Spine最新文献

{"title":"Risk Factors of Failed Conservative Treatment for Adjacent Vertebral Fractures Following Percutaneous Vertebroplasty.","authors":"Po-Hao Huang, Chih-Wei Chen, Ming-Hsiao Hu, Shu-Hua Yang, Chuan-Ching Huang","doi":"10.1097/BRS.0000000000005085","DOIUrl":"10.1097/BRS.0000000000005085","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective, single-center, observational study.</p><p><strong>Objective: </strong>This study investigated the risk factors associated with the failure of conservative treatment for adjacent vertebral fractures (AVFs).</p><p><strong>Summary of background data: </strong>Adjacent vertebral fractures following vertebroplasty for osteoporotic vertebral compression fractures are not uncommon. Presently, there is a lack of consensus regarding the management of adjacent vertebral fractures.</p><p><strong>Methods: </strong>We included patients who developed adjacent vertebral fractures within 2 years post single-level vertebroplasty between January 2013 and December 2020. All patients initially underwent 6 weeks of conservative treatment, including pain medications, bracing, and physical therapy. Surgical intervention was offered to those with intractable back pain due to AVFs. Baseline demographics, AVF characteristics, and radiologic measurements were systematically collected, and sequential univariable and multivariable logistic regression analyses were conducted to explore the risk factors.</p><p><strong>Results: </strong>Of the 114 patients with a mean age of 78.6 years, 2-thirds (76 patients) tolerated conservative treatment well, whereas 38 required surgical interventions for adjacent vertebral fractures. Both groups demonstrated similar baseline demographics and radiologic parameters regarding AVFs ( P >0.05). The multivariable logistic regression analyses revealed that the development of AVFs later than 6 months post-vertebroplasty and their caudal location to the index vertebroplasty were the independent risk factors of unsuccessful conservative treatment, with odds ratios of 3.57 (95% confidence interval [CI]: 1.14-11.1, P =0.029) and 2.50 (95% CI, 1.09-5.88, P =0.032), respectively.</p><p><strong>Conclusion: </strong>Adjacent vertebral fractures following percutaneous vertebroplasty generally have favorable outcomes under conservative treatment. However, the timing and the relative anatomical location of adjacent vertebral fractures are associated with treatment efficacy. Adjacent vertebral fractures occurring later than 6 months following the initial vertebroplasty or situated in the caudal location to the index vertebroplasty may exhibit reduced responsiveness to conservative treatment. These patients might benefit from a more aggressive therapeutic approach.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"339-346"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470822","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":"Enhancing the Clinical Applicability of the Novel Classification System for Proximal Junctional Degeneration.","authors":"Hao Rao","doi":"10.1097/BRS.0000000000005197","DOIUrl":"10.1097/BRS.0000000000005197","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E101"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984362","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 Impact of the Preoperative Mental Health Component Summary (MCS) Score on Short-Term Outcomes After Lumbar Fusion.","authors":"Teeto Ezeonu, Rajkishen Narayanan, Jeremy C Heard, Yunsoo A Lee, Aditya Mazmudar, Jeffrey Zucker, Alexander Shaer, Yoni Dulitzki, Dylan Resnick, Jose A Canseco, Mark F Kurd, Ian D Kaye, Alan S Hilibrand, Alexander R Vaccaro, Christopher Kepler, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005064","DOIUrl":"10.1097/BRS.0000000000005064","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to characterize the relationship between preoperative MCS and surgical outcomes after lumbar spine surgery including inpatient complications, length of stay, readmissions, and reoperations.</p><p><strong>Summary of background data: </strong>As the prevalence of mental health disorders in the United States increases, it is important to identify risks associated with poor mental health status in the surgical spine patient. The mental health component summary (MCS) of the Short Form-12 has been used extensively as an indication of a patient's mental health status and psychological well-being.