Neurosurgical focus最新文献

{"title":"Do patients with government insurance payors experience delayed access to surgical care for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Abraham Dada, Niall Buckley, Satvir Saggi, Anthony DiGiorgio, Jay Kumar, Cheerag D Upadhyaya, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Chun-Po Yen, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni","doi":"10.3171/2025.12.FOCUS25951","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25951","url":null,"abstract":"<p><strong>Objective: </strong>Insurance status is known to influence access to spine surgery, but its role in cervical spondylotic myelopathy (CSM) remains underexplored. The authors hypothesized that government insurance payor status would be associated with delayed care access, evidenced by prolonged symptom duration and greater baseline symptom severity relative to those with private insurance.</p><p><strong>Methods: </strong>This was a prospective observational cohort study of 1085 patients enrolled in the Quality Outcomes Database CSM module of the 14-site Spine CORe™ study group. Patients were included if they had complete data for insurance, symptom duration, and baseline patient-reported outcomes (PROs). Insurance status was categorized as private, Medicare, Medicaid, or Veterans Affairs (VA)/federal. Primary outcomes included surrogates of access to care, assessed by symptom duration (> 12 months) and baseline PROs, i.e., the Neck Disability Index (NDI) and EQ-5D. Associations were evaluated using multivariable logistic regression analysis.</p><p><strong>Results: </strong>A total of 1085 patients with CSM who underwent surgery were enrolled, with more than 80% completing 5-year follow-up. Patients were excluded if they were uninsured or did not report baseline symptom duration, EQ-5D score, or NDI score, leaving a cohort of 977 patients for analysis. The proportion of patients reporting symptom duration > 12 months differed by insurance status (p < 0.001): highest in VA/federal (18/24, 75%), followed by Medicaid (45/70, 64%), Medicare (206/375, 55%), and private insurance (228/508, 45%). Compared to those who had private insurance, patients covered by VA/federal insurance (OR 3.85, 95% CI 1.56-10.89), Medicaid (OR 2.05, 95% CI 1.18-3.61), and Medicare (OR 1.98, 95% CI 1.39-2.82) had symptom duration > 12 months. Of patients with government insurance payors, Medicaid insurance status was independently associated with worse baseline disability (NDI: β = 7.35, 95% CI 2.35-12.35; p = 0.004) and lower quality of life (EQ-5D: β = -0.12, 95% CI -0.18 to -0.07; p < 0.001).</p><p><strong>Conclusions: </strong>Compared to patients with private insurance, patients covered by government insurance payors (VA/federal insurance, Medicare, and Medicaid) had significantly longer symptom duration before undergoing surgery. Patients with VA/federal insurance coverage had the longest symptom duration of the government payors. Of the government insurance payor types, Medicaid was the only one independently associated with significantly worse baseline disability (NDI) and quality of life (EQ-5D). After controlling for other factors, patients with government insurance coverage, and more specifically Medicaid, have difficulty accessing surgical care in a timely fashion to treat CSM compared to patients with private insurance.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E9"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818230","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 cervical disc arthroplasty noninferior to anterior cervical discectomy and fusion for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Daniel Zeitouni, Irina-Mihaela Matache, Izza Tahir, Hendrik von Kentzinsky, Erica F Bisson, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Mohamad Bydon, Anthony L Asher, Matthew J McGirt, Paul K Kim","doi":"10.3171/2025.12.FOCUS25945","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25945","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction, and anterior cervical discectomy and fusion (ACDF) is the gold standard treatment. Cervical disc arthroplasty (CDA) is a relatively novel, motion preserving alternative to ACDF. The aim of this study was to assess CDA versus ACDF in the surgical treatment of CSM at a 5-year follow-up.</p><p><strong>Methods: </strong>This study used the 14-site Spine CORe™ study group cervical module of the Quality Outcomes Database (QOD), which included 1085 patients. Baseline demographics, clinical variables, and surgical parameters were collected. Patient-reported outcome measures (PROMs) included the EQ-5D, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Of the 1085 patients, 22 patients who underwent CDA with baseline and 5-year follow-up PROMs data who met the inclusion/exclusion criteria were selected. Nearest-neighbor propensity score matching was performed using a 4:1 matching ratio. Five-year PROMs were compared between the CDA and ACDF groups using the 2-sample t-test for continuous variables. Multivariable linear regression was performed to identify predictors of 5-year myelopathy severity.