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Open versus Endoscopic Lumbar Discectomy: A Propensity-Matched Analysis of 2,618 Surgical Patients. 开放与内镜下腰椎间盘切除术:2618例手术患者的倾向匹配分析。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-11 DOI: 10.1097/BRS.0000000000005404
Alejandro Perez-Albela, Manjot Singh, Jinseong Kim, Maria Jensen, Gregory Snigur, Alan H Daniels, Bryce A Basques
{"title":"Open versus Endoscopic Lumbar Discectomy: A Propensity-Matched Analysis of 2,618 Surgical Patients.","authors":"Alejandro Perez-Albela, Manjot Singh, Jinseong Kim, Maria Jensen, Gregory Snigur, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005404","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005404","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare intraoperative complications, 90-day medical complications, and 2-year surgical reoperation rates between endoscopic discectomy (ED) and open discectomy (OD).</p><p><strong>Summary of background data: </strong>Symptomatic lumbar disc herniation is common, with discectomy serving as a common surgical intervention. Previous studies comparing ED and OD show inconsistent findings regarding complications and long-term outcomes, often limited by small sample sizes and study heterogeneity.</p><p><strong>Methods: </strong>Patients undergoing ED (CPT-62380) and OD (CPT-63030) from 2010-2022 were identified using PearlDiver database. Propensity score matching (1:1) controlled for age, gender, and Charlson Comorbidity Index (CCI). Outcomes included intraoperative complications such as dural tears and nerve injuries; 90-day medical complications including deep vein thrombosis (DVT), surgical site infections (SSI), dura repair, and urinary tract infections (UTI); and 2-year reoperations. Statistical analyses utilized chi-square tests, t-tests, and multivariate logistic regression adjusting for comorbidities. Odds ratios (OR) with 95% confidence intervals were reported.</p><p><strong>Results: </strong>A total of 2,618 patients were identified and examined (1,309 ED, 1,309 OD). On multivariate analysis, ED was associated with a significantly lower risk of dural tears (0.15% vs. 1.15%, OR: 0.179, P=0.006), surgical site infections (0.08% vs. 1.15%, OR: 0.082, P=0.001), wound complications (0.38% vs. 1.07%, OR: 0.342, P=0.023), and dura repair (0.08% vs. 0.69%, OR: 0.091, P=0.021). ED was also associated with lower odds of persistent pain (2.22% vs 2.83%, OR: 0.665, P=0.048). No significant differences were observed in nerve injuries, DVT, UTI, or readmissions.</p><p><strong>Conclusion: </strong>ED is associated with fewer dural tears, surgical site infections, wound complications, and dura repairs, along with lower odds of persistent pain compared to OD. Rates of DVT, UTI, and reoperations were not significantly different between groups.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609579","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}
引用次数: 0
Insights Into Chronic Low Back Pain Etiology: Population-Based Genome-Wide Association Study Identifies 18 Risk Loci. 慢性腰痛病因的洞察:基于人群的全基因组关联研究确定了18个风险位点。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2025-01-03 DOI: 10.1097/BRS.0000000000005254
Amy Elise Martinsen, Sigrid Børte, Mari Spildrejorde, Ben Michael Brumpton, Ingrid Heuch, John-Anker Zwart, Bendik Slagsvold Winsvold
{"title":"Insights Into Chronic Low Back Pain Etiology: Population-Based Genome-Wide Association Study Identifies 18 Risk Loci.","authors":"Amy Elise Martinsen, Sigrid Børte, Mari Spildrejorde, Ben Michael Brumpton, Ingrid Heuch, John-Anker Zwart, Bendik Slagsvold Winsvold","doi":"10.1097/BRS.0000000000005254","DOIUrl":"10.1097/BRS.0000000000005254","url":null,"abstract":"<p><strong>Study design: </strong>Genome-wide association study (GWAS) meta-analysis with downstream analyses.</p><p><strong>Objective: </strong>To explore the genetic architecture of chronic low back pain (cLBP) and identify underlying biological mechanisms that contribute to its development.</p><p><strong>Background: </strong>cLBP is prevalent and debilitating, with many cases having no identifiable biological cause. Current treatment options provide only limited relief, highlighting the need for a deeper understanding of the genetic and molecular factors involved in cLBP pathogenesis. Identifying these factors may lead to more effective, targeted therapies.</p><p><strong>Materials and methods: </strong>We conducted a GWAS meta-analysis involving 325,078 participants from the UK Biobank and the HUNT population studies. This was followed by downstream analyses, including gene prioritization, tissue enrichment analysis, and functional gene set analysis. Genetic loci were examined for their association with cLBP, and gene sets were assessed for functional relevance.