Journal of neurosurgery. Spine最新文献

{"title":"Safe, simple, and valid position for obtaining flexion-extension radiographs to assess instability in patients with lumbar spondylolisthesis: one specific instruction can make a difference.","authors":"Tomonori Morita, Mitsunori Yoshimoto, Makoto Emori, Noriyuki Iesato, Ryunosuke Fukushi, Hiroyuki Takashima, Toshihiko Yamashita, Atsushi Teramoto","doi":"10.3171/2024.7.SPINE24349","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24349","url":null,"abstract":"<p><strong>Objective: </strong>In lumbar spondylolisthesis, conventional standing flexion-extension radiography can yield varying results depending on the patient's effort and cooperation. Previous research suggested that assisted flexion radiography provides larger flexion with a significantly greater change in lumbar lordosis (ΔLL) and increased sagittal translation (ST), posterior opening (PO), segmental angulation (SA), and instability detection rates. In this study, the authors aimed to identify a safe, simple, and valid position for obtaining functional radiographs to evaluate abnormal instability in lumbar spondylolisthesis.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were included. The patients underwent upright and extension radiography and three different flexion radiography positions: conventional flexion (CF), hand-knee (HK), and hand-ankle (HA). Measurements included ΔLL, ST, PO, and SA, with instability rates compared between the three flexion techniques.</p><p><strong>Results: </strong>This study included 117 patients (81 women, mean age of the study sample 76.8 years). The median ΔLL values were 10.8° (interquartile range [IQR] 5.2°-18.2°) in the CF position, 30.0° (IQR 21.0°-41.1°) in the HK position, and 32.1° (IQR 23.0°-42.4°) in the HA position, with significant differences noted (p < 0.05). For PO and SA, significant differences were observed between the techniques (p < 0.05). ST medians were CF 5.5% (IQR 3.6%-8.1%), HK 9.5% (IQR 7.7%-11.1%), and HA 9.7% (IQR 7.4%-11.4%), with HK and HA positions differing significantly from the CF position (p < 0.001), but not the HK from the HA position (p = 0.15). Instability detection rates were 29.1% in the CF position, 76.1% in the HK position, and 76.9% in the HA position, with significant differences between the HK, HA, and CF positions (p < 0.001), but not between the HK and HA positions (p > 0.99).</p><p><strong>Conclusions: </strong>The study showed that HK and HA flexion radiographs provided greater ΔLL, ST, PO, SA, and better instability detection than the CF position. Given its safety and simplicity, the HK position is suitable for detecting abnormal lumbar mobility in degenerative lumbar spondylolisthesis.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604819","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":"Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.","authors":"Rohan Jha, Joshua I Chalif, Sarah E Blitz, Alexander G Yearley, Velina Chavarro, Yi Lu","doi":"10.3171/2024.7.SPINE24215","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24215","url":null,"abstract":"<p><strong>Objective: </strong>The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts.</p><p><strong>Methods: </strong>An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters.</p><p><strong>Results: </strong>A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up.</p><p><strong>Conclusions: </strong>Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562541","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":"Risk factors for postoperative ileus after corrective spinal surgery: association with reduction in the retrocrural space area.","authors":"Shuhei Ohyama, Toshiaki Kotani, Tsuyoshi Sakuma, Yasushi Iijima, Yosuke Ogata, Shuhei Iwata, Tsutomu Akazawa, Kazuhide Inage, Yasuhiro Shiga, Shohei Minami, Seiji Ohtori","doi":"10.3171/2024.7.SPINE24163","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24163","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine whether a reduction in the retrocrural space (RCS) area is a risk factor for postoperative ileus (POI) in patients with adult spinal deformity (ASD) treated with spinal corrective surgery.</p><p><strong>Methods: </strong>In total, 100 patients (mean age 67.5 ± 8.3 years, 9 males and 91 females) with ASD treated with spinal corrective surgery were included in this study. Spinal parameters, including thoracolumbar kyphosis (TLK), and RCS area were measured pre- and postoperatively. The change (Δ) in spinal parameters was calculated. The percent change between pre- and postoperative RCS areas was calculated as ΔRCS. Patients were identified as having POI if they exhibited both gastrointestinal symptoms and radiographic findings. Each parameter was compared between patients with and without POI. Multivariable logistic regression analysis was performed with development of POI as the dependent variable.