Spine最新文献

{"title":"The Role of the Lumbar Paravertebral Muscles in the Development of Short-term Residual Pain After Lumbar Fusion Surgery.","authors":"Haifu Sun, Wenxiang Tang, Xingyu You, Lei Deng, Liuyu Chen, Zhonglai Qian, Huilin Yang, Jun Zou, Yusen Qiao, Hao Liu","doi":"10.1097/BRS.0000000000005303","DOIUrl":"10.1097/BRS.0000000000005303","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective real-world study.</p><p><strong>Objective: </strong>Using machine learning models to identify risk factors for residual pain after PLIF in patients with degenerative lumbar spine disease.</p><p><strong>Summary of background data: </strong>Residual pain after PLIF is a frequent phenomenon, and the specific risk factors for residual pain are not known.</p><p><strong>Materials and methods: </strong>Between June 2018 and March 2023, 936 patients with lumbar degenerative disease who underwent PLIF surgery were recruited. Group A (n=501) had <7 days of VAS ≥3 pain within 1 month post-PLIF, whereas group B (n=435) had ≥7 days. Imaging outcomes included PMI, MMI, MMD, lumbar lordosis (LL), and LL improvement rate. Functional outcomes were assessed by VAS. Univariate and multivariate logistic regression analyses were used to determine the potential risk of short-term postoperative pain. Risk factors were identified using machine learning models and predicted whether residual pain would occur.</p><p><strong>Results: </strong>A total of 435 (46.5%) patients experienced residual postoperative pain. Independent risk factors included surgical segment, PMI, MMI, and depression level. The Random Forest Model model had an accuracy of 95.7%, a sensitivity of 96.4%, a specificity of 94.1%, and an F1 score of ~95.2% for predicting recurrent pain, indicating high reliability and generalizability.</p><p><strong>Conclusions: </strong>Our study reveals risk factors for the development of residual pain after PLIF. Compared to the pain group, the non-pain group had better paravertebral muscles, good psychological level, lower surgical segment and LL improvement rate. These factors may represent targets for preoperative and perioperative optimization as a means to minimize the potential for residual pain after PLIF.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"537-547"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Paraspinal Muscle in Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis: A Two-Year Follow-Up Study.","authors":"Xing Chen, Rongkun Xu, Suomao Yuan, Wenyang Fu, Xinzhi Zhang, Yuchen Zhang, Lianlei Wang, Xinyu Liu","doi":"10.1097/BRS.0000000000005132","DOIUrl":"10.1097/BRS.0000000000005132","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether paraspinal muscle could influence postoperative coronal balance and its transition in degenerative lumbar scoliosis (DLS).</p><p><strong>Summary of background data: </strong>Although the importance of the paraspinal muscles (PSM) in sagittal alignment is well recognized, there is no information about its role in coronal balance.</p><p><strong>Methods: </strong>The study included 102 DLS patients. Evaluation of the PSM on magnetic resonance imaging were conducted at baseline. Coronal measurements included coronal balance distance (CBD), major Cobb angle, L4 coronal tilt, and L5 coronal tilt. The cohort was divided based on postoperative parameters into persistent coronal balance (PCB), worsened coronal imbalance (WCIB), recurrent coronal balance (RCB), and persistent coronal imbalance (PCIB) according to immediate postoperative and follow-up coronal balance. Multivariate logistic regression models for postoperative CIB, follow-up WCIB and follow-up RCB were utilized to identify statistically significant associations while accounting for confounders.</p><p><strong>Results: </strong>The cohort was divided into 57 with PCB, 13 with WCIB, 10 with RCB, and 22 with PCIB. The follow-up groups with CIB exhibited more severe fatty infiltration in the extensor muscle compared with the balanced groups. Specifically, the WCIB group demonstrated the most severe extensor muscle degeneration, particularly on the concave sides, and the most prominent asymmetric degeneration of the PSM among the four groups. Furthermore, patients with CIB had worse sagittal malalignment compared with those with CB at the last follow-up.</p><p><strong>Conclusions: </strong>Patients exhibiting stronger extensor muscle mass were prone to immediate postoperative CB and more likely to experience spontaneous improvement or recurrence of coronal balance during follow-up. Severe extensor muscle degeneration and prominent asymmetric bilateral PSM degeneration represent potential risk factors for persistent CIB and recurrent CIB. It is crucial to assess the dynamic change during the follow-up period as long-term prognosis may be impacted if CB deteriorates, or otherwise develops during follow-up.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"528-536"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073923","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 Instrumented Versus Uninstrumented Posterolateral Fusion for Single-Level Degenerative Spondylolisthesis.","authors":"Andreas K Andresen, Mikkel Ø Andersen, Leah Y Carreon, Jan Sørensen","doi":"10.1097/BRS.0000000000005310","DOIUrl":"10.1097/BRS.0000000000005310","url":null,"abstract":"<p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Objective: </strong>The aim of this study was to investigate whether instrumented posterolateral fusion is cost-effective compared with uninstrumented posterolateral fusion in elderly patients who undergo fusion surgery for one-level degenerative spondylolisthesis with spinal stenosis.