</p><p><strong>Patients and methods: </strong>Adult patients older than or equal to 18 years who underwent primary one to three level lumbar fusion surgery at our academic medical institution from 2017 to 2021 were retrospectively identified. Preoperative MCS score was used to analyze outcomes in patients based on a cutoff (<45.6). A score >45.6 indicated better preoperative mental health and a score ≤45.6 indicated worse preoperative mental health.</p><p><strong>Results: </strong>Patients with lower preoperative MCS scores had longer hospital stays (3.86±2.16 vs. 3.55±1.42 d, P =0.010) and were more likely to have inpatient renal complications (3.09% vs. 7.19%, P =0.006). Patients with lower preoperative MCS scores also had lower activity measure for post-acute care (AM-PAC) scores (17.1±2.85 vs. 17.6±2.49, P =0.030). Ninety-day surgical readmissions, medical readmissions, and reoperations were not significantly different between groups ( P >0.05).</p><p><strong>Conclusion: </strong>Our study suggests that patients with lower preoperative mental health scores (MCS ≤45.6) were independently more likely to experience more renal complications and longer length of stay after primary lumbar fusion. In addition, higher MCS scores may correlate with better postoperative mobility and daily activity scores. Nevertheless, long-term outcomes are not significantly different between patients of better or worse preoperative mental health.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"326-332"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284843","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":"L5-S1 Transforaminal Lumbar Interbody Fusion is Associated With Increased Revisions Compared With L4-L5 Transforaminal Lumbar Interbody Fusion at Two Years.","authors":"Manjot Singh, Jack Casey, Jacob Glueck, Mariah Balmaceno-Criss, Alejandro Perez-Albela, John Hanna, Bassel G Diebo, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005149","DOIUrl":"10.1097/BRS.0000000000005149","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The aim of this study was to compare outcomes in patients undergoing 1-level transforaminal lumbar interbody fusion (TLIF) at L4-S1.</p><p><strong>Background: </strong>TLIF is frequently performed at L4-S1 to treat degenerative lumbar pathologies. However, the native alignment and biomechanics differ across L4-L5 and L5-S1, and there is limited data regarding comparative radiographic outcomes.</p><p><strong>Patients and methods: </strong>Patients who underwent 1-level TLIF at L4-L5 or L5-S1 at a single academic institution were identified. Baseline demographics, procedural characteristics, change in postoperative spinopelvic alignment patient-reported outcome measures, and 2-year postoperative surgical complications were compared. Multivariate regression analyses, accounting for age, sex, Charlson Comorbidity Index, and body mass index, were also performed.</p><p><strong>Results: </strong>Across the 175 included patients, 125 had L4-L5 TLIF and 50 had L5-S1 TLIF. The mean age was 57.8 years, 56.6% were females, the mean Charlson Comorbidity Index was 0.9, and the mean follow-up was 26.7 months. In the hospital, the 2 cohorts were not statistically different with regard to estimated blood loss and length of stay. Two years postoperatively, multivariate linear regression analyses revealed that L5-S1 TLIF achieved 6.0° higher correction in L4-S1 lordosis ( P = 0.012) than L4-L5 TLIF. At the same time, however, L5-S1 patients undergoing TLIF experienced significantly higher rates of pseudoarthrosis (8.0% vs. 1.6%, P = 0.036) and subsequent spine surgery (18.0% vs. 7.2%, P = 0.034), specifically for pseudoarthrosis (6.0% vs. 0.0%, P = 0.006), with this cohort having 8.7 times higher odds of subsequent spine surgery for pseudoarthrosis ( P = 0.015) than L4-L5 patients undergoing TLIF on multivariate logistic analyses. Patient-reported outcome measures, in contrast, were not different across the 2 cohorts.</p><p><strong>Conclusions: </strong>Although L5-S1 TLIF yielded good radiographic correction, it was associated with higher rates of subsequent spine surgery for pseudoarthrosis compared with L4-L5 TLIF. These findings may be related to differences in native segmental alignment and biomechanics across the L4-L5 and L5-S1 motion segments and are important to consider during surgical planning.