Spine最新文献

{"title":"Measuring Academic Productivity in Orthopaedic and Spine Surgery.","authors":"Andrew J Schoenfeld, Kaitlyn E Holly","doi":"10.1097/BRS.0000000000005350","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005350","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: \"Other Factors That Can Affect Wound Healing With Elective Lumbar Spine Surgery and Perioperative Nutritional Supplementation in Patients\".","authors":"Anthony Yung, Oluwatobi O Onafowokan, Max R Fisher, Ankita Das, Ethan J Cottrill, Isabel P Prado, Caroline M Wu, Peter G Passias","doi":"10.1097/BRS.0000000000005143","DOIUrl":"10.1097/BRS.0000000000005143","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E141"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Outcomes After Preoperative Embolization in Hypervascular Spinal Metastases: A Propensity Scored Study of 191 Patients.","authors":"Robertus J B Pierik, Jantijn J G J Amelink, Olivier Q Groot, Avik Som, Bram T van Munster, Daniël C de Reus, Theresa L Chua, Hester Zijlstra, Jorrit-Jan Verlaan, John H Shin, James D Rabinov, Daniel G Tobert","doi":"10.1097/BRS.0000000000005182","DOIUrl":"10.1097/BRS.0000000000005182","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity-score matched, case-control study at 2 academic tertiary care centers.</p><p><strong>Objective: </strong>To assess the effect of preoperative embolization (PE) on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss; and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies.</p><p><strong>Background context: </strong>PE intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results.</p><p><strong>Materials and methods: </strong>After propensity score matching, 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of propensity score matching did not allow analysis of patients with tumor volumes >9 cm 3 . Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions.</p><p><strong>Results: </strong>There was no difference in EBL [948 mL (IQR: 500-1750) vs. 1100 mL (IQR: 388-1925), P =0.68] and hemoglobin mass loss [201 g (IQR: 119-307) vs. 232 g (IQR: 173-373), P =0.18] between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P =0.05) in PE patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss, or perioperative blood transfusions.</p><p><strong>Conclusions: </strong>Our study demonstrated that, for tumors <9 cm 3 , PE did not reduce EBL, hemoglobin mass loss, or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of preoperative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases.</p><p><strong>Level of evidence: </strong>Level III-treatment benefits.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"437-446"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location of Vascular Structures at Risk in Relation to Sacroiliac Joint Fusion.","authors":"Zachary Brandt, Kai Nguyen, Gideon Harianja, Kirulus Amin, Adel Battikha, Ninous Betdashtoo, Rohan Kubba, David Shin, Mark Oliinik, Jacob Razzouk, Jun Ho Chung, Olumide Danisa, Wayne Cheng","doi":"10.1097/BRS.0000000000005218","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005218","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>This study seeks to establish the normal distribution of the vasculature surrounding the SI joint while also demonstrating associations between distribution and laterality, sex, and ethnicity.</p><p><strong>Summary of background data: </strong>Sacroiliac (SI) joint fusion surgery has emerged as a viable treatment option for patients suffering from low back pain due to chronic SI joint dysfunction. Due to potential complications from iatrogenic injury to vasculature, it becomes critical to understand normal anatomy and locations with a high vasculature concentration surrounding the SI joint.</p><p><strong>Methods: </strong>The authors retrieved medical and radiographic records of patients who underwent computed tomography angiography (CTA) of the pelvis. Anterior and posterior compartments of the SI joint were established on the transverse view by creating an even coronal division of the SI joint. The superior, middle, and inferior compartments were established on the coronal view as three equal transverse compartments. The compartments in which vasculature was visualized were recorded.</p><p><strong>Results: </strong>Distribution of vasculature around the right and left hemipelvis concentrated in the inferior compartments and decreased in concentration while moving superiorly. Anterior compartments contain a higher vascularity than posterior compartments. Vasculature was present in <3% of the posterior middle, and posterior superior compartments while present in >83% of the inferior compartments. There were no significant differences with respect to vascular distribution when comparing the laterality of the right versus left hemipelvis. There were statistically significant relationships between vascular distribution and sex (P<0.05), as well as across self-reported ethnicity (P<0.05).