Spine最新文献

{"title":"Association of Glucagon-like Peptide-1 Receptor Agonist Use with Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease: A BMI-Stratified Retrospective Study.","authors":"Arman Kishan, Harmon S Khela, Nicolas L Carayannopoulos, Manjot Singh, Lara Cohen, Zvipo Chisango, Kyriakos Chatzis, Peter S Tretiakov, Shaleen Vira, Pawel P Jankowski, Andrew J Schoenfeld, Peter G Passias, Alan H Daniels","doi":"10.1097/BRS.0000000000005494","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005494","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort.</p><p><strong>Summary of background data: </strong>Spinal fusions are common interventions for degenerative spine disease (DSD), with increasing utilization in obese and metabolic syndrome populations. Glucagon-like peptide-1 (GLP-1) receptor agonists (RA), widely adopted for diabetes and weight management, may offer systemic benefits that exert a parallel influence on surgical outcomes.</p><p><strong>Objective: </strong>We aimed to evaluate whether preoperative GLP-1 RA use influences 90-day medical and 2- and 10-year surgical complications following thoracic and/or lumbar spinal fusion for DSD, stratified by BMI.</p><p><strong>Methods: </strong>Using a national claims database (2010-2023), we identified patients undergoing thoracic and/or lumbar spinal fusion for degenerative conditions. GLP-1 RA users within 6 months pre-op were 4:1 matched to controls by age, sex, and CCI across six BMI strata. Outcomes included 90-day medical and 2- and 10-year surgical complications (e.g., revisions for infection, pseudoarthrosis, and mechanical failure). Chi-square, t-tests, and Cox models were used for statistical analysis.</p><p><strong>Results: </strong>Among 291,677 patients, 19,232 GLP-1 RA users were matched to 76,778 controls. Ninety-day medical complications-such as infection, pneumonia, thromboembolism, sepsis, stroke, and UTI-were significantly reduced in GLP-1 RA users across BMI categories ≥25. Two-year surgical complications were lower among GLP-1 RA users in BMI 35-39.9 (1.1% vs. 1.6%, P=0.007 for pseudarthrosis-related revision; 0.8% vs. 1.2%, P=0.038 for mechanical failure) and ≥40 groups. At 10 years, GLP-1 RA use was associated with significantly reduced risk of revision in the 25.0-29.9 (HR 0.79, P=0.046) BMI group. Revision due to pseudarthrosis was reduced in BMI 35.0-39.9 (HR 0.69, P=0.014) and ≥40.0 (HR 0.73, P=0.041), while revision for mechanical failure was lower in BMI 35.0-39.9 (HR 0.65, P=0.013) and ≥40.0 (HR 0.57, P=0.003).</p><p><strong>Conclusion: </strong>GLP-1 RA use was linked with reduced perioperative and long-term surgical complications in patients undergoing thoracic and/or lumbar fusions for degenerative spine disease, particularly in those with BMI ≥25. This risk reduction may be attributed to weight loss and/or the systemic metabolic, inflammatory, and vascular benefits of these medications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993449","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":"Expandable, But at What Cost? Failure Patterns in Corpectomy Cages from 373 Real-World Adverse Events.","authors":"Daniel Schneider, Ethan D L Brown, Daniel Toscano, Barnabas Obeng-Gyasi, Aladine A Elsamadicy, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.1097/BRS.0000000000005492","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005492","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>This study aimed to analyze the failure patterns of expandable corpectomy cages.</p><p><strong>Summary of background data: </strong>Expandable corpectomy cages offer significant advantages for anterior column reconstruction but introduce unique mechanical complexities. Device-specific failure patterns and their clinical implications remain poorly characterized in the literature.</p><p><strong>Methods: </strong>We analyzed 373 adverse event reports involving expandable corpectomy cages from the FDA Manufacturer and User Facility Device Experience (MAUDE) database through October 2024. Using validated AI-assisted classification, reports were categorized by failure mode, anatomical location, revision status, and contributing factors. Chi-square tests with Bonferroni correction were used to assess associations between variables.</p><p><strong>Results: </strong>Inserter-related issues constituted the most common adverse events (34.3%), yet rarely resulted in clinical symptoms (5.4%) or revision surgery (21.9%). Conversely, less frequent mechanical failures demonstrated significantly higher revision rates: endplate subsidence (80.0%), device migration (77.8%), and structural fracture (63.8%). Failure modes showed distinct anatomical patterns, with migration predominating in the lumbar spine (31.4% vs. 2.3% cervical), while height loss occurred more frequently in cervical applications (20.5% vs. 7.8% lumbar). Among inserter issues, torque handle calibration failures (18.8%) and set screw complications (25.0%) accounted for nearly half of these events. Surgical technique was identified as the predominant contributing factor across all failure modes (28.7%), while inadequate fixation was specifically associated with device migration (35.6% of migration cases).