Spine最新文献

{"title":"The Canal Bone Ratio: A Novel Indicator for Opportunistic Osteoporosis Screening in Adult Spinal Deformity Patients Through Radiographs.","authors":"Yunsheng Wang, Tong Tong, Jiali Zhang, Dechao Miao, Feng Wang, Linfeng Wang","doi":"10.1097/BRS.0000000000004987","DOIUrl":"10.1097/BRS.0000000000004987","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective diagnostic study.</p><p><strong>Objectives: </strong>To evaluate the utility of quantitative assessment of bone density using proximal femoral morphological parameters based on full-spine x-rays.</p><p><strong>Summary of background data: </strong>CT and MRI are commonly utilized methods for opportunistic assessment of bone density. However, there is currently a lack of means to quantitatively assess bone density in adult spinal deformity (ASD) patients through radiographs.</p><p><strong>Methods: </strong>Data collection involved medical records of ASD patients treated at our hospital. Patients were categorized into osteoporotic and nonosteoporotic groups based on dual-energy x-ray absorptiometry T-scores. Demographic information, radiographic parameters (canal bone ratio, canal bone ratio (CBR); cortical bone thickness, cortical bone thickness (CBT)), Hounsfield units, and vertebral body quality (VBQ) scores were compared. Pearson correlation analysis was conducted to assess the correlation between CBR, CBT, and T-scores. Multiple linear regression analysis identified independent predictors of bone density T-scores. Receiver operating characteristic curves and area under the curve calculations were performed to investigate the predictive performance for osteoporosis.</p><p><strong>Results: </strong>A total of 102 patients were included, with the osteoporotic group showing larger CBR and smaller CBT compared with the nonosteoporotic group. Proximal femoral morphological parameters exhibited the strongest correlation with total hip T-scores. Advanced age (β=-0.028, 95% CI=-0.054 to -0.002, P =0.032), low BMI (β=0.07, 95% CI=0.014-0.126, P =0.015), and high CBR (β=-7.772, 95% CI=-10.519 to -5.025, P <0.001) were identified as independent predictors of low bone density. Receiver operating characteristic analysis demonstrated that CBR had a similar osteoporosis screening capability as Hounsfield units, followed by CBT and VBQ scores.</p><p><strong>Conclusions: </strong>The utilization of CBR from full-spine x-rays is a simple and effective osteoporosis screening indicator for ASD patients, facilitating bone density assessments by spine surgeons for all attending patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1570-1576"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111483","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":"Perioperative Infection Prophylaxis With Vancomycin is a Significant Risk Factor for Deep Surgical Site Infection in Spine Surgery.","authors":"Gregory S Kazarian, Jung K Mok, Mitchell Johnson, Yusef Y Jordan, Takashi Hirase, Tejas Subramanian, Barry Brause, Han Jo Kim","doi":"10.1097/BRS.0000000000005081","DOIUrl":"10.1097/BRS.0000000000005081","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>The purpose of this study was to compare the efficacy of cefazolin versus vancomycin for perioperative infection prophylaxis.</p><p><strong>Summary of background data: </strong>The relative efficacy of cefazolin alternatives for perioperative infection prophylaxis is poorly understood.</p><p><strong>Materials and methods: </strong>This study was a single-center multisurgeon retrospective review of all patients undergoing primary spine surgery from an institutional registry. Postoperative infection was defined by the combination of three criteria: irrigation and debridement within 3 months of the index procedure, clinical suspicion for infection, and positive intraoperative cultures. Microbiology records for all infections were reviewed to assess the infectious organism and organism susceptibilities. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>A total of 10,122 patients met inclusion criteria. The overall incidence of infection was 0.78%, with an incidence of 0.73% in patients who received cefazolin and 2.03% in patients who received vancomycin (OR: 2.83, 95% CI: 1.35-5.91, P= 0.004). Use of IV vancomycin (OR: 2.83, 95% CI: 1.35-5.91, P =0.006), BMI (MD: 1.56, 95% CI: 0.32-2.79, P =0.014), presence of a fusion (OR: 1.62, 95% CI: 1.04-2.52, P =0.033), and operative time (MD: 42.04, 95% CI: 16.88-67.21, P =0.001) were significant risk factors in the univariate analysis. In the multivariate analysis, only noncefazolin antibiotics (OR: 2.48, 95% CI: 1.18-5.22, P =0.017) and BMI (MD: 1.56, 95% CI: 0.32-2.79, P =0.026) remained significant independent risk factors. Neither IV antibiotic regimen nor topical vancomycin significantly impacted Gram type, organism type, or antibiotic resistance ( P >0.05). The most common reason for antibiosis with vancomycin was a penicillin allergy (75.0%).