</p><p><strong>Results: </strong>The incidence of POI was 11.0%. The RCS area was significantly smaller in the POI group than in the non-POI group (p < 0.001). Multivariable logistic regression analysis revealed that ΔTLK and ΔRCS were risk factors for POI (p = 0.029 and p = 0.033, respectively).</p><p><strong>Conclusions: </strong>A reduction in the RCS area is a risk factor for the development of POI after corrective spinal surgery in patients with ASD. Overcorrection of the thoracolumbar junction should be avoided to prevent POI.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562543","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":"Modified transforaminal lumbar endoscopic discectomy for surgical management of extraforaminal lumbar disc herniation: case series and technical note.","authors":"Stylianos Kapetanakis, Nikolaos Gkantsinikoudis","doi":"10.3171/2024.7.SPINE24389","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24389","url":null,"abstract":"<p><strong>Objective: </strong>Extraforaminal lumbar disc herniation (ELDH) represents a unique clinical entity, presenting particular challenges in surgical management. Transforaminal lumbar endoscopic discectomy (TLED) represents a minimally invasive, full-endoscopic procedure that is increasingly selected for surgical treatment of lumbar disc herniation, being theoretically ideal in patients with ELDH. Performance of TLED for management of ELDH has been reported in specific studies in the recent literature. However, foraminal anatomy is significantly disrupted in cases of ELDH, a fact that may represent a true challenge for the operating surgeon, in terms of proper endoscopic visualization. Hence, the aim of this study was to investigate midterm clinical outcomes of a unique modification of the TLED technique in patients with ELDH, in an attempt to enhance endoscopic visualization of foraminal structures and to facilitate safe and effective decompression in these cases.</p><p><strong>Methods: </strong>Twenty-five patients with ELDH were enrolled in this study. All patients underwent modified TLED (mTLED) in the authors' center and were retrospectively assessed. Clinical evaluation was performed via the visual analog scale at 6 weeks; at 3, 6, and 12 months; and at 2 and 5 years postoperatively on an outpatient basis. Moreover, the functional status of enrolled individuals was evaluated with modified Macnab criteria at the end of follow-up.</p><p><strong>Results: </strong>All patients underwent successful mTLED; the mean operative time was 23.7 ± 3.4 minutes. All patients were discharged on the same day as their operation, exhibiting no major perioperative complications. Three patients (12%) reported transient postoperative dysesthesia, which was completely resolved 6 weeks postoperatively. Recorded visual analog scale values were significantly ameliorated up to the end of follow-up, featuring maximal improvement at 6 weeks, with subsequent minimal amelioration and stabilization. According to modified Macnab criteria, excellent or good outcomes were observed in 23 patients (92%), whereas the outcome was fair in 2 patients (8%).</p><p><strong>Conclusions: </strong>mTLED represents a feasible, safe, and effective alternative to conventional TLED and conventional open procedures for the management of ELDH. However, the precise role of this technical modification should be further investigated in future studies.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502326","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":"Is multilevel MIS-TLIF with bilateral facetectomy a lordosing procedure? A retrospective cohort of 3-level MIS-TLIF.","authors":"Yen-Cheng Chang, Ching-Lan Wu, Hsuan-Kan Chang, Jiing-Feng Lirng, Wen-Cheng Huang, Jau-Ching Wu","doi":"10.3171/2024.7.SPINE2468","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE2468","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a common surgery that has been extensively reported. However, publications on 3-level MIS-TLIF are sparse, and the effects of multilevel MIS-TLIF on sagittal balance remain controversial. This study aimed to analyze the outcomes and variables involved in the correction of sagittal imbalance by multilevel MIS-TLIF.