</p><p><strong>Results: </strong>There were 1085 patients in the 14-site Spine CORe™ study group's QOD cervical module; 110 matched patients were analyzed, including 22 who underwent CDA (mean age 47.73 years) and 88 who underwent ACDF (mean age 48.89 years). The subcohort had 100% of PROMs data (NDI, NRS, EQ-5D, and mJOA) at the 5-year follow-up. There were no significant differences for 1- and 2-level operations between the CDA and ACDF groups (p = 0.34). There were no significant differences in 5-year PROMs between the two groups. Patients improved in each PROM category in both treatment groups when comparing baseline with 5-year PROMs. While the rate of reoperation at 5 years was higher in the ACDF group compared with the CDA group, there was no statistically significant difference (17.0% vs 9.1%, p = 0.52).</p><p><strong>Conclusions: </strong>In appropriately selected patients with CSM, CDA can provide comparable outcomes to ACDF while preserving cervical motion.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E14"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818091","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":"Should BMI influence anterior versus posterior approach surgery in patients with CSM? A 5-year Spine CORe™ analysis of QOD data.","authors":"Farhan A Khan, Peter J Chabot, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Andrew K Chan","doi":"10.3171/2025.12.FOCUS25940","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25940","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction worldwide and can be treated through anterior or posterior approaches. Both strategies achieve acceptable results, but the growing prevalence of obesity poses unique challenges. Data directly comparing outcomes across body mass index (BMI) strata are limited. Here, the authors examined rates of achieving minimal clinically important differences (MCIDs) in patient-reported outcomes (PROs) between anterior and posterior approaches relative to BMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a post hoc analysis of prospectively collected data from the 14-site Spine CORe™ study group of the Quality Outcomes Database (QOD). Baseline data and PROs-including numeric rating scale (NRS) neck and arm pain, Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scores-were collected through 60 months. Patients were stratified by an a priori BMI threshold of 30 kg/m2 and by surgical approach (anterior vs posterior). Multivariable regression was used to compare achievement of MCID across approaches within each BMI group. In parallel, unsupervised clustering of baseline-adjusted PROs was combined with a doubly robust estimation framework to assess approach-specific probabilities of achieving optimal outcomes across the continuous BMI spectrum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1085 patients, 759 (70.0%) underwent anterior and 326 (30.0%) underwent posterior surgery. Anterior approaches were associated with shorter length of stay and fewer nonhome discharges (p &lt; 0.001). For patients with BMI &lt; 30 kg/m2, anterior surgery conferred higher odds of achieving MCID in NRS arm pain (OR 0.45, p = 0.032). For those with BMI ≥ 30 kg/m2, anterior surgery was associated with greater odds of achieving MCID in mJOA (OR 0.32, p = 0.007) and NDI (OR 0.42, p = 0.031) scores. The results were consistent in sensitivity analyses. The doubly robust model identified a BMI range of 29.1-36.7 kg/m2, where anterior approaches significantly increased the probability of optimal outcomes (risk difference &gt; 8.1%; lower confidence interval &gt; 0). Anterior approaches also demonstrated greater probability of achieving optimal outcomes at higher BMIs, though without statistical significance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;For BMI &lt; 30 kg/m2, both approaches improved disability and quality of life, with anterior surgery offering added relief of arm pain. For BMI ≥ 30 kg/m2, anterior surgery provided superior functional and disability outcomes. Most importantly, anterior surgery became significantly more advantageous beginning at BMI 29.1 kg/m2. However, approach selection remains multifactorial, as anterior and posterior cohorts differed in mean age (anterior 58.7 vs posterior 64.5 years) and mean operated levels (anterior 1.9 vs posterior 4.2 levels). While anterior approaches may be most commonly employed for younger patients or for