Spine最新文献

{"title":"Development and Validation of Interpretable Machine Learning Models Incorporating Paraspinal Muscle Quality to Predict Cage Subsidence Risk Following Posterior Lumbar Interbody Fusion.","authors":"Haifu Sun, Wenxiang Tang, Lei Deng, Xingyu You, Zhairui Shen, Xiao Sun, Jun Zou, Fanguo Lin, Zhonglai Qian, Huilin Yang, Hao Liu","doi":"10.1097/BRS.0000000000005388","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005388","url":null,"abstract":"<p><strong>Study design: </strong>A real-world, multicenter retrospective study.</p><p><strong>Objective: </strong>To identify independent risk factors for cage subsidence following Posterior Lumbar Interbody Fusion (PLIF) and develop an interpretable machine learning model for risk prediction.</p><p><strong>Materials and methods: </strong>Patients with degenerative lumbar disease who underwent single-level PLIF (January 2018-October 2023) were retrospectively included. A training set (n=620) came from the First Affiliated Hospital of Soochow University, and a validation set (n=100) from the Second Affiliated Hospital. Cage subsidence (≥2 mm intervertebral height loss) was assessed radiographically. Parameters included paraspinal muscle indices (Psoas Muscle Index [PMI], Multifidus Muscle Index [MM]), Fat Infiltration [FI]), bone density markers (Hounsfield Unit [HU] value, Vertebral Bone Quality [VBQ], Endplate Bone Quality [EBQ]), cage position, and postoperative alignment. Multivariate logistic regression identified risk factors; multiple machine learning models were developed and evaluated. A web-based tool was created for clinical deployment.</p><p><strong>Results: </strong>Multivariate analysis identified PMI, FI, HU value, VBQ, cage position, cage height, postoperative Intervertebral Height (IH), corrected IH, and corrected SA as independent risk factors for cage subsidence. Light Gradient Boosting Machine (LightGBM) outperformed other models, achieving the highest AUC (0.9752), accuracy (0.92), and F1-score (0.9216), with the lowest Brier score (0.0660). After excluding indicators related to paravertebral muscle function from the prediction model, the predictive accuracy of the model decreased substantially. (SHapley Additive exPlanations) SHAP analysis confirmed VBQ, PMI, BMI, and EBQ as the most influential predictors. The final model was deployed as a web-based tool for real-time clinical risk assessment.</p><p><strong>Conclusions: </strong>Key risk factors for PLIF cage subsidence were identified, and a validated machine learning model was developed. The high-performance LightGBM model, deployed in a user-friendly web application, enables spine surgeons to optimize surgical planning and reduce subsidence risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047251","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":"Pretapping is Not Effective in Preventing Pedicle Fractures in Lumbar Spinal Instrumentation: A Biomechanical Cadaveric Study.","authors":"David E Bauer, Luca Mari Major, Oliver Wigger, Ramon Rohner, Mazda Farshad, Jonas Widmer, Michael Betz","doi":"10.1097/BRS.0000000000005384","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005384","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical cadaveric study.</p><p><strong>Objective: </strong>To evaluate whether pre-tapping reduces the risk of pedicle fractures following pedicle screw instrumentation.</p><p><strong>Summary of background data: </strong>Pedicle screw instrumentation is the standard for rigid fixation of the thoracolumbar spine. While complications such as screw loosening and misplacement are well-documented, pedicle fractures are rare and poorly understood. Pre-tapping, a technique used during screw insertion, has been proposed to enhance fixation strength and potentially reduce the risk of fractures. However, its biomechanical effects on pedicle integrity remain unclear.</p><p><strong>Methods: </strong>Twenty lumbar vertebrae (L1-L5) were harvested from four cadavers. Preoperative CT scans were used to plan screw trajectories and assess bone mineral density (BMD). Each vertebra was alternately instrumented with screws using pre-tapping and non-pre-tapping techniques. Biomechanical testing measured maximum bending force to failure under a flexion moment. Pedicle fractures were classified based on CT imaging, and statistical analysis was performed to evaluate factors influencing fracture risk.</p><p><strong>Results: </strong>The maximum bending force to failure showed no significant difference between pre-tapping (103.9±47.5 Nm) and non-pre-tapping (98.1±43.4 Nm) groups (P=0.321). Pre-tapping significantly reduced maximum insertion torque (1.30±1.05 Nm vs. 2.91±2.65 Nm, P=0.025). Pedicle fill was a significant predictor of bending force (β=222.29 Nm, P=0.035), while BMD and pedicle diameter were not. Fracture patterns did not differ significantly between groups (P=0.384).