</p><p><strong>Conclusion: </strong>For surgeons, the high reported prevalence of inserter complications may be a key consideration for device selection, particularly regarding set screw mechanisms, despite the apparent lesser clinical impact. Similarly, heightened vigilance may be warranted for lumbar applications of expandable corpectomy cages due to increased migration risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993517","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":"Prevalence of Neural Axis Abnormalities in Typical and Atypical Laterality Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Observational Studies.","authors":"Irene Cortés-Pérez, Juan Ramón Gallego-Siles, Esteban Obrero-Gaitán, Alfonso Javier Ibáñez-Vera, Ana Belén Peinado-Rubia, Rafael Lomas-Vega","doi":"10.1097/BRS.0000000000005485","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005485","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis of observational studies.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to assess the possible relationship between atypical laterality curves and NAA.</p><p><strong>Summary: </strong>Idiopathic scoliosis (IS) is a three-dimensional spinal deformity of unknown origin. Some studies have shown a high prevalence of neural axis abnormalities (NAAs) in patients with IS, with possible differences in the prevalence of NAAs between curves with typical (right thoracic/left lumbar) or atypical laterality (the rest).</p><p><strong>Methods: </strong>This review protocol was previously registered in PROSPERO (CRD42024544809). A systematic search of the PubMed, Scopus, Web of Science, CINAHL and Scopus databases was performed through September 30, 2024.</p><p><strong>Results: </strong>A total of 24 articles published between 1992 and 2021 involving 5379 subjects were included in the analysis. Twenty-four studies reported a prevalence of NAAs among patients with atypical laterality curves of 19.4% (95% CI 15.6 to 23.8) and 12.1% (95% CI 0.1 to 0.16) among those with typical laterality curves. Eleven studies estimated the prevalence of syringomyelia in patients with atypical laterality at 12.4% (95% CI 8 to 18.7) and that in patients with typical laterality at 6.1% (95% CI: 3.8 to 9.5). Eleven studies reported a prevalence of Arnold-Chiari syndrome in patients with atypical laterality of 12% (95% CI 6.9 to 20.1) and 7.7% (95% CI: 3.7 to 15.4) in those with typical laterality curves. Five studies reported a prevalence of tethered cord at 3.1% (95% CI 1.3 to 7.2; I²=0%) in patients with atypical laterality curves and a 2.1% (95% CI 0.5 to 8.8; I²=0%) prevalence among those with typical laterality.</p><p><strong>Conclusion: </strong>This study revealed that the prevalence of associated NAAs is greater among IS patients with atypical laterality curves, especially in patients with left dorsal curves and/or right lumbar curves. Syringomyelia is the most significant associated anomaly.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993501","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":"Postoperative Ketorolac Administration and Pseudoarthrosis Following Multilevel Posterior Cervical Decompression and Fusion: A Retrospective Cohort Study.","authors":"Julian Peregoff, Omkar S Anaspure, Amanda Moser, Ziad Hassan, Anthony N Baumann, Tensae Assefa, Nnaemeka Okorie, David Casper, Amrit Khalsa","doi":"10.1097/BRS.0000000000005493","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005493","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of perioperative ketorolac use after posterior cervical decompression and fusion (PCDF) remains unclear with ongoing concern regarding NSAID-induced pseudoarthrosis. This study investigates the association between postoperative ketorolac use and pseudoarthrosis after multilevel PCDF.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed adults undergoing multilevel PCDF (2002-2024) using TriNetX. Patients were grouped by postoperative ketorolac within 48 hours versus acetaminophen only. Propensity matching controlled for demographics, comorbidities, and surgical indications. Primary outcome was pseudarthrosis at four years; further secondary outcomes were assessed at 30 days, 1 year, and 4 years.</p><p><strong>Results: </strong>After matching, 1,376 patients were included in each cohort across 45 healthcare organizations. No significant differences were observed in pseudarthrosis (2.4% vs. 1.9%), reoperation (<10 instances), postoperative bleeding (0 instances), opioid prescription (13.8% vs. 13.5%), hardware complications (1.1% vs. 0.7%), pulmonary embolism (PE) (0 instances), deep vein thrombosis (DVT) (<10 instances), or surgical site infection (SSI) (<10 instances) at 30 days for the ketorolac group versus control. At 1-year no significant differences were seen in pseudarthrosis (6.3% vs. 6.3%), reoperation (1.7% vs. 2.0%), bleeding (0 instances), opioid use (35.6% vs. 34.8%), hardware issues (3.4% vs. 3.0%), PE (1.1% vs. 1.4%), DVT (1.4% vs. 2.1%), or SSI (1.1% vs. 0.8%). At 4 years, ketorolac use was linked to significantly reduced opioid prescriptions [RR 0.909; 95% CI (0.834, 0.980); P=0.0123], with no significant differences in pseudarthrosis (8.1% vs. 8.4%), reoperation (3.2% vs. 2.8%), bleeding (<10), hardware issues (5.2% vs. 4.7%), PE (1.7% vs. 1.7%), DVT (1.7% vs. 1.7%), or SSI (1.6% vs. 1.7%).