one- and","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E7"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does surgical approach affect headache relief in patients undergoing cervical fusion for subaxial cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Deb A Bhowmick, Benjamin Succop, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Oren N Gottfried","doi":"10.3171/2025.12.FOCUS25934","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25934","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Headache is a common complaint associated with cervical spondylotic myelopathy (CSM), presenting in more than one-third of patients. Surgical treatment of CSM has been linked to improved headache symptoms. The etiology of headache associated with subaxial cervical spine disorders is not well understood, nor is the mechanism of surgery in relieving symptom intensity. The authors hypothesized that surgical treatment of CSM has a positive impact on patients with headache symptoms, and that anterior cervical discectomy and fusion (ACDF) provides simpler access to foraminal decompression without disruption of posterior myofascial planes and thus could better relieve cervicogenic headache symptoms than a posterior approach. The present study seeks to compare the effect of posterior versus anterior approaches on headache symptom relief in patients with CSM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors conducted a post hoc analysis of prospectively collected data from the 14-site Spine CORe™ study group using their data from the cervical module of the Quality Outcomes Database (QOD). Patients who underwent cervical surgery via ACDF or posterior cervical laminectomy and fusion (PCLF) to treat CSM were included and reviewed. The primary outcome of Neck Disability Index (NDI) headache scores (Likert scale 0-5) were collected at baseline and at 3, 12, 24, and 60 months postoperatively. Patients with a minimum preoperative headache score of 1 at baseline were included in the analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of a total of 1085 patients in the QOD database, 697 with CSM and 5-year follow-up data endorsed headache preoperatively, with a median NDI headache score of 2 and a mean NDI headache score of 2.4 at baseline. The mean patient age was 58.6 (SD 11.5) years, 490 (70.3%) had concurrent neck pain and 251 (36.0%) had concurrent C2 (n = 3, 0.4%), C3 (n = 107, 15.4%), or C4 (n = 141, 20.2%) radiculopathy. Four hundred nineteen patients (60.1%) underwent ACDF, 119 (17.1%) underwent PCLF, with the remaining 159 (22.8%) undergoing anterior decompressions without fusion, laminoplasties, laminectomies, foraminotomies, or a combination of nonfusion decompression procedures. Postoperative headache intensities were lower than baseline intensities (Kruskal-Wallis test = 373, p &lt; 0.0001) by a median of 1 point. By the end of the 5-year follow up, 365 (87.1%) of the ACDF patients and 99 (83.2%) of the PCLF patients experienced at least some headache relief (χ2 = 0.49, p = 0.48), defined by ≥ 1-point ordinal scale improvement of the headache score. Furthermore, 201 (48%) ACDF and 42 (35.3%) PCLF patients experienced full headache relief (χ2 = 6.01, p = 0.01), defined as a decrease to a score of zero postoperatively. There was no effect of age (β = 0.5221, p = 0.32), concurrent neck pain (U = 46476, p = 0.56), or C2-4 radiculopathy (U = 24682, p = 0.98) on headache relief by the end of follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Surgi","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E4"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817982","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":"How much do patients benefit in quality of life after surgery for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Zachary Englander, Vardhaan S Ambati, Eunice Yang, Praveen V Mummaneni, Dean Chou, Mohamad Bydon, Erica F Bisson, Christopher I Shaffrey, Oren N Gottfried, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Juan S Uribe, Luis M Tumialán, Jay D Turner, Regis W Haid, Andrew K Chan","doi":"10.3171/2025.12.FOCUS25928","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25928","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction, leading to worsening disability and poor quality of life. The long-term benefits of surgery for patient quality of life remain incompletely defined. Given the current emphasis on value-based care, this study aimed to identify 1) how surgery improves quality of life and 2) what factors are associated with quality of life improvement in patients operated on for CSM.