Spine最新文献

{"title":"Differences in Functional Treadmill Tests in Patients with Adult Symptomatic Lumbar Scoliosis Treated Operatively and Non-operatively at a Minimum Five-Year Follow-up.","authors":"Leah Y Carreon, Steven D Glassman, Justin S Smith, Elizabeth L Yanik, Christine Baldus, Michael P Kelly, Keith H Bridwell","doi":"10.1097/BRS.0000000000005432","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005432","url":null,"abstract":"<p><strong>Study design: </strong>Prospective Longitudinal Cohort.</p><p><strong>Objectives: </strong>To present the long-term Functional Treadmill Test (FTT) results in patients with Adult Symptomatic Lumbar Scoliosis (ASLS) treated operatively (Op) and non-operatively (Non-Op).</p><p><strong>Summary of background data: </strong>A previous study on this cohort showed that at two years after intervention, FTT time ambulated deteriorated in Non-Op patients but improved in Op patients. Post-FTT back and leg pain improved in both groups with greater gains in the Op group.</p><p><strong>Methods: </strong>168 (62%) of 272 surviving subjects who underwent Operative (Op, N=115) or Non-operative treatment (N=53) were included with mean follow-up 7.49 ± 1.61 years. FTT parameters included maximum speed, time to onset of symptoms, distance ambulated, time ambulated, and back and leg pain severity before and after testing.</p><p><strong>Results: </strong>Both groups had deterioration from the two-year to final FTT in maximum selected speed, time ambulated and time to onset of symptoms but the decline was greater in NonOp patients. Patients in the Op group had worse Post-FTT back and leg pain at baseline but improved more than the NonOp at two years and maintained at final FTT.Op patients with two or more revisions had less improvement at two years and at final FTT compared to those who had no revision or only one revision.</p><p><strong>Conclusion: </strong>Patients treated surgically had greater improvements in FTT parameters compared to patients treated nonsurgically at two years that persisted to the final FTT performed at 7 years after their intervention. There was slight deterioration in some parameters from the two year to final FTT but these may be due to aging of the cohort. Patients who had two or more revisions had worse FTT parameters compared to patients with one or no revisions.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302849","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":"Racial/Ethnic Associations With Morbidity and Mortality in Adults With Acute Traumatic Cervical Spinal Cord Injury.","authors":"Aladine A Elsamadicy, Selma Belkasim, Paul Serrato, Sina Sadeghzadeh, Shaila D Ghanekar, Syed I Khalid, Sheng-Fu Larry Lo, Daniel M Sciubba","doi":"10.1097/BRS.0000000000005260","DOIUrl":"10.1097/BRS.0000000000005260","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients.</p><p><strong>Background: </strong>Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.</p><p><strong>Results: </strong>There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5820 (8.2%) HIS, and 7034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P < 0.001) and the longest mean length of stay (NHW: 11.3 ± 13.5 d vs. NHB: 15.5 ± 20.2 d vs. HIS: 15.0 ± 20.5 d vs. OTH: 12.6 ± 17.5 d, P < 0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs . HIS: 69.5% vs . OTH: 75.4%, P < 0.001), whereas, in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs . NHB: 10.1% vs . HIS: 12.4% vs . OTH: 13.4%, P < 0.001). On multivariable analyses, NHB odds ratio (OR: 1.16, P < 0.001), HIS (OR: 1.22, P < 0.001), and OTH (OR: 1.14, P = 0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P < 0.001), whereas, the HIS cohort had significantly decreased odds (OR: 0.78, P = 0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P <0 .001).</p><p><strong>Conclusion: </strong>Our study suggests there may be racial disparities in outcomes and discharge disposition for acute cSCI patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"823-831"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012164","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 Condoliase on Health-related Quality of Life in Participants With Radicular Leg Pain Associated With Lumbar Disk Herniation: Results From a United States Phase 3 Clinical Trial.","authors":"Kevin E Macadaeg, Kee D Kim, Pragya B Gupta, Jose Rivera, Anand Patel, Kinsuk Chauhan, Jun Watanabe, Takayuki Seo, Evan Zucker, Kenneth Candido","doi":"10.1097/BRS.0000000000005327","DOIUrl":"10.1097/BRS.0000000000005327","url":null,"abstract":"<p><strong>Study design: </strong>An exploratory analysis of a randomized, double-blind, sham-controlled, phase three study.