</p><p><strong>Summary of background data: </strong>For patients with persistent symptoms due to degenerative spondylolisthesis, surgical intervention may be recommended, typically decompression and fusion. Evidence on cost-effectiveness of choice of fusion method, related complications, and outcome is sparse.</p><p><strong>Methods: </strong>This cost-effectiveness analysis is based on a single-center, open-label, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either instrumented or un-instrumented posterolateral fusion. Quality-Adjusted Life Years were obtained from EQ-5D. Use of health services was obtained from patient charts and accumulated until 2 years after index surgery.</p><p><strong>Results: </strong>Of the 108 patients included in the study, 107 patients received the allocated intervention. There were no differences in preoperative demographics. Although the base price for the index instrumented surgery was significantly higher than the index uninstrumented surgery, average cost of surgery was only €146 higher in the instrumented group based on two-year cost data. The instrumented fusion group had a significantly lower reoperation rate [1/54 (1.9%)] than the uninstrumented fusion group 7/53 (13.2%), significantly less visits to the outpatient clinic, less magnetic resonance imaging performed and fewer days of hospitalization. The base case incremental cost-effectiveness ratio was estimated at €1536 per QALY gained over a two-year time horizon. Instrumented fusion was favored over uninstrumented fusion in sensitivity analyses including all reoperations or using hospital reimbursement rate.</p><p><strong>Conclusion: </strong>Instrumented fusion is cost-effective compared uninstrumented fusion, with an incremental cost-effectiveness ration well below the standard range of cost-effectivenes, the difference in cost was driven by lower reoperation rates and less health care resource utilization over a two-year time horizon.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"501-507"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459434","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":"Response to: \"Other Factors That Can Affect Wound Healing With Elective Lumbar Spine Surgery and Perioperative Nutritional Supplementation in Patients\".","authors":"Anthony Yung, Oluwatobi O Onafowokan, Max R Fisher, Ankita Das, Ethan J Cottrill, Isabel P Prado, Caroline M Wu, Peter G Passias","doi":"10.1097/BRS.0000000000005143","DOIUrl":"10.1097/BRS.0000000000005143","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E141"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120666","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 Outcomes After Preoperative Embolization in Hypervascular Spinal Metastases: A Propensity Scored Study of 191 Patients.","authors":"Robertus J B Pierik, Jantijn J G J Amelink, Olivier Q Groot, Avik Som, Bram T van Munster, Daniël C de Reus, Theresa L Chua, Hester Zijlstra, Jorrit-Jan Verlaan, John H Shin, James D Rabinov, Daniel G Tobert","doi":"10.1097/BRS.0000000000005182","DOIUrl":"10.1097/BRS.0000000000005182","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity-score matched, case-control study at 2 academic tertiary care centers.</p><p><strong>Objective: </strong>To assess the effect of preoperative embolization (PE) on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss; and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies.</p><p><strong>Background context: </strong>PE intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results.</p><p><strong>Materials and methods: </strong>After propensity score matching, 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of propensity score matching did not allow analysis of patients with tumor volumes >9 cm 3 . Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions.</p><p><strong>Results: </strong>There was no difference in EBL [948 mL (IQR: 500-1750) vs. 1100 mL (IQR: 388-1925), P =0.68] and hemoglobin mass loss [201 g (IQR: 119-307) vs. 232 g (IQR: 173-373), P =0.18] between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P =0.05) in PE patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss, or perioperative blood transfusions.</p><p><strong>Conclusions: </strong>Our study demonstrated that, for tumors <9 cm 3 , PE did not reduce EBL, hemoglobin mass loss, or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of preoperative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases.</p><p><strong>Level of evidence: </strong>Level III-treatment benefits.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"437-446"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508392","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":"Location of Vascular Structures at Risk in Relation to Sacroiliac Joint Fusion.","authors":"Zachary Brandt, Kai Nguyen, Gideon Harianja, Kirulus Amin, Adel Battikha, Ninous Betdashtoo, Rohan Kubba, David Shin, Mark Oliinik, Jacob Razzouk, Jun Ho Chung, Olumide Danisa, Wayne Cheng","doi":"10.1097/BRS.0000000000005218","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005218","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>This study seeks to establish the normal distribution of the vasculature surrounding the SI joint while also demonstrating associations between distribution and laterality, sex, and ethnicity.</p><p><strong>Summary of background data: </strong>Sacroiliac (SI) joint fusion surgery has emerged as a viable treatment option for patients suffering from low back pain due to chronic SI joint dysfunction. Due to potential complications from iatrogenic injury to vasculature, it becomes critical to understand normal anatomy and locations with a high vasculature concentration surrounding the SI joint.