</p><p><strong>Results: </strong>Eighteen genetic loci associated with cLBP were identified corresponding to as many prioritized genes, including 8 novel genes not previously linked to the condition. Tissue enrichment analysis highlighted significant involvement of hippocampal brain tissue, suggesting central memory processes may contribute to cLBP. Functional gene set analysis identified 37 gene sets, many related to transcription factors involved in bone and cartilage maintenance. Literature on the prioritized genes suggested a potential role for neurological, cartilaginous, and inflammatory mechanisms, including genes implicated in the innervation of intervertebral discs, inflammatory cell death, and central sensitization. Comparison with previous GWASs indicated potential differences between individuals who seek medical care and those who do not.</p><p><strong>Conclusion: </strong>This study enhances our understanding of the genetic basis of cLBP, revealing distinct biological mechanisms and suggesting the existence of patient subgroups with differing treatment needs. These insights may pave the way for more tailored and effective treatment approaches in the future.</p><p><strong>Level of evidence: </strong>Level III-observational study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"881-889"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984437","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}
引用次数: 0
One Versus Three-Level Fusion in Patients Undergoing Multilevel Lumbar Decompression : Relative Perioperative Risks and Five-Year Revisions. 腰椎多平面减压术患者的单层融合与三层融合:围手术期的相对风险和五年修订。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2024-08-27 DOI: 10.1097/BRS.0000000000005130
Philip P Ratnasamy, Michael J Gouzoulis, Sahir S Jabbouri, Daniel R Rubio, Jonathan N Grauer
{"title":"One Versus Three-Level Fusion in Patients Undergoing Multilevel Lumbar Decompression : Relative Perioperative Risks and Five-Year Revisions.","authors":"Philip P Ratnasamy, Michael J Gouzoulis, Sahir S Jabbouri, Daniel R Rubio, Jonathan N Grauer","doi":"10.1097/BRS.0000000000005130","DOIUrl":"10.1097/BRS.0000000000005130","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess relative odds of perioperative complications, readmissions, and 5-year survival to reoperation for patients undergoing 3-level lumbar decompression who undergo 3-level fusion relative to 1-level fusion.</p><p><strong>Background: </strong>Patients undergoing multilevel lumbar decompression may be indicated for fusion at one or more levels. The question of fusing only one level with indications such as spondylolisthesis or fusing all levels decompressed is of clinical interest in both the short and longer term.</p><p><strong>Patients and methods: </strong>Patients undergoing 3-level lumbar decompression were extracted from the PearlDiver M165Orto database. The subset of these patients undergoing concomitant 3-level and 1-level lumbar fusion were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence and odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis, and a comparative 5-year survival to lumbar spinal reoperation was determined.</p><p><strong>Results: </strong>After matching, 28,276 patients were identified as undergoing 3-level lumbar decompression with 3-level fusion and the same for those undergoing 3-level decompression with 1-level fusion. Controlling for patient age, sex, and Elixhauser Comorbidity Index, patients undergoing 3-level fusion had significantly greater odds ratio (OR) of many 90-day adverse events and aggregated any (OR: 1.42), serious (OR: 1.44), and minor (OR: 1.42) adverse events, as well as readmissions (OR: 1.51; P < 0.0001 for all). Five-year survival to reoperation was significantly lower for those undergoing 3-level decompression with 3-level fusion ( P < 0.0001).</p><p><strong>Conclusions: </strong>Patients undergoing 3-level lumbar decompression who underwent 3-level fusion were found to be at significantly greater odds of 90-day postoperative adverse events, readmissions, and 5-year reoperations relative to those undergoing 1-level fusion. The current data support the concept of limiting fusion to the levels with specific indications in the setting of multilevel lumbar decompressions and not needing to match the decompression and fusion levels.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E242-E247"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073921","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}
引用次数: 0
Long-Term Loss of Alignment Following ASD Surgery in the Absence of Mechanical Complications: Aging Spine? 在没有机械并发症的情况下,ASD 手术后的长期对位丧失:脊柱老化?