</p><p><strong>Methods: </strong>The Spine CORe™ study group performed a post hoc analysis of the prospectively collected, 14-site Quality Outcomes Database CSM cohort. The primary outcome was the 5-dimension EuroQol-5 (EQ-5D) score, assessed at baseline and at 3, 12, 24, and 60 months postoperatively. The minimal clinically important difference (MCID) for the EQ-5D score was defined as 0.11. A multivariable logistic model was used to identify preoperative factors associated with the MCID for the 60-month EQ-5D score, controlling for variables reaching a p value < 0.20 on univariate analysis. Quality-adjusted life years (QALYs) gained were also calculated using the area under the curve method, with baseline projected QALYs subtracted from observed values.</p><p><strong>Results: </strong>At 60 months, follow-up status was available for 895 of 1085 patients (82.4%). A total of 788 patients had EQ-5D scores recorded at 60 months for inclusion in the initial phase of this analysis. The mean EQ-5D score improved significantly from 0.58 ± 0.22 at baseline to 0.76 ± 0.22 at 60 months (p < 0.001), with gains evident by 3 months and sustained through all subsequent follow-up intervals. At 60 months, 58.7% of patients achieved the EQ-5D MCID. Multivariable analysis identified greater baseline numeric rating scale neck pain score and use of anterior cervical corpectomy and fusion (ACCF) as independent predictors of decreased odds of MCID achievement (p < 0.05). Conversely, lower baseline EQ-5D scores, corresponding to worse quality of life, were associated with increased odds of improvement (p < 0.05). The authors further found in the full cohort of patients that there was a mean QALY gain of 0.72 ± 1.11 following surgery.</p><p><strong>Conclusions: </strong>Patients undergoing surgery for CSM experience significant and durable postoperative improvements in their quality of life, with notable gains of 0.72 QALYs achieved 5 years after surgery. Additionally, more than 50% of patients achieve a clinically meaningful benefit in EQ-5D score at 5 years. Greater baseline neck pain severity and ACCF were associated with reduced odds of achieving the MCID, whereas worse baseline quality of life was associated with greater odds of achieving long-term improvement. Overall, these findings confirm that surgery for CSM yields sustained quality of life benefits for the majority of patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E2"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818011","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":"Predictors of long-term myelopathy relief in patients with moderate to severe cervical spondylotic myelopathy following surgery: a Spine CORe™ analysis of QOD data.","authors":"Joshua S Fuller, Harrison J Howell, Nathan J Winans, Praveen V Mummaneni, Dean Chou, Mohamad Bydon, Erica F Bisson, Christopher I Shaffrey, Oren N Gottfried, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, John J Knightly, Scott A Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Juan S Uribe, Luis M Tumialán, Jay D Turner, Regis W Haid, Andrew K Chan","doi":"10.3171/2025.12.FOCUS25932","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25932","url":null,"abstract":"<p><strong>Objective: </strong>Surgery for cervical spondylotic myelopathy (CSM) aims to halt disease progression. However, some patients will also ultimately note relief from their myelopathic symptoms. This study aimed to identify factors that predict improvement from moderate or severe myelopathy to mild or no myelopathy through an analysis of preoperative clinical and demographic data. Predictive models were developed to identify patients likely to achieve durable relief from myelopathy 24 months after surgery for CSM.</p><p><strong>Methods: </strong>Data were obtained from the Quality Outcomes Database (QOD) CSM dataset, a prospective registry cohort of 1085 patients from the 14 Spine CORe™ sites. Patients were excluded if they were younger than 18 years, were missing baseline or 24-month modified Japanese Orthopaedic Association scale (mJOA) scores, or had baseline mJOA score > 14. The remaining patients were partitioned into a training (n = 467) or test (n = 117) set. Logistic regression and random forest models, with and without principal component analysis, were trained to predict whether patients achieved mild/no myelopathy at 24 months, which was defined as an mJOA score of 15 or greater.</p><p><strong>Results: </strong>Overall, 584 patients (47.1% female) with moderate to severe myelopathy met the prespecified inclusion criteria, with a mean ± SD age of 61.7 ± 11.2 years, body mass index (BMI) 30.3 ± 6.3 kg/m2, and preoperative mJOA score 11.2 ± 2.4. At 24 months, 45% of patients (n = 263) had mJOA score > 14. There were no significant differences in performance between models with area under the receiver operating characteristic curve (AUROC) near 0.63 and area under the precision-recall curve (AUPRC) near 0.56. Significant positive predictors of postoperative relief from myelopathy in both the models and sensitivity analysis were symptom duration ≤ 12 months (OR 1.88, 95% CI 1.20-2.94, p < 0.01) and participation in activities outside the home (OR 2.19, 95% CI 1.12-4.27, p = 0.02).