Spine最新文献

{"title":"Sagittal Femur-Pelvis Balancing Mechanism and Linear Correlation Chain in Patients with Spinal Disorders: A Radiographic Retrospective Analysis.","authors":"Yuxi Liu, Weiguo Zhu, Chao Kong, Xiangyao Sun, Sitao Zhang, Shibao Lu","doi":"10.1097/BRS.0000000000005344","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005344","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To investigate how the femurs and pelvis collaboratively maintain sagittal balance and energy-efficient alignment by investigating sagittal parameters.</p><p><strong>Summary of background data: </strong>Sagittal parameters are increasingly acknowledged as fundamental determinants in sustaining balance and energy-efficient postures. Among numerous parameters, pelvic morphology and retroversion compensation are critical in restoring sagittal imbalance caused by aging and pathological changes. Despite the significant role of the femurs in the sagittal plane, relevant research remains lacking.</p><p><strong>Methods: </strong>Standing lateral full-length radiographs, including the upper femurs, were obtained from 368 consecutive patients with symptomatic spinal pathologies. Sagittal plane parameters of the thoracic spine, lumbar spine, pelvis, and femurs-such as angulation, tilt, and offset-and pelvic morphology were measured to reflect the sagittal profile. All participants completed the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) questionnaires to evaluate Health-Related Quality of Life (HRQOL). Relationships between radiographic and clinical parameters were assessed using Pearson correlation coefficients.</p><p><strong>Results: </strong>This cohort (154 males, 214 females) had a mean age of 64.6±11.0 years, height of 163.2±8.5 cm, and BMI of 25.8±3.8 kg/m². The ODI is correlated with the tilt and offset parameters, except those of the pelvic and lumbar regions. Correlations were observed among all tilt and offset parameters regarding offset values, except for TT with PT and LT, and TO with PO and LO. These correlations pertain to the symmetry of S1. From the cephalad T1S to the caudal FT, all parameters exhibit the highest correlation with their adjacent parameters.</p><p><strong>Conclusion: </strong>A linear correlation chain exists in the sagittal plane in patients with spinal disorders. The back tilt of a longer femur increases posterior offset more efficiently, shifting the center of gravity backward in patients with spinal disorders. Anterior pelvic tilt relative to the femur reduces the Pelvic-Femur Angle (PFA) to maintain lumbar lordosis and economic sagittal alignment. These collaborative compensatories are crucial for understanding sagittal balance and alignment of the spine, pelvis, and lower extremities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711359","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":"Erector Spinae Plane Block is Associated with Earlier Discontinuation of Opioids and Return-to-Work Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Eric Mai, Eric Zhao, Jung K Mok, Junho Song, Patawut Bovonratwet, Tomoyuki Asada, Tejas Subramanian, Chad Z Simon, Joshua Zhang, Cole Kwas, William Doran, Evan Sheha, James Dowdell, Douglas S Wetmore, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005345","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005345","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>To assess the impact of erector spinae plane (ESP) blocks on recovery kinetics and patient-reported outcomes (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).</p><p><strong>Summary of background data: </strong>ESP block continues to emerge as a safe and effective regional anesthetic technique and has been shown to reduce immediate postoperative pain and opioid requirements, although its impact on patient recovery and outcomes farther out postoperatively remains unclear.</p><p><strong>Methods: </strong>Patients who underwent single-level MI-TLIF who did or did not receive ESP blocks performed by a single anesthesiologist were included. PROMs and MCID achievement rates for ODI, VAS-Back, VAS-Leg, and SF-12 PCS were determined within early (within 3 mo) and late (6 mo to 2 y) postoperative periods. Return-to-activities (RTA) metrics included driving, work, and discontinuation of opioids which were measured by days after surgery. Multivariable regression analyses were performed to determine factors associated with return-to-activities.</p><p><strong>Results: </strong>A total of 172 patients were included (mean age: 60.5 y, 46.5% female); 110 received ESP blocks and 62 did not. There were no differences in baseline characteristics between the cohorts. On univariate analysis, there were no differences in days to RTA between the cohorts. On multivariable analyses, ESP block was identified as a predictor for return-to-work by 30 days (OR 4.48, 95% CI [1.25-1.60], P=0.021), discontinuation of opioids by 15 days (OR: 2.40, 95% CI [1.08-5.35], P=0.032), and discontinuation of opioids by 30 days (OR: 5.57, 95% CI [1.87-16.56], P=0.002). There were no significant differences in change in PROM scores or MCID achievement rates between the cohorts.</p><p><strong>Conclusions: </strong>Our study demonstrated that ESP block administered prior to MI-TLIF may be associated with earlier return-to-work and discontinuation of opioids, while having limited impact on functional PROMs, MCID achievement rates, and GRC scores.