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2024-09-05 DOI: 10.1097/BRS.0000000000005142
Sleiman Haddad, Eva Jacobs, Susana Núñez-Pereira, Aleix Ruiz de Villa, Anika Pupak, Maggie Barcheni, Manuel Ramírez Valencia, Javier Pizones, Frank S Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Ahmet Alanay, Ibrahim Obeid, Ferran Pellisé
{"title":"Long-Term Loss of Alignment Following ASD Surgery in the Absence of Mechanical Complications: Aging Spine?","authors":"Sleiman Haddad, Eva Jacobs, Susana Núñez-Pereira, Aleix Ruiz de Villa, Anika Pupak, Maggie Barcheni, Manuel Ramírez Valencia, Javier Pizones, Frank S Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Ahmet Alanay, Ibrahim Obeid, Ferran Pellisé","doi":"10.1097/BRS.0000000000005142","DOIUrl":"10.1097/BRS.0000000000005142","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a prospective multicenter adult spinal deformity (ASD) registry.</p><p><strong>Objective: </strong>Assess whether spinal alignment deteriorates postsurgery in the absence of mechanical complications and evaluate the long-term outcomes of ASD surgery over a 5-year period.</p><p><strong>Summary of background data: </strong>ASD is prevalent among older adults, leading to significant pain and disability. Surgical intervention, although increasingly popular, is associated with complications, high costs, and uncertain long-term outcomes beyond 2 years. Mechanical failure and alignment loss often necessitate revision surgeries, but the natural progression of spinal alignment postsurgery without complications remains unclear.</p><p><strong>Methods: </strong>Clinical and radiological data were analyzed from surgical patients in a multicenter ASD registry who maintained alignment within the instrumented region and completed a 5-year follow-up. The study evaluated patient demographics, surgical details, radiological parameters, and quality of life (QoL) outcomes. Subanalyses were conducted to compare patients with different initial postoperative alignments and fixation levels.</p><p><strong>Results: </strong>The study included 79 patients (83.5% women, average age 61.9 y) with a mean of 10.7 fused levels. Of these, 29.1% underwent 3-column osteotomies (3CO), and 88.6% had a posterior-only approach. Although 65% showed favorable alignment at 6 weeks postsurgery, there was a progressive deterioration in global sagittal alignment (Global Tilt/RSA) and thoracic kyphosis over 5 years ( P <0.05), along with increased pelvic compensation (PT SS/RPV). These changes did not correlate with worsening health-related quality-of-life outcomes ( P >0.05). Older age was linked to greater progression in T2-T12 kyphosis, and osteoporosis was associated with increased SVA and RPV. Optimal immediate postoperative sagittal alignment did not prevent this \"aging effect.\"</p><p><strong>Conclusions: </strong>ASD surgery and achieving ideal postoperative alignment do not prevent the ongoing \"aging\" of the noninstrumented spine. Both thoracic and global sagittal alignments deteriorate over time. Although no functional decline has been observed, the implications of these changes for surgical planning remain uncertain.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"909-915"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133852","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}
引用次数: 0
Long-term Clinical Outcomes and Optimal Treatment Approaches of Degenerative Cervical Spondylosis: A 12-Year Multicenter Retrospective Cohort Study. 退行性颈椎病的长期临床结果和最佳治疗方法:一项12年多中心回顾性队列研究
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2025-01-21 DOI: 10.1097/BRS.0000000000005266
Pan Li, Runbo Lei, Lixiang Ding, Youxue Wang, Zhengxu Ye, Dechen Yu, Kangkang Su, Xuerui Yang, Bin Wei, Jinfeng Huang, Xiongfei Cao, Le Chang, Yongfeng Chen, Lu Gan, Junjie Du, Lei Shangguan, Mo Li, Zhuojing Luo
{"title":"Long-term Clinical Outcomes and Optimal Treatment Approaches of Degenerative Cervical Spondylosis: A 12-Year Multicenter Retrospective Cohort Study.","authors":"Pan Li, Runbo Lei, Lixiang Ding, Youxue Wang, Zhengxu Ye, Dechen Yu, Kangkang Su, Xuerui Yang, Bin Wei, Jinfeng Huang, Xiongfei Cao, Le Chang, Yongfeng Chen, Lu Gan, Junjie Du, Lei Shangguan, Mo Li, Zhuojing Luo","doi":"10.1097/BRS.0000000000005266","DOIUrl":"10.1097/BRS.0000000000005266","url":null,"abstract":"<p><strong>Study design/setting: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis.</p><p><strong>Summary of background data: </strong>ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, whereas SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters.</p><p><strong>Results: </strong>The CDR group exhibited a significantly higher overall success rate compared with CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved the angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristics and calibration curves.</p><p><strong>Conclusion: </strong>This study suggests that CDR provides similar clinical outcomes with fewer complications compared with ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and the potential for selection bias.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"890-901"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012160","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}
