Spine最新文献

{"title":"Impact of Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Ankita Das, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Peter S Tretiakov, Elizbeth L Lord, Pawel P Jankowski, Douglas G Orndorff, Andrew J Schoenfeld, Christopher I Shaffrey, Peter G Passias","doi":"10.1097/BRS.0000000000005213","DOIUrl":"10.1097/BRS.0000000000005213","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of prospectively enrolled database.</p><p><strong>Objective: </strong>We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.</p><p><strong>Background: </strong>Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.</p><p><strong>Materials and methods: </strong>Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.</p><p><strong>Results: </strong>A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P < 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36's physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P > 0.05).</p><p><strong>Conclusion: </strong>Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty ","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 6","pages":"357-367"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484047","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 Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?","authors":"Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, Michelle C Welborn, John T Smith, Ron El-Hawary, Kenneth Cheung, Kenneth D Illingworth, David L Skaggs, Lindsay M Andras","doi":"10.1097/BRS.0000000000005072","DOIUrl":"10.1097/BRS.0000000000005072","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).</p><p><strong>Summary of background data: </strong>Tether breakage after VBT is common with rates up to 50% reported. In these cases, it remains unknown whether the curve will progress or remain stable.</p><p><strong>Materials and methods: </strong>Adolescent and juvenile idiopathic scoliosis patients in a multicenter registry with ≥2-year-follow-up after VBT were reviewed. Broken tethers were listed as postoperative complications and identified by increased screw divergence of >5 degrees on serial radiographs. Revision procedures and curve magnitude at subsequent visits were recorded.</p><p><strong>Results: </strong>Of 186 patients who qualified for inclusion, 84 (45.2%) patients with tether breakage were identified with a mean age at VBT of 12.4±1.4 years and mean curve magnitude at index procedure of 51.8±8.1 degrees. Tether breakage occurred at a mean of 30.3±11.8 months and mean curve of 33.9±13.2 degrees. Twelve patients (12/84, 14.5%) underwent 13 revision procedures after tether breakage, including six tether revisions and seven conversions to fusion. All tether revisions occurred within 5 months of breakage identification. No patients with curves <35 degrees after breakage underwent revision. Revision rate was greatest in skeletally immature (Risser 0-3) patients with curves ≥35 degrees at time of breakage (Risser 0-3: 9/17, 53% vs. Risser 4-5: 3/23, 13%, P =0.01). Curves increased by 3.1 and 3.7 degrees in the first and second year, respectively. By 2 years, 15/30 (50%) progressed >5 degrees and 8/30 (26.7%) progressed >10 degrees. Overall, 66.7% (40/60) reached a curve magnitude >35 degrees at their latest follow-up, and 14/60 (23.3%) reached a curve magnitude >45 degrees. Skeletal maturity did not affect curve progression after tether breakage ( P >0.26), but time to rupture did ( P =0.048).</p><p><strong>Conclusions: </strong>While skeletal immaturity and curve magnitude were not independently associated with curve progression, skeletally immature patients with curves ≥35 degrees at time of rupture are most likely to undergo additional surgery. Most patients can expect progression at least 5 degrees in the first 2 years after tether breakage, though longer term behavior remains unknown.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"405-411"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306929","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":"Identifying Factors for Predicting Postoperative Segmental Motor Paralysis in Patients Undergoing Anterior Cervical Spine Surgery: A Multicenter Study.","authors":"Hiroaki Onuma, Takashi Hirai, Kenichiro Sakai, Motonori Hashimoto, Hiroyuki Inose, Kentaro Yamada, Yu Matsukura, Shingo Morishita, Satoru Egawa, Jun Hashimoto, Kentaro Sakaeda, Satoshi Tamura, Ichiro Torigoe, Masaki Tomori, Kyohei Sakaki, Yutaka Kobayashi, Kazuyuki Otani, Kazuo Kusano, Norihiko Miyake, Tsuyoshi Yamada, Shuta Ushio, Shigeo Shindo, Yoshiyasu Arai, Atsushi Okawa, Toshitaka Yoshii","doi":"10.1097/BRS.0000000000005193","DOIUrl":"10.1097/BRS.0000000000005193","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery.</p><p><strong>Summary of background data: </strong>Segmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors.</p><p><strong>Results: </strong>Ninety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels at a final follow-up.</p><p><strong>Conclusion: </strong>This study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"375-382"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508387","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":"Letter to the Editor: Single-Position Prone Lateral Interbody Fusion is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Hao-Ju Lo, Tsan-Wen Huang","doi":"10.1097/BRS.0000000000005264","DOIUrl":"10.1097/BRS.0000000000005264","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E120-E121"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012064","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":"Untreated Osteoporosis in Lumbar Fusion Surgery Patients: Prevalence, Risk-factors, and Effect on Bone Metabolism.","authors":"Paul Köhli, Jan Hambrecht, Shu-Han Wang, Jiaqi Zhu, Erika Chiapparelli, Lukas Schönnagel, Ali E Guven, Gisberto Evangelisti, Arne Kienzle, Jennifer Shue, Koki Tsuchiya, Marco D Burkhard, Matthias Pumberger, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BRS.0000000000005231","DOIUrl":"10.1097/BRS.0000000000005231","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of a prospective single-center study.