</p><p><strong>Methods: </strong>Consecutive patients who underwent 3-level MIS-TLIF were retrospectively analyzed. Demographics and clinical outcomes were evaluated. Standard radiological and spinopelvic parameters were measured pre- and postoperatively, and at the last follow-up. A linear regression model was used to examine the correlation between preoperative segmental lordosis (SL) and the degree of sagittal correction. An optimal cutoff of preoperative SL to predict the change in sagittal correction was determined by receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Forty-seven patients (mean follow-up 24.63 ± 12.69 months) were included. Postoperatively, all patients showed clinical improvements, demonstrated by the Oswestry Disability Index and visual analog scale. The overall SL at the last follow-up was slightly nonsignificantly increased (1.23°, p = 0.267), while the other spinopelvic parameters, including lumbar lordosis (p = 0.008), sacral slope (p < 0.001), pelvic tilt (p = 0.002), and pelvic incidence-lumbar lordosis mismatch (p = 0.006), all improved significantly compared with preoperatively. The preoperative SL was negatively correlated with the change in SL at the last follow-up (r2 = 0.2591, p = 0.0003), and the cutoff value was 26.89° (area under the ROC curve = 0.7836, p = 0.0087). The 24 patients who had a less lordotic lumbar spine (i.e., preoperative SL ≤ 27°) demonstrated significant improvement in spinopelvic parameters, whereas the other 23 patients (SL > 27°) had a slight, insignificant decrease of spinopelvic parameters.</p><p><strong>Conclusions: </strong>Multilevel MIS-TLIF improved sagittal balance and SL with satisfactory patient-reported clinical outcomes at 2 years postoperatively. Multilevel MIS-TLIF was more effective in increasing lordosis in patients whose lumbar spine had a smaller preoperative lordotic curve (SL ≤ 27°).</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502325","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":"Posterior aggressive debulking versus minimal decompression surgery in patients with metastatic spinal cord compression: propensity-score-matching analysis from a multicenter study cohort.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee, Bong-Soon Chang, Hyoungmin Kim, Sam Yeol Chang, Jiyong Lee","doi":"10.3171/2024.7.SPINE24206","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24206","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to evaluate the comparative outcomes of aggressive debulking (AD) and minimal decompression (MD) surgeries for metastatic spinal cord compression based on surgical burden, functional improvement, and symptomatic local recurrence (SLR).</p><p><strong>Methods: </strong>In this retrospective analysis from 2 tertiary hospitals, the authors assessed patients with metastatic spinal cord compression treated via AD and MD surgeries between 2010 and 2022. The evaluation included patient demographics, Eastern Cooperative Oncology Group performance status (ECOG-PS), primary tumor type, modified Tokuhashi scores, surgical burden, and SLR. Propensity-score matching (1:1 ratio) was conducted based on oncological status for intergroup comparisons. Survival analysis and logistic regression analyses were conducted.</p><p><strong>Results: </strong>A total of 264 patients were included in the study. After 1:1 propensity-score matching, a total of 156 matched patients were analyzed (78 patients each in the AD and MD groups). Operation time, estimated blood loss, transfused red blood cell units, and inpatient medical complications were significantly higher in the AD group compared to the MD group (p = 0.001, p = 0.002, p = 0.006, and p = 0.035, respectively). There was no significant difference in distribution of postoperative ECOG-PS between the AD and MD groups (OR 1.461, 95% CI 0.821-2.599, p = 0.197). In initially nonambulatory patients (ECOG-PS of grade 3 or 4), the AD group showed a higher proportion of patients regaining ambulatory function compared to the MD group (56.5% vs 36.2%; OR 2.294, p = 0.049). In cases with a preoperative ECOG-PS of grade 3, the difference in ambulation recovery between AD and MD was not statistically significant (60.0% vs 53.3%, p = 0.577). However, for severely impaired patients (ECOG-PS of grade 4), the AD group showed a higher proportion of patients regaining ambulatory function compared to the MD group (33.3% vs 5.9%, p = 0.086). Symptomatic SLR-free survival showed no significant differences at final follow-up (p = 0.095). Multivariate analysis identified the modified Tokuhashi score as the sole predictor of SLR (OR 1.871, p = 0.001).</p><p><strong>Conclusions: </strong>This study found that MD surgery significantly reduced surgical burden compared to AD. AD surgery led to slightly better functional recovery showing greater rescue ratios, especially in patients with a preoperative ECOG-PS of grade 4. However, no difference in rescue ratio was observed in patients with a preoperative ECOG-PS of grade 3. There was no significant difference in SLR rates between the AD and MD groups.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468010","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":"Unintended readmissions and reoperations within 30 and 90 days following adult spinal deformity surgery.","authors":"Seung-Ho Seo, Seung-Jae Hyun, Jae-Koo Lee, Ki-Jeong Kim","doi":"10.3171/2024.7.SPINE2466","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE2466","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the rates and etiologies of unintended readmissions and reoperations within 30 and 90 days after adult spinal deformity (ASD) surgery. The authors aimed to identify the risk factors for readmission and reoperation by analyzing patient demographic and surgical characteristics.