Spine最新文献

{"title":"Associations Between Problem List Items and Clinically Significant Distress in Patients with Metastatic Spine Disease.","authors":"Dana G Rowe, Joshua Woo, Seeley Yoo, Jacqueline M Emerson, Ellen O'Callaghan, Michael Goodin, Kerri-Anne Crowell, Victoria Bradley, Jeremy Reynolds, Margaret O Johnson, Melissa M Erickson, C Rory Goodwin","doi":"10.1097/BRS.0000000000005343","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005343","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to identify sources of distress in patients with metastatic spine disease and elucidate factors associated with clinically significant distress.</p><p><strong>Summary of background data: </strong>Distress is associated with poorer outcomes and lower quality of life in cancer patients. Patients with metastatic spine disease are particularly vulnerable to clinically significant levels of distress. However, specific factors contributing to distress in these patients have been largely unexplored.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of patients with metastatic spine disease (MSD) who underwent surgery from 2015 to 2023. We analyzed National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) scores and Problem List items within 30 days prior to surgery, which was defined as \"baseline\" distress. We calculated the frequency of each problem and the proportion of patients with clinically significant distress (DT score ≥4). We used chi-square tests to analyze associations between Problem List items and significant distress, with a significance threshold of P<0.05.</p><p><strong>Results: </strong>Among 160 patients with MSD, 48.1% reported clinically significant distress. Patients most frequently reported Physical concerns (93.8%), followed by Emotional (55.6%) and Practical concerns (31.9%). The most common individual Problem List item was pain (72.5%), followed by fatigue (48.1%) and worry (41.2%). Emotional (P=0.001), Practical (P=0.04), and Social concerns (P=0.039) were significantly associated with clinically significant distress, but Physical concerns were not (P=0.05).</p><p><strong>Conclusion: </strong>Though physical concerns were most common for patients with MSD, emotional and practical concerns were more strongly associated with significant distress among patients with metastatic spine disease. These findings highlight the need for multidisciplinary care focused on emotional and practical issues to enhance patients' quality of life.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After 1- or 2-level Minimally Invasive Decompression for Patients with High 5-Item Modified Frailty Index.","authors":"John Lama, Tejas Subramanian, Tomoyuki Asada, Tim Xu, Ted Shi, Rebecca Boyle, Arsen Omurzakov, Zora Hahn, James Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005333","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005333","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>To evaluate the efficacy of the 5-factor modified frailty (mFI-5) index in predicting patient outcomes and recovery kinetics in minimally invasive decompression (MI-decompression) for the treatment of degenerative lumbar disorders.</p><p><strong>Summary of background data: </strong>The mFI-5 index, which measures frailty or the age-associated decline in recovery ability following a significant stressor, has risen as a patient-specific indicator for postoperative morbidity and mortality. However, no studies have evaluated the utility of frailty in predicting outcomes after MI-decompression for degenerative lumbar pathologies.</p><p><strong>Methods: </strong>Patients who underwent primary one- or two-level MI-Decompression for degenerative lumbar spine conditions were included. Patients were stratified into three groups: non-frail (mFI-5=0), moderately frail (mFI-5=1), and severely frail (mFI-5≥2). Outcome measures included surgical details, complications, return to activity, and patient reported outcome measures at preop and ≥6 months postop.</p><p><strong>Results: </strong>A total of 956 patients were included, 438 non-frail, 418 moderately frail, and 100 severely frail. Frail patients (mFI-5 ≥1) were older (P<0.001), had greater BMI (P=0.047), elevated CCI (P<0.001), and greater percentages of ASA class ≥3 (P<0.001). Higher severities of frailty were associated with longer operative times (P<0.001) and lengths of stay (P<0.001), while blood loss was similar. Frail patients demonstrated worse preoperative symptoms, including ODI (P=0.019), VAS-back pain (P=0.019), and SF12-PCS (P=0.015), which continued postoperatively, including ODI (P=0.014) and SF12-PCS (P<0.001). The magnitude of improvement between outcome metrics was comparable at ≥ 6-month follow-up. Return to activities-driving, working, and discontinuation of narcotics-as well as all complication categories-intraoperative, in-hospital, and postoperative-were similar across all patients.