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711357","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":"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":"https://doi.org/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 prior to 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 chi-square 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>Conclusion: </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":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","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":"Outcomes After 1- or 2-level Minimally Invasive Decompression for Patients with High 5-Item Modified Frailty Index.","authors":"John Lama, Tejas Subramanian, Tomoyuki Asada, Tim Xu, Ted Shi, Rebecca Boyle, Arsen Omurzakov, Zora Hahn, James Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005333","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005333","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>To evaluate the efficacy of the 5-factor modified frailty (mFI-5) index in predicting patient outcomes and recovery kinetics in minimally invasive decompression (MI-decompression) for the treatment of degenerative lumbar disorders.</p><p><strong>Summary of background data: </strong>The mFI-5 index, which measures frailty or the age-associated decline in recovery ability following a significant stressor, has risen as a patient-specific indicator for postoperative morbidity and mortality. However, no studies have evaluated the utility of frailty in predicting outcomes after MI-decompression for degenerative lumbar pathologies.</p><p><strong>Methods: </strong>Patients who underwent primary one- or two-level MI-Decompression for degenerative lumbar spine conditions were included. Patients were stratified into three groups: non-frail (mFI-5=0), moderately frail (mFI-5=1), and severely frail (mFI-5≥2). Outcome measures included surgical details, complications, return to activity, and patient reported outcome measures at preop and ≥6 months postop.</p><p><strong>Results: </strong>A total of 956 patients were included, 438 non-frail, 418 moderately frail, and 100 severely frail. Frail patients (mFI-5 ≥1) were older (P<0.001), had greater BMI (P=0.047), elevated CCI (P<0.001), and greater percentages of ASA class ≥3 (P<0.001). Higher severities of frailty were associated with longer operative times (P<0.001) and lengths of stay (P<0.001), while blood loss was similar. Frail patients demonstrated worse preoperative symptoms, including ODI (P=0.019), VAS-back pain (P=0.019), and SF12-PCS (P=0.015), which continued postoperatively, including ODI (P=0.014) and SF12-PCS (P<0.001). The magnitude of improvement between outcome metrics was comparable at ≥ 6-month follow-up. Return to activities-driving, working, and discontinuation of narcotics-as well as all complication categories-intraoperative, in-hospital, and postoperative-were similar across all patients.</p><p><strong>Conclusions: </strong>MI-decompression provides comparable symptom relief and postoperative recovery, even among patients with significant frailty that could limit their ability to withstand the stresses of spine surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701609","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 Severe Hip and Knee Osteoarthritis on Patient-Reported Outcomes and Global Alignment Following Lumbar Spinal Stenosis Surgery.","authors":"Shota Tamagawa, Hidetoshi Nojiri, Juri Teramoto, Arihisa Shimura, Hiromitsu Takano, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Muneaki Ishijima","doi":"10.1097/BRS.0000000000005340","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005340","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the impact of concomitant severe hip or knee osteoarthritis (OA) on patient-reported outcome measures (PROMs) and global alignment in patients undergoing surgery for lumbar spinal stenosis (LSS).</p><p><strong>Summary of background data: </strong>Hip and knee OA frequently coexist with LSS, contributing to diagnostic and therapeutic complexities. Limited evidence exists regarding the impact of severe lower extremity OA on baseline and postoperative outcomes in patients with LSS.</p><p><strong>Methods: </strong>A total of 121 patients with LSS who underwent decompression surgery with or without interbody fusion and completed 1-year follow-up were included. Patients were divided into severe OA and non-severe OA groups based on the Kellgren-Lawrence (KL) classification, with grades 3-4 classified as severe OA. We compared radiographic parameters and PROMs, including the Visual Analog Scale (VAS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Oswestry Disability Index (ODI), at baseline and 1-year follow-up. Multivariable linear regression was used to assess the effect of severe OA on 1-year postoperative PROMs.</p><p><strong>Results: </strong>Sixty-seven patients (55.4%) had severe hip or knee OA. Severe OA was independently associated with higher VAS scores for low back pain (β=0.234, P=0.030) and leg pain (β=0.272, P=0.012), poorer JOABPEQ scores across multiple domains, and higher ODI scores (β=0.269, P=0.008) at 1-year follow-up. Patients with severe OA exhibited greater sagittal vertical axis and coronal imbalance postoperatively despite comparable spinopelvic mismatch. Additionally, the severe OA group experienced a higher rate of implant-related complications (10.5% vs. 1.9%, P=0.043).