Spine最新文献

{"title":"Risk Factor Analysis and Risk Prediction Model Construction of Ossification Progression after Postoperative Cervical Ossification of Posterior Longitudinal Ligament.","authors":"Changlin Lv, Jianyi Li, Jianwei Guo, Tianyu Bai, Xiaofan Du, Guodong Zhang, Jiale Shao, Han Zhang, Wenkang Yang, Shiqi Xu, Yukun Du, Jun Dong, Yongming Xi","doi":"10.1097/BRS.0000000000005286","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005286","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To develop a nomogram to predict the progression of ossification of the posterior longitudinal ligament (OPLL) after surgery, identify potential risk factors, and provide a theoretical basis for preventing postoperative ossification progression.</p><p><strong>Summary of background data: </strong>OPLL is a degenerative condition prevalent in Asian populations, leading to spinal cord and nerve root compression. While surgery is the primary treatment, postoperative ossification progression, particularly after posterior surgeries, remains a challenge, potentially requiring reoperation. Current methods for predicting risk factors rely on clinical experience, highlighting the need for a multi-dimensional prediction model to identify at-risk patients and improve outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed 271 patients who underwent posterior cervical spine surgery for OPLL. Univariate and multivariate logistic regression were used to identify independent risk factors for postoperative ossification progression. A nomogram was constructed based on these factors. The model's performance was evaluated using the C-index, ROC curve, calibration curve, and decision curve analysis (DCA), with validation conducted using data from a separate group.</p><p><strong>Results: </strong>Multivariate logistic regression analysis identified four independent risk factors for ossification progression after OPLL. A nomogram was subsequently constructed based on these factors. The C-index values in both the training and validation groups demonstrated high accuracy and stability of the model. The area under the ROC curve (AUC) indicated excellent discriminative ability, while the calibration curves showed high agreement between predicted and observed outcomes in both groups. The decision curve analysis demonstrated that the nomogram provided the highest net clinical benefit within a probability threshold range 0.01-1.</p><p><strong>Conclusion: </strong>Younger patients with OPLL, greater initial ossification thickness, more than three affected levels, or continuous/mixed ossification types are at higher risk of postoperative progression. The nomogram provides clinicians with an effective tool to predict and prevent postoperative ossification progression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120902","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":"The Impact of Modern Warfare on the Nature of Spinal Injuries in Combat Trauma: A Retrospective Cohort Study.","authors":"Shachar Shapira, Adi Givon, Roy Nadler, Alon Friedlander, Danny Epstein","doi":"10.1097/BRS.0000000000005397","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005397","url":null,"abstract":"<p><strong>Study design: </strong>Nationwide retrospective cohort study.</p><p><strong>Objective: </strong>Determine the incidence and epidemiology of combat-related spinal injuries during Israel-Hamas war.</p><p><strong>Summary of background data: </strong>In recent conflicts, injury mechanisms have evolved. Advancements in body armor and trauma care have increased survival rates, significantly altering the epidemiology of combat trauma and leading to changes in the characteristics of combat-related spinal injuries.</p><p><strong>Methods: </strong>This retrospective cohort study included patients hospitalized between October 9, 2023, and October 31, 2024, with combat-related injuries. Data was obtained from the Israel National Trauma Registry (INTR), focusing on soldiers with spinal injuries, defined by specific ICD-9 codes. Data collected included demographics, injury mechanisms, vital signs, additional injuries, injury severity, hospital resource utilization, and clinical outcomes. Statistical analysis included descriptive statistics and multivariate logistic regression to identify factors associated with spinal injury.</p><p><strong>Results: </strong>Out of 2,182 combat-related hospitalizations, 93 patients (4.3%) sustained spinal injuries, predominantly fractures affecting the lumbosacral spine. Explosions were the leading cause of injury (53.8%), followed by blunt trauma (24.7%) and ballistic injuries (21.5%). Serious concomitant injuries were common, with 50.5% of patients experiencing polytrauma. 23.7% had severe injuries (ISS 16-24) and 36.6% had critical injuries (ISS ≥25). ICU admission was required for 47.3% and 65% were discharged to rehabilitation facilities. The in-hospital mortality rate was 5.4%. Patients with spinal trauma had significantly longer hospital stay and higher rates of ICU admission compared to those without spinal injuries. Polytrauma and blunt trauma were independently associated with spinal injuries.