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E79-E84"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133851","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":"Immediate Postoperative Change in the Upper Instrumented Screw-Vertebra Angle is a Predictor for Proximal Junctional Kyphosis and Failure.","authors":"Riza M Cetik, Steven D Glassman, John R Dimar, Charles H Crawford, Jeffrey L Gum, Jensen Smith, Nicole McGrath, Leah Y Carreon","doi":"10.1097/BRS.0000000000005048","DOIUrl":"10.1097/BRS.0000000000005048","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objectives: </strong>To determine if change in position of upper instrumented vertebral (UIV) screw between intraoperative prone and immediate postoperative standing radiographs is a predictor for proximal junctional kyphosis or failure (PJK/PJF).</p><p><strong>Summary of background data: </strong>Cranially directed UIV screws on postoperative radiographs have been found to be associated with PJK. Change in the screw position between intraoperative and immediate postoperative radiographs has not been studied.</p><p><strong>Materials and methods: </strong>Patients with posterior fusion greater than or equal to three levels and UIV at or distal to T8, and minimum two-year follow-up were identified from a single-center database. Primary outcomes were radiographic PJK/PJF or revision for PJK/PJF. Demographic, surgical, and radiographic variables, including intraoperative screw-vertebra (S-V) angle, change in S-V angle, direction of UIV screw (cranial-neutral-caudal), and rod-vertebra (R-V) angle were collected.</p><p><strong>Results: </strong>Totally, 143 cases from 110 patients were included with a mean age of 62.9 years and a follow-up of 3.5 years. Fifty-four (38%) cases developed PJK/PJF, of whom 30 required a revision. Mean S-V angle was -0.9°±5.5° intraoperative and -2.8°±5.5° postoperative. The group with PJK/PJF had a mean S-V angle change of -2.5°±2.4 while the rest had a change of -1.0°±1.6 ( P =0.010). When the change in S-V angle was <5°, 33% developed PJK, this increased to 80% when it was ≥5° ( P =0.001). Revision for PJK/PJF increased from 16% to 60% when S-V angle changed ≥5° ( P =0.001). Regression analysis showed S-V angle change as a significant risk factor for PJK/PJF ( P =0.047, OR=1.58) and for revision due to PJK/PJF ( P =0.009, OR=2.21).</p><p><strong>Conclusions: </strong>Change in the S-V angle from intraoperative prone to immediate postoperative standing radiograph is a strong predictor for PJK/PJF and for revision. For each degree of S-V angle change, odds of revision for PJK/PJF increases by x2.2. A change of 5° should alert the surgeon to the likely development of PJK/PJF requiring revision.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"304-310"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086323","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 Predictive Hemodynamic Monitoring on Intraoperative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery.","authors":"Leah Y Carreon, Steven D Glassman, Desiree Chappell, Steven Garvin, Anna M Lavelle, Jeffrey L Gum, Mladen Djurasovic, Wael Saasouh","doi":"10.1097/BRS.0000000000005121","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005121","url":null,"abstract":"<p><strong>Study design: </strong>Prospective longitudinal comparative cohort.</p><p><strong>Objectives: </strong>To determine if the use of predictive hemodynamic monitoring (PHM) during elective multi-level posterior instrumented spine fusions decreases episodes of intraoperative hypotension (IOH) and complications.</p><p><strong>Background: </strong>A recent study showed an association between complications and duration of IOH in patients undergoing multi-level spine fusions. Whether the use of PHM to maintain hemodynamic stability intraoperatively decreases postoperative complications has not been evaluated.</p><p><strong>Methods: </strong>Adults undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring were identified and stratified into those in which predictive hemodynamic monitoring (PHM) was used and those in which it was not. Number of minutes of hypotension (MAP <65 mm Hg) and hypertension (MAP ≥100 mm Hg), volume of fluids, blood products and vasopressors administered intraoperatively and within the first 4 hours postoperatively as well as the number and type of postoperative complications were collected.</p><p><strong>Results: </strong>The 47 cases in the PHM group and 70 in the non-PHM group had similar demographic and operative characteristics. A shorter duration of IOH was seen in the PHM group (8.13 min) compared with the non-PHM group (13.28 min, P=0.029); and a shorter duration of intraoperative hypertension seen in the PHM group (0.46 min) compared with the non-PHM group (1.38 min, P=0.032). There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs. 13%, P=0.027), postoperative nausea and vomiting (0 vs. 14%, P=0.004) and postoperative cognitive dysfunction (6% vs. 19%, P=0.049) compared with the non-PHM group. There was also a statistically significant shorter length of hospitalization in the PHM (4.62 d) compared with the non-PHM group (5.99 d, P=0.017).