</p><p><strong>Conclusions: </strong>MI-decompression provides comparable symptom relief and postoperative recovery, even among patients with significant frailty that could limit their ability to withstand the stresses of spine surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Severe Hip and Knee Osteoarthritis on Patient-Reported Outcomes and Global Alignment Following Lumbar Spinal Stenosis Surgery.","authors":"Shota Tamagawa, Hidetoshi Nojiri, Juri Teramoto, Arihisa Shimura, Hiromitsu Takano, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Muneaki Ishijima","doi":"10.1097/BRS.0000000000005340","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005340","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the impact of concomitant severe hip or knee osteoarthritis (OA) on patient-reported outcome measures (PROMs) and global alignment in patients undergoing surgery for lumbar spinal stenosis (LSS).</p><p><strong>Summary of background data: </strong>Hip and knee OA frequently coexist with LSS, contributing to diagnostic and therapeutic complexities. Limited evidence exists regarding the impact of severe lower extremity OA on baseline and postoperative outcomes in patients with LSS.</p><p><strong>Methods: </strong>A total of 121 patients with LSS who underwent decompression surgery with or without interbody fusion and completed 1-year follow-up were included. Patients were divided into severe OA and non-severe OA groups based on the Kellgren-Lawrence (KL) classification, with grades 3-4 classified as severe OA. We compared radiographic parameters and PROMs, including the Visual Analog Scale (VAS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Oswestry Disability Index (ODI), at baseline and 1-year follow-up. Multivariable linear regression was used to assess the effect of severe OA on 1-year postoperative PROMs.</p><p><strong>Results: </strong>Sixty-seven patients (55.4%) had severe hip or knee OA. Severe OA was independently associated with higher VAS scores for low back pain (β=0.234, P=0.030) and leg pain (β=0.272, P=0.012), poorer JOABPEQ scores across multiple domains, and higher ODI scores (β=0.269, P=0.008) at 1-year follow-up. Patients with severe OA exhibited greater sagittal vertical axis and coronal imbalance postoperatively despite comparable spinopelvic mismatch. Additionally, the severe OA group experienced a higher rate of implant-related complications (10.5% vs. 1.9%, P=0.043).</p><p><strong>Conclusion: </strong>Concomitant severe lower extremity OA was associated with worse PROMs, sagittal and coronal alignment following LSS surgery. These findings underscore the importance of recognizing and addressing severe lower extremity OA during preoperative planning for LSS to optimize surgical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jiri Dvorak: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg","doi":"10.1097/BRS.0000000000005339","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005339","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Greater Segmental Lordosis with Intraoperative Mechanical Hinging and Bilateral Facetectomies in Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Rahul K Chaliparambil, Mykhaylo Krushelnytskyy, Amr J Alwakeal, Mehul Mittal, Muhammad T Hassan, Pavlos Texakalidis, Hanna Kemeny, Najib El Tecle, Nader S Dahdaleh, Tyler Koski","doi":"10.1097/BRS.0000000000005341","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005341","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>We add to the literature a series of TLIF cases using a minimally invasive surgical (MIS) approach with the use of a mechanically hinging operating table and bilateral facetectomies (Smith-Petersen osteotomy, SPO).</p><p><strong>Summary of background data: </strong>Transforaminal lumbar interbody fusion (TLIF) with interbody cages is understood to have a poor preservation of lordosis in the literature and can often be a kyphosing procedure. Intraoperative flexion using a hinged operating table to increase interbody spacing for cage placement followed by intraoperative extension to facilitate osteotomy closure, may allow a greater degree of segmental lordosis to be achieved and maintained.</p><p><strong>Materials and methods: </strong>We identified patients from 2018 to 2024 who underwent MIS-TLIF at our institution. Clinical and operative variables collected included age, sex, body mass index, hemoglobin A1C, smoking status, post-surgical Baastrup's disease, indications for surgery, fusion level, and spacer details. Radiographic variables included segmental lordosis (SL) at preoperative, intraoperative, and postoperative timepoints. Outcomes included post-surgical correction and 6-month correction. Clinical and radiographic findings were analyzed with standard statistical approaches.