</p><p><strong>Conclusions: </strong>In a large prospective registry cohort of patients operated on for CSM, consistent factors associated with myelopathic symptom relief at 24 months were symptom duration ≤ 12 months and participation in activities outside the home. The finding that longer symptom duration was associated with a decreased propensity for relief from myelopathic symptoms suggests that earlier surgery may be beneficial for patients with moderate to severe myelopathy.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E3"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818084","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 surgery associated with improvement of sleep disturbance in patients with grade 2 lumbar spondylolisthesis? Insights from the Spine CORe™ analysis of QOD data.","authors":"Nima Alan, Abraham Dada, Jay Kumar, Vivian P Le, Jay D Turner, Juan S Uribe, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Vincent J Alentado, Mohamad Bydon, Paul Park, Michael Y Wang, Steven D Glassman, Mladen Djurasovic, Kevin T Foley, Cheerag D Upadhyaya, Timothy J Yee, Andrew K Chan, Dean Chou, Chun-Po Yen, Erica F Bisson, Regis Haid, Praveen V Mummaneni","doi":"10.3171/2025.12.FOCUS25957","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25957","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to evaluate the prevalence of sleep disturbance in patients with grade 2 lumbar spondylolisthesis and assess postoperative trajectories and predictors of improvement at 5 years. They hypothesized that surgical treatment of grade 2 spondylolisthesis would result in high rates of long-term improvement in sleep disturbance.</p><p><strong>Methods: </strong>Patients with grade 2 lumbar spondylolisthesis were identified from the 14-site Spine CORe™ study group within the Quality Outcomes Database (QOD). Sleep disturbance was measured using the sleep item of the Oswestry Disability Index (ODI) at baseline and 3, 12, 24, and 60 months postoperatively. The prevalence of baseline sleep disturbance was determined. Clinically meaningful improvement was defined using minimal clinically important difference thresholds. Predictors of improvement were analyzed using multivariate Firth's logistic regression, and associations with pain, disability, quality of life, and satisfaction were assessed.</p><p><strong>Results: </strong>A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At baseline, 300 of 328 patients (91.5%) reported sleep disturbance. The 60-month follow-up rate in this subgroup was 81% (21 died within 5 years of surgery of unrelated causes and 223 of the 300 patients followed up at 5 years). Improvement in sleep disturbance was observed in 165 patients (74.0%), while 58 patients (26.0%) continued to report sleep disturbance at 60 months. Those with improved sleep were more likely to achieve clinically meaningful gains in back pain (80.5% vs 50.0%, p < 0.001), leg pain (83.6% vs 53.4%, p < 0.001), EQ-5D (31.1% vs 7.3%, p < 0.001), and ODI (62.8% vs 5.3%, p < 0.001) scores, with a trend toward higher satisfaction in patients with improved sleep (88.5% vs 77.8%; risk difference 10.7%, 95% CI -0.01 to 0.23). On multivariate analysis, only private insurance (OR 2.20, 95% CI 1.03-4.78; p = 0.041) was associated with greater odds of 60-month sleep improvement.</p><p><strong>Conclusions: </strong>Sleep disturbance was highly prevalent in 91.5% of patients with grade 2 spondylolisthesis, and 74.0% experienced meaningful improvement by 3 months and this was sustained for 5 years following surgery. Sleep recovery was closely tied to gains in pain, disability, and quality of life. These results demonstrate that surgery for grade 2 spondylolisthesis not only improves mechanical symptoms but also substantially alleviates sleep disturbance.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E20"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818029","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":"What factors predict return to work after surgery for grade 1 lumbar spondylolisthesis? A 5-year Spine CORe™ analysis of QOD data.","authors":"Timothy J Yee, Vardhaan S Ambati, Jay Kumar, Swetha Atluri, Catherine Ravikumar, Arati Patel, Anthony DiGiorgio, Paul K Kim, Anthony L Asher, Eric A Potts, Erica F Bisson, John J Knightly, Kai-Ming G Fu, Michael S Virk, Kevin T Foley, Paul Park, Chun-Po Yen, Mohamad Bydon, Dean Chou, Andrew K Chan, Christopher I Shaffrey, Jonathan R Slotkin, Michael Y Wang, Regis W Haid, Steven D Glassman, Praveen V Mummaneni","doi":"10.3171/2025.12.FOCUS25961","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25961","url":null,"abstract":"<p><strong>Objective: </strong>Unemployment following surgery incurs significant societal costs. The authors aimed to identify predictors of return to work (RTW) following surgery for patients with grade 1 lumbar spondylolisthesis.