</p><p><strong>Conclusions: </strong>Prophylactic antibiosis with IV vancomycin leads to a 2.5 times higher risk of infection compared with IV cefazolin in primary spine surgery. We recommend the routine use of IV cefazolin for infection prophylaxis, and caution against the elective use of alternative regimens like IV vancomycin unless clinically warranted.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1583-1590"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493480","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":"Lumbar Arthroplasty is Associated With a Lower Incidence of Adjacent Segment Disease Compared With ALIF.","authors":"Xu Tao, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005016","DOIUrl":"10.1097/BRS.0000000000005016","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E386"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861826","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":"RE: TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared With ALIF.","authors":"Xu Tao, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005015","DOIUrl":"10.1097/BRS.0000000000005015","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E385"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Development of Spinal Endoscopic Ultrasonic Imaging System With an Automated Tissue Recognition Algorithm.","authors":"Chang Jiang, Yiwei Xiang, Zhiyang Zhang, Yuanwu Cao, Nixi Xu, Yinglun Chen, Jiaqi Yao, Xiaoxing Jiang, Fang Ding, Rui Zheng, Zixian Chen","doi":"10.1097/BRS.0000000000005100","DOIUrl":"10.1097/BRS.0000000000005100","url":null,"abstract":"<p><strong>Study design: </strong>Preclinical experimental study.</p><p><strong>Objective: </strong>To develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeons recognition of different tissue types during endoscopic spinal surgery (ESS).</p><p><strong>Summary of background data: </strong>ESS remains a challenging task for spinal surgeons. Great proficiency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots.</p><p><strong>Methods: </strong>We constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a 2-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated for accuracy and consistency.</p><p><strong>Results: </strong>The probe can be easily used in the ESS working channel and produces clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosis, and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration.</p><p><strong>Conclusion: </strong>Our system was able to be used in existing ESS working channels and identify at-risk spinal structures in vitro. The trained algorithms could identify 6 intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E378-E384"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735046","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":"Preoperative Radiographic Predictors of Subsequent Fusion After Lumbar Decompression Surgery.","authors":"Mark J Lambrechts, Jeremy C Heard, Nicholas D D'Antonio, Yunsoo Lee, Rajkishen Narayanan, Teeto Ezeonu, Garrett Breyer, John Paulik, Sydney Somers, Anthony J Labarbiera, Jose A Canseco, Mark F Kurd, Ian D Kaye, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1097/BRS.0000000000005109","DOIUrl":"10.1097/BRS.0000000000005109","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery.</p><p><strong>Summary of background data: </strong>There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery.</p><p><strong>Methods: </strong>Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed.</p><p><strong>Results: </strong>Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P =0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P =0.001], decreased SS [OR=0.96 (0.93-0.99), P =0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P =0.040] as significant independent predictors of fusion after decompression surgery.