Journal of neurosurgery. Spine最新文献

{"title":"Neighborhood-level measures of socioeconomic status impact healthcare utilization and surgical outcomes in cervical spondylotic myelopathy patients in the Deep South.","authors":"Yifei Sun, Evan G Gross, Mohammad A Hamo, Sasha G Howell, James Mooney, Nicholas M B Laskay, Jakub Godzik","doi":"10.3171/2024.8.SPINE24604","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24604","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the association of neighborhood-level and individual-level measures of socioeconomic status with readmission, complication rates, and postoperative length of stay of patients with cervical spondylotic myelopathy (CSM) in the Deep South.</p><p><strong>Methods: </strong>The authors identified all patients undergoing surgical intervention for the treatment of CSM from November 2010 to February 2022 using Current Procedural Terminology and ICD-9/ICD-10 codes. Patient demographic, socioeconomic, perioperative, and postoperative data for each patient were collected via review of the electronic medical record. Patient addresses underwent geospatial analysis and were used to extract the Area of Deprivation Index (ADI). Patients with ADIs greater than 75 were considered highly deprived. Univariate comparison and multivariate logistic regressions were used to analyze the relationship between socioeconomic variables and outcomes of interest.</p><p><strong>Results: </strong>In total, 490 patients with CSM met the inclusion and exclusion criteria. The median age at the time of surgery was 60 (IQR 54-68) years. The median ADI was 75 (IQR 57-90). On multivariate regression analysis, unemployment was found to predict readmission within 1 year of index surgery (OR 4.08, 95% CI 1.87-9.61; p < 0.001). Having high ADI (OR 0.53, 95% CI 0.29-0.94; p = 0.033) and being African American (OR 0.51, 95% CI 0.26-0.97; p = 0.043) were found to be independently protective of readmission. Unemployment was found to be an independent predictor of postoperative complications (OR 3.65, 95% CI 1.52-9.82; p = 0.006). On multivariate regression analysis, high ADI (OR 1.69, 95% CI 1.02-2.81; p = 0.042) and living in a skilled nursing facility/residential facility (OR 8.84, 95% CI 3.08-28.5, p < 0.001) were independent predictors of prolonged length of hospital stay postoperatively.</p><p><strong>Conclusions: </strong>This is the first single-institution study investigating the influence of neighborhood-level and employment status on readmission, complications, and lengths of stay in patients with CSM in the Deep South. Neighborhood-level measures of socioeconomic status play complex and unique roles in CSM patient outcomes in the Deep South, highlighting the Deep South as a potentially unique geographic region in terms of neurosurgical outcomes. Further research is needed to evaluate methods of alleviating these disparities and improve patient outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927445","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. Methodological considerations for long-term lumbar surgery outcomes in patients with depression and anxiety.","authors":"Jixin Chen, Qinxin Zhou","doi":"10.3171/2024.9.SPINE241143","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE241143","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895461","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":"Maintaining stability at the lumbosacral-pelvic region in adult spinal deformity surgery without sacroiliac joint fusion: are 4 pelvic screws superior to 2 pelvic screws?","authors":"Sarthak Mohanty, Stephen R Stephan, Christopher Mikhail, Andrew Platt, Joshua Bakhsheshian, Fthimnir M Hassan, Erik Lewerenz, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke","doi":"10.3171/2024.8.SPINE231331","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE231331","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to compare a multiple pelvic screw fixation strategy (dual bilateral 4 pelvic screw fixation [4PvS]) with the use of single bilateral 2 pelvic screw fixation (2PvS), with the aim of addressing lumbosacral junction stability.</p><p><strong>Methods: </strong>This analysis is a single-center, retrospective review of ASD patients treated between 2015 and 2021. All patients had a minimum 2-year follow-up and spinal fusion to the sacrum without sacroiliac fusion and met at least one radiographic and procedural criterion: pelvic incidence-lumbar lordosis ≥ 20°, T1 pelvic angle ≥ 20°, sagittal vertical axis ≥ 7.5 cm, scoliosis ≥ 50°, three-column osteotomy, or spinal fusion of ≥ 8 levels. Two sacropelvic fixation methods were compared: 4PvS versus 2PvS. Primary outcomes included spinal implant-related reoperation and screw breakage, while secondary outcomes included reoperation for symptomatic pelvic screws, screw loosening or bending, L5-S1 pseudarthrosis, and patient-reported outcomes. Propensity score matching and inverse probability of treatment weighting (IPTW) were used to minimize selection bias and estimate causal treatment effects. Clinical outcomes were assessed using conditional multivariable logistic regression.