</p><p><strong>Results: </strong>202 patients met inclusion criteria. For 1-level and 2-level fusion, the mean post-surgical correction was 5.0 degree and 4.6 degrees respectively, and the mean 6-month correction was 4.6 degrees and 6.6 degrees respectively. Significant differences in lordosis were appreciated between preoperative and postoperative scans for both 1-level (P<0.0001) and 2-level (P=0.0017) fusion, and between preoperative and 6-month scans for 1-level (P<0.0001) fusion. Negative correlations were appreciated between preoperative and postoperative SL (R=-0.31, P=0.0001) and preoperative SL and 6-month correction (R=-0.19, P=0.0289) for 1-level fusions.</p><p><strong>Conclusion: </strong>The use of an intraoperative hinging surgical table during MIS-TLIF with bilateral SPOs can effectively lead to an increase in and the maintenance of SL.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable Machine Learning Models for Short- and Long-term Prognostic Prediction and Risk Factor Identification in Radiofrequency Treatment of Lumbar Facetogenic Pain: A Retrospective Cohort Study with Temporal Validation.","authors":"Yunfei Wang, Ziyang Chen, Junjie Lu, Qingqing He, Jingyuan Liu, Zhifei Cui, Chengjie Huang, Tao Chen, Zhihai Su, Hai Lu","doi":"10.1097/BRS.0000000000005342","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005342","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To develop machine learning (ML) models integrating clinical/imaging variables for predicting 3- and 6-month outcomes of radiofrequency (RF) treatment in lumbar facetogenic pain, and an independent temporal validation cohort was used to evaluate the model's performance. Shapley Additive Explanations (SHAP) analysis was utilized to identify key variables and construct a simplified model.</p><p><strong>Summary of background data: </strong>Early identification of RF-responsive patients remains challenging, with limited non-invasive prognostic tools available.</p><p><strong>Methods: </strong>Six ML models were trained using 16 clinical/imaging variables from 372 RF-treated patients. Model performance was evaluated via AUROC, with SHAP analysis identifying key variables. Simplified models using clinical-only, imaging-only, and SHAP-selected variables were compared.</p><p><strong>Results: </strong>In the discovery (n=312) and temporal validation (n=60) cohorts, 141 and 26 patients had unsuccessful 3-month outcomes, respectively. The logistic model outperformed others, achieving AUROCs of 0.834 (95% CI: 0.725-0.942) and 0.818 (0.713-0.923) for 3-month prediction in discovery and validation cohorts. Simplified models showed comparable performance (discovery AUROC: 0.795-0.837; validation: 0.699-0.814). Six-month predictions demonstrated similar robustness (discovery AUROC: 0.813; validation: 0.783). Decision curve analysis confirmed the logistic model's clinical utility, providing net benefits at threshold probabilities >40%.</p><p><strong>Conclusions: </strong>The Logistic model, which is based on clinical and imaging variables, has the potential to facilitate early screening of patients who might benefit from RF treatment in the short- and long-term. SHAP analysis helps evaluate the impact of variables and build simplified models with comparable performance. The key variables identified in this study require further verification through external geographic validations.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two-Screw versus Four-Screw Internal Fixation on Fusion Speed in Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial.","authors":"Cheng-Yi Huang, Xia-Qing Sheng, Xing-Jin Wang, Zi-Han Peng, Ting-Kui Wu, Kangkang Huang, Yang Meng","doi":"10.1097/BRS.0000000000005334","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005334","url":null,"abstract":"<p><strong>Background context: </strong>The insertion process of the new two-screw internal fixation is simpler than that of four-screw internal fixation for anterior cervical discectomy and fusion (ACDF). However, it is unclear whether there is a difference in fusion rate.</p><p><strong>Purpose: </strong>This study aimed to compare the time required to achieve osseous fusion and the clinical efficacy of four-screw versus two-screw internal fixation.</p><p><strong>Study design: </strong>Prospective randomized controlled trial.</p><p><strong>Patient sample: </strong>From October 2021 to April 2023, eighty patients diagnosed with single-level cervical spondylosis were recruited and randomly allocated into a four- or two-screw group.</p><p><strong>Outcome measures: </strong>The primary endpoint was the fusion rate six months postoperatively. Secondary outcomes included the prevalence of complications and patient-reported outcome measures (PROMs), including the Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale scores for arm and neck pain.