Spine最新文献

{"title":"Relationship Between Lumbar Foraminal Stenosis and Multifidus Muscle Atrophy: A Retrospective Cross-Sectional Study.","authors":"Ali E Guven, Lukas Schönnagel, Erika Chiapparelli, Gaston Camino-Willhuber, Jiaqi Zhu, Thomas Caffard, Artine Arzani, Kyle Finos, Isaac Nathoo, Krizia Amoroso, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Alexander P Hughes","doi":"10.1097/BRS.0000000000005113","DOIUrl":"10.1097/BRS.0000000000005113","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cross-sectional study.</p><p><strong>Objective: </strong>To evaluate the relationship between lumbar foraminal stenosis (LFS) and multifidus muscle atrophy.</p><p><strong>Background: </strong>The multifidus muscle is an important stabilizer of the lumbar spine. In LFS, the compression of the segmental nerve can give rise to radicular symptoms and back pain. LFS can impede function and induce atrophy of the segmentally innervated multifidus muscle.</p><p><strong>Materials and methods: </strong>Patients with degenerative lumbar spinal conditions who underwent posterior spinal fusion for degenerative lumbar disease from December 2014 to February 2024 were analyzed. Multifidus fatty infiltration (FI) and functional cross-sectional area (fCSA) were determined at the L4 upper endplate axial level on T2-weighted MRI scans using dedicated software. The severity of LFS was assessed at all lumbar levels and sides using the Lee classification (grade: 0-3). For each level, Pfirrmann and Weishaupt gradings were used to assess intervertebral disc disease (IVDD) and facet joint osteoarthritis (FJOA), respectively. Multivariable linear mixed models were run for the LFS grade of each level and side separately as the independent predictor of multifidus FI and fCSA. Each analysis was adjusted for age, sex, BMI, as well as FJOA and IVDD of the level corresponding to the LFS.</p><p><strong>Results: </strong>A total of 216 patients (50.5% female) with a median age of 61.6 years (interquartile range=52.0-69.0) and a median BMI of 28.1 kg/m 2 (interquartile range=24.8-33.0) were included. Linear mixed model analysis revealed that higher multifidus FI [estimate (CI)=1.7% (0.1-3.3), P =0.043] and lower fCSA [-18.6 mm 2 (-34.3 to -2.6), P =0.022] were both significantly predicted by L2-L3 level LFS severity.</p><p><strong>Conclusion: </strong>The observed positive correlation between upper segment LFS and multifidus muscle atrophy points toward compromised innervation. This necessitates further research to establish the causal relationship and guide prevention efforts.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"702-706"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860954","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":"Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.","authors":"Mohammad Daher, Andrew Xu, Manjot Singh, Renaud Lafage, Breton G Line, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Robert K Eastlack, Munish C Gupta, Gregory M Mundis, Jeffrey L Gum, Kojo D Hamilton, Richard Hostin, Virginie Lafage, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Frank J Schwab, Christopher I Shaffrey, Justin S Smith, Shay Bess, Eric O Klineberg, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005250","DOIUrl":"10.1097/BRS.0000000000005250","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospectively collected data.</p><p><strong>Objective: </strong>This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.</p><p><strong>Background: </strong>Current definitions of excessive blood loss after spine surgery are highly variable and may be suboptimal in predicting adverse events (AEs).</p><p><strong>Materials and methods: </strong>Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. \"Least Absolute Shrinkage and Selection Operator\" regression was performed to identify 5 variables from demographic and perioperative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristic curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE was plotted against EBL and EBVL to confirm the identified thresholds.</p><p><strong>Results: </strong>In total, 552 patients were included with a mean age of 60.7 ± 15.1 years, 68% females, mean Charlson Comorbidity Index was 1.0 ± 1.6, and 22% experienced AEs. Least Absolute Shrinkage and Selection Operator regression identified the American Society of Anesthesiologists score, baseline hypertension, preoperative albumin, and use of intraoperative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in the receiver operating characteristic curve, which was used to identify a cutoff of 2.3 L of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds ratio: 2.1, 95% CI: 1.2-3.6) and 31% (odds ratio: 1.7, 95% CI: 1.1-2.8), compared with 21% for those below the thresholds of EBL and EBVL, respectively.