Journal of neurosurgery. Spine最新文献

{"title":"Correlation of anterior CSF space in the cervical spine with Chicago Chiari Outcome Scale score in adult females.","authors":"Philip A Allen, Francis Loth, Dorothy Loth, Mohamad Motaz Al Samman, Richard Labuda, Christine Herrera, Jayapalli Rajiv Bapuraj, Petra M Klinge","doi":"10.3171/2024.7.SPINE24370","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24370","url":null,"abstract":"<p><strong>Objective: </strong>Craniocervical junction morphology has been associated with Chiari malformation type I (CMI) symptom severity; however, little is known about its deterministic effect on surgical outcomes in patients across age and sex differences. The goal of the present study was to assess the effects of age and sex on surgical outcomes in CMI.</p><p><strong>Methods: </strong>In the present study, the authors examined MRI-based morphometric data from 115 individuals diagnosed with CMI (54 adults including 39 women and 15 men, and 61 children including 24 girls and 37 boys) and correlated them with Chicago Chiari Outcome Scale (CCOS) scores obtained 1 year after posterior fossa decompression. The authors assessed 7 craniocervical junction morphology-related measures that have been associated with CMI symptom severity: McRae line length, clivus length, Wackenheim angle, anterior and posterior CSF spaces, clivo-supraoccipital angle, and tonsillar position.</p><p><strong>Results: </strong>In the pediatric cohort, none of the morphometric measures correlated with CCOS score, but both anterior and posterior CSF spaces did in adults. To further study sex and age effects, the authors used age group (children vs adults) and sex (female vs male) as independent variables and ran 3 separate ANOVA tests using CCOS score, anterior CSF space, and posterior CSF space as dependent variables, respectively. Both CCOS and anterior CSF space analyses resulted in significant interactions. Specifically, women showed lower CCOS scores and smaller anterior CSF spaces than girls, boys, or men.</p><p><strong>Conclusions: </strong>These results provide evidence that joint age and sex differences moderate the surgical outcome of CMI patients. In females, smaller anterior CSF space was associated with lower CCOS score.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789629","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. Improving neurosurgical differences and recommendations for interventions by modifying the study model and covariates.","authors":"Yafei Wang, Chenran Zhang","doi":"10.3171/2024.9.SPINE241106","DOIUrl":"https://doi.org/10.3171/2024.9.SPINE241106","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789633","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":"Comparative analysis of the impacts of 30-day perioperative complications on patient-reported outcome measures following multilevel anterior versus posterior cervical fusion.","authors":"Adewale A Bakare, Jesus R Varela, Jacob Mazza, Ruth Saganty, Gibson Reine, John Stathopoulos, Harel Deutsch, John E O'Toole, Ricardo B V Fontes, Richard G Fessler, Vincent C Traynelis","doi":"10.3171/2024.8.SPINE24257","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24257","url":null,"abstract":"<p><strong>Objective: </strong>Many studies have compared outcomes following anterior and posterior cervical fusion, yet the differences in the impacts of perioperative complications on outcomes have not been well studied. This study aimed to assess the differences in the effects of 30-day perioperative complications on patient-reported outcome measures (PROMs) after multilevel anterior versus posterior cervical fusion.</p><p><strong>Methods: </strong>Adult patients who underwent anterior or posterior cervical fusion at three or more levels between 2014 and 2020 were analyzed. Each group was subdivided based on the occurrence and severity of perioperative complication: no complication versus minor complication versus major complication. The study primarily compared PROMs and minimal clinically important differences (MCIDs) within and between the groups.</p><p><strong>Results: </strong>A total of 146 anterior (102 with no complications, 36 with minor complications, 8 with major complications) and 55 posterior (36 with no complications, 13 with minor complications, 6 with major complications) cervical fusion cases were analyzed. Within the anterior or posterior group, there were no significant differences in the PROM change or proportions of patients achieving the MCID. In comparing the anterior group with the posterior group, anterior patients without complications had better improvement in the 3-month Neck Disability Index (coefficient 11.2, p = 0.019), with higher odds of achieving the MCID for the modified Japanese Orthopaedic Association score at 3 months (OR 2.0, p = 0.039). Otherwise, there were no significant differences in the PROM change or proportions of patients achieving the MCID in subsets of anterior or posterior patients with minor or major complications. Furthermore, patients with major complications had higher early readmission rates regardless of the surgical approach. Major complications were also associated with longer and increased rates of intensive care unit stays after posterior fusion compared with anterior fusion.