</p><p><strong>Conclusion: </strong>Ketorolac administration following multilevel PCDF was not associated with increased rates of pseudarthrosis or other surgical complications at four years. Ketorolac use was linked to a modest reduction in oral opioid prescriptions. Ketorolac may be a safe and effective adjunct in postoperative analgesia.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993493","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 Lordosis Distribution Index on Proximal Junctional Kyphosis and Clinical Outcomes in Patients Undergoing Thoracolumbar Fusion for Degenerative Flatback Syndrome.","authors":"Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee, Se-Jun Park","doi":"10.1097/BRS.0000000000005489","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005489","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study using prospectively collected data.</p><p><strong>Objective: </strong>To investigate the impact of the lordosis distribution index (LDI) on proximal junctional kyphosis (PJK) and clinical outcomes in patients with degenerative flatback syndrome (DFS).</p><p><strong>Summary of background data: </strong>Proper lumbar lordosis (LL) correction is essential for successful outcomes in corrective surgery for DFS. However, the clinical significance of LDI remains debatable, likely due to the lack of a clear definition regarding normal LDI.</p><p><strong>Methods: </strong>Patients with DFS who underwent fusion from the low thoracic spine (T9-T12) to the pelvis with ≥2 years of follow-up were included. LDI correction status was categorized as undercorrection, matched correction, and overcorrection based on pelvic incidence (PI)-adjusted normative LDI values. The impact of LDI correction on PJK development and clinical outcomes was evaluated using logistic regression analysis, both with and without age-adjusted PI-LL correction status.</p><p><strong>Results: </strong>A total of 222 patients were included in the study (female, 89.6%; mean age, 69.6 y; mean fusion length, 7.7). PJK developed in 69 patients (31.1%) during a mean follow-up of 45.1 months. Logistic regression analysis revealed that LDI alone did not affect PJK development, but when combined with overcorrection of age-adjusted PI-LL (vs. matched correction; odds ratio [OR]=2.255, P<0.001), LDI overcorrection (vs. matched correction; OR=1.784, P=0.030) significantly increased the risk of PJK. Clinical outcomes were not influenced by the LDI correction status but were significantly affected by age-adjusted PI-LL correction status.</p><p><strong>Conclusions: </strong>LDI correction alone did not affect PJK occurrence, but in conjunction with age-adjusted PI-LL overcorrection, LDI overcorrection significantly increased the risk of PJK. Clinical outcomes were affected by age-adjusted PI-LL correction with best outcomes in matched correction group but not by the LDI correction status. This lack of association between LDI and clinical outcomes may be attributable to the fact that LDI alone did not have a significant effect on determining spinopelvic alignment.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993570","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":"Cost-effectiveness of Surgery for Spinal Metastasis: A Systematic Review.","authors":"Philip Heesen, Emil O R Nordin, Vivek Sanker, María José Cavagnaro, Corinna C Zygourakis, John Ratliff, Atman M Desai","doi":"10.1097/BRS.0000000000005486","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005486","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy.</p><p><strong>Summary of background data: </strong>The optimal treatment for many cases of spinal metastasis (SM) is surgery followed by adjuvant radiotherapy (RT). However, the cost-effectiveness of combined therapy (CT; surgery & RT) is unclear due to the short median survival time among SM patients and the higher costs of combined therapy compared to RT alone.</p><p><strong>Methods: </strong>We performed a systematic literature search from inception to 01/21/2024. We included studies that reported on the cost-effectiveness of surgical intervention for SM and assessed their quality using Quality of Health Economic Studies instrument.</p><p><strong>Results: </strong>We identified 5,024 studies of which 8 met our inclusion. All included studies were of fair to high quality. Of 7 studies that compared CT to definitive RT, six concluded that CT was cost-effective. Of note, one of the studies concluding that CT was cost-effective, only found CT to be cost effectiveness when considering patients with a 3-month survival probability above 50%. An additional study compared their calculated Incremental Cost Effectiveness Ratio (ICER) value to the standard Willingness to Pay (WTP) threshold in Thailand and concluded that CT was not cost-effective in Thailand. After comparing their reported ICER value to a commonly used WTP in the United States, we found CT to be cost-effective.