</p><p><strong>Conclusion: </strong>In complex ASD surgery, intraoperative EBL of 2.3 L and an EBVL of 42% are associated with clinically significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, health care system quality initiatives, and clinical perioperative blood loss management strategies in patients undergoing complex spine surgery. In addition, a similar methodology could be performed in other specialties to establish procedure-specific clinically relevant blood loss thresholds.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"645-651"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898299","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":"Ideal Lumbar Lordosis Correction in Patients With Adult Spinal Deformity Without Adversely Impacting Pelvic Tilt and Pelvic Incidence Minus Lumbar Lordosis: A Study of 426 Cases.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005077","DOIUrl":"10.1097/BRS.0000000000005077","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To determine the ideal pelvic incidence (PI)-lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background: </strong>PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.</p><p><strong>Methods: </strong>We included patients with ASD undergoing ≥5-level fusion, including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of the ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (below 70 and 70 yr or above).</p><p><strong>Results: </strong>In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged below 70 years, and 7.9° for patients aged 70 years or above. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged below 70 years, and 13.3° for patients aged 70 years or above. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.</p><p><strong>Conclusions: </strong>The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3° to 12.5° for patients aged below 70 years and 7.9° to 13.3° for patients aged 70 years or above. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"694-701"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447168","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":"Single-Position Prone Lateral Interbody Fusion Is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared With Single-Position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Alexander W Parsons, Tyler K Williamson, Andrew Eck, Jamshaid Mir, Ankita Das, Mateo Gilsilvetti, Peter S Tretiakov, Christopher I Shaffrey, Peter G Passias","doi":"10.1097/BRS.0000000000005320","DOIUrl":"10.1097/BRS.0000000000005320","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E198-E199"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630812","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":"Outcome After Anterior Cervical Decompression and Fusion-A Nationwide FinSpine Register Study of Independent Predictors of Outcome at 12 Months After Surgery for Degenerative Cervical Spine.","authors":"Nikolai Klimko, Nils Danner, Henri Salo, Anna Kotkansalo, Ville Leinonen, Jukka Huttunen","doi":"10.1097/BRS.0000000000005323","DOIUrl":"10.1097/BRS.0000000000005323","url":null,"abstract":"<p><strong>Study design: </strong>Longitudinal, nationwide register study.</p><p><strong>Objective: </strong>To identify independent predictors of clinical outcomes at 12 months for patients undergoing primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease (DCSD).</p><p><strong>Summary of background data: </strong>ACDF is an established surgical treatment for DCSD. Identifying factors that predict successful surgical outcomes can improve patient selection and inform decision-making.</p><p><strong>Methods: </strong>This study utilized data from the Finnish National Spine Register (FinSpine), covering all Finnish centers that perform ACDF surgery. Patients undergoing primary ACDF surgery for DCSD between June 2016 and February 2024 without prior cervical spine surgery were included (n=5517). Patients were grouped based on the patient symptom status (\"improved\" vs. \"indifferent or worse\") at 12 months postsurgery. Predictive factors were identified using classification tree analysis followed by binary logistic regression.</p><p><strong>Results: </strong>At 12 months, 76.8% (n=1799) of patients reported symptom improvement, while 23.2% (n=542) reported that symptoms were indifferent or worse. Loss to follow-up for the outcome variable was 57.6% at 12 months. The following factors were associated with better outcomes: shorter preoperative pain duration (≤1 yr, OR=1.95, P <0.001), lower preoperative Neck Disability Index (NDI) scores (≤42, OR=1.37, P =0.012), and nonsmoking (OR=1.37, P =0.030). The initial diagnosis also influenced outcomes: patients treated for herniated disks and nerve root stenosis were more likely to report improvement compared to those with central canal stenosis or myelopathy ( P <0.001). Gender, age, BMI, working status, regular use of pain medication, perioperative complications, muscle weakness, levels fused, and use of plate versus stand-alone cage were not independently predictive of outcomes.