</p><p><strong>Conclusion: </strong>Pre-tapping does not significantly influence the biomechanical stability of pedicle screws or the risk of pedicle fractures under flexion moments. However, pedicle fill is a critical factor in screw fixation strength. These findings suggest that optimizing pedicle fill is more relevant than pre-tapping in enhancing construct stability.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035091","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":"A Biomechanical Comparison of Alternatives to C2 Pedicle Screws.","authors":"Qiang Jian, Weiwei Da, Jason DePhillips, Joshua P McGuckin, Izabella T Lachcik, Nathanial A Myers, Jonathan M Mahoney, Dean Chou, Brandon S Bucklen","doi":"10.1097/BRS.0000000000005383","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005383","url":null,"abstract":"<p><strong>Study design: </strong>Cadaveric biomechanics study.</p><p><strong>Objective: </strong>This study compares five C2 fixation methods: pedicle, pars, translaminar, medial in-out-in, and subfacetal screws.</p><p><strong>Summary of background data: </strong>Variations in vascular and pedicle anatomy of the C2 vertebra can make C2 fixation difficult. Two novel trajectories--the medial in-out-in and subfacetal trajectory--may be alternatives. The medial in-out-in trajectory enables three-point cortical fixation while the subfacetal trajectory avoids the VA.</p><p><strong>Methods: </strong>Polyaxial screws were inserted into C1 lateral masses and C2 vertebrae in 12 cadaveric specimens. Specimens were assigned to one of four test groups based on C2 screw trajectory: pedicle, pars, medial in-out-in, subfacetal, and translaminar. Range of motion (ROM) in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) were measured at C1-2 using a custom-built six-degree-of-freedom motion simulator and motion analysis software. Two ROM tests were performed on each specimen: 1) intact construct and 2) screw-rod construct. C2 screws were then subjected to pullout testing.</p><p><strong>Results: </strong>Average ROM for intact constructs was 11.04° in FE, 3.21° in LB, and 59.43° in AR. There was a significant difference of ROM in all three directions (P<.01) among constructs. For the screw-rod construct, average ROM decreased 87% in FE, 86% in LB, and 97% in AR compared to intact. A two-way mixed ANOVA showed there was no significant difference in ROM between test groups for FE (P=0.738), LB (P=0.714), or AR (P=0.996) independent of construct. Medial in-out-in showed 10% higher pullout strength compared to the pedicle screw and subfacetal showed an 83% increase in pullout strength compared to the pars screw.</p><p><strong>Conclusions: </strong>The medial in-out-in and subfacetal trajectories represent viable alternatives for C1-2 stabilization in anatomically constrained cases, such as a high-riding vertebral artery or a narrow C2 pedicle. These novel techniques may expand surgical options for achieving robust C2 fixation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032377","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":"What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis.","authors":"Brandon Yoshida, Jacquelyn N Valenzuela-Moss, Tyler A Tetreault, Tishya A L Wren, Tiffany Phan, Gerard K Williams, Lindsay M Andras, Michael J Heffernan","doi":"10.1097/BRS.0000000000005380","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005380","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).</p><p><strong>Summary of background data: </strong>Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.</p><p><strong>Methods: </strong>Patients aged 7-21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with pre-operative curves≥80° and <80°.</p><p><strong>Results: </strong>337 patients met inclusion criteria with a mean curve of 83.1°±26.5°. Patients with curves≥80° had greater blood loss (994±607 vs 764±535 mL, P=0.0003), transfusion requirement (795±647 vs 478±482 mL, P<0.0001), surgical time (418±117 vs 338±117 min, P<0.0001), anesthesia time (552±123 vs 472±122 min, P<0.0001), and ICU stay (3±2 vs 2±1 d, P=0.009) compared to patients with curves<80°. Continued intubation was 2.4 times more likely (OR 2.4; 95% CI [1.5, 3.9], P=0.0002) and the odds of utilizing adjunctive surgical techniques (i.e. intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves≥80° (OR 4.1; 95% CI [2.5, 6.6], P<0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR 4.6; 95% CI [2.8, 7.2], P<0.0001). Residual curve magnitude (44.7°±20.5° vs 22.6°±13.6°, P<0.0001) and pelvic obliquity (10.2°±12 .6° vs 4.8°±8.7°, P<0.0001) were higher in the≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR 3.07; 95%CI:[1.40, 6.73], P=0.003).