Spine最新文献

{"title":"Comorbidity-Specific Risk of Revision Following Single-Level Degenerative Spinal Fusion (2010-2023): US Cohort Study Among Over 399K Patients.","authors":"Arman Kishan, Harmon S Khela, Alex Hernandez Manriquez, Gregory S Kazarian, Mihir S Dekhne, Dhiraj J Pangal, Andrew J Schoenfeld, William C Eward, Sami H Tuffaha, Alan H Daniels, Raffi S Avedian, Han Jo Kim, Peter G Passias, Sravisht Iyer, Anand Veeravagu","doi":"10.1097/BRS.0000000000005888","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005888","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the associations of 28 preoperative comorbidities with all-cause and etiology-specific revisions (pseudarthrosis, mechanical failure, adjacent segment disease [ASD], infection) following single-level degenerative spinal fusion.</p><p><strong>Summary of background data: </strong>Revision following spinal fusion for degenerative spinal disease remains frequent and costly. While technical factors are well studied, the extent to which preoperative comorbidities differentially predispose to specific revision etiologies is unclear.</p><p><strong>Materials and methods: </strong>Using the PearlDiver Mariner170 claims database (2010-2023), we identified adults undergoing single-level degenerative spinal fusion and followed them for 2 years for reoperation. All-cause and etiology-specific revisions were defined by CPT/ICD codes. Preoperative comorbidities were analyzed using multivariable cox proportional hazards models adjusted for age, sex, and all comorbidities. Bonferroni correction set significance at P≤0.00036.</p><p><strong>Results: </strong>Among 399,186 patients (mean age 59.7±13.0; 56.7% female; mean CCI 1.4±1.2), anaemia (HR 1.33), osteoporosis (HR 1.31), substance-related disorders (HR 1.25), and depression (HR 1.19) conferred the greatest risk of all-cause revision. Type 2 diabetes (HR 1.07) and essential hypertension (HR 1.14) had smaller but significant effects. Etiology-specific analyses showed that osteoporosis, anaemia, depression, and substance-related disorders were consistently associated with increased risk across pseudarthrosis, mechanical failure, and ASD. Mechanical failure was additionally associated with hypertension (HR 1.20) and diabetes (HR 1.28), which were not significant in the other revision subtypes. In contrast, ASD revisions were uniquely associated with osteoarthritis (HR 1.26). No comorbidity was significantly associated with infection-related revision. All hazard ratios were significant at P<0.001 unless otherwise specified.</p><p><strong>Conclusion: </strong>In this national cohort of patients, osteoporosis, anaemia, depression, and substance-related disorders emerged as significant predictors of non-infectious revision within two years. Hypertension and type 2 diabetes conferred more modest risks for mechanical failure. These findings support the integration of comorbidity-informed risk stratification into preoperative planning and highlight the potential optimization to minimize revisions and enhance clinical outcomes.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075845","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":"Letter to the Editor Regarding \"Explainable Machine Learning for Perioperative Risk Stratification of Radiographic Adjacent Segment Degeneration After Short-Segment Lumbar Fusion\".","authors":"Chunyu Zhang, Yulei Xie, Jun He","doi":"10.1097/BRS.0000000000005882","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005882","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075812","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":"Effect Modifiers of the Association Between Physical Activities and Subsequent Low Back Pain Flares.","authors":"Jason S Silver, Andrew Timmons, Jihong Min, Hannah F Brubeck, Adrienne D Tanus, Anna Korpak, Albert Chang, Srecharan Gorukanti, Bianca I Dowling, Clinton J Daniels, Mark P Jensen, Pradeep Suri","doi":"10.1097/BRS.0000000000005886","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005886","url":null,"abstract":"<p><strong>Study design: </strong>Prospective case-crossover study.</p><p><strong>Objective: </strong>This study evaluated whether concurrent actions, work-relatedness, and analgesic use modify the associations between physical activities and subsequent LBP flares.</p><p><strong>Summary of background data: </strong>Prior longitudinal case-crossover studies found transient risks of various activities on LBP flares. These studies have focused on the main effects of exposures for LBP. However, little is known about contextual factors that could modify activity-flare relationships.