</p><p><strong>Conclusions: </strong>This study suggests that the severity of perioperative complications following anterior or posterior cervical fusion did not predict changes in PROMs or achievement of MCIDs in the anterior or posterior group. Also, PROMs may not fully differentiate the full extent of the impact of perioperative complications following anterior versus posterior cervical fusion. Otherwise, in subsets of patients without complications, anterior compared with posterior patients had improved Neck Disability Index scores at 3 months, with a significant proportion of patients achieving the MCID for the modified Japanese Orthopaedic Association score at 3 months.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789627","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":"External validation of the Spinal Infection Treatment Evaluation score: a single-center 19-year review of de novo spinal infections.","authors":"Esteban Quiceno, Mohamed A R Soliman, Ali M A Khan, Alexander O Aguirre, Rehman Ali Baig, Umar Masood, Megan D Malueg, Asham Khan, John Pollina, Jeffrey P Mullin","doi":"10.3171/2024.7.SPINE24394","DOIUrl":"https://doi.org/10.3171/2024.7.SPINE24394","url":null,"abstract":"<p><strong>Objective: </strong>The escalating incidence of de novo spinal infections poses a substantial neurological impact on patients. This has prompted a growing interest in discerning which patients would derive greater benefit from medical as opposed to surgical management of these occurrences. The authors assessed the predictive applicability of the Spinal Infection Treatment Evaluation (SITE) score in discerning between surgical intervention and medical management. This assessment represents the first external validation of the SITE score conducted in a cohort of patients with de novo spinal infections.</p><p><strong>Methods: </strong>A comprehensive retrospective chart review was conducted to identify patients diagnosed with de novo spinal infections (osteomyelitis, discitis, or epidural abscess) at a tertiary center between July 1, 2004, and March 31, 2023. All necessary data for calculating the SITE score were collected for each patient. Surgical intervention was advised for patients scoring 0-8 or exhibiting acute plegia or bladder or bowel dysfunction and optional for those scoring 9-12; medical treatment was recommended for patients scoring 13-15. Predictability of the score was scrutinized using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Among 194 identified patients, the mean ± SD age was 65.96 ± 13.66 years and 58% were men. Stratification of patients based on medical and surgical management revealed that 27% underwent medical treatment alone and 73% required surgical intervention. In the medical group, 72.2% of patients were neurologically intact compared to 50% in the surgical group (p = 0.006). Surgically managed patients exhibited a higher incidence of spinal stenosis with impingement of the spinal cord, with or without deformity, when compared to nonsurgical patients (38.6% vs 22.2%, p = 0.04). Additionally, surgically managed patients had a lower mean ± SD SITE score (7.16 ± 2.39 vs 8.2 ± 2.33, p < 0.005) and were more likely to have multilevel infection than patients who underwent medical management (59.3% vs 33.3%, p < 0.001). When patients were categorized on the basis of SITE score, the sensitivity of the score (using a threshold of 8) to predict surgical management was 68.6% and specificity was 59.3%. According to ROC curve, the SITE score exhibited an AUC of 0.66.</p><p><strong>Conclusions: </strong>Validation of the SITE score could not accurately predict medical versus surgical management in a tertiary center cohort of patients with de novo spinal infections. Further multicenter studies incorporating additional variables and larger cohorts are imperative to develop an optimal predictive tool.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789631","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":"Outpatient lateral lumbar interbody fusion: single-institution consecutive case series.","authors":"Nima Alan, Katriel E Lee, Juan Pablo Leal Isaza, Juan P Giraldo, Robert K Dugan, James J Zhou, S Harrison Farber, Luke K O'Neill, Juan S Uribe","doi":"10.3171/2024.7.SPINE231041","DOIUrl":"10.3171/2024.7.SPINE231041","url":null,"abstract":"<p><strong>Objective: </strong>Outpatient spine surgery could reduce hospital costs and improve patient outcomes. Outpatient lateral lumbar interbody fusion (LLIF) can be performed for select patients. This study identified and compared the demographic, clinical, and surgical characteristics of patients who underwent outpatient versus inpatient single-level LLIF.