</p><p><strong>Conclusion: </strong>Curve magnitude≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000393","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":"Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis.","authors":"Brandon Edelbach, Dylan Glaser, Ahmad K Almekkawi, James P Caruso, Ghewa Sbaiti, Salah G Aoun, Carlos A Bagley","doi":"10.1097/BRS.0000000000005244","DOIUrl":"10.1097/BRS.0000000000005244","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and network meta-analysis.</p><p><strong>Objective: </strong>This study aimed to systematically review the literature on the management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations.</p><p><strong>Background: </strong>Primary osteomyelitis discitis is a challenging condition with varying management strategies.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was conducted. Studies reporting outcomes for the treatment of primary osteomyelitis discitis were included. A random-effect network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4 to 8 weeks, 8 to 12 weeks, and 12 to 16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness.</p><p><strong>Results: </strong>Sixty-three articles with 4233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4 to 8-week antibiotic duration ranked highest across fixed-effect and random-effect models (SUCRA: 0.8207 and 0.8343). The 12 to 16-week duration ranked highest in the fixed-effect model (SUCRA: 0.8460) but dropped substantially in the random-effect model (SUCRA: 0.3067). The <4-week duration showed mixed results. The 8 to 12-week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief.</p><p><strong>Conclusion: </strong>Antibiotic therapy for 4 to 8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"636-644"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898298","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":"Is Frailty Discouraging Surgeons From Performing Thoracolumbar Fusion?: A Retrospective Study.","authors":"Benjamin M Linden, Abbygale M Willging, Masoom Chainani, Kelsey Koch, Colette Galet, Patrick W McGonagill","doi":"10.1097/BRS.0000000000005203","DOIUrl":"10.1097/BRS.0000000000005203","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate whether frailty scoring is associated with adverse outcomes and management of patients with thoracolumbar fractures (TLFs).</p><p><strong>Background: </strong>Trauma patients with TLF often face longer recovery. The Canadian Study of Health and Aging Clinical Frailty Scale predicts outcomes in older trauma patients.</p><p><strong>Patients and methods: </strong>Adult trauma patients admitted from 2017 to 2021 who presented with TLF were included. Frailty was scored using the Canadian Study of Health and Aging Clinical Frailty Scale. Endpoints were in-hospital mortality, hospital length of stay, surgery, complications, and discharge disposition. Multivariate analyses adjusting for baseline characteristics were performed. P <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Overall, 1456 patients were included; 1013 fit, 240 pre-frail, and 203 frail. Frail patients underwent fewer surgeries [Odd ratio (OR) = 0.5 (0.32-0.77), P = 0.002]. Thoracolumbar (TL) fusion was associated with lower mortality [OR = 0.31 (0.11-0.85), P = 0.024]. Pre-frailty and frailty were associated with increased risk of pneumonia [OR = 2.522 (1.428-4.456), P = 0.001; OR = 2.93 (1.32-6.54), P = 0.008, respectively] and death [OR = 3.581 (1.853-6.921), P < 0.001; OR = 2.46 (1.07-5.67), P = 0.035]. Pre-frail and frail patients were more likely to be discharged to skilled nursing facilities [OR = 1.687 (1.024-2.780), P = 0.04; OR = 4.89 (2.66-9.0), P < 0.001].</p><p><strong>Conclusions: </strong>Pre-frailty and frailty were associated with poor outcomes and higher levels of care at discharge. Frail patients were less likely to undergo TL fusion, despite its association with improved survival. This suggests frailty should not discourage surgeons from performing TL fusion. Frailty scoring upon admission may help guide management and set realistic expectations for patients and their families.