</p><p><strong>Objective: </strong>To evaluate the impact of SI-6603 (condoliase) on health-related quality of life (HRQoL)-related outcomes in patients with lumbar disk herniation (LDH)-associated radicular leg pain from the Discovery 6603 study (NCT03607838).</p><p><strong>Summary of background data: </strong>Condoliase is a novel chemonucleolytic agent that selectively degrades chondroitin sulfate in the nucleus pulposus. Condoliase is approved in Japan for the treatment of radicular leg pain associated with LDH. Recently, the Discovery 6603 study demonstrated the efficacy and tolerability of condoliase in the United States (US).</p><p><strong>Methods: </strong>Adults with LDH and unilateral radicular leg pain were randomized to receive a single intradiscal injection of condoliase (1.25 units) or sham, followed by 52 weeks of observation. Exploratory HRQoL-related outcomes included change from baseline (CFB) in EuroQol Group 5-Dimension Quality of Life instrument, 5-Level version (EQ-5D-5L), and visual analogue scale (EQ-VAS), CFB in the 36-item Short Form Health Survey (SF-36), Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and CFB in Work Productivity and Activity Impairment (WPAI) scores. EQ-5D-5L and SF-36 measures were assessed using a longitudinal analysis model.</p><p><strong>Results: </strong>Of 352 randomized participants, 341 constituted the modified intention-to-treat population (condoliase: 169; sham: 172). Condoliase showed numerically greater improvements in EQ-5D-5L self-care and pain/discomfort dimensions at week 13 and week 52 compared with sham ( P <0.05). The SF-36 physical component and WPAI scores numerically favored condoliase compared with sham. Patients and clinicians more frequently reported \"very much improved\" in overall status following condoliase treatment versus sham.</p><p><strong>Conclusions: </strong>Previous findings confirmed the efficacy and tolerability of condoliase for LDH management. Condoliase showed notable improvements in exploratory HRQoL-related outcomes, which were consistent across multiple patient-reported measures. Condoliase has the potential to enhance QoL and work productivity in individuals with LDH.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"796-803"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606161","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":"Associations Between Problem List Items and Clinically Significant Distress in Patients With Metastatic Spine Disease.","authors":"Dana G Rowe, Joshua Woo, Seeley Yoo, Jacqueline M Emerson, Ellen O'Callaghan, Michael Goodin, Kerri-Anne Crowell, Victoria Bradley, Jeremy Reynolds, Margaret O Johnson, Melissa M Erickson, C Rory Goodwin","doi":"10.1097/BRS.0000000000005343","DOIUrl":"10.1097/BRS.0000000000005343","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to identify sources of distress in patients with metastatic spine disease and elucidate factors associated with clinically significant distress.</p><p><strong>Summary of background data: </strong>Distress is associated with poorer outcomes and lower quality of life in cancer patients. Patients with metastatic spine disease are particularly vulnerable to clinically significant levels of distress. However, specific factors contributing to distress in these patients have been largely unexplored.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of patients with metastatic spine disease (MSD) who underwent surgery from 2015 to 2023. We analyzed National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) scores and Problem List items within 30 days before surgery, which was defined as \"baseline\" distress. We calculated the frequency of each problem and the proportion of patients with clinically significant distress (DT score ≥4). We used χ 2 tests to analyze associations between Problem List items and significant distress, with a significance threshold of P <0.05.</p><p><strong>Results: </strong>Among 160 patients with MSD, 48.1% reported clinically significant distress. Patients most frequently reported Physical concerns (93.8%), followed by Emotional (55.6%) and Practical concerns (31.9%). The most common individual Problem List item was pain (72.5%), followed by fatigue (48.1%) and worry (41.2%). Emotional ( P =0.001), Practical ( P =0.04), and Social concerns ( P =0.039) were significantly associated with clinically significant distress, but Physical concerns were not ( P =0.05).</p><p><strong>Conclusions: </strong>Though physical concerns were most common for patients with MSD, emotional and practical concerns were more strongly associated with significant distress among patients with metastatic spine disease. These findings highlight the need for multidisciplinary care focused on emotional and practical issues to enhance patients' quality of life.