</p><p><strong>Conclusions: </strong>Shorter preoperative pain duration, lower NDI scores, and nonsmoking status were significant predictors of good outcomes at 12 months after ACDF surgery for DCSD. These findings can help to guide preoperative patient counseling and enhance evidence-based decision-making for treating DCSD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"664-671"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cadaveric Comparison of Discectomy Performance During Transforaminal Lumbar Interbody Fusion Approach Using an Endoscopic Technique Versus a Minimally Invasive Tubular Approach.","authors":"Venakat Boddapati, Frank Yuk, Sohrab Virk","doi":"10.1097/BRS.0000000000005122","DOIUrl":"10.1097/BRS.0000000000005122","url":null,"abstract":"<p><strong>Study design: </strong>Cadaveric study.</p><p><strong>Objective: </strong>Compare discectomy performance between transforaminal lumbar interbody fusion (TLIF) done via an endoscopic versus a tubular technique.</p><p><strong>Summary of background data: </strong>Performance of an adequate discectomy is essential to lumbar fusion when performing a TLIF. Previous cadaveric studies comparing open and minimally invasive techniques have reported 36.6% to 80% discectomy. There is controversy whether an endoscopic TLIF (E-TLIF) can allow for an adequate discectomy.</p><p><strong>Materials/methods: </strong>An E-TLIF was performed on 14 discs (T12-L5) and a minimally invasive tubular TLIF (T-TLIF) was performed on 15 discs (T12-L4, L5-S1). Fellowship trained surgeons performed the TLIFs. Each disc was transected after discectomy, and a digital image was analyzed using an imaging processing software to determine the percent of discectomy. Each quadrant of the discectomy was compared. Quadrant one was defined as the left posterior-ipsilateral quadrant of the disc, with each quadrant numbered 2 to 4 clockwise around the disc. The time to perform the discectomy was compared. Pedicle screws were placed contralaterally to the TLIF, and the change in interpedicular distance was compared between techniques after expandable cage implantation as a marker for indirect decompression. A Student's t -test was used to determine statistical significance.</p><p><strong>Results: </strong>There was no difference in discectomy performance between techniques (48.86%±6.98% T-TLIF vs . 50.26%±7.38% E-TLIF, P =0.61). There was no statistical difference between T-TLIF versus E-TLIF at quadrants 1, 3, and 4. There was a difference in discectomy performance at quadrant 2 (39.02%±10.18% T-TLIF vs . 50.13%±14.00% E-TLIF, P =0.02). There was no statistical difference between interpedicular distance created (2.20±1.97 mm T-TLIF vs . 1.36±1.82 mm E-TLIF, P =0.24). E-TLIF took less time than MIS-TLIF (20.00±7.12 min vs. 15.22 min±4.42 min, P =0.048).</p><p><strong>Conclusions: </strong>Our cadaveric study demonstrates that an adequately performed E-TLIF discectomy may be comparable to a T-TLIF discectomy. Further research is required to maximize the efficiency and instrumentation of this technique.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"713-719"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988944","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":"Performance of Artificial Intelligence in Diagnosing Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis.","authors":"Xuanzhe Yang, Yuming Zhang, Yi Li, Zixiang Wu","doi":"10.1097/BRS.0000000000005174","DOIUrl":"10.1097/BRS.0000000000005174","url":null,"abstract":"<p><strong>Study design: </strong>The present study followed the reporting guidelines for systematic reviews and meta-analyses.</p><p><strong>Objective: </strong>We conducted this study to review the diagnostic value of artificial intelligence (AI) for various types of lumbar spinal stenosis (LSS) and the level of stenosis, offering evidence-based support for the development of smart diagnostic tools.</p><p><strong>Background: </strong>AI is currently being utilized for image processing in clinical practice. Some studies have explored AI techniques for identifying the severity of LSS in recent years. Nevertheless, there remains a shortage of structured data proving its effectiveness.