Spine最新文献

{"title":"Long-Term Reoperation Rates After Single-Level Lumbar Discectomy: A Nationwide Cohort Study.","authors":"Suhas K Etigunta, Andy M Liu, Adeesya Gausper, Vivien Chan, Justin Scheer, Tiffany Perry, David L Skaggs, Corey Walker, Alexander Tuchman","doi":"10.1097/BRS.0000000000005328","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005328","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>This study aims to evaluate reoperation rates following single-level lumbar discectomy.</p><p><strong>Summary of background data: </strong>Reoperation rates following single-level lumbar discectomy are debated, with reports ranging from 5-24%. Accurately characterizing these rates is essential for provider and patient education.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the PearlDiver database. Patients aged 18 or older with minimum five years follow-up after a single-level lumbar discectomy were included. The primary outcome was subsequent lumbar surgery rate at five years. Secondary analysis evaluated subsequent lumbar surgery following revision discectomy, lumbar fusion rate after primary or revision discectomy, and risk factors for subsequent lumbar surgery. Kaplan-Meier analysis and Cox regression models were employed.</p><p><strong>Results: </strong>There were 308,979 patients included in this study. The five-year subsequent lumbar surgery rate was 14.4% and the five-year subsequent lumbar fusion rate was 6.1%. There were 67,098 patients who received revision discectomy. Of those, five-year subsequent lumbar surgery rate was 18.2% and subsequent lumbar fusion rate was 12.4%. Kaplan-Meier curves demonstrated that the probability of avoiding subsequent lumbar surgery decreased more rapidly within the first year following both index and revision discectomy. Cox regression identified obesity (HR=1.12, 95% CI=[1.097, 1.141]) and higher Elixhauser Comorbidity Index (HR=1.06, 95% CI=[1.060, 1.068]) as significant predictors of subsequent lumbar surgery following index discectomy.</p><p><strong>Conclusion: </strong>Five-year subsequent lumbar surgery rate following single-level lumbar discectomy was 14.4%, with a higher rate of 18.2% following revision discectomy. This is the largest cohort to date studying reoperation rates after single-level lumbar discectomy. Patients should be counseled regarding the significant risk of subsequent surgeries, particularly after revision discectomy. Fusion procedures were more frequently performed after revision discectomy, underscoring the need to carefully consider surgical planning and patient selection in recurrent lumbar disc herniation cases.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630732","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 Application of 3D-Printed Microporous Laminae in Kyphosis Correction Surgery for Ankylosing Spondylitis: Minimum Two-Year Follow-Up.","authors":"Chao Li, Hong Li, Xiangning Meng, Beiyu Xu, Yao Zhao, Longtao Qi, Chunde Li, Yu Wang","doi":"10.1097/BRS.0000000000005331","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005331","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>This study designed an innovative 3D-printed microporous lamina and aimed to evaluate the feasibility and effectiveness in kyphosis correction surgery for patients with ankylosing spondylitis (AS).</p><p><strong>Summary of background data: </strong>Spinal osteotomy is a widely employed treatment for severe kyphotic deformities in AS. However, mitigating complications associated with osteotomy remains a significant clinical challenge.</p><p><strong>Methods: </strong>A total of 72 consecutive patients with ankylosing spondylitis who underwent kyphosis correction surgery were analyzed. Customized 3D-printed microporous laminae were designed based on preoperative imaging and three-dimensional modeling of each patient's spinal anatomy. Patients were divided into two groups: Group A (25 patients), treated with the 3D-printed microporous lamina technique, and Group B (47 patients), treated using the traditional technique. Radiological assessments included bone fusion rate, global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), osteotomy angle (OA), pelvic index (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). Clinical outcomes assessed were surgery-related complications, reoperation rates, operative time, estimated blood loss, postoperative hospital stay, and Scoliosis Research Society Outcomes Instrument-22 (SRS-22). All patients were followed up for at least two years postoperatively.</p><p><strong>Results: </strong>The bone fusion rate in the 3D-printed microporous lamina group was 96%. There were no statistically significant differences between the two groups in terms of surgery-related complications, reoperation rate, estimated blood loss, postoperative stay, GK, TLK, LL, OA, PI, PT, SS, SVA, or SRS-22. Although the mean operative time was longer in Group A than in Group B, this difference was not statistically significant.</p><p><strong>Conclusion: </strong>The use of 3D-printed microporous laminae in kyphosis correction surgery for ankylosing spondylitis provides a promising method for achieving high bone fusion rates through effective laminar reconstruction.