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"604-611"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558845","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":"Osteotomies at the Time of Graduation Surgery: How Much Do We Get From Them?","authors":"Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, John B Emans, Lawrence I Karlin, Amer F Samdani, Ilkka J Helenius, Michael G Vitale, Lindsay M Andras","doi":"10.1097/BRS.0000000000005139","DOIUrl":"10.1097/BRS.0000000000005139","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>Determine if posterior column osteotomies (PCO) at time of conversion from growth friendly instrumentation (GFI) to definitive fusion in early onset scoliosis (EOS) graduates impacts outcomes.</p><p><strong>Summary of background data: </strong>Increasing spinal rigidity following treatment of EOS with GFI can limit curve correction at time of conversion to definitive spinal fusion. PCO are often employed at the time of fusion to improve flexibility. This technique's efficacy has not been studied.</p><p><strong>Methods: </strong>Patients with EOS with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.</p><p><strong>Results: </strong>Eight hundred thirty-two patients met inclusion criteria. One hundred seventy-five (21%) patients had PCO. Age at index surgery was younger (6.6 vs . 7.4 y, P =0.0009), and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Before fusion, curve magnitude was similar between the groups (PCO=61.9°, no PCO=59.3°, P =0.18). On average 4.4 osteotomies (range: 1-12) were performed for the PCO group and EBL (PCO=820 cc vs . no PCO=752 cc, P <0.01) and surgical time (PCO=403 min vs . no PCO=349 min, P <0.01) were greater. Postoperatively, mean curve correction (PCO=16.6°, no PCO=14.4°, P =0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction ( P =0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI ( P =0.12). Postoperative complications at 2 years were similar (PCO=25% vs. no PCO=27%, P =0.63).</p><p><strong>Conclusions: </strong>EOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. More PCOs resulted in more correction, though less than that anticipated in a previously uninstrumented spine.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E161-E166"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112304","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":"Machine Learning-based Cluster Analysis Identifies Three Unique Phenotypes of Patients With Adult Spinal Deformity With Distinct Clinical Profiles and Long-term Recovery Trajectory: A Development Study.","authors":"Peng Cui, Peng Wang, Shuaikang Wang, Di Han, Qingyang Huang, Wei Wang, Xiaolong Chen, Shibao Lu","doi":"10.1097/BRS.0000000000005267","DOIUrl":"10.1097/BRS.0000000000005267","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review of a prospective adult spinal deformity data.</p><p><strong>Objective: </strong>To identify distinct patient clinical profiles and recovery trajectories in patients with adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>Patients with ASD exhibit a diverse array of symptoms and significant heterogeneity in clinical presentations, posing challenges to precise clinical decision-making. Accurate patient selection may provide further insight to personalized management strategies.</p><p><strong>Methods: </strong>Latent profile analysis (LPA) was performed to determine possible patient phenotype. Goodness-of-fit indices were used to determine the optimal cluster profiles. Outcome differences were evaluated using analysis of variance (ANOVA) and subsequent post hoc Tukey test, whereas significant predictors of group membership were identified through multinomial logistic regression.</p><p><strong>Results: </strong>A total of 204 ASD patients (mean age of 60.3 ± 11.8 years, comprising 62.3% females) with complete 1-year and 2-year follow-up outcomes were included. LPA identified three phenotypes: 51 patients in phenotype 1, 73 patients in phenotype 2, and 80 patients in phenotype 3, respectively. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. Patients in phenotype 3, although demonstrated the worst Scoliosis Research Society-22 questionnaire (SRS-22r) domains at baseline, patients in this cluster exhibited the most substantial Δchange in SRS-22r domains except for self-image at both 1-year and 2-year follow-up. Remarkably, a relatively large proportion of patients (58.8%) who were dissatisfied at 1-year follow-up transited to satisfied at 2-year follow-up. Advanced age, longer symptom duration, severe preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, higher preoperative sagittal vertical axis (SVA), fusion extending to sacrum/pelvis, and grade ≥ 3 osteotomy predicted membership in the phenotype 3.</p><p><strong>Conclusions: </strong>LPA enabled the delineation of three distinct phenotypes among ASD patients, each characterized by unique clinical profiles and distinct long-term recovery trajectories. By pinpointing the crucial variables that uniquely distinguish and predict membership in different phenotypes, the study provides valuable guidance for patient stratification.