引用次数: 0
Focused Perioperative Nutritional Supplementation Reduces Wound Complications in Patients Undergoing Spinal Fusion Surgery. 围手术期集中补充营养可减少脊柱融合手术患者的伤口并发症。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2024-08-29 DOI: 10.1097/BRS.0000000000005136
Christopher J Como, Joshua C Setliff, Jonathan F Dalton, Yunting Melissa Tang, Anthony A Oyekan, Kimberly Hua, Kevin Byrne, Shaan Sadhwani, Michael Spitnale, Kira L Russell, Richard Wawrose, Joon Y Lee, Jeremy D Shaw
{"title":"Focused Perioperative Nutritional Supplementation Reduces Wound Complications in Patients Undergoing Spinal Fusion Surgery.","authors":"Christopher J Como, Joshua C Setliff, Jonathan F Dalton, Yunting Melissa Tang, Anthony A Oyekan, Kimberly Hua, Kevin Byrne, Shaan Sadhwani, Michael Spitnale, Kira L Russell, Richard Wawrose, Joon Y Lee, Jeremy D Shaw","doi":"10.1097/BRS.0000000000005136","DOIUrl":"10.1097/BRS.0000000000005136","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate intensive postoperative nutritional supplementation on wound healing complications and outcomes after spinal fusion surgery.</p><p><strong>Background: </strong>Poor nutritional status leads to inferior postoperative outcomes by increasing mortality and predisposing patients to infection and wound-healing complications. While perioperative nutritional supplementation has shown promise in mitigating these risks, there is a paucity of literature regarding specific nutritional routines in spinal fusion surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on patients who underwent spinal fusion surgery between 2019 and 2022. Demographic and nutritional data, including preoperative prealbumin (PAB) levels and postoperative supplemental diet, were examined. Primary endpoints included wound complications, with secondary outcomes assessing Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Health (PH) scores. Statistical analyses included unpaired t tests and χ 2 /Fischer exact tests with significance set at P <0.05.</p><p><strong>Results: </strong>Patients receiving the supplemental diet (n=229) demonstrated fewer wound complications (7% vs . 21%, P =0.004) and reoperations (3% vs . 11%, P =0.016) compared with those without supplementation (n=56). No significant differences were observed in preoperative or postoperative PROMIS PH or ODI scores. Patients with normal preoperative PAB had more wound complications without the supplemental diet (5% vs . 18%, P =0.025). A similar trend was seen in the patients with low preoperative PAB (12% vs . 26%, P =0.12).</p><p><strong>Conclusion: </strong>Postoperative nutritional supplementation significantly reduces wound complications after spinal fusion surgery in a cost-effective manner. This study underscores the modifiability of certain perioperative risk factors and suggests that nutritional strategies can mitigate potential complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E253-E258"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112302","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}
引用次数: 0
Letter to the Editor "Adjacent Level Canal Area Changes up to Two Years After Lumbar Spinal Stenosis Decompressive Surgery" by Brisby et al. 布里斯比等人的“腰椎管狭窄减压手术后两年相邻水平管面积的变化”。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2025-04-16 DOI: 10.1097/BRS.0000000000005368
Yingjie Xu, Yongguang Wang
{"title":"Letter to the Editor \"Adjacent Level Canal Area Changes up to Two Years After Lumbar Spinal Stenosis Decompressive Surgery\" by Brisby et al.","authors":"Yingjie Xu, Yongguang Wang","doi":"10.1097/BRS.0000000000005368","DOIUrl":"10.1097/BRS.0000000000005368","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E268"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019779","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}
引用次数: 0
Effect of a Surgeon-Directed Cocktail of Ropivacaine, Methylprednisolone, and Ketoprofen on Postoperative Pain and Ambulation in Adolescent Idiopathic Scoliosis Surgery: A Double-Blind Randomized Controlled Trial. 罗哌卡因、甲基强的松龙和酮洛芬对青少年特发性脊柱侧凸手术术后疼痛和活动的影响:一项双盲随机对照试验。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 Epub Date: 2025-03-28 DOI: 10.1097/BRS.0000000000005314
Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Koichiro Ide, Kenta Kurosu, Yosuke Shibata, Yukihiro Matsuyama
{"title":"Effect of a Surgeon-Directed Cocktail of Ropivacaine, Methylprednisolone, and Ketoprofen on Postoperative Pain and Ambulation in Adolescent Idiopathic Scoliosis Surgery: A Double-Blind Randomized Controlled Trial.","authors":"Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Koichiro Ide, Kenta Kurosu, Yosuke Shibata, Yukihiro Matsuyama","doi":"10.1097/BRS.0000000000005314","DOIUrl":"10.1097/BRS.0000000000005314","url":null,"abstract":"<p><strong>Study design: </strong>Double-blind randomized controlled trial.</p><p><strong>Objective: </strong>To assess the safety and efficacy of surgeon-directed intraoperative subfascial cocktail analgesics in adolescent scoliosis surgery.</p><p><strong>Summary of background data: </strong>Several studies have demonstrated the efficacy of intraoperative surgeon-directed analgesics in idiopathic scoliosis surgery. However, their retrospective analyses provided limited clinical evidence. Are cocktail analgesics effective in improving postoperative pain in idiopathic scoliosis surgery? Can surgeon-directed intraoperative cocktail analgesics improve postoperative pain scores and help patients ambulate?</p><p><strong>Methods: </strong>Forty-two adolescent patients (mean age 15.8±2.1 yr, 31 females) were randomly assigned to two groups: one receiving cocktail analgesics (21 patients), and the other serving as a control (21 patients). The cocktail consisted of 0.75% ropivacaine, methylprednisone, and ketoprofen. The primary outcome measured was postoperative pain (NRS). Secondary outcomes included ambulation timing, fentanyl and acetaminophen usage. Epidural anesthesia usage was recorded but not analyzed as an independent outcome since perceived pain severity may have influenced its administration.</p><p><strong>Results: </strong>Forty-two patients (mean age: 15.8±2.1 yr, 31 females) were included. Both groups had comparable baseline characteristics, including age, sex distribution, and preoperative curve severity. The cocktail group showed significantly lower pain scores one-hour post-surgery (4.1±3.7 vs. 5.6±2.9, P =0.044) and ambulated earlier (2.5±0.5 vs. 3.3±2.5 d, P =0.049). However, there were no significant differences in pain scores after six hours or in fentanyl/acetaminophen consumption. Adverse events attributable to the procedures were comparable between both groups.</p><p><strong>Conclusions: </strong>Surgeon-directed cocktail therapy alone is insufficient to achieve significant improvements in pain control, as evidenced by the minimal impact on NRS scores and early ambulation promotion. Clinically, this underscores the need for more comprehensive, multimodal pain management strategies to optimize postoperative recovery and enhance outcomes for patients with adolescent scoliosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"902-908"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731662","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}
引用次数: 0
ECAP-controlled Closed-loop Spinal Cord Stimulation for Chronic Non-surgical Refractory Back Pain: Subgroup Analysis from Two Prospective Multicenter Clinical Trials. ecap控制的闭环脊髓刺激治疗慢性非手术性难治性背痛:两项前瞻性多中心临床试验的亚组分析
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 DOI: 10.1097/BRS.0000000000005445
Corey W Hunter, Jeffrey S Raskin, Nagy A Mekhail, Erika A Petersen, Shivanand P Lad, Jason E Pope, Shrif J Costandi, Leonardo Kapural, Ronald B Boeding, Ajay Antony, Steven M Rosen, Robert D Heros, Dawood Sayed, Sean Li, Ahmed M Raslan, G Lawson Smith, Johnathan H Goree, Angela Leitner, Nicole Soliday, Rui V Duarte, Timothy R Deer
{"title":"ECAP-controlled Closed-loop Spinal Cord Stimulation for Chronic Non-surgical Refractory Back Pain: Subgroup Analysis from Two Prospective Multicenter Clinical Trials.","authors":"Corey W Hunter, Jeffrey S Raskin, Nagy A Mekhail, Erika A Petersen, Shivanand P Lad, Jason E Pope, Shrif J Costandi, Leonardo Kapural, Ronald B Boeding, Ajay Antony, Steven M Rosen, Robert D Heros, Dawood Sayed, Sean Li, Ahmed M Raslan, G Lawson Smith, Johnathan H Goree, Angela Leitner, Nicole Soliday, Rui V Duarte, Timothy R Deer","doi":"10.1097/BRS.0000000000005445","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005445","url":null,"abstract":"<p><strong>Study design: </strong>Subgroup analysis of patients with chronic non-surgical refractory back pain (NSRBP) from two prospective multicenter clinical trials to 12-month follow-up.