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"816-822"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701594","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":"Transforaminal Versus Anterior Lumbar Interbody Fusion at L5-S1 for Degenerative Spine Disease : A Meta-Analysis.","authors":"Alan H Daniels, Mohammad Daher, Joseph E Nassar, Sleiman Haddad, Louis Boissiere, Richard K Hurley, William F Lavelle, Peter G Passias, Bassel G Diebo, Amer Sebaaly","doi":"10.1097/BRS.0000000000005315","DOIUrl":"10.1097/BRS.0000000000005315","url":null,"abstract":"<p><strong>Study design: </strong>Meta-analysis.</p><p><strong>Objective: </strong>This meta-analysis will compare transforaminal lumbar interbody fusion (TLIF) to anterior lumbar interbody fusion (ALIF) at L5-S1 in lumbar degenerative spine diseases (DSDs).</p><p><strong>Background: </strong>Interbody device placement is indicated for alignment correction, sustaining decompression, achieving fusion, and is an effective and widely performed surgical treatment for lumbar DSD. ALIF and TLIF are the 2 most commonly performed approaches for the management of DSD at L5-S1.</p><p><strong>Materials and methods: </strong>Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1 to 20) were accessed and explored until December 2024. The extracted data consisted of complications, reoperations, surgery-related parameters, patient-reported outcome measures, and postoperative radiographic parameters. Across all studies, mean differences (MDs) with 95% CIs were used for continuous data, whereas odds ratio (OR) was utilized for dichotomous data.</p><p><strong>Results: </strong>Nine retrospective articles were included in the meta-analysis, including 1292 patients, with 694 in the TLIF group and 598 in the ALIF group. Patients undergoing TLIF were found to have higher rates of overall complications (Odds-ratio = 1.66; P = 0.005) and reoperations (Odds-ratio = 5.92; P = 0.03; although 2 studies were included in this analysis), shorter operative time in MIS TLIF compared with ALIF (MD = -47.00; P < 0.001), more blood loss in open TLIF compared with ALIF (MD = 135.05; P < 0.001), and less improvement in lumbar lordosis and segmental lordosis (MD = -3.48; P = 0.03; MD = -5.86; P < 0.001). However, there was no difference in patient-reported outcome measures between the 2 groups.</p><p><strong>Conclusion: </strong>Patients undergoing TLIF at L5-S1 for their DSD, compared with ALIF, had higher rates of complications and reoperations, greater blood loss, and less improvement in sagittal alignment. These results highlight the efficacy, power, and safety of ALIF and its benefits in restoring alignment, which may optimize long-term outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E231-E239"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606352","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":"Corner Osteotomy As the More Advanced Approach to Deformity Correction in Adult Spinal Deformity: A Retrospective Comparative Study Between Two Osteotomy Techniques.","authors":"Ki Young Lee, Jung-Hee Lee, Kyung-Chung Kang, Won-Young Lee, Jin-Hyung Kim","doi":"10.1097/BRS.0000000000005124","DOIUrl":"10.1097/BRS.0000000000005124","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To investigate the usefulness of corner osteotomy (CO) in patients with adult spinal deformity (ASD) by comparing it with pedicle subtraction osteotomy (PSO) for lordosis correction.</p><p><strong>Summary of background data: </strong>PSO remains a valuable procedure for patients with ASD, but it has a limit to obtaining correction angles exceeding 45° in patients with a large pelvic incidence or with previous spinal fusion surgeries. Theoretically, CO can exceed the limitation of PSO and can achieve a wide range of correction angles. However, no study has analyzed the clinical data and usefulness of CO.</p><p><strong>Methods: </strong>This study included 115 patients (mean age: 71.1 yr, mean follow-up period: 78.9 mo) with ASD who underwent deformity correction using PSO or CO. Comparative analysis was performed on spinopelvic parameters including segmental angle (SA) around the osteotomy site, and clinical and surgical assessment between the PSO and corner groups.