</p><p><strong>Results: </strong>In this study of 406 patients (67.98% female, mean age 64.48 years), 349 patients (85.96%) received 2PvS and 57 (14.04%) received 4PvS. Age (OR 1.081, 95% CI 1.027-1.145) and total number of osteotomies (OR 1.180, 95% CI 1.048-1.355) emerged as independent predictors of receiving the 4PvS technique. In unmatched cohorts (n = 406), 2-year implant-related reoperation rates (p = 0.1896) and pelvic screw breakage rates (p = 0.2498) were not significantly different between groups. However, in the 4:1 propensity score-matched cohort, the 2-year reoperation rate (10.53% for 2PvS vs 3.51% for 4PvS; OR 3.27, 95% CI 1.10-9.74 [p = 0.0312]) and the pelvic screw breakage rate (9.21% for 2PvS vs 3.51% for 4PvS; OR 2.87, 95% CI 1.08-7.63 [p = 0.0349]) were significantly higher among the 2PvS groups. The IPTW analysis confirmed these findings, with reoperation rates of 10.45% for 2PvS and 1.18% for 4PvS (p = 0.0244) and pelvic screw breakage rates of 8.72% and 1.18%, respectively (p = 0.0477). A safety assessment revealed comparable operative times and intra- and perioperative complications between the two techniques.</p><p><strong>Conclusions: </strong>Patients who underwent 4PvS demonstrated significantly lower 2-year implant-related reoperation and pelvic screw breakage rates compared with 2PvS, with no differences in intraoperative or perioperative complications.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895467","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 propensity score-matched comparison between single-stage and multistage anterior/posterior lumbar fusion surgery: a Michigan Spine Surgery Improvement Collaborative study.","authors":"Anisse N Chaker, Michael Melhem, Dheeraj Kagithala, Edvin Telemi, Tarek R Mansour, Leticia Simo, Kylie Springer, Lonni Schultz, Kari Jarabek, Anneliese F Rademacher, Matthew Brennan, Enoch Kim, David R Nerenz, Jad G Khalil, Richard Easton, Miguelangelo Perez-Cruet, Ilyas Aleem, Paul Park, Teck Soo, Doris Tong, Muwaffak Abdulhak, Jason M Schwalb, Victor Chang","doi":"10.3171/2024.8.SPINE24423","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24423","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing anterior/posterior lumbar fusion surgery can undergo either a single-stage or multistage operation, depending on surgeon preference. The goal of this study was to assess different patient outcomes between single-stage and multistage lumbar fusion procedures in a multicenter setting.</p><p><strong>Methods: </strong>The Michigan Spine Surgery Improvement Collaborative database was queried for anterior/posterior lumbar fusion surgeries between July 2018 and January 2022. Patients who underwent either single-stage or multistage procedures were included. For multistage procedures, the first surgery included both anterior lumbar interbody fusions and lateral lumbar interbody fusions. Primary outcomes included postoperative complications and improvement in patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Physical Function, EQ-5D, and satisfaction. The two cohorts were propensity score matched, while Poisson generalized estimating equation models were used for multivariate analyses.</p><p><strong>Results: </strong>After one-to-one propensity score matching, 355 patients were identified in the single-stage and multistage cohorts. Single-stage procedures were associated with a lower risk of complications (p = 0.024), fewer emergency department visits (p = 0.029), and higher patient satisfaction after 1 year (p = 0.026) and 2 years (p = 0.007), compared with multistage procedures. After adjusting for baseline patient and operative characteristics, patients undergoing multistage procedures had a higher risk of complications (relative risk [RR] 1.17, 95% CI 1.02-1.34; p = 0.026), were less likely to be satisfied after 1 year (RR 0.83, 95% CI 0.74-0.93; p < 0.001), and were less likely to experience improvement in back pain after 90 days (RR 0.86, 95% CI 0.75-0.99; p = 0.039) and 2 years (RR 0.76, 95% CI 0.60-0.96; p = 0.023).</p><p><strong>Conclusions: </strong>The authors observed that patients who undergo lumbar fusion surgery using a multistage approach have higher postoperative complication rates and are less likely to report satisfaction compared with a matched, single-stage procedure cohort.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

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

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

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