</p><p><strong>Conclusions: </strong>We found CT consisting of surgery and RT to be cost effective in 6 out of 7 (85.7%) studies. Cost effectiveness might be even more pronounced in certain patient subgroups, such as patients with a high predicted survival. However, most studies did not report therapy details - a factor which could greatly influence cost-effectiveness.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993401","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":"Commentary on \"Letter to the Editor regarding Global, Regional, and National Burden of Low Back Pain Findings from the Global Burden of Disease Study 2021 and Projections to 2050\" by Cheng et al.","authors":"Mei Cheng, Yinkai Xue, Min Cui, Xianlin Zeng, Cao Yang, Fan Ding, Lin Xie","doi":"10.1097/BRS.0000000000005490","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005490","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969932","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":"Effect of Preoperative Nutritional Status on Postoperative Clinical Outcomes of Patients with Metastatic Spinal Tumors: Japan Association of Spine Surgeons with Ambition Multicenter Study.","authors":"Masafumi Kawai, Satoshi Kato, Noriaki Yokogawa, Takaki Shimizu, Satoru Demura, Yuki Shiratani, Akinobu Suzuki, Koji Tamai, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Koji Akeda, Norihiko Takegami, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Haruki Funao, Koji Uotani, Shinji Tanishima, Koichi Sairyo, Ko Hashimoto, Chizuo Iwai, Shoji Seki, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya","doi":"10.1097/BRS.0000000000005487","DOIUrl":"10.1097/BRS.0000000000005487","url":null,"abstract":"<p><strong>Study design: </strong>A multicenter prospective study.</p><p><strong>Objective: </strong>To evaluate the effect of preoperative nutritional status, assessed using the Prognostic Nutritional Index (PNI), on clinical outcomes, including survival prognosis, postoperative complications, hospitalization duration, and functional prognosis, in patients with metastatic spinal tumors undergoing surgery.</p><p><strong>Summary of background data: </strong>Malnutrition is common in patients with cancer and is associated with poor clinical outcomes. However, data on the role of nutritional status in metastatic spinal tumors are limited.</p><p><strong>Methods: </strong>We included 309 patients who underwent surgery for metastatic spinal tumors between October 2018 and March 2021. Patients were divided into two groups: normal nutrition (PNI ≥40) and malnutrition (PNI <40). Clinical outcomes, including 1-year mortality, postoperative complications, and functional improvements (performance status, Frankel grade, Barthel Index, Vitality Index, and EuroQol 5-Dimension 5-level), were compared using propensity score matching to adjust for confounding factors, such as age, sex, preoperative chemotherapy, performance status, primary tumor type, and visceral metastases.</p><p><strong>Results: </strong>Thirty-six percent of patients were malnourished. After propensity score matching, the malnutrition group had a significantly higher mortality rate within 1 year than the normal nutrition group (55% vs. 31%, P<0.001) and showed limited physical improvement, including neurological recovery, 1 month postoperatively. However, improvements in motivation and quality of life (QOL) were comparable between the groups, and physical function recovery at 6 months was similar. No significant differences in postoperative complications or length of hospital stay were observed between the groups.</p><p><strong>Conclusion: </strong>Preoperative malnutrition was observed in 36% of patients with metastatic spinal tumors who underwent surgery and was associated with a poor postoperative survival prognosis and delayed physical recovery. However, surgical treatment improved motivation, QOL, and physical function 6 months after surgery. These findings highlight the importance of assessing the nutritional status preoperatively and considering both survival and functional prognoses when selecting surgical treatment for patients with malnutrition.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969930","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":"Prospective Comparison of Posterior Decompression and ACDF for 1-2-Level Degenerative Cervical Myelopathy.","authors":"Tatsuya Yamamoto, Narihito Nagoshi, Junichi Yamane, Toshiki Okubo, Yasuhiro Kamata, Norihiro Isogai, Hitoshi Kono, Kanehiro Fujiyoshi, Yoshiomi Kobayashi, Reo Shibata, Takahiro Kitagawa, Takahito Iga, Kazuki Takeda, Satoshi Suzuki, Masahiro Ozaki, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1097/BRS.0000000000005491","DOIUrl":"10.1097/BRS.0000000000005491","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter cohort study.