</p><p><strong>Methods: </strong>A retrospective review was conducted of a prospectively collected database of patients who underwent first-time single-level LLIF at a single institution performed by the same surgeon from January 1, 2017, through December 31, 2022. Demographic characteristics, including age, sex, BMI, and medical comorbidities, were collected. Surgical factors, such as level of surgery, operative duration, and estimated blood loss, were also collected. Length of stay and 30-day readmission were the primary outcomes of interest. Patients discharged on the day of surgery or the following day were considered to be in the outpatient group. ANOVA and chi-square tests were performed to compare continuous and categorical variables, respectively. Univariate logistic regression was used to examine the correlation between baseline demographic and surgical variables and outpatient surgery. If a variable significantly correlated with outpatient surgery on univariate analysis, it was subsequently used in multivariate logistic regression.</p><p><strong>Results: </strong>A total of 107 patients underwent first-time single-level LLIF, and 48 (44.9%) did not have posterior instrumentation. Fifty-three (49.5%) patients were women. The median age and BMI were 66.3 years and 28.9, respectively. The mean length of stay was 1 day (range 0-4 days), with 71 (66.4%) of 107 single-level LLIFs managed on an outpatient basis. There were no readmissions within 30 days. Patients in the outpatient group were more likely than patients in the inpatient group to be male (59% [42/71] vs 25% [9/36], p = 0.002), have a low LACE (risk criteria based on length of stay, acuity of the admission, comorbidity of the patient, and emergency department use within 6 months before admission) readmission index (63% [45/71] vs 28% [10/36], p < 0.001), and have a stand-alone construct (62% [44/71] vs 11% [4/36], p < 0.001). The outpatient cohort also had a shorter mean operative duration (104.4 vs 175.5 minutes, p < 0.001) and lower mean estimated blood loss (20 vs 100 mL, p < 0.001). There was no difference in age between the groups. Factors that remained significant on multivariate logistic regression were male sex (OR 0.14, 95% CI 0.04-0.53; p = 0.004), lower LACE readmission index (OR 0.06, 95% CI 0.02-0.25; p < 0.001), and stand-alone construct (OR 8.17, 95% CI 1.49-44.74; p = 0.02).</p><p><strong>Conclusions: </strong>Multiple baseline and surgical characteristics were more common in the outpatient setting. With appropriate patient selection, single-level LLIF can be achieved on an outpatient basis.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"140-146"},"PeriodicalIF":2.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical strategy for metastatic spinal tumors based on Spine Instability Neoplastic Score and patient-reported outcomes: JASA multicenter prospective study.","authors":"Hideaki Nakajima, Shuji Watanabe, Kazuya Honjoh, Arisa Kubota, Yuki Shiratani, Akinobu Suzuki, Hidetomi Terai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya","doi":"10.3171/2024.7.SPINE24340","DOIUrl":"10.3171/2024.7.SPINE24340","url":null,"abstract":"<p><strong>Objective: </strong>Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis.</p><p><strong>Results: </strong>Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0-6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0-9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery.</p><p><strong>Conclusions: </strong>Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient's background and the plan for postoperative adjuvant therapy.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"203-214"},"PeriodicalIF":2.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755217","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":"Perioperative outcomes after minimally invasive and open surgery for treatment of spine metastases: a systematic review and meta-analysis.","authors":"Husain Shakil, Ahmad Essa, Armaan K Malhotra, Alex Kiss, Christopher D Witiw, Donald A Redelmeier, Jefferson R Wilson","doi":"10.3171/2024.7.SPINE24518","DOIUrl":"10.3171/2024.7.SPINE24518","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis compared minimally invasive surgery (MIS) to open surgery for treatment of spinal metastases with respect to perioperative outcomes. Few studies have systemically assessed the body of evidence on this topic.