</p><p><strong>Results: </strong>In the corner group, the postoperative SA (35° vs. -39.3°, P =0.004) and the degree of SA correction (34.8° vs. 39.7°, P =0.004) were greater, and a broader range of SA correction was also possible (18-51° vs. 18-61°). Although the operative time was longer in the corner group (316.8 vs. 342.3 min, P =0.014), the estimated blood loss (EBL) was lower (2841.3 vs. 2465.4 mL, P =0.032). There was no difference in major complication rates, but the frequency of rod fracture (RF) was lower in the corner group (36/27 vs. 1/51, P <0.05).</p><p><strong>Conclusions: </strong>CO showed a greater SA correction and achieved a broader range of SA correction angles than PSO, with no difference in the incidence of major complications. In addition, the EBL and the frequency of RF were lower. Based on these results, we expect that CO can serve as a promising surgical alternative to PSO for spinal deformity correction among patients with ASD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E223-E230"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037046","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":"Staged Versus Simultaneous Surgery for Adult Spinal Deformity : A Systematic Review and Meta-analysis.","authors":"Aman Verma, Parshwanath Bondarde, Anil Kumar, Siddharth Sekhar Sethy, Aakash Jain, Vibhor Abrol, Kaustubh Ahuja, Pankaj Kandwal","doi":"10.1097/BRS.0000000000005279","DOIUrl":"10.1097/BRS.0000000000005279","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To assess the safety and efficacy of staged versus same-day spinal fusion surgeries in adult spinal deformity (ASD).</p><p><strong>Background: </strong>ASD surgeries are associated with high complication rates, ranging from 10% to 40%. Among the strategies to enhance safety, staging the procedure into two smaller procedures has been evaluated as an effective alternative.</p><p><strong>Materials and methods: </strong>A systematic literature review following PRISMA guidelines was conducted using PubMed, Cochrane, Scopus, and Embase. Studies comparing staged and same-day spinal fusion for ASD were included. Perioperative data, patient-reported outcomes (ODI, SRS), radiologic outcomes, and complication rates were analyzed. The extracted data was analyzed, and forest plots were generated to draw comparisons between the staged and same-day groups.</p><p><strong>Results: </strong>Eleven studies, including 1323 patients (541 staged, 782 same-day) were analyzed. Staged surgeries were associated with longer operative time and length of hospital stay. There was no significant difference in estimated blood loss, clinical and radiologic outcomes, or overall complication rates between groups. However, venous thromboembolism (VTE) rates were significantly higher in staged surgeries (odds ratio=4.33). In the staged group, surgical site infections were the most common complication, with a rate of 10.5%, whereas neurological complications were the most frequent group of complications in the same-day group.</p><p><strong>Conclusion: </strong>Staged surgeries for ASD result in longer operative time, length of hospital stay, and increased VTE risk but show similar efficacy in clinical and radiologic outcomes compared with same-day surgeries. Careful patient selection is crucial to balance risks and optimize outcomes in ASD surgical planning.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"859-870"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068092","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":"Automated Measurements of Spinal Parameters for Scoliosis Using Deep Learning.","authors":"Xianghong Meng, Shan Zhu, Qilong Yang, Fengling Zhu, Zhi Wang, Xiaoming Liu, Pei Dong, Shuaikun Wang, Lianxi Fan","doi":"10.1097/BRS.0000000000005280","DOIUrl":"10.1097/BRS.0000000000005280","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-institution study.</p><p><strong>Objective: </strong>To develop and validate an automated convolutional neural network (CNN) to measure the Cobb angle, T1 tilt angle, coronal balance, clavicular angle, height of the shoulders, T5-T12 Cobb angle, and sagittal balance for accurate scoliosis diagnosis.</p><p><strong>Summary of background data: </strong>Scoliosis, characterized by a Cobb angle >10°, requires accurate and reliable measurements to guide treatment. Traditional manual measurements are time-consuming and have low interobserver and intraobserver reliability. While some automated tools exist, they often require manual intervention and focus primarily on the Cobb angle.</p><p><strong>Materials and methods: </strong>In this study, we utilized four data sets comprising the anterior-posterior (AP) and lateral radiographs of 1682 patients with scoliosis. The CNN includes coarse segmentation, landmark localization, and fine segmentation. The measurements were evaluated using the dice coefficient, mean absolute error (MAE), and percentage of correct key-points (PCK) with a 3-mm threshold. An internal testing set, including 87 adolescent (7-16 yr) and 26 older adult patients (≥60 yr), was used to evaluate the agreement between automated and manual measurements.