</p><p><strong>Objective: </strong>To compare clinical outcomes between posterior decompression without fusion (PD) and anterior cervical discectomy and fusion (ACDF) in patients with 1-2-level degenerative cervical myelopathy (DCM).</p><p><strong>Summary of background data: </strong>While numerous studies have assessed surgical strategies for multilevel DCM, limited evidence is available for cases involving only one or two levels.</p><p><strong>Methods: </strong>Among 1,482 patients with degenerative cervical spine disorders from 10 Japanese institutions, 353 patients with 1-2-level DCM treated with either PD (n=233) or ACDF (n=120) and followed for two years were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and Short Form-36 (SF-36). Group comparisons were adjusted for baseline characteristics and preoperative clinical outcomes using a general linear model.</p><p><strong>Results: </strong>Perioperative complication and reoperation rates did not significantly differ between groups. ACDF provided significantly greater improvements in VAS scores for neck pain (-22.6 mm vs. -6.1 mm, P=0.003), upper extremity pain/numbness (-32.7 mm vs. -18.3 mm, P=0.011), and SF-36 bodily pain (22.8 vs. 10.1, P=0.003) and physical component summary (PCS) scores (9.1 vs. 3.5, P=0.007) compared to the PD group. Conversely, PD yielded greater improvement in the SF-36 social functioning domain (13.3 vs. 2.6, P=0.011). No significant differences were observed in JOA scores, the five domains of JOACMEQ, or other SF-36 domains.</p><p><strong>Conclusions: </strong>Both PD and ACDF provided comparable improvements in neurological function as measured by JOA and JOACMEQ scores, indicating similar efficacy in treating DCM. ACDF was more effective for alleviating neck and arm pain and enhancing physical health, while PD resulted in social functioning. Given similar complication rates, surgical strategy should be individualized based on each patient's clinical presentation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Preoperative Dehydration on Outcomes after Single-Level Lumbar Fusion.","authors":"Jonathan Dalton, Teeto Ezeonu, Robert J Oris, Rachel Huang, Joydeep Baidya, Rajkishen Narayanan, Timothy Hagan, Catherine Alvaro, Claire Christman, Mark F Kurd, Ian David Kaye, Thomas D Cha, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Gregory Schroeder, Christopher Kepler","doi":"10.1097/BRS.0000000000005418","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005418","url":null,"abstract":"<p><strong>Background context: </strong>Preoperative laboratory testing can identify patients with health conditions that increase perioperative risk and represent opportunities for optimization.</p><p><strong>Purpose: </strong>To assess the effect of preoperative and postoperative day 1 (POD1) hydration status on outcomes after single-level lumbar fusion surgery.</p><p><strong>Study design/setting: </strong>Retrospective Cohort.</p><p><strong>Patient sample: </strong>Adult patients who underwent primary, elective, single-level lumbar fusion (2017-2021). Patients were excluded if they had chronic kidney disease (CKD) or end-stage renal disease (ESRD).</p><p><strong>Outcome measures: </strong>Length of stay (LOS), transfusion requirements, discharge disposition, 90-day emergency department (ED) visit, 90-day readmission, and 1-year spine reoperation.</p><p><strong>Methods: </strong>Patients were analyzed based on their preoperative and postoperative day 1 BUN/Creatinine ratio. Patients with a ratio ≥20 were considered dehydrated. Dehydrated patients were compared to hydrated patients preoperatively, postoperatively, and postoperatively within the group who was dehydrated preoperatively.</p><p><strong>Results: </strong>Preoperatively, 281/752 (37.4%) patients were dehydrated (BUN/Cr: 24.2 vs. 14.6; P<0.001). Preoperatively dehydrated patients were more likely to be older, female, and less likely to be current smokers (P<0.05). On multivariate regression, preoperative dehydration was independently predictive of reoperation and requiring a transfusion. Patients who remained dehydrated on POD1 were more likely to be older and have higher comorbidity burden. Amongst the full dehydrated group on POD1 (preoperatively either hydrated or dehydrated), patients were older, more commonly female, had higher comorbidity burden, and greater mean levels decompressed. On multivariate analysis, postoperative dehydration was independently predictive of transfusion need, but not non-home discharge or length of stay.</p><p><strong>Conclusion: </strong>Preoperatively dehydrated patients appear to be at increased risk of blood transfusion and spine re-operation after single-level lumbar fusion. Remaining or becoming dehydrated postoperatively, despite intraoperative rehydration, seem to be associated with increased age, female sex, more medical co-morbidities, and more extensive surgical decompression. These results suggest that hydration status may be another useful marker to risk-stratify and optimize patients during the preoperative and in-hospital period.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970021","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}