month follow-up, a higher proportion of smokers achieved the MCID in mJOA (69.4% vs 56.6%, p < 0.01) compared with nonsmokers. However, after accounting for significant covariates, there was no significant difference in the baseline disease severity. There was also no difference between the PROs at the 24-month follow-up. The two groups also achieved similar MCIDs for most PROs and were similarly satisfied (NASS score of 1 or 2: smoker 81.2% vs nonsmoker 84.6%, p = 0.29) 24 months after surgery.</p><p><strong>Conclusions: </strong>Smokers and nonsmokers with CSM had similar baseline disease severity and 24-month PROs. They also achieved similar rates of MCIDs for PROs and satisfaction after surgery. Numerous previous studies have documented the association between tobacco usage and inferior clinical outcomes after spine surgery. However, in the context of severe and debilitating spinal disorders such as cervical myelopathy, meaningful and impactful improvements are still seen in properly selected patients.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416717","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":"Vitality of global alignment following adult spinal deformity surgery to long-term improvement of patient-reported outcomes regardless of regional alignment.","authors":"Christopher Mikhail, Sarthak Mohanty, Fthimnir M Hassan, Christopher S Lai, Stephen R Stephan, Andrew Platt, Nathan J Lee, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke","doi":"10.3171/2024.11.SPINE231213","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE231213","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to discern whether patients who achieve a cranial sagittal vertical axis to the hip (CrSVA-H) < 2 cm at 2 years of follow-up, regardless of mismatch between pelvic incidence and lumbar lordosis (PI-LL), have a greater improvement in patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>This was a retrospective analysis of a prospectively collected single-center database of adult spinal deformity (ASD) patients who underwent corrective surgery with a minimum follow-up of 2 years. Patient demographics, perioperative data, radiographic parameters, and PROMs were collected at baseline and follow-up. Patients were placed into four cohorts: combined aligned (CA) (CrSVA-H < 2 cm, PI-LL < 10°), globally aligned (GA) (CrSVA-H < 2 cm, PI-LL ≥ 10°), regionally aligned (RA) (CrSVA-H ≥ 2 cm, PI-LL < 10°), and completely malaligned (CM) (CrSVA-H ≥ 2 cm, PI-LL ≥ 10°) at final follow-up.</p><p><strong>Results: </strong>A total of 162 patients were included (71 CA, 58 GA, 11 RA, and 22 CM patients). The CA cohort was younger (mean [standard error of the mean]: 44.1 [2.2] vs 57.6 [1.8] vs 54.7 [3.1] years, p = 0.0003) and had a smaller PI-LL (1.6° [2.3°] vs 27.9° [2.4°] vs 25.0° [4.8°], p < 0.0001) than the GA and CM cohorts. The CrSVA-H differed significantly between the CA and CM cohorts (-1.5 [0.5] vs 4.1 [1.2] cm, p = 0.0012). There was no significant difference in BMI or total instrumented levels across all four cohorts (p > 0.05). The CA and GA cohorts had greater baseline PROMs when compared with the CM cohort, specifically in the SRS-22r total score (p = 0.0025 and p = 0.0244, respectively), self-image (p = 0.0032 and p = 0.0074, respectively), and satisfaction (p = 0.0313 and p = 0.0011, respectively) domains. Baseline Oswestry Disability Index (ODI) scores differed only between the CA and CM cohorts (32.2 [2.5] vs 41.1 [2.4], p = 0.0312). The CA and GA cohorts possessed greater PROMs by the final follow-up, including the aforementioned PROMs (p = 0.0016) and ODI scores (p = 0.0044) when compared with the CM cohort. The mixed-effects model of PROMs demonstrated that the CA and GA cohorts experienced a greater increase in patient-reported outcomes when compared with the CM cohort (p < 0.05).</p><p><strong>Conclusions: </strong>ASD patients with a CrSVA-H < 2 cm by the final follow-up improved significantly across the majority of PROMs regardless of regional alignment when compared with patients who were both globally and regionally malaligned. These results further emphasize that the position of the head relative to the hips is a vital measure for the long-term improvement of PROMs following ASD surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416721","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":"Intravenous tranexamic acid and reduction in blood loss and perioperative transfusion requirements in adult spinal deformity: a multicenter propensity-scored observational study.","authors":"Mert Marcel Dagli, Connor A Wathen, Joshua L Golubovsky, Yohannes Ghenbot, John D Arena, Jonathan Heintz, Dominick Macaluso, Gabrielle Santangelo, Zarina S Ali, Neil Malhotra, Jang W Yoon, William C Welch, Vincent Arlet, Ali K Ozturk","doi":"10.3171/2024.10.SPINE24701","DOIUrl":"10.3171/2024.10.SPINE24701","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative antifibrinolytic therapy with tranexamic acid (TXA) is a focus of interest for blood loss reduction in multilevel adult spinal deformity (ASD) correction surgery. There is considerable heterogeneity in the reported findings regarding the safety and efficacy of this therapy. In the present study, the authors aimed to rigorously investigate the safety and efficacy of TXA in multilevel ASD correction surgery and to explore secondary perioperative outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the authors' institutional spine deformity database, including records of surgeries performed between January 1, 2013, and December 13, 2021, with a minimum follow-up of 2 years. Adult patients undergoing elective thoracolumbosacral posterior spinal fusion involving 6 or more vertebrae were included. The primary outcome was the safety and efficacy of TXA, with secondary outcomes including postoperative complications and overall outcomes. Propensity-scored stabilized inverse probability of treatment weighting was used to adjust for confounding factors. Subsequent weighted analysis of the treatment effect was performed using regression models for hypothesis testing, with 95% confidence intervals calculated based on weighted means, variances, and standard errors. The p values of primary outcomes and subgroup analyses were adjusted for multiplicity testing with the Benjamini-Hochberg correction at a false discovery rate of 0.05. The conduct and reporting of this study were supported by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.</p><p><strong>Results: </strong>The study included 598 patients, with 257 receiving TXA and 341 controls. Weighted analysis revealed that TXA administration was associated with significant reductions in estimated blood loss (p = 0.007), percentage of estimated blood volume lost (p = 0.035), intraoperative total red blood cell transfusion volume (p = 0.035), and postoperative packed red blood cells transfusion volume (p = 0.035). No significant differences were observed in postoperative thromboembolic events (p = 0.397).</p><p><strong>Conclusions: </strong>TXA was significantly associated with reduced blood loss and transfusion requirements in multilevel ASD correction surgery without increasing the risk of thromboembolic complications.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"481-489"},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370630","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}