</p><p><strong>Conclusions: </strong>SI screw placement in the posterior superior has the lowest risk of iatrogenic vascular injury. Careful consideration should be taken during SI joint fusion surgery in the inferior compartments due to its high vasculature density.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 7","pages":"493-499"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should We Operate on Octogenarians With Cervical Myelopathy or Radiculopathy?","authors":"Omar Zakieh, Maryam Y Jawid, Mitchell F Bowers, Mason W Young, Scott L Zuckerman, Julian G Lugo-Pico, Raymond J Gardocki, Amir M Abtahi, Byron F Stephens","doi":"10.1097/BRS.0000000000005232","DOIUrl":"10.1097/BRS.0000000000005232","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>Investigate the disparities between octogenarians and nonoctogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes.</p><p><strong>Summary of background data: </strong>As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians.</p><p><strong>Materials and methods: </strong>Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients below 80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient-reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain.</p><p><strong>Results: </strong>There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P =0.548), 90-day readmission (10.3% vs. 6.9%, P =0.548), and 12-month reoperation (3.4% vs. 2.3%, P =0.736) between octogenarians and nonoctogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P =0.393), improvement in 3- and 12-month PROMs, and MCID achievement.</p><p><strong>Conclusions: </strong>Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and nonoctogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E122-E127"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rigid Thoracolumbar Orthosis Does Not Improve Outcomes of Acute Adolescent Spondylolysis as Compared With Placebo. Bony Union Predicts Improved Health-Related Quality of Life Outcomes at 2-Year Follow-Up.","authors":"Ella Virkki, Milja Holstila, Terhi Kolari, Markus Lastikka, Kimmo Mattila, Sari Malmi, Olli Pajulo, Ilkka Helenius","doi":"10.1097/BRS.0000000000005120","DOIUrl":"10.1097/BRS.0000000000005120","url":null,"abstract":"<p><strong>Study design: </strong>A prospective, comparative study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in adolescents with acute spondylolysis treated with a rigid thoracolumbar orthosis (Boston brace) or with a placebo (elastic lumbar support) with a 2-year follow-up time.</p><p><strong>Objective: </strong>To compare outcomes of acute adolescent spondylolysis treated with a rigid thoracolumbar orthosis or a placebo with a 2-year follow-up time.</p><p><strong>Background: </strong>The benefits of the use of rigid orthosis for the treatment of spondylolysis and achieving a bony union of spondylolysis remain unclear.</p><p><strong>Patients and methods: </strong>Sixty consecutive patients with acute spondylolysis were prospectively enrolled. Three patients were excluded from the analysis as they did not fulfil the inclusion criteria. The first 14 patients were randomized, and the remaining 46 chose the treatment method themselves. Treatment time was 4 months, and the follow-up time was 2 years. HRQoL was measured using the Scoliosis Research Society-24 (SRS-24) outcome questionnaire. The primary outcome was the HRQoL at 24 months and whether treatment type, bony union of the spondylolysis, or development of spondylolisthesis affected it.</p><p><strong>Results: </strong>Thirty (30/57) patients were treated with a Boston brace, and 27 (27/57) patients with a placebo. The bony union rate of spondylolysis did not differ between study groups (20/30 vs. 17/27, respectively, P = 0.789). The HRQoL did not differ between treatment groups in the SRS-24 domains through follow-up ( P > 0.05 for all). Five patients (5/57) developed spondylolisthesis (mean slip: 4.2 mm) during the 2-year follow-up time. Nonunion of the spondylolysis predicted the development of spondylolisthesis ( P = 0.005), but the treatment type did not affect it ( P > 0.05). Two years after treatment, patients who had bony union had higher SRS-24 total ( P = 0.005) and satisfaction domain ( P < 0.001) compared with patients with nonunion.</p><p><strong>Conclusion: </strong>A rigid brace is not necessary for the treatment of acute spondylolysis. Achieving a bony union of adolescent spondylolysis is desirable as their HRQoL is higher at 2 years.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"454-462"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Predictive Scoring System for Bone Union Rate After Conservative Management of Lumbar Spondylolysis.","authors":"Hisanori Gamada, Masaki Tatsumura, Tomoyuki Asada, Shun Okuwaki, Katsuya Nagashima, Yosuke Takeuchi, Toru Funayama, Masashi Yamazaki","doi":"10.1097/BRS.0000000000005094","DOIUrl":"10.1097/BRS.0000000000005094","url":null,"abstract":"<p><strong>Study design: </strong>A single-center retrospective cohort study.</p><p><strong>Objectives: </strong>To develop a predictive scoring system for bone union after conservative treatment of lumbar spondylolysis and assess its internal validity.