</p><p><strong>Methods: </strong>This was a secondary analysis of a 1-year prospective case-crossover study evaluating transient risks of 10 common physical activities on LBP flares. Participants completed scheduled surveys and self-initiated flare surveys inquiring about potential modifiers and activity exposures. Multivariate-adjusted conditional logistic regression analyses evaluated various concurrent actions, work-relatedness, and analgesic use as potential modifiers of the association between each activity and subsequent flares.</p><p><strong>Results: </strong>Of 416 participants, the mean age was 47.6 years and 77% had LBP duration >5 years. Many concurrent actions (15 of 21 candidate effect modifiers) were significantly associated with greater activity-flare associations, including but not limited to twisting (odds ratio [OR]=1.48, [95% confidence interval [CI] 1.23-1.78]), bending (OR=1.32 [95% CI 1.10-1.59]), lifting weights of 20-29 pounds (OR=1.70 [95% CI 1.30-2.23]), and vibration exposure (OR=2.00 [95% CI 1.24-3.21]). Work-relatedness was associated with lower flare risk for 3 out of 10 activities (lifting, climbing, and squatting), but these findings were not directionally consistent in secondary analyses using 2-hour exposure windows, suggesting that work-relatedness does not modify activity-flare associations. Analgesic use did not meaningfully modify activity-flare associations.</p><p><strong>Conclusions: </strong>Concurrent biomechanical actions were generally associated with greater activity-flare risk. Work-relatedness and analgesic administration did not modify activity-flare associations. These findings provide the first epidemiologic evidence that contextual factors, and not solely the type of activity, may influence activity-associated LBP flare risk for some activities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075833","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":"Regarding \"Prospective, Multicenter Study of Two-Level Cervical Arthroplasty With a PEEK-On-Ceramic Cervical Total Disc Replacement: Five-Year Follow-Up\".","authors":"Aikeremujiang Muheremu, Yangjie Qin, Yisimayi Aihemaitijiang","doi":"10.1097/BRS.0000000000005883","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005883","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075848","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 Lower Lordotic Arch More Precisely Predicts Pelvic Positioning for Adult Spinal Deformity Patients with an Aligned T4-L1-Hip Axis.","authors":"Alexander T Yahanda, Tim T Bui, Karan Joseph, Samuel Vogl, Munish C Gupta, Jeffrey Hills, Eric O Klineberg, Gregory M Mundis, Christopher P Ames, Han Jo Kim, Michael P Kelly, Camilo A Molina","doi":"10.1097/BRS.0000000000005885","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005885","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To assess the combined effect of lower lordotic arch (LLA) and thoracolumbar (T4-L1-hip axis) alignment correction on the ability to predict sacral slope (SS) (i.e. pelvic retroversion) in adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>The Roussouly framework characterizes the spine through a series of lordotic and kyphotic arches. The LLA should be equivalent to SS, meaning that pelvic positioning should be predicted by lumbar lordosis modifications between the lordotic apex and S1. However, positive T4-L1-hip axis mismatches will drive persistent pelvic retroversion. We hypothesized that postoperative SS prediction from LLA correction will be highest among patients with aligned T4-L1 hip axes.</p><p><strong>Methods: </strong>339 ASD patients receiving fusions of ≥L2-pelvis had spinopelvic parameters measured on preoperative and 6-week scoliosis radiographs to determine LLA-SS correlations. Uni- and multivariable analyses were used to ascertain the effect of the LLA, T4-L1-hip axis, and other factors on pre-/postoperative SS.</p><p><strong>Results: </strong>LLA and SS were correlated among all patients preoperatively (ρ=0.68, R2=0.47, P<0.0001) and postoperatively (ρ=0.74, R2=0.55, P<0.0001). Postoperative strength and predictive ability of these correlations improved when the T4-L1-hip axis was respected (ρ=0.82, R2=0.68, P<0.0001) versus non-respected (ρ=0.68, R2=0.47, P<0.0001). Multivariable analysis demonstrated that preoperative LLA (P<0.0001), T4-L1-hip axis alignment (P=0.02), pelvic incidence (P<0.0001) and sex (P=0.01) were predictors of preoperative SS. Postoperative LLA (P<0.0001), aligned T4-L1-hip axis (P=0.04), pelvic incidence (P=0.0005), and revision surgery (P=0.01) were significant predictors of postoperative SS.