</p><p><strong>Materials and methods: </strong>Four databases (PubMed, Cochrane, Embase, and Web of Science) were searched until March 2024, including original studies that utilized deep learning (DL) and machine learning (ML) models to diagnose LSS. The risk of bias of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies is a quality evaluation tool for diagnostic research (diagnostic tests). Computed Tomography. PROSPERO is an international database of prospectively registered systematic reviews. Summary Receiver Operating Characteristic. Magnetic Resonance. Central canal stenosis. three-dimensional magnetic resonance myelography. The accuracy in the validation set was extracted for a meta-analysis. The meta-analysis was completed in R4.4.0.</p><p><strong>Results: </strong>A total of 48 articles were included, with an overall accuracy of 0.885 (95% CI: 0.860-0907) for dichotomous tasks. Among them, the accuracy was 0.892 (95% CI: 0.867-0915) for DL and 0.833 (95% CI: 0.760-0895) for ML. The overall accuracy for LSS was 0.895 (95% CI: 0.858-0927), with an accuracy of 0.912 (95% CI: 0.873-0.944) for DL and 0.843 (95% CI: 0.766-0.907) for ML. The overall accuracy for central canal stenosis was 0.875 (95% CI: 0.821-0920), with an accuracy of 0.881 (95% CI: 0.829-0.925) for DL and 0.733 (95% CI: 0.541-0.877) for ML. The overall accuracy for neural foramen stenosis was 0.893 (95% CI: 0.851-0.928). In polytomous tasks, the accuracy was 0.936 (95% CI: 0.895-0.967) for no LSS, 0.503 (95% CI: 0.391-0.614) for mild LSS, 0.512 (95% CI: 0.336-0.688) for moderate LSS, and 0.860 for severe LSS (95% CI: 0.733-0.954).</p><p><strong>Conclusions: </strong>AI is highly valuable for diagnosing LSS. However, further external validation is necessary to enhance the analysis of different stenosis categories and improve the diagnostic accuracy for mild to moderate stenosis levels.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E179-E196"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508390","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":"Adjunctive Use of Gabapentinoids Increases Opioid Consumption Following One-Level to Three-Level Anterior Lumbar Interbody Fusion With Posterior Fixation: A Propensity Score-Matched Analysis.","authors":"Xu Tao, Aydin Kaghazchi, Geet Shukla, Janesh Karnati, Andrew Wu, Sachin Shankar, Ahmed Ashraf, Sruthi Ranganathan, Julia Garcia-Vargas, Parikshit Barve, Kelly Childress, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005225","DOIUrl":"10.1097/BRS.0000000000005225","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following one to three levels anterior lumbar interbody fusion (ALIF) with posterior fixation.</p><p><strong>Summary of background data: </strong>Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and are frequently used as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated.</p><p><strong>Materials and methods: </strong>The PearlDiver database was queried from 2010 to 2021 for patients who underwent primary one to three levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within six months before index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score matched to patients with opioid-only treatment.</p><p><strong>Results: </strong>The propensity score-matching resulted in two equal groups of 2617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average morphine milligram equivalent (MME) per day [standardized mean difference (SMD): -1.33, 95% CI: -2.657 to -0.002, P =0.050]. However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD: 94.97, 95% CI: 56.976-132.967, P <0.001) and a 41.7% increase in total MME consumption per patient (SMD: 4817.23, 95% CI: 1864.410-7770.044, P =0.001). In addition, gabapentinoid use was associated with an increased risk of readmission due to pain [relative risk (RR): 1.10, 95% CI: 1.002-1.212, P =0.050] and the development of drug abuse (RR: 1.37, 95% CI: 1.016-1.833, P =0.046).</p><p><strong>Conclusion: </strong>Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"679-685"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717149","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":"Chronic Gabapentinoid Use and Lumbar Fusion Outcomes: A Comparative Analysis of Gabapentinoids Alone and in Combination With Opioids.","authors":"Riza M Cetik, Steven D Glassman, Colleen Mahoney, Jeffrey L Gum, Charles H Crawford, Roger K Owens, John R Dimar, Benjamin Kostic, Leah Y Carreon","doi":"10.1097/BRS.0000000000005221","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005221","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative cohort study.</p><p><strong>Objectives: </strong>To examine the effects of chronic use of gabapentinoids (GPs) (alone or with opioids) on the outcomes of lumbar fusions.