</p><p><strong>Methods: </strong>Patients were randomized to receive four-screw internal fixation (n=40) or two-screw internal fixation (n=40).</p><p><strong>Results: </strong>A total of 77 patients completed the trial and were included in the analysis. No significant differences were observed between groups at baseline. The fusion rate in the two-screw group was significantly higher than that in the four-screw group (69.2% vs. 42.1%, P=0.022) at six months postoperatively. No significant difference was found in the fusion rates at 3 and 12 months postoperatively between groups. Overall, PROMs significantly improved after surgery in both groups and did not differ significantly between groups at any follow-up time point. The prevalence of complications was not significantly different between groups.</p><p><strong>Conclusions: </strong>Two-screw internal fixation can achieve osseous fusion faster than four-screw internal fixation in ACDF. Two-screw internal fixation seems to achieve the same PROMs and safety as four-screw internal fixation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Oral Steroid Use Shortly Following Lumbar Microdiscectomy.","authors":"Henry Avetisian, Will Karakash, David McCavitt, Bahador Athari, Marc A Abdou, Dil Patel, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.1097/BRS.0000000000005337","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005337","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine the incidence and identify risk factors for radiculopathy requiring treatment with oral glucocorticoids within one month following lumbar microdiscectomy.</p><p><strong>Summary of background data: </strong>Lumbar microdiscectomy (MD) often provides immediate relief of low back and leg pain; however, some patients experience recurrent postoperative radicular pain. While oral steroids are commonly used to manage this condition, the frequency of their use and associated risk factors remain unclear.</p><p><strong>Methods: </strong>The PearlDiver national database was queried for patients who underwent lumbar MD for disc herniation. Patients were stratified based on whether they were prescribed oral steroids (Prednisone, Methylprednisolone, Prednisolone) from postoperative day 1 to day 30. Patient demographics and comorbidities were compared using Chi-squared analysis and Student's t-test. Multivariate logistic regression controlling for age, gender, Elixhauser Comorbidity Index (ECI), and the number of levels operated on was used to identify independent risk factors.</p><p><strong>Results: </strong>Among 326,315 patients who underwent lumbar MD, 38,455 (11.78%) received oral steroids within 30 days postoperatively. Patients who received steroids were more likely to be female (51.88% vs. 46.70%) and have a higher ECI (3.04 vs. 2.71) (P<0.001). Independent risk factors included opioid use (OR: 2.10, [2.05-2.15]), far lateral disc herniation (OR: 1.37, [1.29-1.46]), female gender (OR: 1.23 [1.21-1.26]), prior epidural steroid injection (OR: 1.18, [1.15-1.21]), fibromyalgia (OR: 1.17, [1.13-1.20]), tobacco use (OR: 1.09, [1.08-1.13]), delaying surgery >90 days from disc herniation (OR: 1.14 [1.11-1.17]), depression (OR: 1.12 [1.09-1.15]), ECI (OR: 1.07, [1.06-1.071]), and revision MD (OR: 1.05, [1.01-1.09]) (all P<0.05).</p><p><strong>Conclusion: </strong>This study found that 11.78% of patients undergoing lumbar MD require oral steroids postoperatively, reflecting a significant subset of patients with postoperative radiculopathy. Several patient- and procedural-related risk factors were identified. Further research is warranted to clarify the role of oral steroids and develop strategies to reduce postoperative radiculopathy.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Chronic Preoperative Gabapentinoid Exposure on Surgical and Patient Reported Outcome Measures following Lumbar Fusion.","authors":"Jonathan Dalton, Rachel Huang, Alec Giakas, Michael Carter, Robert J Oris, Jeremy Heard, Chloe K Herczeg, Rajkishen Narayanan, Alexander Charlton, Evgeniy V Uvarov, Sehajvir Singh, Mark F Kurd, Jeffrey A Rihn, Ian David Kaye, Thomas D Cha, John J Mangan, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Gregory Schroeder, Christopher Kepler","doi":"10.1097/BRS.0000000000005338","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005338","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To assess the relationship between long-term gabapentinoid use and outcomes after lumbar fusion.