</p><p><strong>Conclusion: </strong>Spinal injuries are common in modern combat, typically caused by high-energy blasts, with the lumbosacral region most frequently affected. Clinicians should maintain a high index of suspicion in severe injury or blunt trauma cases. As neurogenic shock is uncommon early post-injury, other causes of hypotension should be considered. Only a minority of casualties require neurosurgical intervention.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111949","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":"Effects of Perineural Dexamethasone and Dexmedetomidine on Neuromonitoring and Analgesia in Pediatric Scoliosis Surgery: A Randomized Controlled Trial.","authors":"Malgorzata Reysner, Juliusz Huber, Tomasz Reysner, Piotr Janusz, Grzegorz Kowalski, Przemysław Daroszewski, Katarzyna Wieczorowska-Tobis, Tomasz Kotwicki","doi":"10.1097/BRS.0000000000005399","DOIUrl":"10.1097/BRS.0000000000005399","url":null,"abstract":"<p><strong>Study design: </strong>A randomized controlled trial (RCT).</p><p><strong>Objective: </strong>To evaluate the effects of dexamethasone and dexmedetomidine as adjuvants to the erector spinae plane block (ESPB) on motor-evoked potential (MEP) recordings, postoperative analgesia, and hemodynamic stability in pediatric scoliosis surgery.</p><p><strong>Summary of background data: </strong>Intraoperative neuromonitoring using MEPs is crucial for assessing spinal cord integrity during scoliosis surgery. The ESPB is widely used for postoperative pain management; however, its impact on neuromonitoring remains uncertain, especially when combined with perineural adjuvants.</p><p><strong>Methods: </strong>Ninety pediatric patients undergoing scoliosis correction surgery were randomized into three groups: (1) Control (ESPB with 0.2% ropivacaine), (2) DEX (ropivacaine + 0.1 mg/kg dexamethasone), and (3) DEM (ropivacaine + 0.1 µg/kg dexmedetomidine). The primary outcome was time to first opioid analgesia. Secondary outcomes included total opioid consumption, postoperative pain scores, MEP amplitude and latency, transcranial electrical stimulation (TES) intensity required to evoke MEP, and hemodynamic stability.</p><p><strong>Results: </strong>Both adjuvants significantly prolonged analgesia and reduced opioid consumption ( P <0.0001). Pain scores (NRS) at 8, 12, 16, and 24 hours were lower in both adjuvant groups compared to the control. Dexamethasone was associated with the highest MEP amplitudes post-surgical correction and required lower TES intensity ( P =0.04), indicating superior neuromonitoring conditions. Dexmedetomidine was linked to lower MEP amplitudes and increased incidence of bradycardia (11 patients), whereas intraoperative hypotension occurred in five DEX patients.</p><p><strong>Conclusions: </strong>Dexamethasone improves neuromonitoring conditions by enhancing MEP amplitudes and reducing TES requirements, whereas dexmedetomidine is associated with MEP suppression and hemodynamic instability. These findings highlight the importance of balancing analgesia with neuromonitoring integrity in pediatric scoliosis surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111967","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":"Adverse Impact of Diabetes on Spine Fusion and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis.","authors":"Michael P Steinmetz, John E O'Toole, James S Harrop, Gonzalo Mariscal, Christopher D Chaput, Paul M Arnold, W Bradley Jacobs, Christopher D Witiw, Rick C Sasso","doi":"10.1097/BRS.0000000000005396","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005396","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Purpose: </strong>This meta-analysis aimed to provide a comprehensive evaluation of the impact of diabetes on spinal surgery outcomes.</p><p><strong>Summary of background data: </strong>Diabetes Mellitus is believed to be associated with an increased risk of adverse events during spinal surgery. With the increasing prevalence of diabetes and the increasing number of degenerative spinal procedures, understanding postsurgical expectations and optimal care is essential.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across PubMed, EMBASE, Scopus, and the Cochrane Library, selecting studies comparing diabetes and without diabetes who underwent spine fusion surgeries. 18 studies with 118,617 patients were included. The outcomes of interest were the risk of the incidence of spinal pseudoarthrosis and PROMs, including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), EQ-5D and SF-12/36 score. Odds ratios (OR) were calculated for dichotomous variables, mean differences (MD) for continuous variables and Standard Mean Differences (SMD) for continuous variables not sharing the same scale or units. Random effects were used if there was evidence of statistical heterogeneity.