</p><p><strong>Methods: </strong>A systematic review of EMBASE and PubMed from database inception to December 2023 was performed to identify studies comparing MIS with open surgery for the treatment of spine metastases. Nine outcomes were collected: estimated blood loss (EBL), operative time, hospital length of stay (LOS), risk of revision, risk of neurological deterioration, likelihood of receiving postoperative radiation therapy, time to radiation therapy, time to chemotherapy, and treatment of pain measured through patient-reported visual analog scale (VAS) scores. Meta regression was used to estimate adjusted mean differences (aMDs) and adjusted odds ratios (aORs) for outcomes. Certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations approach.</p><p><strong>Results: </strong>There were 34 eligible studies including 1656 patients with spinal metastases; 904 (54.6%) patients were treated with MIS and 752 (45.4%) were treated with open surgery. MIS was associated with significantly less blood loss (aMD -602 mL, 95% CI -1204 to -0.2 mL; I2 = 97%) with a moderate certainty of evidence. MIS was found to be noninferior with respect to operative time (aMD -2.6 minutes, 95% CI -53.3 to 48.1 minutes; I2 = 88%), risk of revision (aOR 0.9, 95% CI 0.8-1.1; I2 < 0.01), risk of neurological deterioration (aOR 0.9, 95% CI 0.8-1.0; I2 < 0.01), likelihood of postoperative radiation therapy (aOR 0.9, 95% CI 0.7-1.4; I2 < 0.01), and postoperative VAS score (aMD -0.6, 95% CI -1.5 to 0.4; I2 = 52%) with low certainty of evidence. MIS was associated with significantly shorter time to chemotherapy (MD -0.9 weeks, 95% CI -1.9 to -0.01 weeks; I2 = 22%), with very low certainty of evidence. Inferences for LOS and time to radiation were indeterminate; however, we found a trend toward earlier radiation therapy with MIS that was significant in the subgroup of patients treated with decompression and fusion.</p><p><strong>Conclusions: </strong>Treatment with MIS compared with open surgery was associated with reduced EBL, shorter time to chemotherapy, similar operative time, and similar reductions in postoperative pain. Limitations were largely due to heterogeneity across studies. Future research among subgroups is very likely to improve certainty in the comparative effect estimates.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"215-229"},"PeriodicalIF":2.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755203","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":"When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.","authors":"Peter G Passias, Peter Tretiakov, Oluwatobi O Onafowokan, Ankita Das, Renaud Lafage, Justin S Smith, Breton G Line, Pratibha Nayak, Bassel Diebo, Alan H Daniels, Jeffrey L Gum, D Kojo Hamilton, Thomas J Buell, Alex Soroceanu, Justin K Scheer, Robert K Eastlack, Jeffrey P Mullin, Andrew J Schoenfeld, Gregory M Mundis, Naobumi Hosogane, Mitsuru Yagi, Praveen V Mummaneni, Dean Chou, Kai-Ming Fu, Khoi D Than, Neel Anand, David O Okonkwo, Michael Y Wang, Eric Klineberg, Khaled M Kebaish, Stephen Lewis, Richard Hostin, Munish Gupta, Lawrence Lenke, Han Jo Kim, Christopher P Ames, Christopher I Shaffrey, Shay Bess, Frank Schwab, Virginie Lafage, Douglas Burton","doi":"10.3171/2024.8.SPINE24365","DOIUrl":"10.3171/2024.8.SPINE24365","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.</p><p><strong>Methods: </strong>Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts. Backstep logistic regression and conditional inference tree analysis were used to identify variable thresholds associated with study-specific definitions of an optimal outcome in each cohort, defined as no intraoperative or surgery-related in-hospital adverse event.</p><p><strong>Results: </strong>There were 439 patients with complex ASD in the dataset (mean age 64.0 ± 9.3 years, 68% female, mean BMI 28.7 ± 5.5 kg/m2). Overall, 58.8% of patients were in the same-day group, while 41.2% were in the staged group. Demographically, cohorts were not significantly different (p > 0.05), but staged patients were more frail per total Edmonton Frail Scale score (p = 0.043). Staged patients also reported greater numeric rating scale scores for back pain than same-day patients (p = 0.002). Cohorts were comparable in magnitude of planned correction of C7-S1 sagittal vertical axis, pelvic incidence-lumbar lordosis (PI-LL) mismatch, and T4-12 kyphosis (all p > 0.05). Controlling for baseline age, frailty, and number of levels fused, staged patients reported significantly higher PROMIS Discretionary Social Activities scores by 6 weeks (p = 0.029). Radiographic outcomes by 6 weeks were comparable between cohorts, in terms of both magnitude of change from baseline and overall result (all p > 0.05). Same-day patients were significantly more likely to experience in-hospital complications (p = 0.013). When considering frailty thresholds for staging, only a Charlson Comorbidity Index ≤ 1.0 was associated with optimal outcome in same-day patients, while Edmonton Frail Scale score ≥ 7 (p = 0.036), ≥ 9 levels fused (p = 0.016), and baseline PI-LL mismatch ≥ 15.3° (p = 0.028) were associated with optimal outcome for staged patients. Yet, staging alone was not significantly associated with an optimal outcome perioperatively (p = 0.056).