</p><p><strong>Methods: </strong>This Spine CORe™ study is a post hoc analysis of prospectively collected data from the Quality Outcomes Database (QOD) grade 1 lumbar spondylolisthesis module. Patients were divided into 2 groups: employed preoperatively and unemployed preoperatively. Univariate and multivariate instruments were used to identify predictors of RTW/employment within 5 years postoperatively.</p><p><strong>Results: </strong>Across the 12 highest enrolling QOD sites (Spine CORe™ group), 608 patients were enrolled with 81% having Oswestry Disability Index (ODI) follow-up data. Of these 608 patients, 604 patients had baseline employment status recorded. Of 275 patients who were employed preoperatively, 249 had RTW follow-up data. Of the 329 patients unemployed preoperatively, 218 had RTW follow-up data. The study cohort follow-up for RTW was 77%. By 5 years postoperatively, 87.1% (n = 217) of those employed preoperatively and 22.0% (n = 48) of those unemployed preoperatively returned to work. In each cohort, there were no differences in age, sex, BMI, and American Society of Anesthesiologists class between those who did and those who did not RTW. These results remained consistent in the subgroup analysis of patients younger than 65 years at baseline. However, the only difference observed in this age group was within the preoperatively unemployed cohort, where the RTW group had a lower BMI (28.4 ± 5.5 vs 32.8 ± 9.0, p = 0.001). On multivariate analysis for the preoperatively employed cohort, college degree (OR 3.6, 95% CI 1.3-12.2) and active employment (OR 6.0, 95% CI 1.9-19.8) remained independent predictors of returning to work. For those preoperatively unemployed, a college degree (OR 2.2, 95% CI 1.1-4.4) independently predicted RTW.</p><p><strong>Conclusions: </strong>Approximately 87% of patients employed preoperatively RTW, and 22% of patients unemployed preoperatively returned to the workforce within 60 months after surgery for grade 1 spondylolisthesis. College-level education independently predicted RTW for both preoperatively employed and preoperatively unemployed patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E21"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818177","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":"What determines patient satisfaction after surgery for grade 2 lumbar spondylolisthesis? A Spine CORe™ analysis of QOD data.","authors":"Nima Alan, Paul Park, Abraham Dada, Jay Kumar, Vivian P Le, Jay D Turner, Juan S Uribe, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Mohamad Bydon, Michael Y Wang, Steven D Glassman, Kevin T Foley, Cheerag D Upadhyaya, Timothy J Yee, Andrew K Chan, Dean Chou, Chun-Po Yen, Erica F Bisson, Regis W Haid, Praveen V Mummaneni","doi":"10.3171/2025.12.FOCUS25960","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25960","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate predictors of patient satisfaction following surgical treatment of Meyerding grade 2 lumbar spondylolisthesis. The authors hypothesized that postoperative improvements in patient-reported outcomes (PROs) would be the primary determinants of satisfaction.</p><p><strong>Methods: </strong>Patients with grade 2 lumbar spondylolisthesis were identified from the Spine CORe™ study group of the Quality Outcomes Database, a multicenter consortium of 14 participating sites. This cohort comprises 328 patients with a 60-month follow-up rate of 81%. Demographic, clinical, and surgical characteristics were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back (NRS-BP) and leg pain (NRS-LP), and EQ-5D, measured at baseline and at 60 months. The primary outcome was satisfaction at 60 months, assessed using the North American Spine Society patient satisfaction index. Satisfaction was defined as a score of 1 (\"surgery met my expectations\") or 2 (\"I did not improve as much as I had hoped, but I would undergo the same surgery again\"). Minimal clinically important difference (MCID) thresholds were ≥ 14.3 for the ODI, ≥ 0.2 for the EQ-5D, ≥ 1.7 for the NRS-LP, and ≥ 1.6 for the NRS-BP. Univariate comparisons and logistic regression were performed to identify predictors of satisfaction.