</p><p><strong>Objective: </strong>To analyze the prevalence and risk factors for untreated osteoporosis in patients undergoing lumbar spinal fusion surgery (LFS) and its impact on bone mineral density (BMD) and bone turnover markers.</p><p><strong>Background: </strong>Osteoporosis is a risk factor for mechanical complications in LFS, which can be mitigated by antiosteoporotic treatment. However, there is limited research on factors leading to untreated osteoporosis before LFS and its impact on preoperative bone status.</p><p><strong>Materials and methods: </strong>A secondary analysis of a prospective study enrolling adults undergoing LFS for degenerative conditions (2014-2024) with preoperative quantitative CT osteoporosis screening was performed. Demographic data and medical history were analyzed for prevalence and risk factors of untreated osteoporosis, while BMD, vitamin D, PTH levels, and bone turnover markers were assessed for the effects of lacking treatment.</p><p><strong>Results: </strong>A total of 445 patients (48% female, median age 64) were included, of which 137 patients (31%) had osteoporosis. Of these, 66 (48%) were untreated and 71 (52%) were treated, with 40 (56%) receiving pharmacological and 31 (44%) nonpharmacologic treatment, including vitamin D supplementation and lifestyle modifications. Of the untreated patients, 55 (80%) were identified by preoperative screening. Seventy-one percent of osteoporotic men versus 35% of osteoporotic women were untreated ( P <0.001). Multivariable logistic regression confirmed male sex as a significant contributing factor (OR: 4.3, 95% CI: 1.9-10.1, P <0.001) for untreated osteoporosis. Treated osteoporotic patients had higher BMD ( P <0.001), higher vitamin D levels ( P =0.023), and lower levels of bone resorption parameters ( P =0.004) than untreated patients.</p><p><strong>Conclusion: </strong>Untreated osteoporosis is common before LFS, especially in men, with untreated having lower BMD and higher bone resorption marker levels than treated patients. Identification of osteoporotic cases and subsequent osteological optimization could potentially reduce the risks of adjacent fractures or screw loosening.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"420-428"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772408","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 Arabic Oswestry Disability Index as a Unidimensional Measure: Confirmatory Factor Analysis.","authors":"Ali H Alnahdi","doi":"10.1097/BRS.0000000000005223","DOIUrl":"10.1097/BRS.0000000000005223","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>To evaluate the structural validity of the Arabic version of the Oswestry disability index (ODI) in patients with low back pain (LBP).</p><p><strong>Summary of background data: </strong>The Arabic ODI is currently used in clinical and research settings to assess disability, but questions remain regarding its structural validity.</p><p><strong>Materials and methods: </strong>Adult patients with LBP were recruited from physical therapy departments of two hospitals in Saudi Arabia. Participants completed the Arabic ODI and the numeric pain rating scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to examine the factor structure of the ODI. Maximum likelihood extraction and parallel analysis were used in the EFA, and the goodness-of-fit indices [χ 2 statistics, Tucker-Lewis index (TLI), comparative-fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean residual (SRMR)] were assessed in the CFA to confirm the factor structure.</p><p><strong>Results: </strong>A total of 113 patients (47.8% male, 52.2% female) participated. The EFA identified a unidimensional structure for the Arabic ODI, with one factor explaining 45.8% of the total variance. All items had significant factor loadings, with loadings ranging from 0.48 (sleeping) to 0.84 (sex life and social life). The CFA confirmed this unidimensional structure, yielding good fit indices [χ 2 =49.53, P <0.04; TLI=0.96; CFI=0.97; RMSEA=0.06 (90% CI=0.07-0.10), SRMR=0.04]. All ODI items exhibited significant positive loadings consistent with the expected correlation between the single latent variable (LBP-related disability) and the ODI items. A high error covariance was observed between items related to walking and standing.</p><p><strong>Conclusion: </strong>The Arabic Oswestry disability index demonstrates sufficient structural validity as a unidimensional measure of disability in Arabic-speaking patients with low back pain. These findings support the continued use of the Oswestry disability index for disability assessment in clinical and research settings and support the validity of using one total score representing the single underlying latent construct.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E103-E109"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732614","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":"Minimally Invasive Versus Open Surgery for Thoracolumbar Fractures Treatment : A Meta-analysis of Randomized Controlled Trials and Prospective Studies.","authors":"Mohammad Daher, Marven Aoun, Ethan J Cottrill, Zhi Wang, Richard K Hurley, William F Lavelle, Peter G Passias, Bassel G Diebo, Alan H Daniels, Amer Sebaaly","doi":"10.1097/BRS.0000000000005252","DOIUrl":"10.1097/BRS.0000000000005252","url":null,"abstract":"<p><strong>Study design: </strong>Meta-analysis.