</p><p><strong>Results: </strong>Eighteen studies, comprising 118,617 patients, were included in the final analysis. Diabetes patients had a higher incidence of pseudoarthrosis at the lumbar spine (OR 1.13, 95%CI 1.02 to 1.25, P<0.05). Patients with diabetes also reported increased VAS back/neck pain scores (SMD 0.21, 95%CI 0.14 to 0.28, P<0.001) and worse ODI outcomes (MD 3.96, 95%CI 3.10 to 4.82, P<0.001), EQ-5D (MD -0.06, 95%CI -0.08 to -0.03, P<0.001) and SF-12/36 scores (SMD -2.70, 95%CI -4.99 to -0.41, P<0.05).</p><p><strong>Conclusion: </strong>Patients with diabetes who underwent spinal surgery had a higher incidence of pseudoarthrosis and worse functional outcomes compared to non-diabetic patients. These findings underscore the need for targeted clinical management and preventive strategies for patients with diabetes undergoing these procedures.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093572","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":"Breaking Down Instability: The Associations between Muscle Health, Facet Joint Morphology, Spinopelvic Alignment, and Stability Status in Degenerative Lumbar Spondylolisthesis.","authors":"Eric Zhao, Sereen Halayqeh, Troy Amen, Austin Kaidi, Zora Hahn, John Lama, Arsen Omurzakov, Tim Xu, Luis Colon, Tomoyuki Asada, Stephane Owusu-Sarpong, Quante Singleton, Farah Musharbash, Atahan Durbas, Adrian Lui, Andrea Pezzi, Adin Ehrlich, Myles Allen, Olivia Tuma, Kasra Araghi, Tarek Harhash, James Dowdell, Kyle Morse, Francis Lovecchio, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005393","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005393","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>to compare muscle health and imaging markers in patients with 1-level L4-L5 stable versus unstable degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Summary of background data: </strong>DLS may be stable or unstable. It is unknown how muscle health and other imaging markers are associated with DLS stability.</p><p><strong>Methods: </strong>Patients≥18 years with 1-level L4-L5 DLS and preoperative flexion/extension radiographs were included. Normalized total psoas area (NTPA), body mass index (BMI)-normalized paralumbar (PL) (multifidus [MF]+erector spinae [ES]) cross-sectional area (PL-CSA/BMI), and Goutallier were assessed. Other L4-L5 markers included: facet orientation, slip percentage, pelvic incidence (PI), tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI-LL. Instability was defined as>3 mm translation or>10 degrees endplate change on flexion-extension. Low versus normal muscle health was defined as NTPA or PL-CSA/BMI below the lowest sex-specific quartile. Multivariate logistic regression was used to determine variables associated with instability.</p><p><strong>Results: </strong>251 patients (unstable=50; stable=201) were included. There were no significant differences in muscle health at L3, L4, or L5 or Goutallier on univariate analysis. The stable cohort had smaller slip percentage (19±9% vs. 15±8%, P=0.007) and PI-LL (13.56±12.75 vs. 5.81±14.46, P=0.001). The stable cohort had more patients with MF and ES total Goutallier≤2 (P=0.031, P=0.002, respectively) at L3-L4 versus L4-L5 and more patients with MF and ES total Goutallier≤2 (P=0.013, P=0.004, respectively) at L4-L5 versus L5-S1. On regression, low L4-L5 MF Goutallier was associated with instability (OR: 2.50, 95% CI [1.01 - 6.20], P=0.047).</p><p><strong>Conclusion: </strong>Patients with unstable L4-L5 spondylolisthesis have lower multifidus Goutallier at the slip level, greater slip percentage, and greater PI-LL mismatch. Patients with stable L4-L5 spondylolisthesis have greater Goutallier of the caudal paralumbars.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094239","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":"Posterior Spinal Fusion with Rib Resection Allows for Improved Deformity Correction as well as Patient Satisfaction.","authors":"Vishal Sarwahi, Katherine Eigo, Effat Rahman, Brian Li, Victor Koltenyuk, Sayyida Hasan, Keshin Visahan, Yungtai Lo, Jon-Paul DiMauro, Terry Amaral","doi":"10.1097/BRS.0000000000005392","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005392","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>This study aimed to compared radiographic and clinical outcomes in Adolescent Idiopathic Scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with and without thoracoplasty.</p><p><strong>Summary of background data: </strong>Scoliosis is a three-dimensional deformity. As a result, patients often have an associated rib cage deformity, with clinical and aesthetic implications. Direct vertebral rotation (DVR) allows for some reduction of the rib hump; however, the deformed ribs remain deformed. Rib resection has been utilized to further reduce the rib hump, however there are concerns of increased pain, operative time, and blood loss.