</p><p><strong>Summary of background data: </strong>Lumbar spondylolysis, a common stress fracture in young athletes, is typically treated conservatively. Predicting bone union rates remains a challenge.</p><p><strong>Methods: </strong>This study included patients aged 18 years or younger with lumbar spondylolysis undergoing conservative treatment. A multivariable logistic regression analysis was used to develop a scoring system containing 6 factors: sex, age, lesion level, main side stage of the lesion, contralateral side stage of the lesion, and spina bifida occulta. The predictive scoring system was internally validated from the receiver operating characteristic (ROC) curve using bootstrap methods.</p><p><strong>Results: </strong>The final analysis included 301 patients with 416 lesions, with an overall bone union rate of 80%. On multivariable analysis, the main and contralateral stages were identified as factors associated with bone union. The predictive scoring system was developed from the main side stage score (prelysis, early=0, progressive stage=1) and the contralateral side stage score (none=0, prelysis, early, progressive stage=1, terminal stage=3). The area under the curve was 0.855 (95% confidence interval, 0.811-0.896) for the ROC curve, showing good internal validity. The predicted bone union rates were generally consistent with the actual rates.</p><p><strong>Conclusions: </strong>A simple predictive scoring system was developed for bone union after conservative treatment of lumbar spondylolysis, based on the stage of the lesion on the main and contralateral sides. The predicted bone union rate was ~90% for a total score of 0-1 and ≤30% for a score of 3-4. This system demonstrated good internal validity, suggesting its potential as a useful tool in clinical decision-making for the management of spondylolysis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"463-469"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotonergic Antidepressants Are Associated With Higher Rates of Hematoma After Anterior Cervical Spine Surgery: A Large Propensity-Matched Cohort Analysis.","authors":"Jeremy M Adelstein, Andrew J Moyal, John T Strony, Robert J Burkhart, David C Kaelber, Christina W Cheng, Zachary L Gordon, Christopher G Furey","doi":"10.1097/BRS.0000000000005168","DOIUrl":"10.1097/BRS.0000000000005168","url":null,"abstract":"<p><strong>Study design: </strong>Large database propensity-matched retrospective cohort analysis.</p><p><strong>Objective: </strong>This study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery. It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after anterior cervical spine surgery.</p><p><strong>Background: </strong>Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopedic procedures.</p><p><strong>Materials and methods: </strong>A retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included through Current Procedural Terminology codes and the International Classification of Disease, 10th Revision, encounter diagnosis codes. Cohorts were 1:1 propensity-matched across 7 demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as health care utilization, within 14 days, 30 days, 90 days, and 2 years postoperatively was evaluated.</p><p><strong>Results: </strong>Following propensity matching, each cohort consisted of 9249 patients, for a total of 18,498 patients included in the final statistical analysis. SSRIs/SNRIs were associated with higher odds of hematoma formation within 7 days [0.69% vs . 0.46%, odds ratio (OR): 1.5 (95% CI: 1.02-2.2), P = 0.04] and within 14 days postoperatively [0.81% vs . 0.52%, OR: 1.6 (95% CI: 1.1-2.3), P = 0.01]. Within 30 and 90 days, SSRIs/SNRIs were associated with a higher risk of emergency department utilization [30 d, OR: 1.30 (1.1-1.4); 90 d, OR: 1.3 (1.2-1.4)] and irrigation & debridement (I&D; 30 d, OR: 1.9 (1.2-3.0)]. SSRIs/SNRIs were also associated with a significantly higher risk of I&D within 2 years [OR: 1.3 (1.1-1.6)].</p><p><strong>Conclusion: </strong>The use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization, and the need for irrigation and debridement. Future prospective studies are required to confirm these results.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort analysis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"477-484"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity in the Definitions of Proximal Junctional Kyphosis and Failure in Spinal Deformity Literature: A Tower of Babel.","authors":"Izzet Akosman, Takashi Hirase, Jarred Lihan Chow, Tejas Subramanian, Robert Uzzo, Charlotte Henry Jones, Steven Govinda Persaud, Bryce Demopoulos, Olivia Tuma, Matthew Cunningham, Han Jo Kim, Francis Lovecchio","doi":"10.1097/BRS.0000000000005096","DOIUrl":"10.1097/BRS.0000000000005096","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To describe the various definitions of PJK and PJF used in spinal deformity literature and their utility over time.