</p><p><strong>Methods: </strong>This retrospective cohort study included 307 consecutive patients who underwent surgery for ASD from 2012 to 2022 at a single academic institution. Data were collected on patient demographic characteristics, comorbidities, operative details, and postoperative complications. Chi-square and multivariable logistic regression models were used to identify the risk factors associated with 30- and 90-day readmissions and reoperations.</p><p><strong>Results: </strong>The mean ± SD age at surgery was 66.6 ± 10.5 years, and the majority (80.8%) of patients were female. The 30-day and 90-day readmission rates were 11.7% and 15.3%, respectively. Multivariable regression for 30-day readmissions revealed that length of hospital stay (LOS) after index surgery of > 20 days (OR 2.48) and surgical factors such as vertebral column resection (VCR) (OR 4.26) and pelvic fixation (OR 4.38) were risk factors. Other factors such as the American Society of Anesthesiologists Physical Status Classification System (ASA) class, prior spine surgery, and age were not associated with 30-day readmissions. Ninety-day readmission was associated with high ASA class (OR 2.37) and LOS > 20 days (OR 2.82). The 30- and 90-day reoperation rates were 7.8% and 10.1%, respectively. The variables associated with 30-day reoperations were intraoperative VCR (OR 3.34) and LOS > 20 days (OR 9.38). Ninety-day reoperations were associated with dural tears (OR 3.33) and LOS > 20 days (OR 3.68).</p><p><strong>Conclusions: </strong>This study provides valuable insights into the incidence of unintended readmission and reoperation within 30 and 90 days after ASD surgery in an Asian population. By identifying the associated risk factors, healthcare providers can customize surgical strategies and optimize perioperative care to effectively mitigate these events.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468012","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":"Could indirect decompression occur for cord compression by the ligamentum flavum with anterior cervical discectomy and fusion?","authors":"Dong-Ho Lee, Sehan Park, Chang Ju Hwang, Jae Hwan Cho","doi":"10.3171/2024.6.SPINE24422","DOIUrl":"https://doi.org/10.3171/2024.6.SPINE24422","url":null,"abstract":"<p><strong>Objective: </strong>Cord compression by the ligamentum flavum (CCLF) has been reported to adversely affect the clinical outcomes of anterior cervical discectomy and fusion (ACDF). While indirect decompression does occur for foraminal stenosis with ACDF, whether ACDF could improve CCLF with the distraction of disc space remains unclear. This study aimed to identify 1) whether indirect decompression occurs for CCLF with ACDF, and 2) risk factors that hinder the improvement of CCLF.</p><p><strong>Methods: </strong>This retrospective cohort study included 119 patients who underwent ACDF for the treatment of cervical myelopathy and CCLF was detected on preoperative MRI. Patients who demonstrated improvement in CCLF grade after ACDF were included in the improved group, while those who did not show improvement were classified as the unimproved group. Patient characteristics, cervical sagittal parameters, neck and arm pain visual analog scale score, and Japanese Orthopaedic Association (JOA) score were assessed. A comparison between the improved and unimproved groups was performed. Regression analyses were performed to identify factors associated with CCLF grade improvement.</p><p><strong>Results: </strong>Overall, 58.0% (69/119) of patients showed improvement in CCLF grade after ACDF. CCLF grade did not improve in the remaining 42.0% (50/119) of patients, and 3.4% (4/119) of patients experienced aggravation of CCLF after ACDF. Preoperative spondylolisthesis (OR 0.252, 95% CI 0.090-0.711; p = 0.009) and greater segmental lordosis 3 months postoperatively (OR 0.835, 95% CI 0.731-0.953; p = 0.008) were the factors that hindered the improvement of CCLF after ACDF. Furthermore, patients with higher pre- or postoperative CCLF grades showed significantly less improvement in JOA score 2 years postoperatively.