</p><p><strong>Results: </strong>A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At 5 years, follow-up data was complete in 266 patients (81%). Of these patients, 25 died within 5 years of surgery of unrelated causes and 241 had complete satisfaction scores at 5 years. At 60 months, 208 of the 241 patients were satisfied with surgery. Baseline demographic, comorbidity, and operative characteristics were similar between groups. Lower rates of 90-day readmissions were observed in satisfied patients (1.6% vs 19.4% p < 0.001). At 60 months, satisfied patients reported lower mean NRS-BP (2.6 vs 5.3, p < 0.001), NRS-LP (2.3 vs 5.2, p < 0.001), and ODI scores (8.9 vs 19.5, p < 0.001). MCID achievement was higher in satisfied patients for NRS-BP (78.3% vs 54.5%, p = 0.008), NRS-LP (79.8% vs 54.5%, p = 0.003), ODI (53.4% vs 15.2%, p < 0.001), and EQ-5D (30.0% vs 3.0%, p < 0.001) scores. In multivariable analysis, greater 5-year improvements in ODI (OR 0.88, p = 0.010) and NRS-LP (OR 0.74, p = 0.010) scores, as well as lower baseline NRS-LP scores (OR 0.54, p = 0.001) were independently associated with higher odds of satisfaction. No baseline demographic, comorbidity, or surgical factor predicted satisfaction.</p><p><strong>Conclusions: </strong>Eighty-six percent of patients with grade 2 lumbar spondylolisthesis were satisfied with results 5 years after surgery. Satisfaction was primarily associated with improvements in disability (ODI), while baseline and perioperative characteristics were not predictive.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E19"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does insurance type influence patient-reported satisfaction at 60 months following surgery for cervical myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Christine Park, Bradley Q Fox, Anthony M DiGiorgio, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Vincent J Alentado, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, John J Knightly, Scott Meyer, Paul Park, Kevin T Foley, Cheerag D Upadhyaya, Chun-Po Yen, Andrew K Chan, Dean Chou, Luis M Tumialán, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Oren N Gottfried","doi":"10.3171/2025.12.FOCUS25941","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25941","url":null,"abstract":"<p><strong>Objective: </strong>Surgical intervention is a standard treatment for severe cervical spondylotic myelopathy (CSM), but postoperative outcomes can vary based on socioeconomic characteristics such as insurance status. The aim of this study was to investigate the influence of insurance on patient-reported outcomes (PROs) at 60 months postoperatively.</p><p><strong>Methods: </strong>In this prospective cohort study, the Spine CORe™ study group analyzed data from the Quality Outcomes Database (QOD) database. Chi-square and Kruskal-Wallis tests were performed to identify the associations between sociodemographic and clinical variables and insurance type. The chi-square test was also used to examine the influence of insurance type on the achievement of minimal clinically important difference (MCID) for each outcome measure. Statistically significant covariates (p < 0.001) were used in a multivariate linear regression model measuring the influence of insurance type on 60-month changes in scores for neck and arm pain numeric rating scale (NRS), Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scores.</p><p><strong>Results: </strong>From a dataset of 1085 patients who underwent CSM surgery, 106 patients died during the 5-year follow-up period and 793 had an NDI score at the 5-year follow-up. The follow-up rate was 83% ([793 with NDI + 106 died]/1085 patients). Of the 1085 patients, the authors excluded patients with Veterans Affairs insurance, no insurance, or who were missing baseline PROs, which left 1030 patients with Medicare (n = 408), Medicaid (n = 75), and private (n = 547) insurance with 60-month PROs. Insurance status varied based on demographics and medical comorbidities (each p < 0.05). Medicaid patients had significantly worse scores at baseline and 60 months for arm and neck NRS, NDI, EQ-5D, and mJOA (each p < 0.05). In multivariate analysis after adjustment for relevant covariates, compared with private insurance, only Medicare insurance was associated with lower 60-month EQ-5D scores (β -0.05, 95% CI -0.09 to -0.01; p < 0.05). Otherwise, there was no significant difference in PROs. Medicaid insurance was not significantly associated with differences in any of the outcomes after covariate adjustment compared to private insurance.</p><p><strong>Conclusions: </strong>Despite having worse baseline scores, patients with Medicaid insurance coverage had similar rates of achievement of MCID compared with those with private insurance. These results suggest that patients with CSM who underwent surgery had improvement in PROs for all insurance types.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E8"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818289","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}