</p><p><strong>Objective: </strong>To evaluate pain-related and holistic response, safety events as well as neurophysiologic metrics associated with the use of evoked compound action potential (ECAP)-controlled closed-loop spinal cord stimulation (SCS) for patients with chronic back pain without prior surgery.</p><p><strong>Summary of background data: </strong>Innovations in SCS such as the development of physiologic ECAP-controlled closed-loop SCS overcome limitations of traditional, fixed-output SCS for the treatment of NSRBP. The outcomes of closed-loop SCS to 12-month follow-up for patients with NSRBP have not been previously reported.</p><p><strong>Methods: </strong>Patient-reported outcome measures for pain intensity, physical function, health-related quality of life, sleep quality and emotional function were collected from 68 patients with NSRBP in two prospective multicenter clinical trials. Change in opioid use, its reduction or elimination were assessed at 12-month follow-up. A validated composite outcome measure comprising the different health domains was used to evaluate holistic treatment response through minimal clinically important differences (MCIDs). Objective device metrics provide information on system utilization, loop performance (dose accuracy), and neurophysiologic dose metrics.</p><p><strong>Results: </strong>At 12-months, 79% of patients reported ≥50% reduction in pain intensity and 48% obtained ≥80% pain relief. Significant improvements in all patient-reported outcome measures assessed were observed at 3- and 12-months. Voluntary reduction or elimination of opioid use was observed in approximately half of the patients that were taking opioids at baseline. System utilization was >80%, dose ratio was >1.3 (i.e., 30% above ECAP threshold) with a high dose accuracy keeping the elicited ECAP within 3.5 μV of the target ECAP set on the system.</p><p><strong>Conclusion: </strong>ECAP-controlled closed-loop SCS represents a safe and effective treatment option for patients with NSRBP.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529610","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}
引用次数: 0
Pedicle Enhancement on contrast-enhanced MRI As A Risk Factor for Progressive Collapse in Acute Osteoporotic Compression Fractures. 对比增强MRI椎弓根增强是急性骨质疏松性压缩性骨折进行性塌陷的危险因素。
IF 2.6 2区 医学
Spine Pub Date : 2025-07-01 DOI: 10.1097/BRS.0000000000005444
Byung-Jou Lee, Seonghoon Jeong, Kwang Hyeon Kim, Hae-Won Koo
{"title":"Pedicle Enhancement on contrast-enhanced MRI As A Risk Factor for Progressive Collapse in Acute Osteoporotic Compression Fractures.","authors":"Byung-Jou Lee, Seonghoon Jeong, Kwang Hyeon Kim, Hae-Won Koo","doi":"10.1097/BRS.0000000000005444","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005444","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To verify the association between pedicle enhancement (PE) on contrast-enhanced magnetic resonance imaging (MRI) and progressive collapse, and analyze the correlation between the degree of PE and progressive collapse.</p><p><strong>Summary of background data: </strong>Osteoporotic compression fracture (OCF) is generally considered a stable fracture, with most patients achieving successful recovery through conservative treatment such as bracing and physical therapy. However, in some cases, progressive collapse occurs, requiring additional treatment or surgery.</p><p><strong>Methods: </strong>We enrolled 203patitents and analyzed factors related to progressive collapse. We evaluated the association between PE and progressive collapse and determined the best cult off value of the signal-to-noise ratio of PE (SNR of PE) for predicting progressive collapse. Survival analysis using Kaplan-Meier curve was performed to assess the cumulative risk of positive progressive collapse over time.</p><p><strong>Results: </strong>Presence of PE, SNR of PE, age, body mass index, and segmental kyphosis were significantly correlated with progressive collapse. The optimal cutoff point of SNR of PE was measured at 89.3 with 71.1% and 78.7% sensitivity and specificity, respectively, with an AUC of 0.781. Analysis of cumulative progressive collapse incidence revealed a significant difference between the PE and NPE groups within 1-2 months after OCF, which stabilized after three months.</p><p><strong>Conclusions: </strong>PE is a significant predictor of progressive collapse in OCF within a year, aiding spine surgeons in risk assessment of progressive collapse and management of acute OCF.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529611","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}
引用次数: 0
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