</p><p><strong>Results: </strong>The automated measures by the CNN achieved high mean dice coefficients (>0.90), PCK of 89.7%-93.7%, and MAE for vertebral corners of 2.87-3.62 mm on AP radiographs. Agreement on the internal testing set for manual measurements was acceptable, with an MAE of 0.26 mm or degree-0.51 mm or degree for the adolescent subgroup and 0.29 mm or degree-4.93 mm or degree for the older adult subgroup on AP radiographs. The MAE for the T5-T12 Cobb angle and sagittal balance, on lateral radiographs, was 1.03° and 0.84 mm, respectively, in adolescents, and 4.60° and 9.41 mm, respectively, in older adults. Automated measurement time was significantly shorter compared with manual measurements.</p><p><strong>Conclusion: </strong>The deep learning automated system provides rapid, accurate, and reliable measurements for scoliosis diagnosis, which could improve clinical workflow efficiency and guide scoliosis treatment.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"849-858"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731660","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":"Comparison of Restricted Versus Liberal Postsurgical Ambulation Protocols on Outcomes After Lumbar Fusion Surgery.","authors":"Rajkishen Narayanan, Alec Kellish, Teeto Ezeonu, Yunsoo A Lee, Jessica Carroll, Timothy Hagan, Emma Hammelef, Eric Teichner, Jose A Canseco, Ian David Kaye, Mark F Kurd, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005118","DOIUrl":"10.1097/BRS.0000000000005118","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The objective of this study was to explore the impact of different hospital-based ambulation protocols on mobility and surgical outcomes after lumbar fusion surgery.</p><p><strong>Summary of background data: </strong>Previous research has highlighted the value of early ambulation after surgery; still some hospitals choose to adopt a more conservative ambulation approach due to concern for patient safety.</p><p><strong>Methods: </strong>Adult patients ≥18 years of age who underwent primary posterior lumbar decompression and fusion (PLDF) surgery at a hospital with restricted ambulation and a hospital with a liberal ambulation protocol within the same health system from 2021 to 2022 were identified and matched based on patient demographic characteristics. Surgical outcomes included inpatient complications, length of stay, readmissions, reoperations, and discharge disposition. Mobility outcomes included Activity Measure for Post-Acute Care (AM-PAC) daily activity score, post-therapy session pain rating, and gait trial distance from the first inpatient physical therapy session.</p><p><strong>Results: </strong>Patients within the liberal ambulation protocol cohort had shorter hospital stays ( P <0.001) and were less likely to require reoperation within 1 year of surgery ( P =0.013). Patients within the restricted ambulation protocol were more likely to experience a complication ( P =0.005) and were less likely to be discharged home after surgery ( P =0.020). Patients at the liberal ambulation hospital had higher AM-PAC basic mobility scores ( P <0.001) and achieved further gait distances ( P <0.001). On multivariable regression analysis, a further gait distance at the first inpatient PT session was a significant predictor of decreased odds of inpatient complications ( P =0.010), decreased length of stay ( P =0.005), and increased odds of discharge to home ( P <0.001).</p><p><strong>Conclusions: </strong>Liberal ambulation protocols are safe and effective postoperative management strategies after PLDF to decrease inpatient complications, length of stay and discharge to a rehabilitation facility. These findings highlight the role that such protocols can play in helping patients to achieve early mobilization and favorable short-term outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"809-815"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042797","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":"Constructive Suggestions for Enhancing Research on Osteoporotic Vertebral Fractures.","authors":"Yun Zhao, Xingyao Yang, Xiao Liu","doi":"10.1097/BRS.0000000000005292","DOIUrl":"10.1097/BRS.0000000000005292","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E240"},"PeriodicalIF":2.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383341","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}