</p><p><strong>Conclusions: </strong>This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1598-1606"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761027","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":"Cervical Laminoplasty Versus Laminectomy and Fusion: A Comprehensive Time-driven Activity-based Cost Analysis.","authors":"Theresa Chua, Perry L Lim, Stuart H Hershman, Harold A Fogel, Daniel G Tobert","doi":"10.1097/BRS.0000000000005150","DOIUrl":"10.1097/BRS.0000000000005150","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To compare the true cost between posterior cervical laminectomy and fusion and cervical laminoplasty using time driven activity-based costing methodology.</p><p><strong>Summary of background data: </strong>Cervical laminoplasty (LP) and posterior cervical laminectomy with fusion (LF) are effective procedures for treating cervical myelopathy. A comprehensive accounting of cost differences between LP versus LF is not available. Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs in patients with cervical myelopathy undergoing LP versus LF.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of 277 LP and 229 LF performed between 2019 and 2023. Total facility costs, which included personnel and supply costs, were assessed using TDABC. Separate analyses including and excluding implant costs were performed. Multiple regression analysis was utilized to assess the independent effect of LP compared with LF on facility costs, with all costs standardized using cost units (CUs).</p><p><strong>Results: </strong>Patients undergoing LP had lower total supply costs [672.5 vs. 765.0 CUs (0.88x), P <0.001] and lower total personnel costs [330.0 vs. 830.0 CUs (0.40x), P <0.001], resulting in a lower total facility cost both including [1003.8 vs. 1600.0 CUs (0.63x), P <0.001] and excluding implant costs [770.0 vs. 875.0 CUs (0.88x), P <0.001] (Table 1). After controlling for demographics and comorbidities, LF was associated with increased total facility costs, including (588.5 CUs, 95% CI: 517.1-659.9 CUs, P <0.001) and excluding implant costs (104.3 CUs, 95% CI: 57.6-151.0 CUs, P <0.001).</p><p><strong>Conclusions: </strong>Using time-driven activity-based costing, we found that total facility costs were lower in patients treated with laminoplasty. These findings suggest that laminoplasty may offer a less costly and more efficient surgical option for treating cervical myelopathy.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1555-1560"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133847","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":"Nonlinear Effect of Preexisting Cranial Adjacent Disc Degeneration on Cumulative 12-Year Revision Risk Following Lumbar Fusions.","authors":"Leevi A Toivonen, Heikki Mäntymäki, Lorin M Benneker, Hannu Kautiainen, Arja Häkkinen, Marko H Neva","doi":"10.1097/BRS.0000000000004949","DOIUrl":"10.1097/BRS.0000000000004949","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospectively collected data.</p><p><strong>Objective: </strong>To evaluate how preexisting adjacent segment degeneration status impacts revision risk for adjacent segment disease (ASD) after lumbar fusions.</p><p><strong>Summary of background data: </strong>ASD incurs late reoperations after lumbar fusion surgeries. ASD pathogenesis is multifactorial. Preexisting adjacent segment degeneration, measured by Pfirrmann, is suggested as one of the predisposing factors. We sought to find deeper insights into this association by using a more granular degeneration measure, the combined imaging score (CIS).</p><p><strong>Patients and methods: </strong>A total of 197 consecutive lumbar fusions for degenerative pathologies were enrolled in a prospective follow-up (median: 12 yr). Preoperative cranial adjacent segment degeneration status was determined using Pfirrmann and CIS, which utilize both radiographs and magnetic resonance imaging. On the basis of CIS, patients were trichotomized into tertiles (CIS <7, CIS 7-10, and CIS >10). The cumulative ASD revision risk was determined for each tertile. After adjusting for age, sex, body mass index, sacral fixation, and fusion length, hazard ratios (95% CI) for ASD revisions were determined for each Pfirrmann and CIS score.</p><p><strong>Results: </strong>Patients in the intermediate CIS tertile had a cumulative ASD revision risk of 25.4% (17.0%-37.0%), while both milder degeneration (CIS <7) [13.2% (6.5%-25.8%)] and end-stage degeneration (CIS >10) [13.6% (7.0%-25.5%)] appeared to be protective against surgical ASD. Pfirrmann failed to show a significant association with ASD revision risk. Adjusted analysis of CIS suggested increased ASD revisions after CIS 7, which turned contrariwise after CIS 10.