</p><p><strong>Methods: </strong>Retrospective review of 400 AIS patients undergoing PSF between 2018-2023. Patients were stratified based on those who underwent rib resectioning (RR) and those who did not (Non-Rib Resection, N-RR). Radiographic, surgical, and clinical outcomes were compared. Clinical outcomes were collected utilizing SRS-22 and our institution's activity questionnaire, validated via \"test-retest\" method. All data is presented as medians, IQR, frequencies, and percents. Fisher's Exact, Chi-squared, and Wilcoxon rank-sum tests were used.</p><p><strong>Results: </strong>153 patients were in the RR group, 247 were in the N-RR. Preoperative rib hump was not statistically significant between the two groups (P=0.49). Final rib hump was 16.3 mm in RR patients and 29.8 mm in N-RR (P<0.001). RR had 60.5% rib hump correction; N-RR had 30.4% correction (P<0.001). Patient reported self-image (P=0.02) and mental health (P=0.01) scores had significantly improved in RR. No differences in 90-day complication rates (P=0.19) or self-reported return to activities (P>0.05).</p><p><strong>Conclusion: </strong>Rib resectioned patients had approximately double the amount of rib hump correction at 60.5%, compared to those who did not undergo rib resectioning at 30.4%, with no increase in the rate of complications. RR patients had improved self-reported self-image and mental health scores, with no difference in timing for return to activities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094625","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":"Identification of Optimal Candidates for Operative Management of Mild Degenerative Cervical Myelopathy: A Novel trajectory-based Analysis of Postoperative Recovery.","authors":"Alex B Bak, Mohammed Ali Alvi, Ali Moghaddamjou, Michael G Fehlings","doi":"10.1097/BRS.0000000000005394","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005394","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study using prospectively accrued data.</p><p><strong>Objective: </strong>To describe the functional recovery trajectories after surgery for mild degenerative cervical myelopathy (DCM) and identify trajectory-associated preoperative factors.</p><p><strong>Summary of background data: </strong>Indications for surgical intervention of mild DCM remain a topic of discussion and uncertainty. We sought to address the hypothesis that optimal surgical candidates with mild DCM could be identified based on their predicted postoperative functional recovery after surgery.</p><p><strong>Methods: </strong>We identified patients that underwent surgical decompression for mild DCM (modified Japanese Orthopedic Association score 15 - 17) enrolled in the prospective, multicenter AO Spine CSM-NA and CSM-I trials. Patients were classified using trajectory modelling into distinct recovery trajectories for their mJOA and Short Form 36, version 2 Physical Component Summary (SF36-PCS) scores over 2yr follow up. Predictors of recovery trajectories were identified using multivariate logistic regression.</p><p><strong>Results: </strong>Of 198 patients with mild DCM, two distinct functional recovery trajectories for mJOA and two trajectories for SF36-PCS were identified. The good recovery trajectory for mJOA included 138 patients (69.7%) that achieved clinically important improvements in their function through two-year follow up while 60 patients (30.3%) followed a marginal recovery trajectory, whereas the SF36-PCS good recovery trajectory group captured 166 patients (59.5%), and 79 patients (40.5%) in the marginal recovery group. Achieving good recovery in both mJOA and SF36-PCS was associated with higher self-reported baseline physical functioning. Patients who were older or current or former tobacco smokers were less likely to have a good postoperative recovery.</p><p><strong>Conclusion: </strong>Most mild DCM patients achieve clinically important recoveries of their function and selfreported physical function after surgery. However, there is a heterogenous group of patients that do not improve after surgical management. Further prospective studies are needed to evaluate clinically relevant factors associated with varying postoperative trajectories.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094624","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":"Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery:: Radiological and Clinical Results from the NORDSTEN Spinal Stenosis Trial.","authors":"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby","doi":"10.1097/BRS.0000000000005263","DOIUrl":"10.1097/BRS.0000000000005263","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E197"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012052","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":"Biplane Ultrasound Versus Fluoroscopy for Guidance of Percutaneous Lumbar Intervertebral Foramen Insertion : A Randomized Controlled Clinical Trial.","authors":"Yi Mao, Peng Huang, Yuhong Tao, Chao Zhang, Mingbo Zhang","doi":"10.1097/BRS.0000000000005295","DOIUrl":"10.1097/BRS.0000000000005295","url":null,"abstract":"<p><strong>Study design: </strong>A randomized controlled study.