</p><p><strong>Methods: </strong>The authors retrieved medical and radiographic records of patients who underwent computed tomography angiography (CTA) of the pelvis. Anterior and posterior compartments of the SI joint were established on the transverse view by creating an even coronal division of the SI joint. The superior, middle, and inferior compartments were established on the coronal view as three equal transverse compartments. The compartments in which vasculature was visualized were recorded.</p><p><strong>Results: </strong>Distribution of vasculature around the right and left hemipelvis concentrated in the inferior compartments and decreased in concentration while moving superiorly. Anterior compartments contain a higher vascularity than posterior compartments. Vasculature was present in <3% of the posterior middle, and posterior superior compartments while present in >83% of the inferior compartments. There were no significant differences with respect to vascular distribution when comparing the laterality of the right versus left hemipelvis. There were statistically significant relationships between vascular distribution and sex (P<0.05), as well as across self-reported ethnicity (P<0.05).</p><p><strong>Conclusions: </strong>SI screw placement in the posterior superior has the lowest risk of iatrogenic vascular injury. Careful consideration should be taken during SI joint fusion surgery in the inferior compartments due to its high vasculature density.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 7","pages":"493-499"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575989","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 We Operate on Octogenarians With Cervical Myelopathy or Radiculopathy?","authors":"Omar Zakieh, Maryam Y Jawid, Mitchell F Bowers, Mason W Young, Scott L Zuckerman, Julian G Lugo-Pico, Raymond J Gardocki, Amir M Abtahi, Byron F Stephens","doi":"10.1097/BRS.0000000000005232","DOIUrl":"10.1097/BRS.0000000000005232","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>Investigate the disparities between octogenarians and nonoctogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes.</p><p><strong>Summary of background data: </strong>As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians.</p><p><strong>Materials and methods: </strong>Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients below 80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient-reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain.</p><p><strong>Results: </strong>There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P =0.548), 90-day readmission (10.3% vs. 6.9%, P =0.548), and 12-month reoperation (3.4% vs. 2.3%, P =0.736) between octogenarians and nonoctogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P =0.393), improvement in 3- and 12-month PROMs, and MCID achievement.</p><p><strong>Conclusions: </strong>Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and nonoctogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E122-E127"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772484","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":"Rigid Thoracolumbar Orthosis Does Not Improve Outcomes of Acute Adolescent Spondylolysis as Compared With Placebo. Bony Union Predicts Improved Health-Related Quality of Life Outcomes at 2-Year Follow-Up.","authors":"Ella Virkki, Milja Holstila, Terhi Kolari, Markus Lastikka, Kimmo Mattila, Sari Malmi, Olli Pajulo, Ilkka Helenius","doi":"10.1097/BRS.0000000000005120","DOIUrl":"10.1097/BRS.0000000000005120","url":null,"abstract":"<p><strong>Study design: </strong>A prospective, comparative study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in adolescents with acute spondylolysis treated with a rigid thoracolumbar orthosis (Boston brace) or with a placebo (elastic lumbar support) with a 2-year follow-up time.</p><p><strong>Objective: </strong>To compare outcomes of acute adolescent spondylolysis treated with a rigid thoracolumbar orthosis or a placebo with a 2-year follow-up time.</p><p><strong>Background: </strong>The benefits of the use of rigid orthosis for the treatment of spondylolysis and achieving a bony union of spondylolysis remain unclear.</p><p><strong>Patients and methods: </strong>Sixty consecutive patients with acute spondylolysis were prospectively enrolled. Three patients were excluded from the analysis as they did not fulfil the inclusion criteria. The first 14 patients were randomized, and the remaining 46 chose the treatment method themselves. Treatment time was 4 months, and the follow-up time was 2 years. HRQoL was measured using the Scoliosis Research Society-24 (SRS-24) outcome questionnaire. The primary outcome was the HRQoL at 24 months and whether treatment type, bony union of the spondylolysis, or development of spondylolisthesis affected it.</p><p><strong>Results: </strong>Thirty (30/57) patients were treated with a Boston brace, and 27 (27/57) patients with a placebo. The bony union rate of spondylolysis did not differ between study groups (20/30 vs. 17/27, respectively, P = 0.789). The HRQoL did not differ between treatment groups in the SRS-24 domains through follow-up ( P > 0.05 for all). Five patients (5/57) developed spondylolisthesis (mean slip: 4.2 mm) during the 2-year follow-up time. Nonunion of the spondylolysis predicted the development of spondylolisthesis ( P = 0.005), but the treatment type did not affect it ( P > 0.05). Two years after treatment, patients who had bony union had higher SRS-24 total ( P = 0.005) and satisfaction domain ( P < 0.001) compared with patients with nonunion.