</p><p><strong>Conclusions: </strong>Indirect decompression for CCLF with ACDF is not reliable because 42.0% of patients did not demonstrate improvement in CCLF grade after the operation. Preoperative spondylolisthesis and postoperative increased segmental lordosis were risk factors for failure of CCLF improvement. Both pre- and postoperative higher CCLF grades were associated with poor neurological recovery 2 years postoperatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468007","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 smoking on patient-reported outcomes following lumbar decompression: an analysis of the Quality Outcomes Database.","authors":"Mladen Djurasovic, R Kirk Owens, Leah Y Carreon, Jeffrey L Gum, Erica F Bisson, Mohamad Bydon, Steven D Glassman","doi":"10.3171/2024.7.SPINE24138","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24138","url":null,"abstract":"<p><strong>Objective: </strong>Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc.</p><p><strong>Methods: </strong>The Quality Outcomes Database was queried for patients with spinal stenosis or lumbar disc herniation who underwent one- or two-level lumbar decompression without fusion. All patients had preoperative and 12-month outcome measures and were divided into groups of nonsmokers and current smokers. Outcomes were compared between the two groups, as well as the percentage of patients reaching the minimal clinically important difference (MCID) threshold for numeric rating scale (NRS) back and leg pain scores and the Oswestry Disability Index (ODI).</p><p><strong>Results: </strong>Of 17,271 patients, 14,233 were nonsmokers and 3038 were current smokers. Smokers had worse baseline NRS back and leg pain, ODI, and EQ-5D scores and experienced slightly less improvement in all measures following lumbar decompression (p ≤ 0.009), although changes were largely similar, and a high percentage of patients achieved the MCID thresholds for NRS back pain (78% nonsmokers vs 75% smokers), NRS leg pain (79% nonsmokers vs 73% smokers), and ODI (74% nonsmokers vs 68% smokers). Comparison of propensity-matched cohorts did not identify any difference in outcomes in smokers versus nonsmokers.</p><p><strong>Conclusions: </strong>In patients undergoing lumbar decompression for spinal stenosis or herniated disc, smokers demonstrated slightly less improvement in outcomes compared with nonsmokers, and a high proportion of both groups achieved meaningful improvement with surgery. While smoking cessation should be strongly encouraged in all patients, lumbar decompression procedures for spinal stenosis and herniated disc should not be denied to smokers.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468011","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":"Gender differences in spine surgery for degenerative lumbar disease: prospective cohort study.","authors":"Mark A MacLean, Raphaële Charest-Morin, Alexandra Stratton, Supriya Singh, Adrienne M Kelly, Gwynedd E Pickett, Andrew Glennie, Christopher Bailey, Michael H Weber, Najmedden Attabib, Ahmed Cherry, Eric Crawford, Jerome Paquet, Nicolas Dea, Andrew Nataraj, Edward Abraham, Kelechi C Eseonu, Michael G Johnson, Hamilton Hall, Kenneth Thomas, Greg McIntosh, Charles G Fisher, Y Raja Rampersaud, Ryan Greene, Sean D Christie","doi":"10.3171/2024.7.SPINE231388","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE231388","url":null,"abstract":"<p><strong>Objective: </strong>Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions.</p><p><strong>Methods: </strong>Consecutive adult patients undergoing spinal surgery for degenerative lumbar conditions (disc herniation [DH], spinal canal stenosis [SCS], and degenerative spondylolisthesis [DS]) were prospectively enrolled across 16 tertiary academic centers. Outcome domains included pain, disability, health-related quality of life (HRQOL), expectations of surgery, and satisfaction with surgical outcome. Covariates pertaining to the preoperative use of healthcare resources, diagnostic testing, and visits to healthcare providers were compared between genders before and after propensity score matching for 13 baseline demographic and procedural variables.</p><p><strong>Results: </strong>Data were analyzed for 5038 patients (2396 female, 2642 male) with degenerative spinal pathologies including SCS (40.2%), DS (33.2%), and DH (26.6%). Surgical treatment effect was similar for both genders. For all conditions, female patients had worse pre- and postoperative pain, disability, and HRQOL. Significant gender differences were identified for marital status, education, employment status, exercise activities, and disability claims. Female patients were more likely to use select medications, diagnostic imaging tests, and nonsurgical therapeutic interventions, and access various healthcare providers. Findings were similar following post hoc propensity score matching.</p><p><strong>Conclusions: </strong>In this multicenter, prospective, observational cohort study, male and female patients benefitted similarly from surgery for degenerative lumbar spine disease. However, female patients had worse preoperative clinical assessment scores and were more likely to use select healthcare resources.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468008","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}