</p><p><strong>Conclusions: </strong>The effect of preexisting adjacent segment degeneration on ASD reoperation risk is not linear. The risk appears to increase with advancing degeneration but diminishes with end-stage degeneration. Therefore, end-stage degenerative segments may be considered to be excluded from fusion constructs.</p><p><strong>Level of evidence: </strong>Therapeutic 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E372-E377"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672723","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":"Prospective Registration Study for Establishing Minimal Clinically Important Differences in Patients Undergoing Surgery for Spinal Metastases.","authors":"Ryosuke Hirota, Tsutomu Oshigiri, Noriyuki Iesato, Makoto Emori, Atsushi Teramoto, Yuki Shiratani, Akinobu Suzuki, Hidetomi Terai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya","doi":"10.1097/BRS.0000000000005062","DOIUrl":"10.1097/BRS.0000000000005062","url":null,"abstract":"<p><strong>Study design: </strong>Multicenter, prospective registry study.</p><p><strong>Objective: </strong>To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes.</p><p><strong>Background: </strong>Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases.</p><p><strong>Patients and methods: </strong>This study included 171 (out of 413) patients from the multicenter \"Prospective Registration Study on Surgery for Metastatic Spinal Tumors\" by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes.</p><p><strong>Results: </strong>The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively.</p><p><strong>Conclusion: </strong>We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1539-1547"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301652","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":"Assessment of Surgical Complications Strengthen the Relationship Between Spine Surgery Procedure Intensity and Chronic Opioid Use After Surgery.","authors":"Daniel I Rhon, Tina A Greenlee, Bryan K Lawson, Randall R McCafferty, Norman W Gill","doi":"10.1097/BRS.0000000000005069","DOIUrl":"10.1097/BRS.0000000000005069","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort using routinely collected health data.</p><p><strong>Objective: </strong>To compare opioid use based on surgery intensity (low or high).</p><p><strong>Summary of background data: </strong>Many factors influence an individual's experience of pain. The extent to which postsurgical opioid use is influenced by the severity of spine surgery is unknown.</p><p><strong>Methods: </strong>The participants were individuals undergoing spine surgery in a large military hospital. Procedures were categorized as low intensity (eg, microdiscectomy and laminectomy) and high intensity (eg, fusion and arthroplasty). The Surgical Scheduling System and Military Health System Data Repository were queried for healthcare utilization the 1 year before and after surgery. We compared opioid use after surgery between groups, adjusting for prior opioid use and surgical complications.</p><p><strong>Results: </strong>A total of 342 individuals met the inclusion criteria, with mean age 45.4 years (SD 10.9), and 33.0% were women. Of these, 221 (64.6%) underwent a low-intensity procedure and 121 (35.4%) underwent a high-intensity procedure. Mean postoperative opioid prescription fills were greater in the high- versus low-intensity group (9.0 vs. 5.7; P <0.001), as were the mean total days' supply (158.9 vs. 81.8; P <0.001). Median morphine milligram equivalents (MMEs) were not significantly different (40.2 vs. 42.7; P =0.287). Of the cohort, 26.3% were chronic opioid users after surgery. Adjusted rates of long-term opioid use were not different between groups when only accounting for prior opioid use but significantly higher for the high-intensity group when adjusting for surgical complications (OR=2.08; 95% CI 1.09-3.97). Of the entire cohort, 52.5% was still filling opioid prescriptions after 6 months.</p><p><strong>Conclusions: </strong>Higher-intensity procedures were associated with greater postoperative opioid use than lower-intensity procedures. Chronic opioid use was not significantly different between surgical intensity groups when considering only prior opioid use. Chronic opioid use was significantly higher among higher intensity procedures when accounting for surgical complications. The presence of surgical complications is a stronger predictor of postsurgical long-term opioid use in high-intensity surgeries than history of opioid use alone.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1607-1613"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331733","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}