</p><p><strong>Conclusion: </strong>Concomitant severe lower extremity OA was associated with worse PROMs, sagittal and coronal alignment following LSS surgery. These findings underscore the importance of recognizing and addressing severe lower extremity OA during preoperative planning for LSS to optimize surgical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701603","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":"Jiri Dvorak: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg","doi":"10.1097/BRS.0000000000005339","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005339","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693311","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":"Achieving Greater Segmental Lordosis with Intraoperative Mechanical Hinging and Bilateral Facetectomies in Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Rahul K Chaliparambil, Mykhaylo Krushelnytskyy, Amr J Alwakeal, Mehul Mittal, Muhammad T Hassan, Pavlos Texakalidis, Hanna Kemeny, Najib El Tecle, Nader S Dahdaleh, Tyler Koski","doi":"10.1097/BRS.0000000000005341","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005341","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>We add to the literature a series of TLIF cases using a minimally invasive surgical (MIS) approach with the use of a mechanically hinging operating table and bilateral facetectomies (Smith-Petersen osteotomy, SPO).</p><p><strong>Summary of background data: </strong>Transforaminal lumbar interbody fusion (TLIF) with interbody cages is understood to have a poor preservation of lordosis in the literature and can often be a kyphosing procedure. Intraoperative flexion using a hinged operating table to increase interbody spacing for cage placement followed by intraoperative extension to facilitate osteotomy closure, may allow a greater degree of segmental lordosis to be achieved and maintained.</p><p><strong>Materials and methods: </strong>We identified patients from 2018 to 2024 who underwent MIS-TLIF at our institution. Clinical and operative variables collected included age, sex, body mass index, hemoglobin A1C, smoking status, post-surgical Baastrup's disease, indications for surgery, fusion level, and spacer details. Radiographic variables included segmental lordosis (SL) at preoperative, intraoperative, and postoperative timepoints. Outcomes included post-surgical correction and 6-month correction. Clinical and radiographic findings were analyzed with standard statistical approaches.</p><p><strong>Results: </strong>202 patients met inclusion criteria. For 1-level and 2-level fusion, the mean post-surgical correction was 5.0 degree and 4.6 degrees respectively, and the mean 6-month correction was 4.6 degrees and 6.6 degrees respectively. Significant differences in lordosis were appreciated between preoperative and postoperative scans for both 1-level (P<0.0001) and 2-level (P=0.0017) fusion, and between preoperative and 6-month scans for 1-level (P<0.0001) fusion. Negative correlations were appreciated between preoperative and postoperative SL (R=-0.31, P=0.0001) and preoperative SL and 6-month correction (R=-0.19, P=0.0289) for 1-level fusions.</p><p><strong>Conclusion: </strong>The use of an intraoperative hinging surgical table during MIS-TLIF with bilateral SPOs can effectively lead to an increase in and the maintenance of SL.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693038","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":"Interpretable Machine Learning Models for Short- and Long-term Prognostic Prediction and Risk Factor Identification in Radiofrequency Treatment of Lumbar Facetogenic Pain: A Retrospective Cohort Study with Temporal Validation.","authors":"Yunfei Wang, Ziyang Chen, Junjie Lu, Qingqing He, Jingyuan Liu, Zhifei Cui, Chengjie Huang, Tao Chen, Zhihai Su, Hai Lu","doi":"10.1097/BRS.0000000000005342","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005342","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To develop machine learning (ML) models integrating clinical/imaging variables for predicting 3- and 6-month outcomes of radiofrequency (RF) treatment in lumbar facetogenic pain, and an independent temporal validation cohort was used to evaluate the model's performance. Shapley Additive Explanations (SHAP) analysis was utilized to identify key variables and construct a simplified model.</p><p><strong>Summary of background data: </strong>Early identification of RF-responsive patients remains challenging, with limited non-invasive prognostic tools available.</p><p><strong>Methods: </strong>Six ML models were trained using 16 clinical/imaging variables from 372 RF-treated patients. Model performance was evaluated via AUROC, with SHAP analysis identifying key variables. Simplified models using clinical-only, imaging-only, and SHAP-selected variables were compared.</p><p><strong>Results: </strong>In the discovery (n=312) and temporal validation (n=60) cohorts, 141 and 26 patients had unsuccessful 3-month outcomes, respectively. The logistic model outperformed others, achieving AUROCs of 0.834 (95% CI: 0.725-0.942) and 0.818 (0.713-0.923) for 3-month prediction in discovery and validation cohorts. Simplified models showed comparable performance (discovery AUROC: 0.795-0.837; validation: 0.699-0.814). Six-month predictions demonstrated similar robustness (discovery AUROC: 0.813; validation: 0.783). Decision curve analysis confirmed the logistic model's clinical utility, providing net benefits at threshold probabilities >40%.</p><p><strong>Conclusions: </strong>The Logistic model, which is based on clinical and imaging variables, has the potential to facilitate early screening of patients who might benefit from RF treatment in the short- and long-term. SHAP analysis helps evaluate the impact of variables and build simplified models with comparable performance. The key variables identified in this study require further verification through external geographic validations.