</p><p><strong>Conclusion: </strong>Predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intraoperative hypotension, a lower prevalence of complications, and a decreased hospital stay in multi-level spinal fusion surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 5","pages":"333-338"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383359","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 Impact of Disc Height on Outcomes Following Cervical Disc Replacement: A Systematic Review.","authors":"Gregory S Kazarian, Robert Cecere, Michelle A Zabat, Mihir S Dekhne, Even Sheha, James Dowdell, Sravisht Iyer, Sheeraz Qureshi","doi":"10.1097/BRS.0000000000005211","DOIUrl":"10.1097/BRS.0000000000005211","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To describe the impact of disc height (DH) on outcomes after cervical disc replacement (CDR).</p><p><strong>Background: </strong>Implant sizing and positioning may impact outcomes after CDR.</p><p><strong>Materials and methods: </strong>A systematic review was performed in accordance with the \"Preferred Reporting Items for Systematic Reviews and Meta-Analyses\" guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative \"DH\" on clinical and radiologic outcomes after CDR.</p><p><strong>Results: </strong>A total of 12 studies were included in the systematic review. In the literature, \"DH\" was assessed using multiple different measures: postoperative DH (n = 4), DH change (DHC; n = 4), degree of disc distraction (n = 2), prosthesis height (n = 2), functional spinal unit height (n = 2), and facet distraction (n = 1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2 mm as an important cutoff to optimize outcomes.</p><p><strong>Conclusions: </strong>\"DH,\" especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2 mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"347-356"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628589","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":"Morbidly Obese Patients Have Similar Clinical Outcomes and Recovery Kinetics After Minimally Invasive Decompression.","authors":"Pratyush Shahi, Tejas Subramanian, Sumedha Singh, Kasra Araghi, Tomoyuki Asada, Maximilian Korsun, Nishtha Singh, Olivia Tuma, Chad Simon, Avani Vaishnav, Eric Mai, Joshua Zhang, Cole Kwas, Myles Allen, Eric Kim, Annika Heuer, Evan Sheha, James Dowdell, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005045","DOIUrl":"10.1097/BRS.0000000000005045","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To study the impact of class 2/3 obesity (body mass index, BMI ≥35) on outcomes following minimally invasive decompression.</p><p><strong>Summary of background data: </strong>No previous study has analyzed the impact of class 2/3 obesity on outcomes following minimally invasive decompression.</p><p><strong>Materials and methods: </strong>Patients who underwent primary minimally invasive decompression were divided into four cohorts based on their BMI: normal (BMI: 18.5-<25), overweight (25-<30), class 1 obesity (30-<35), and class 2/3 obesity (BMI ≥35). Outcome measures were: 1) intraoperative variables: operative time, estimated blood loss (EBL); 2) patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; 4) return to activities; and 5) complication and reoperation rates.</p><p><strong>Results: </strong>Totally, 838 patients were included (226 normal, 357 overweight, 179 class 1 obesity, and 76 class 2/3 obesity). Class 1 and 2/3 obesity groups had significantly greater operative times compared with the other groups. Class 2/3 obesity group had worse ODI, VAS back and SF-12 PCS preoperatively, worse ODI, VAS back, VAS leg and SF-12 PCS at below six months, and worse ODI and SF-12 PCS at above six months. However, they had significant improvement in all PROMs at both postoperative timepoints and the magnitude of improvement was similar to other groups. No significant differences were found in MCID and PASS achievement rates, likelihood of betterment on the GRC scale, return to activities, and complication/reoperation rates.