</p><p><strong>Conclusions: </strong>While staged and same-day combined-approach surgeries yield comparable radiographic and patient-reported outcomes, certain subsets of complex ASD patients may benefit from staged surgery despite the invariably increased hospital length of stay. Individuals with increased frailty, moderate to severe PI-LL mismatch, and increased anticipated number of levels fused may experience a lower risk of perioperative adverse events if they undergo a staged procedure. Clinical trial registration no.: NCT04194138 (ClinicalTrials.gov).</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"185-192"},"PeriodicalIF":2.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693215","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. Outcome associated with novel biologics in posterior lumbar fusion.","authors":"Vishwajeet Singh","doi":"10.3171/2024.9.SPINE241091","DOIUrl":"10.3171/2024.9.SPINE241091","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"249"},"PeriodicalIF":2.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693213","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":"Fractional curve following adult idiopathic scoliosis correction: impact of curve magnitude on postoperative outcomes.","authors":"Alan H Daniels, Manjot Singh, Mohammad Daher, Mariah Balmaceno-Criss, Renaud Lafage, Munish C Gupta, Jeffrey L Gum, Kojo D Hamilton, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Lawrence G Lenke, Christopher P Ames, Eric O Klineberg, Han Jo Kim, Christopher I Shaffrey, Justin S Smith, Breton G Line, Frank J Schwab, Shay Bess, Virginie Lafage, Bassel G Diebo","doi":"10.3171/2024.7.SPINE24519","DOIUrl":"10.3171/2024.7.SPINE24519","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to assess the impact of fractional curve (FC) severity on curve progression and postoperative outcomes in patients undergoing adult idiopathic scoliosis (AdIS) correction.</p><p><strong>Methods: </strong>Patients with AdIS who had preoperative coronal plane deformity and who had undergone thoracolumbar fusion with a lowermost instrumented vertebra (LIV) between L1 and L4 were included. Patients were stratified by 6-week postoperative FC severity (small FC, ≤ 40th percentile, large FC, ≥ 60th percentile of the entire cohort; calculated as the Cobb angle between LIV and S1) and age groups. Preoperative to 2-year postoperative changes in FC were evaluated using Student t-tests. Demographics, spinopelvic alignment, patient-reported outcome measures (PROMs), and complications were compared using chi-square tests for categorical variables and Student t-tests for quantitative variables. Multivariate regression analyses, accounting for age, sex, frailty, and 6-week postoperative LIV, were also performed when feasible to assess the impact of FC on 2-year postoperative outcomes.</p><p><strong>Results: </strong>In total, 86 patients, with 34 in the group with small FCs and 34 in the group with large FCs, were examined (18 were in the group with medium FC). The mean age (36.4 years for those with small FCs vs 36.0 years for those with large FCs, p > 0.05) was similar. Preoperatively, spinopelvic parameters and PROMs were comparable (p > 0.05). Two years postoperatively, higher postoperative FC was associated with larger thoracolumbar deformity (i.e., higher thoracolumbar/lumbar/lumbosacral Cobb angles) and lower perceived lumbar stiffness (p < 0.05); however, other PROMs and complications, including revisions, were comparable (p > 0.05). Bidirectional change in postoperative FC was associated with a lower C7 pelvic angle and lower C7 plumb line (R2 = -0.03, 95% CI -0.05 to 0.00, p = 0.050). Across all patients, the mean FC improved from baseline to 6 weeks postoperatively (from 18.1° to 6.5°, p < 0.001) but changed minimally from 6 weeks to 2 years postoperatively (from 6.5° to 6.5°, p = 0.942). After stratification, the cohort with small FCs exhibited a relative increase (from 1.6° to 3.5°, p < 0.001), whereas the cohort with large FCs noted a nonsignificant change (from 11.9° to 9.8°, p = 0.121) in FC over time.</p><p><strong>Conclusions: </strong>Following surgery for AdIS, larger residual lumbosacral FCs were not correlated with adverse events or poor outcomes at 2 years postoperatively. FCs may improve or worsen over time to drive improvement in global coronal balance surgery, but are not associated with adverse outcomes or reoperation during the first 2 years after surgery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"193-202"},"PeriodicalIF":2.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639034","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}