</p><p><strong>Conclusion: </strong>A rigid brace is not necessary for the treatment of acute spondylolysis. Achieving a bony union of adolescent spondylolysis is desirable as their HRQoL is higher at 2 years.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"454-462"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988993","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":"Novel Predictive Scoring System for Bone Union Rate After Conservative Management of Lumbar Spondylolysis.","authors":"Hisanori Gamada, Masaki Tatsumura, Tomoyuki Asada, Shun Okuwaki, Katsuya Nagashima, Yosuke Takeuchi, Toru Funayama, Masashi Yamazaki","doi":"10.1097/BRS.0000000000005094","DOIUrl":"10.1097/BRS.0000000000005094","url":null,"abstract":"<p><strong>Study design: </strong>A single-center retrospective cohort study.</p><p><strong>Objectives: </strong>To develop a predictive scoring system for bone union after conservative treatment of lumbar spondylolysis and assess its internal validity.</p><p><strong>Summary of background data: </strong>Lumbar spondylolysis, a common stress fracture in young athletes, is typically treated conservatively. Predicting bone union rates remains a challenge.</p><p><strong>Methods: </strong>This study included patients aged 18 years or younger with lumbar spondylolysis undergoing conservative treatment. A multivariable logistic regression analysis was used to develop a scoring system containing 6 factors: sex, age, lesion level, main side stage of the lesion, contralateral side stage of the lesion, and spina bifida occulta. The predictive scoring system was internally validated from the receiver operating characteristic (ROC) curve using bootstrap methods.</p><p><strong>Results: </strong>The final analysis included 301 patients with 416 lesions, with an overall bone union rate of 80%. On multivariable analysis, the main and contralateral stages were identified as factors associated with bone union. The predictive scoring system was developed from the main side stage score (prelysis, early=0, progressive stage=1) and the contralateral side stage score (none=0, prelysis, early, progressive stage=1, terminal stage=3). The area under the curve was 0.855 (95% confidence interval, 0.811-0.896) for the ROC curve, showing good internal validity. The predicted bone union rates were generally consistent with the actual rates.</p><p><strong>Conclusions: </strong>A simple predictive scoring system was developed for bone union after conservative treatment of lumbar spondylolysis, based on the stage of the lesion on the main and contralateral sides. The predicted bone union rate was ~90% for a total score of 0-1 and ≤30% for a score of 3-4. This system demonstrated good internal validity, suggesting its potential as a useful tool in clinical decision-making for the management of spondylolysis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"463-469"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555496","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":"Serotonergic Antidepressants Are Associated With Higher Rates of Hematoma After Anterior Cervical Spine Surgery: A Large Propensity-Matched Cohort Analysis.","authors":"Jeremy M Adelstein, Andrew J Moyal, John T Strony, Robert J Burkhart, David C Kaelber, Christina W Cheng, Zachary L Gordon, Christopher G Furey","doi":"10.1097/BRS.0000000000005168","DOIUrl":"10.1097/BRS.0000000000005168","url":null,"abstract":"<p><strong>Study design: </strong>Large database propensity-matched retrospective cohort analysis.</p><p><strong>Objective: </strong>This study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery. It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after anterior cervical spine surgery.</p><p><strong>Background: </strong>Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopedic procedures.</p><p><strong>Materials and methods: </strong>A retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included through Current Procedural Terminology codes and the International Classification of Disease, 10th Revision, encounter diagnosis codes. Cohorts were 1:1 propensity-matched across 7 demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as health care utilization, within 14 days, 30 days, 90 days, and 2 years postoperatively was evaluated.</p><p><strong>Results: </strong>Following propensity matching, each cohort consisted of 9249 patients, for a total of 18,498 patients included in the final statistical analysis. SSRIs/SNRIs were associated with higher odds of hematoma formation within 7 days [0.69% vs . 0.46%, odds ratio (OR): 1.5 (95% CI: 1.02-2.2), P = 0.04] and within 14 days postoperatively [0.81% vs . 0.52%, OR: 1.6 (95% CI: 1.1-2.3), P = 0.01]. Within 30 and 90 days, SSRIs/SNRIs were associated with a higher risk of emergency department utilization [30 d, OR: 1.30 (1.1-1.4); 90 d, OR: 1.3 (1.2-1.4)] and irrigation & debridement (I&D; 30 d, OR: 1.9 (1.2-3.0)]. SSRIs/SNRIs were also associated with a significantly higher risk of I&D within 2 years [OR: 1.3 (1.1-1.6)].</p><p><strong>Conclusion: </strong>The use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization, and the need for irrigation and debridement. Future prospective studies are required to confirm these results.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort analysis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"477-484"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354330","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}