</p><p><strong>Conclusions: </strong>Class 2/3 obese patients have worse PROMs preoperatively and postoperatively. However, they show similar improvement in PROMs, MCID and PASS achievement rates, likelihood of betterment, recovery kinetics, and complication/reoperation rates as other BMI groups following minimally invasive decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"318-325"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959466","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 Effect of Thrombin-gelatin Matrix Compared With Absorbable Gelatin Sponge on Intraoperative Hemostasis in Unilateral Open-door Laminoplasty: A Randomized Controlled Trial.","authors":"Chengyi Huang, Zhu Chen, Hao Liu, Junbo He, Yiwei Shen, Tingkui Wu, Beiyu Wang","doi":"10.1097/BRS.0000000000005107","DOIUrl":"10.1097/BRS.0000000000005107","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomized, parallel-controlled trial.</p><p><strong>Objective: </strong>The primary aim of this study was to determine whether thrombin-gelatin matrix (TGM) combined with an absorbable gelatin sponge (AGS) could more greatly reduce intraoperative blood loss (IBL) in unilateral open-door laminoplasty than the sole use of an AGS could. The secondary aims were to evaluate the hemostatic efficiency, amount of postoperative bleeding, and safety of the application of TGM combined with an AGS.</p><p><strong>Summary of background data: </strong>IBL during cervical laminoplasty is substantial and is a proper indication for the application of hemostatic agents. However, we are unaware of any clinical trials on the application of TGM and an AGS in posterior cervical spine surgery.</p><p><strong>Methods: </strong>A total of 80 consecutive patients who underwent unilateral open-door laminoplasty were enrolled from September 2020 to March 2022. Patients were randomized into 2 groups, the TGM-AGS group and the AGS group, with 40 patients in each group. The primary outcome was IBL. Other outcomes included the duration of operation, duration of hemostasis, duration of drainage, maximum decrease in hemoglobin (Hb), length of hospital stay, volume of drainage, number of drainage days, occurrence of adverse events, coagulation indicators, and patient-reported outcome measures (PROMs).</p><p><strong>Results: </strong>The mean IBL for patients in the TGM-AGS group (75.22 ± 21.83 mL) was significantly lower than that in the AGS group (252.43 ± 57.39 mL) (mean difference = 177.21 mL, 95% confidence interval [CI], 157.88-196.53 mL, t=18.25, P <0.001); the duration of hemostasis, volume of drainage, days of drainage in the TGM group, and maximum decrease in Hb were also significantly less than those in the AGS group ( P <0.01).</p><p><strong>Conclusion: </strong>The hemostatic efficacy of TGM-AGS is better than that of an AGS alone in IBL. TGM-AGS is also superior to an AGS alone in the evaluation of hemostatic efficiency and postoperative bleeding.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"285-293"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789105","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 Low-density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion.","authors":"Ankit Hirpara, Cheryl L Ackert-Bicknell, Vikas V Patel","doi":"10.1097/BRS.0000000000005217","DOIUrl":"10.1097/BRS.0000000000005217","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To understand how preoperative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multilevel ACDF.</p><p><strong>Summary of background data: </strong>Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF.</p><p><strong>Materials and methods: </strong>Patients undergoing ACDF were identified using TriNetX, a health care database with over 100 million patients. Pseudarthrosis rates following single-level and multilevel ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and comorbidities.</p><p><strong>Results: </strong>Patients with an LDL above 142 mg/dL, compared with below 66 mg/dL, had significantly higher rates of pseudarthrosis at six months, one year, and two years after single-level and multilevel ACDF. Patients not taking a statin or fish oil, compared with those taking a statin or fish oil, respectively, also had significantly higher rates of pseudarthrosis at all time points after multilevel ACDF, but not single-level ACDF.</p><p><strong>Conclusion: </strong>Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multilevel ACDF. Statin and fish oil intake before surgery are also associated with reduced rates of pseudarthrosis after multilevel, but not single-level ACDF. These associations may be used for preoperative planning, patient optimization, and risk stratification.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 5","pages":"294-303"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383390","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}