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"593-603"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012162","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":"Effect of the Comprehensive Addiction and Recovery Act (CARA) on Buprenorphine Prescribing for Opioid Use Disorder among Medicare Beneficiaries with Back Pain.","authors":"Hyunkyu Ko, Julie M Fritz, Thomas F Higgins, Darrel S Brodke, Brook I Martin","doi":"10.1097/BRS.0000000000005243","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005243","url":null,"abstract":"<p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Objective: </strong>To examine the effects of the Comprehensive Addition and Recovery Act (CARA) on buprenorphine prescribing and opioid use disorder (OUD) among Medicare beneficiaries with back pain.</p><p><strong>Summary of background data: </strong>Enacted in January 2017, CARA extended buprenorphine prescribing authority to Nurse Practitioners (NP) and Physician Assistants (PA) to treat OUD, defined as a physical or psychological dependence on opioids, but adoption varied by state. Leveraging this policy variation, we examined the effect of CARA on buprenorphine prescribing and OUD employing Medicare beneficiaries over age 65 with back pain from 2016 to 2019, and who were eligible for Part D prescription drug benefits. Only buprenorphine and buprenorphine/naloxone combinations that are FDA-approved for OUD treatment were included as our outcome.</p><p><strong>Methods: </strong>A difference-in-difference regression examined the change in buprenorphine prescribing and OUD before and after CARA between states that did and did not expand prescription authority. Subgroup analysis examined treatment effect heterogeneity by gender and race/ethnicity.</p><p><strong>Results: </strong>States that adopted a full scope-of-practice under CARA had a significant increase in buprenorphine prescribing (6.5%, 95%CI: 1.3%, 12.2%) and a reduction in OUD (7.2%, 95%CI: -9.3%, -4.8%) compared to states that did not expand prescribing authority after the policy implementation. States that expanded prescribing authority following CARA had a disproportionate increase in use of buprenorphine and a reduction in OUD among males and Hispanic patients compared to female and White patients. The magnitude of the policy effects increased over time across all groups.</p><p><strong>Conclusions: </strong>CARA was associated with increased buprenorphine prescribing and a reduction in OUD among older adults with back pain. Expanded authorization of prescription of buprenorphine to treat OUD by NPs/PAs in states that have not adopted full scope-of-practice under CARA might effectively reduce OUD, as well as racial/ethnic disparities in buprenorphine prescribing and OUD.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039726","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":"Comparative Analysis of Surgical Outcomes in Separation Surgery Versus Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.","authors":"Jantijn J G J Amelink, Robertus J B Pierik, Olivier Q Groot, John H Shin, Jorrit-Jan Verlaan, Daniel G Tobert","doi":"10.1097/BRS.0000000000005207","DOIUrl":"10.1097/BRS.0000000000005207","url":null,"abstract":"<p><strong>Study design: </strong>Retrospectively matched case-control study.</p><p><strong>Objective: </strong>To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC).</p><p><strong>Summary of background data: </strong>The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods.</p><p><strong>Materials and methods: </strong>Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion, and complications. The Mann-Whitney U test was used for continuous data, and the Fisher exact test for categorical data.</p><p><strong>Results: </strong>Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss [median 500 mL (IQR: 300-1000) vs . 925 mL (IQR: 500-1425); P =0.036] and shorter operating times [median 214 min (IQR: 164-281) vs . 286 min (IQR: 220-328); P =0.028]. Intraoperative blood transfusion occurred in 7 patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group ( P =0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative blood transfusion, reoperations, or survival ( P <0.05).</p><p><strong>Conclusion: </strong>Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control.</p><p><strong>Level of evidence: </strong>Level IV-treatment benefits.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"612-619"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628598","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}