</p><p><strong>Summary of background data: </strong>Gabapentinoids, which include gabapentin and pregabalin, are commonly prescribed for radiculopathic pain. Basic science research has indicated that gabapentinoids may be detrimental to bone health/healing and clinical works has shown that initiating gabapentinoids at the time of spine surgery may decrease postoperative opioid requirements and increase risks of adverse outcomes. Despite these findings, no literature exists examining the impact of chronic gabapentinoid prescriptions on outcomes after lumbar fusion.</p><p><strong>Methods: </strong>Adult patients who underwent elective one/two-level lumbar fusion (2017-2022) were identified via Structured Query Language search. Patient demographic/surgical characteristics, surgical outcomes, patient-reported outcome measures (PROMs), and preoperative gabapentinoid use were collected. Perioperative opioid data were collected utilizing the Pennsylvania Prescription Drug Monitoring Program. Appropriate statistical analyses were conducted with alpha set at 0.05.</p><p><strong>Results: </strong>Amongst 461 included patients, 47 (10.2%) and 61 (13.2%) were chronically prescribed pregabalin and gabapentin, respectively. All groups were similar in terms of demographics, and surgical type/complexity. There were no differences in surgical outcomes, including two-year revision rate. Patients taking pregabalin consumed more total MMEs compared to gabapentin (132±344 vs. 104±351, P=0.022) and non-gabapentinoid patients (132±344 vs. 90.3±267, P=0.007). However, preoperative total MMEs were similar 60 days prior to surgery. Bivariate analysis demonstrated postoperative differences in back pain improvement at six-months (P=0.025) between groups, however pairwise comparison did not show significance. Similarly, multivariate analysis did not show gabapentinoid usage as independently predictive of back pain scores. All other PROM comparisons were similar between groups.</p><p><strong>Conclusion: </strong>Despite compelling basic science literature suggesting gabapentinoid exposure hindering bone health and healing capacity, the current investigation did not find an increase in surgical revision or other adverse outcomes, including opioid use and PROMs, associated with chronic preoperative gabapentinoid use.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658616","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":"Comprehensive Review of Biportal Endoscopic Spine Surgery: History, Techniques, and Implications in Minimally Invasive Spine Surgery.","authors":"Alexander Yu, Samuel Q Li, Laura Ndjonko, Jamie Frost, Daniel Berman, Hyun-Jin Park, Samuel K Cho","doi":"10.1097/BRS.0000000000005335","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005335","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>To provide an overview of the evolution of biportal endoscopic spine surgery (BE) and its role in addressing specific challenges in minimally invasive spinal procedures, focusing on its technical features and clinical applications.</p><p><strong>Summary of background data: </strong>Minimally invasive spine surgery has gained momentum due to its ability to reduce tissue damage, postoperative pain, and recovery times compared to traditional open surgery. BE has emerged as an innovative technique, offering unique visualization and maneuverability that allow for addressing complex spinal pathologies with comparable outcomes to other minimally invasive techniques.</p><p><strong>Methods: </strong>This review explores the development of BE, its advantages and disadvantages compared to traditional and full endoscopic spine surgery, and its application in various spinal conditions, based on current literature.</p><p><strong>Results: </strong>BE facilitates enhanced visualization and maneuverability through the use of two independent portals, which allow for precise decompression, discectomy, and fusion procedures with minimal muscle disruption. Studies suggest that BE is well-suited for specific cases requiring delicate tissue handling and complex anatomical access. Studies report reduced postoperative pain, shorter hospital stays, and faster recovery compared to traditional methods. While challenges such as longer operation times and learning curves exist, BE offers a valuable alternative to other minimally invasive techniques in procedures like lumbar laminectomy, foraminotomy, and interbody fusion.</p><p><strong>Conclusions: </strong>Biportal endoscopic spine surgery represents an important addition to the arsenal of minimally invasive spine techniques. Its flexibility and adaptability make it a promising option for specific spinal pathologies, particularly in cases where other techniques may pose limitations. Future research should focus on refining surgical protocols, enhancing training frameworks, and expanding the application of BE to other spinal regions and complex conditions.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658599","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}