</p><p><strong>Objective: </strong>The purpose of this systematic review and meta-analysis was to pool the available data comparing MIS to open surgery for thoracolumbar fractures and provide a more comprehensive assessment of this topic.</p><p><strong>Background: </strong>There remains a debate over whether minimally invasive surgery (MIS) or open fixation provides superior outcomes for patients with thoracolumbar fractures. While several randomized controlled trials and prospective studies have compared these two approaches, the published studies are limited by sample size.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic review of the PubMed, Cochrane, and Google Scholar (pages 1-20) databases was performed on October 1, 2024. The extracted data consisted of complications, surgery-related parameters, early and late postoperative back pain, and postoperative regional kyphosis.</p><p><strong>Results: </strong>Five RCTs and five prospective studies were included in the meta-analysis, including 584 patients, with 299 in the MIS group and 285 in the open group. MIS patients were shown to have less EBL (MD=-155.86; 95% CI: -217.97 to -93.76, P <0.001), a shorter LOS (MD=-3.34; 95% CI: -4.62 to -2.06, P <0.001), lower pain scores during the early postoperative period (MD=-1.14; 95% CI: -1.56 to -0.71, P <0.001), and less regional kyphosis (MD=-5.17; 95% CI: -7.17 to -3.16, P <0.001), even when stratifying by study type. In addition, fluoroscopy time was longer in the MIS group (MD=0.60; 95% CI: 0.21-0.98, P =0.003), although this difference was not seen when looking at RCTs only.</p><p><strong>Conclusions: </strong>Among patients with thoracolumbar fractures, treatment with MIS was associated with decreased EBL, shorter LOS, earlier pain reduction, and less regional kyphosis compared with treatment with open fixation. In addition, higher radiation exposure was seen among patients treated with MIS. While MIS offers several potential benefits, both MIS and open fixation remain safe and reliable options for the treatment of thoracolumbar fractures.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"412-419"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980037","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":"Letter to the Editor Regarding Same-Day Versus Staged Spinal Fusion : A Meta-Analysis of Clinical Outcomes.","authors":"Yixi Wang, Xinkai Luo, Jian Cui, Paerhati Rexiti","doi":"10.1097/BRS.0000000000005251","DOIUrl":"10.1097/BRS.0000000000005251","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E118"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898297","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 the Letter to the Editor Regarding Same-Day Versus Staged Spinal Fusion : A Meta-Analysis of Clinical Outcomes.","authors":"Mohammad Daher, Alan H Daniels","doi":"10.1097/BRS.0000000000005256","DOIUrl":"10.1097/BRS.0000000000005256","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E119"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Prognostic Nutritional Index on Outcomes in Native Spine Infection.","authors":"Teeto Ezeonu, Rajkishen Narayanan, Samuel Alfonsi, Yunsoo Lee, John Liam Gibbons, Christian McCormick, Jacob Spring, Gabrielle Kozlowski, John J Mangan, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1097/BRS.0000000000005135","DOIUrl":"10.1097/BRS.0000000000005135","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The objective of this study was to determine if a baseline prognostic nutritional index (PNI) score could be used to predict outcomes in patients with native spine infections, including the need for operative intervention.</p><p><strong>Summary of background data: </strong>Nutritional status is an important, potentially modifiable risk factor to consider in the native spine population. The PNI score is a tool that has demonstrated utility as a marker of preoperative nutritional status in patients undergoing surgery; however, it has not yet been studied in the context of native spine infection.</p><p><strong>Methods: </strong>Adult patients (≥18 y) with a diagnosis of spine infection from 2017 to 2022 were retrospectively identified. Native spine infection was defined as a diagnosis of spinal infection in the absence of prior spine surgery within 3 months of diagnosis. PNI was calculated using the equation: PNI=10×serum albumin (g/dL)+0.005 total lymphocyte count (/μL). Patients were stratified into high or low PNI groups based on their PNI being above or below the average, respectively.</p><p><strong>Results: </strong>There were 45 patients in the low PNI group and 56 patients in the high PNI group. Patients in the low PNI group were more likely to require surgery ( P =0.046), had more levels decompressed ( P =0.012), and were more likely to undergo two or more irrigation and debridement procedures ( P =0.016). Patients in the low PNI group were also less likely to be discharged home ( P =0.016). There was no difference in length of stay, inpatient complications, 90-day readmissions, 90-day ED visits, or 1-year reoperations between groups.</p><p><strong>Conclusion: </strong>While postadmission outcomes and inpatient complications were similar across PNI groups, PNI on admission provides useful insight into the severity of infection and predicts the need for operative intervention in patients presenting with native spine infection.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"389-394"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073920","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}