</p><p><strong>Summary of background data: </strong>Opioids have historically been the mainstay medications for pain management, but the ongoing opioid epidemic led physicians to look for alternatives. GPs are used for various indications, and chronic use for any indication may lead to a higher risk of adverse events, especially when combined with opioids.</p><p><strong>Materials and methods: </strong>Patients aged 18 years and older who underwent posterior fusion of the lumbosacral spine and ≥1-year follow-up were included. Patients were grouped according to their preoperative chronic GP and opioid usage as GP and opioid nonuser (-/-), GP user opioid nonuser (+/-), GP nonuser and opioid user (-/+), and GP and opioid user (+/+).</p><p><strong>Results: </strong>A total of 563 patients (M/F%=41/59, mean age 61.1 y) were included. Two hundred eighty (49%) patients were in the group -/-, while 110 (19%) were in +/-, 78 (15%) were in -/+, and 95 (17%) were in +/+. For ODI, back pain and leg pain, +/+ had the worst outcomes at all time points, while -/- had the best. Chronic GP users (+/-) showed back pain improvement similar to the -/- group; however, the improvements in leg pain and ODI were considerably less. GP use resulted in increased postoperative opioid requirements, although not as much as chronic opioid use. Complication rates were similar.</p><p><strong>Conclusions: </strong>Chronic preoperative use of GPs may lead to inferior outcomes when compared with GP-naive patients, and this is significantly accentuated when taken concurrently with opioids. Patients who are using both GPs and opioids had the worst results for almost every outcome measure. Given the significantly worse surgical outcomes documented in this study, concurrent use with opioids should be avoided.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 10","pages":"672-678"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033182","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":"Comparisons of Interapical Distance and Coronal Balance Measurements Among Standing Positions in Participants With and Without Adolescent Idiopathic Scoliosis Using 3D Ultrasound Imaging.","authors":"Janie Pollard, Brianna Fehr, Aislinn Ganci, Eric C Parent, Edmond Lou","doi":"10.1097/BRS.0000000000005284","DOIUrl":"10.1097/BRS.0000000000005284","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>The objective of this study was to quantify whether interapical distance and coronal balance measured on 3D ultrasound (3DUS) images differed among 10 standing positions of participants with and without adolescent idiopathic scoliosis (AIS).</p><p><strong>Summary of background data: </strong>Apical vertebral translation (AVT) is an indicator of clinical symptoms and treatment outcomes in AIS. Stereoradiography simultaneously captures a frontal and lateral image, yet patients are required to elevate their arms during the examination and varied positioning may impact coronal plane measurements. Ultrasound can assess these measurements without exposing participants to radiation.</p><p><strong>Materials and methods: </strong>Females with and without AIS were recruited from a scoliosis clinic, and e-mail advertisements, respectively. Participants underwent 3DUS scans in 10 positions: standing; arms anteriorly supported in 60° of shoulder flexion; fingers to clavicles, chin, zygomatic processes, and eyebrows; shoulders abducted at 90° with hands open and thumbs on shoulders; hands on anterior wall with and without blocks; and hands unsupported. AVT and coronal balance measurements were obtained using custom software. Positions and groups were compared using repeated measures ANOVAs with Sidak pairwise comparisons.</p><p><strong>Results: </strong>Fifty-nine females had a mean age, height, and weight of 17.5±4.9 years, 162.8±5.8 cm, and 56.2±10.6 kg, respectively. Seventeen single and 14 double curve participants were included with mean maximum curve angles of 26.4°±3.6° and 25.2°±3.1°, respectively. Overall, there were no statistically significant differences in interapical distance or coronal balance among the 10 positions, as well as in coronal balance between the groups ( P >0.05). The interapical distance of participants without AIS significantly differed from those with single curves in eight positions and from those with double curves in all 10 positions.</p><p><strong>Conclusions: </strong>The positions evaluated may be interchangeable for coronal plane lateral deviation measurements of females with AIS.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"652-663"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256466","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}