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674564","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 Two-Screw versus Four-Screw Internal Fixation on Fusion Speed in Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial.","authors":"Cheng-Yi Huang, Xia-Qing Sheng, Xing-Jin Wang, Zi-Han Peng, Ting-Kui Wu, Kangkang Huang, Yang Meng","doi":"10.1097/BRS.0000000000005334","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005334","url":null,"abstract":"<p><strong>Background context: </strong>The insertion process of the new two-screw internal fixation is simpler than that of four-screw internal fixation for anterior cervical discectomy and fusion (ACDF). However, it is unclear whether there is a difference in fusion rate.</p><p><strong>Purpose: </strong>This study aimed to compare the time required to achieve osseous fusion and the clinical efficacy of four-screw versus two-screw internal fixation.</p><p><strong>Study design: </strong>Prospective randomized controlled trial.</p><p><strong>Patient sample: </strong>From October 2021 to April 2023, eighty patients diagnosed with single-level cervical spondylosis were recruited and randomly allocated into a four- or two-screw group.</p><p><strong>Outcome measures: </strong>The primary endpoint was the fusion rate six months postoperatively. Secondary outcomes included the prevalence of complications and patient-reported outcome measures (PROMs), including the Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale scores for arm and neck pain.</p><p><strong>Methods: </strong>Patients were randomized to receive four-screw internal fixation (n=40) or two-screw internal fixation (n=40).</p><p><strong>Results: </strong>A total of 77 patients completed the trial and were included in the analysis. No significant differences were observed between groups at baseline. The fusion rate in the two-screw group was significantly higher than that in the four-screw group (69.2% vs. 42.1%, P=0.022) at six months postoperatively. No significant difference was found in the fusion rates at 3 and 12 months postoperatively between groups. Overall, PROMs significantly improved after surgery in both groups and did not differ significantly between groups at any follow-up time point. The prevalence of complications was not significantly different between groups.</p><p><strong>Conclusions: </strong>Two-screw internal fixation can achieve osseous fusion faster than four-screw internal fixation in ACDF. Two-screw internal fixation seems to achieve the same PROMs and safety as four-screw internal fixation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693296","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":"Incidence and Predictors of Oral Steroid Use Shortly Following Lumbar Microdiscectomy.","authors":"Henry Avetisian, Will Karakash, David McCavitt, Bahador Athari, Marc A Abdou, Dil Patel, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.1097/BRS.0000000000005337","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005337","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine the incidence and identify risk factors for radiculopathy requiring treatment with oral glucocorticoids within one month following lumbar microdiscectomy.</p><p><strong>Summary of background data: </strong>Lumbar microdiscectomy (MD) often provides immediate relief of low back and leg pain; however, some patients experience recurrent postoperative radicular pain. While oral steroids are commonly used to manage this condition, the frequency of their use and associated risk factors remain unclear.</p><p><strong>Methods: </strong>The PearlDiver national database was queried for patients who underwent lumbar MD for disc herniation. Patients were stratified based on whether they were prescribed oral steroids (Prednisone, Methylprednisolone, Prednisolone) from postoperative day 1 to day 30. Patient demographics and comorbidities were compared using Chi-squared analysis and Student's t-test. Multivariate logistic regression controlling for age, gender, Elixhauser Comorbidity Index (ECI), and the number of levels operated on was used to identify independent risk factors.</p><p><strong>Results: </strong>Among 326,315 patients who underwent lumbar MD, 38,455 (11.78%) received oral steroids within 30 days postoperatively. Patients who received steroids were more likely to be female (51.88% vs. 46.70%) and have a higher ECI (3.04 vs. 2.71) (P<0.001). Independent risk factors included opioid use (OR: 2.10, [2.05-2.15]), far lateral disc herniation (OR: 1.37, [1.29-1.46]), female gender (OR: 1.23 [1.21-1.26]), prior epidural steroid injection (OR: 1.18, [1.15-1.21]), fibromyalgia (OR: 1.17, [1.13-1.20]), tobacco use (OR: 1.09, [1.08-1.13]), delaying surgery >90 days from disc herniation (OR: 1.14 [1.11-1.17]), depression (OR: 1.12 [1.09-1.15]), ECI (OR: 1.07, [1.06-1.071]), and revision MD (OR: 1.05, [1.01-1.09]) (all P<0.05).</p><p><strong>Conclusion: </strong>This study found that 11.78% of patients undergoing lumbar MD require oral steroids postoperatively, reflecting a significant subset of patients with postoperative radiculopathy. Several patient- and procedural-related risk factors were identified. Further research is warranted to clarify the role of oral steroids and develop strategies to reduce postoperative radiculopathy.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693309","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}