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630815","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":"Perioperative Safety of Lumbar Decompression Surgery Performed Under Continuous Low-Dose Aspirin Administration.","authors":"Hiromitsu Takaoka, Ko Takano, Osamu Matsushige, Seiji Ohtori","doi":"10.1097/BRS.0000000000005330","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005330","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical analysis.</p><p><strong>Objective: </strong>To investigate the changes in perioperative bleeding and overall safety associated with the use of low-dose aspirin (LDA) in spinal surgery.</p><p><strong>Summary of background data: </strong>There is no consensus on whether to continue the use of LDA in patients requiring spinal surgery. Furthermore, previous studies have shown inconsistent results regarding the impact of LDA on the risk of intraoperative and postoperative bleeding.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single institution from 2014 to 2023, involving 375 patients diagnosed with lumbar spinal stenosis. Of these, 98 were on LDA therapy and 207 were not. After excluding those on other antiplatelet or anticoagulant therapies, propensity score matching was applied, resulting in two groups of 89 patients each. The study assessed variables such as operative time, intraoperative blood loss, postoperative drain volume, and hemoglobin level changes up to one week post-surgery.</p><p><strong>Results: </strong>The LDA treated group (L group) experienced significantly higher intraoperative blood loss (70.3 ml) compared to the non-LDA treated group (N group) (46.4 ml, P =0.003). Postoperative drain volumes did not differ significantly, but postoperatively, hemoglobin levels decreased by 2.2 g/dL in the L group and by 1.9 g/dL in the N group after one week ( P =0.04). There were no significant differences in the rate of postoperative transfusions or serious bleeding complications between the groups.</p><p><strong>Conclusion: </strong>Although LDA use was associated with increased intraoperative blood loss and a significant drop in postoperative hemoglobin levels, it did not lead to serious bleeding complications. These findings suggest that with careful management, LDA can be safely continued in patients undergoing lumbar decompression surgery. However, the generalizability of these results is limited by the observational nature of the study and its single-center design.</p><p><strong>The level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630809","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 Condoliase on Health-Related Quality of Life in Participants with Radicular Leg Pain Associated with Lumbar Disc Herniation: Results From a United States Phase 3 Clinical Trial.","authors":"Kevin E Macadaeg, Kee D Kim, Pragya B Gupta, Jose Rivera, Anand Patel, Kinsuk Chauhan, Jun Watanabe, Takayuki Seo, Evan Zucker, Kenneth Candido","doi":"10.1097/BRS.0000000000005327","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005327","url":null,"abstract":"<p><strong>Study design: </strong>An exploratory analysis of a randomized, double-blind, sham-controlled, phase 3 study.</p><p><strong>Objective: </strong>To evaluate the impact of SI-6603 (condoliase) on health-related quality of life (HRQoL)-related outcomes in patients with lumbar disc herniation (LDH)-associated radicular leg pain from the Discovery 6603 study (NCT03607838).</p><p><strong>Summary of background data: </strong>Condoliase is a novel chemonucleolytic agent that selectively degrades chondroitin sulfate in the nucleus pulposus. Condoliase is approved in Japan for the treatment of radicular leg pain associated with LDH. Recently, the Discovery 6603 study demonstrated the efficacy and tolerability of condoliase in the United States (US).</p><p><strong>Methods: </strong>Adults with LDH and unilateral radicular leg pain were randomized to receive a single intradiscal injection of condoliase (1.25 units) or sham followed by 52 weeks of observation. Exploratory HRQoL-related outcomes included change from baseline (CFB) in EuroQol Group 5-Dimension Quality of Life instrument, 5-Level version (EQ-5D-5L) and visual analogue scale (EQ-VAS), CFB in the 36-item Short Form Health Survey (SF-36), Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and CFB in Work Productivity and Activity Impairment (WPAI) scores. EQ-5D-5L and SF-36 measures were assessed using a longitudinal analysis model.</p><p><strong>Results: </strong>Of 352 randomized participants, 341 constituted the modified intention-to-treat population (condoliase: 169; sham: 172). Condoliase showed numerically greater improvements in EQ-5D-5L self-care and pain/discomfort dimensions at Week 13 and Week 52 compared with sham (P<0.05). The SF-36 physical component and WPAI scores numerically favored condoliase compared with sham. Patients and clinicians more frequently reported \"very much improved\" in overall status following condoliase treatment vs sham.</p><p><strong>Conclusion: </strong>Previous findings confirmed the efficacy and tolerability of condoliase for LDH management. Condoliase showed notable improvements in exploratory HRQoL-related outcomes, which were consistent across multiple patient-reported measures. Condoliase has the potential to enhance QoL and work productivity in individuals with LDH.