</p><p><strong>Objective: </strong>The aim of this study was to develop a clinical process of biplane ultrasound (US) guided percutaneous lumbar intervertebral foramen insertion (PLIFI) and to verify that biplane US can improve accuracy and reduce number of fluoroscopies.</p><p><strong>Summary of background data: </strong>PLIFI is crucial for drug injection and establishment of transforaminal surgical channel. The traditional fluoroscopy guidance involves radiation and requires practical experience.</p><p><strong>Methods: </strong>Patients with lumbar disc herniation scheduled for an epidural steroid injection or percutaneous endoscopic lumbar discectomy were randomized to the biplane US and fluoroscopy groups. The biplane US group was divided into training and proficiency stages using a learning curve fitted by cumulative sum analysis. All punctures were performed by a junior spine surgeon and a junior sonographer. The primary outcomes were the first success rate, number of punctures and radiographs, puncture time, and confidence score.</p><p><strong>Results: </strong>Sixty-eight patients (age 51.4±15.4 yr, 36 males) were divided into the biplane US and fluoroscopy groups. According to the 12th turning point of a learning curve, the biplane US group was divided into training and proficiency periods. The first-attempt success rate was achieved in 61% using biplane US at the proficiency period, compared with 32% using fluoroscopy [ P =0.033, RR: 1.634]. The number of radiographies [1 (IQR 1-2) vs . 2 (IQR 2-3), P =0.001] was significantly smaller, and puncture time [120 s (IQR 57-210) vs. 197 s (IQR 159-341), P =0.001] was significantly faster using biplane US at the proficiency period.</p><p><strong>Conclusion: </strong>Biplane US provides an accurate, safe, and convenient approach for PLIFI. With further clinical practice, biplane US would be conducive to rapid skill acquisition for novices and has the potential to achieve a completely radiation-free puncture process.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"686-693"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650838","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":"The Minimal Clinically Important Difference for the Oswestry Disability Index Substantially Varies Based on Calculation Method: Implications to Value-Based Care.","authors":"Matthew J Solomito, Cameron Kia, Heeren Makanji","doi":"10.1097/BRS.0000000000005074","DOIUrl":"10.1097/BRS.0000000000005074","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>Evaluate differences in the minimal clinically important difference (MCID) threshold value based on various acceptable statistical methods and how these differences may influence the interpretation of surgical benefit following elective 1- and 2-level lumbar fusion.</p><p><strong>Summary of background data: </strong>The MCID is a statistically determined threshold value to evaluate if a patient has received benefit from a medical procedure. In the era of value-based medicine, the MCID has become increasingly important. However, there is substantial ambiguity surrounding the interpretation of this value, given that it can be influenced by both demographic and methodological factors.</p><p><strong>Methods: </strong>A total of 371 patients who underwent 1- or 2-level elective lumbar fusions between June 2021 and June 2023 were included in this study. All patients completed both their preoperative and 6-month postoperative Oswestry Disability Index (ODI), as well as 2 anchor questions concerning satisfaction with their surgical procedure. The MCID values were calculated using 16 accepted statistical methods, and the resulting MCID values were applied to the cohort to determine how many patients reached MCID by 6 months postfusion.</p><p><strong>Results: </strong>Results demonstrated significant variability in the MCID value. The average MCID value for all 16 methods was 10.5±7.0 points in the in the range (0.8 to 25). Distribution methods provided lower threshold MCID values but had greater variability while the Anchor methods resulted in higher threshold values but had lower variability. Depending on the method used 30% to 83% of the cohort reached MCID by 6 months.</p><p><strong>Conclusion: </strong>The statistical method used to calculate the MCID resulted in significantly different threshold values and greatly affected the number of patients meeting MCID. The results demonstrates the complexity surrounding the interpretation of MCID values and calls into question the utility of a single statistically determined value to assess surgical success.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"707-712"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421075","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}