</p><p><strong>Summary of background data: </strong>Proximal junctional kyphosis or failure (PJK/PJF) is among the most common complications after long-segment fusions, but there is no consensus on their definitions. This presents challenges in understanding risk factors, management, and prevention strategies.</p><p><strong>Methods: </strong>A systematic literature review was performed on studies specifying a definition of PJK and/or PJF. PJK definitions were categorized as radiographic versus nonradiographic, and data were collected on PJK criteria, including the threshold for proximal junctional angle (PJA), change in PJA, vertebra selection for PJA measurement, and follow-up time points. PJF definitions were categorized as structural failure, need for revision, symptomatic failure, and radiographic (angular).</p><p><strong>Results: </strong>A total of 359 studies defining PJK and/or PJF were identified. While 56% of studies used the definition PJA>10 ° and PJA change from baseline>10 ° , the remainder expressed significant heterogeneity with respect to criteria for the magnitude of PJA and degree of PJA change. The most common vertebrae assessed were UIV/UIV+2 (74%), and the most common minimum follow-up (mFU) listed was two years (60%). Mean FUs for studies varied considerably even in studies with the same mFU, from 2.1 to 8.9 years (2-yr mFU) and 1.1 to 4.0 years (1-yr mFU). PJF definitions were most commonly structural (58%) or defined as a need for revision (48%), with a much less common use of PJA thresholds (23%).</p><p><strong>Conclusions: </strong>The challenges faced in preventing proximal junctional complications are mired in the heterogenous groundwork by which PJK and PJF are defined. Most definitions of PJK use radiographic thresholds without consideration of clinical relevance and variations in individual alignment. Conversely, definitions of PJF are based on clinical criteria, which are often subjective. Future research should focus on understanding the mechanisms of PJK/PJF, as only then will we be able to accurately define and prevent these complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"485-492"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724563","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":"Adjacent Level Canal Area Changes up to Two Years After Lumbar Spinal Stenosis Decompressive Surgery.","authors":"Helena Brisby, Tor Åge Myklebust, Hasan Banitalebi, Ivar Austevoll, Jorn Aaen, Kjersti Storheim, Christian Hellum, Eric Franssen, Kari Indrekvam, Erland Hermansen","doi":"10.1097/BRS.0000000000005247","DOIUrl":"10.1097/BRS.0000000000005247","url":null,"abstract":"<p><strong>Study design: </strong>A secondary analysis of data from the NORDSTEN-spinal stenosis trial (SST).</p><p><strong>Objective: </strong>The aim of the present study was to investigate whether the dural sac cross-sectional area (DSCA) on magnetic resonance imaging (MRI) of adjacent segments decreases after decompressive surgery due to lumbar spinal stenosis (LSS) up to 2 years postoperatively and to investigate possible associations with baseline variables, including preoperative patient and radiological characteristics, and surgical method used.</p><p><strong>Summary of background data: </strong>Decompressive surgery for LSS is currently the most common spinal surgery procedure; however, there is limited knowledge of changes in the DSCA over time adjacent to a decompressed segment.</p><p><strong>Materials and methods: </strong>In the NORDSTEN-SST, 437 patients were randomized to decompression with one of three minimally invasive surgical methods for LSS. The patients underwent an MRI of the lumbar spine (L2-L5) before surgery and at 3 and 24 months postoperatively. Descriptive statistics of adjacent DSCA and changes in adjacent DSCA are presented. Possible prognostic factors (preoperative factors, radiologic measures, and surgical method) for changes in the adjacent DSCA were examined using multivariate regression analyses.</p><p><strong>Results: </strong>Three hundred twenty-two patients (74%) in the original NORDSTEN-SST had undergone MRI at both 3 and 24 months postoperatively and were included (360 adjacent levels, 263 cranial, and 97 caudal to a decompressed level). Up to two years postoperatively, no decrease in adjacent DSCA was observed. No associations were found between the investigated baseline variables and DSCA change from zero to two years, except for a weak association with baseline adjacent DSCA.</p><p><strong>Conclusions: </strong>Up to two years postoperatively, the DSCA did not decrease at adjacent levels after decompressive surgery. None of the investigated baseline variables showed any clinically meaningful prognostic value regarding adjacent DSCA changes two years postoperatively. The findings support previous reports that decompression of adjacent levels is not required to prevent subsequent stenosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"429-436"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898296","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}