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606161","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 Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis.","authors":"Takashi Hirase, Avani S Vaishnav, Joshua Zhang, Annika Bay, Eric T Kim, Mitchell S Fourman, Keith W Lyons, John C F Clohisy, Tomoyuki Asada, Hiroyuki Nakarai, Gregory S Kazarian, Kevin J DiSilvestro, Russel C Huang, Matthew E Cunningham, Sravisht Iyer, Todd J Albert, Han Jo Kim, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005325","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005325","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1.</p><p><strong>Summary of background data: </strong>Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters.</p><p><strong>Methods: </strong>Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL.</p><p><strong>Results: </strong>Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF.</p><p><strong>Conclusion: </strong>Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630763","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":"MIS-TLIF Achieves Comparable Outcomes in Challenging Spondylolisthesis Cases: Radiographic Difficulty Assessed with a Novel Grading System.","authors":"Tomoyuki Asada, Venkat Boddapati, Arsen Omurzakov, Olivia Tuma, Kasra Araghi, Tejas Subramanian, Eric Zhao, Annika Bay, Adin M Ehrlich, Sereen Halayqeh, Adrian Lui, Andrea Pezzi, Francis Lovecchio, James Dowdell, Harvinder Sandhu, Russel Huang, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005324","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005324","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To compare clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among patients with different radiographical difficult spondylolisthesis.</p><p><strong>Summary of background context: </strong>High-grade vertebral slip, collapsed disc, and less mobile segment can complicate segmental parameter restoration in MIS-TLIF. Few studies have examined if MIS-TLIF can achieve comparable outcomes in these challenging cases.</p><p><strong>Materials and methods: </strong>This study included patients who underwent single-level MIS-TLIF for degenerative spondylolisthesis. Radiographical difficulty was defined using a \"difficulty point\" system: disc height (<5 mm=1point), angular flexibility at the operated level by preoperative flexion-extension standing X-ray (<5degrees=1point), and slippage rate (>25%=1 point). Patients were categorized into \"simple\" (0 point), \"moderate\" (1 point), and \"difficult\" (2-3 points) cohorts. Outcomes included radiographic parameters (postoperative disc height, segmental lordosis restoration, and slippage reduction), complications, patient-reported outcomes such as Oswestry Disability Index (ODI) from 2 weeks to 1 year postoperatively.</p><p><strong>Results: </strong>A total of 208 patients were included, with 52 in the difficult, 89 in the moderate, and 67 in the simple. The difficult cohort showed significantly greater restoration of disc height (161.0% vs. 26.5% vs. 9.3%, P<0.001), resulting in similar postoperative disc height (8.3 mm vs. 9.0 mm vs. 0.1 mm, P=0.10) and segmental lordosis at the operated level (14.5 vs. 13.0 vs. 12.5 degrees, P=0.17). Postoperative outcomes indicated a greater improvement trend in ODI in the difficult group compared to the moderate group (β= 7.3, 9=0.011), with similar minimal clinically important difference achievement rate in ODI at 1-year postoperatively (Difficult, 69.2% vs. Moderate, 62.8% vs. Simple, 54.3%, P=0.46).</p><p><strong>Conclusion: </strong>MIS-TLIF is a feasible treatment option in patients with technically challenging radiographic parameters, achieving comparable postoperative radiographical and clinical outcomes.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630734","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":"https://doi.org/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 which perform ACDF surgery. Patients undergoing primary ACDF surgery for DCSD between June 2016 and February 2024 without prior cervical spine surgery were included (n=5,517). Patients were grouped based on the patient symptom status (\"Improved\" vs. \"Indifferent or worse\") at 12 months post-surgery. 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 year, OR: 1.95, P<0.001), lower preoperative Neck Disability Index (NDI) scores (≤42, OR: 1.37, P=0.012), and non-smoking (OR: 1.37, P=0.030). The initial diagnosis also influenced outcomes: patients treated for herniated discs 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>Conclusion: </strong>Shorter preoperative pain duration, lower NDI scores, and non-smoking status were significant predictors of good outcomes at 12 months after ACDF surgery for DCSD. These findings can help to guide preoperative patient counselling and enhance evidence-based decision making for treating DCSD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to 'Letter to the Editor: Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion\": A Single Institution Experience.","authors":"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":"https://doi.org/10.1097/BRS.0000000000005320","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","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":"Impact of Short-term Perioperative Steroid Administration on Outcomes of 1- and 2-Level Transforaminal Lumbar Interbody Fusion.","authors":"Mitsuhiro Nishizawa, Steven D Glassman, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, John R Dimar, R Kirk Owens, Leah Y Carreon","doi":"10.1097/BRS.0000000000005321","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005321","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort.</p><p><strong>Objective: </strong>To assess the impact of short-term perioperative use of systemic steroids on the surgical outcomes of one- to two-level transforaminal lumbar fusion (TLIF), with a primary focus on complications.</p><p><strong>Summary of background data: </strong>Steroids are commonly used in the perioperative period, including as a standard anesthesia practice and control for postoperative pain. However, the impact of perioperative use of systemic steroids on the surgical outcomes of lumbar fusion surgery remains unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed 560 patients who underwent one- or two-level TLIF. Complications rates within one year postoperatively were compared between the patients who received perioperative steroids and those who did not. Additionally, the total cumulative steroid dose as prednisolone equivalents was compared between patients with and without complications.</p><p><strong>Results: </strong>380 patients (68%) received steroids perioperatively, with a mean prednisolone equivalent dose of 110±341.3 mg. Intraoperative steroids were administered to 359 patients (64%), with a mean dose of 46.6±13.8 mg, while 45 patients (8%) received steroids postoperatively, with a mean dose of 558.1±863.5 mg. There were no significant differences in any complication rates between patients who received steroids perioperatively, postoperatively, or intraoperatively and those who did not, respectively. Patients who experienced complications had lower total cumulative steroid dose compared to those without any complications, and the differences reached to significant in infections (39.9±53.2 mg vs. 77.6±297.0 mg, P=0.015); minor complications (37.2±51.5 mg vs. 79.9±304.2 mg, P=0.005); and nonunion (49.8±78.1 mg vs. 89.1±336.5 mg, P=0.046).</p><p><strong>Conclusion: </strong>This study found that short-term perioperative use of systemic steroids was not associated with increased complications, and perioperative administration of steroids may have potential protective effects.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606245","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":"Predicting Postoperative Neurological Outcomes in Metastatic Spinal Tumor Surgery Using Machine Learning.","authors":"Satoshi Maki, Yuki Shiratani, Sumihisa Orita, Akinobu Suzuki, Koji Tamai, 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, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Kenji Kato, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Gen Inoue, Shiro Imagama, Kota Watanabe, Satoshi Kato, Seiji Ohtori, Takeo Furuya","doi":"10.1097/BRS.0000000000005322","DOIUrl":"10.1097/BRS.0000000000005322","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of data collected across multiple centers.</p><p><strong>Objective: </strong>To develop machine learning models for predicting neurological outcomes one month postoperatively in patients with metastatic spinal tumors undergoing surgery, and to identify key factors influencing neurological recovery.</p><p><strong>Summary of background data: </strong>The increasing prevalence of spinal metastases has led to a growing need for surgical intervention to address mechanical instability and neurological deficits. Predicting postoperative neurological status, as assessed by the Frankel classification, can provide valuable insights for surgical planning and patient counseling. Traditional prognostic models have shown limitations in capturing the complexity of neurological recovery patterns.</p><p><strong>Methods: </strong>We analyzed data from 244 patients who underwent spinal surgery for metastatic disease across 38 institutions. The primary outcome was functional ambulation, defined as Frankel grades D or E at one month postoperatively. Four machine learning algorithms (Random Forest, XGBoost, LightGBM, and CatBoost) were used to build predictive models. Feature selection employed the Boruta algorithm and Variance Inflation Factor analysis to reduce multicollinearity.</p><p><strong>Results: </strong>Among the 244 patients, the proportion of ambulatory patients (Frankel grades D or E) increased from 36.8% preoperatively to 63.1% at one month postoperatively. The Random Forest model achieved the highest area under the receiver operating characteristic curve (AUC-ROC) of 0.8516, followed by XGBoost (0.8351), CatBoost (0.8331), and LightGBM (0.8098). SHapley Additive exPlanations analysis identified preoperative Frankel classification, transfer ability, inflammatory markers (C-reactive protein, white blood cell-lymphocyte), and surgical timing as the most important predictors of postoperative outcomes.</p><p><strong>Conclusions: </strong>Machine learning models showed strong predictive performance in assessing postoperative neurological status for patients with metastatic spinal tumors. Key factors including preoperative neurological function, functional ability, and inflammation markers significantly influenced outcomes. These findings could inform surgical decision-making and help set realistic postoperative expectations while potentially improving patient care through more accurate outcome prediction.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626035","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}