</p><p><strong>Conclusions: </strong>LLA and SS were correlated pre-and postoperatively for all patients. Correlation strength and predictive ability was superior for patients with aligned T4-L1-hip axes, highlighting the importance of proper alignment of the arches cranial to the LLA. Focusing on the LLA and T4-L1-hip axis should be a priority for surgical planning to optimize prediction of SS (and thus elimination of pathologic pelvic retroversion) after LLA modification regardless of fusion length or Roussouly curve type.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075815","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":"Association of CT-Based Body Composition Phenotypes With Lumbar Degenerative Disease Characteristics: A Two-Center Cross-Sectional Study.","authors":"Qiao Xu, Xiaohong Wang, Mengchao Zhang, Liang Chen","doi":"10.1097/BRS.0000000000005881","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005881","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A two-center retrospective cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association between CT-derived body composition phenotypes and lumbar degenerative disease (LDD) characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary of background data: &lt;/strong&gt;While individual measures of fat distribution and muscle status are known to be associated with LDD, their combined synergistic or antagonistic effects remain largely uncharacterized. Furthermore, conventional body mass index (BMI) often fails to accurately represent the complexity of individual body composition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 262 patients with chronic low back pain were retrospectively included. Subcutaneous adipose tissue area (SAT), visceral adipose tissue area (VAT), abdominal muscle fat area (AMF), paraspinal muscle fat area (PMF), abdominal muscle area (AMA), and paraspinal muscle area (PMA) were quantified on axial CT images at the L3-L4 vertebral levels. After variable selection using Spearman correlation analysis (P&lt;0.05) and variance inflation factor (VIF) diagnostics (VIF &lt;5), K-means clustering was performed to derive distinct body composition phenotypes. Three BMI groups based on Chinese standards were used as the comparative classification. The primary outcome was the lumbar composite degeneration grade (grades I-IV). Trend tests were performed using the Jonckheere-Terpstra and Cochran-Armitage tests. Age- and sex-adjusted ordinal logistic regression was used to evaluate the association between phenotypes and degenerative grade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VAT, AMF, PMF, AMA, and PMA were identified as key clustering variables. K-means clustering identified three distinct body composition phenotypes: high-fat muscle-rich (n=95), low-fat muscle-preserved (n=112), and fat-infiltrated muscle-atrophic (n=55). The three phenotypes exhibited significant gradient trends in degeneration grade, anterior osteophytes, posterior osteophytes, intervertebral space narrowing, and facet joint changes (all trend P&lt;0.01). After adjustment for age and sex, the fat-infiltrated muscle-atrophic phenotype was associated with higher degenerative grade (ordered logistic regression, OR=3.02, 95% CI 1.45-6.31, P=0.003). The Oswestry Disability Index (ODI) differed across phenotypes (trend P=0.008), with the lowest adjusted ODI in the low-fat muscle-preserved phenotype (0.300±0.020) and similar adjusted ODI values in the high-fat muscle-rich (0.327±0.025) and fat-infiltrated muscle-atrophic phenotypes (0.333±0.031). In contrast, the conventional BMI groups showed no significant trend for any degenerative outcome (all P&gt;0.05). No significant differences were observed in supine sagittal parameters under either classification system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Body composition-based phenotypes are significantly associated with lumbar degenerative features, reflecting the synergistic and antagonistic interplay between fat distr","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025662","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 Concerning \"Impact of Posterior Cord Compression from Ligamentum Flavum on Clinical Outcomes Following ACDF or CDR\".","authors":"Andrea Pezzi, Tomoyuki Asada, Atahan Durbas, Eric Zhao, Adrian Lui, Adin Ehrlich, Sereen Halayqeh, Kasra Araghi, Tarek Harshash, Olivia Tuma, Tejas Subramanian, Courtney Harris, Sophie Kush, Amy Lu, Karim Shafi, James E Dowdell, Kyle Morse, Stravisht Iyer, Sheeraz Qureshi","doi":"10.1097/BRS.0000000000005858","DOIUrl":"10.1097/BRS.0000000000005858","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025645","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":"Sagittal Alignment in Adolescent Idiopathic Scoliosis with Major Thoracic Curves: Pelvic Incidence and Its Influences on Lumbar Lordosis and Thoracic Kyphosis.","authors":"Saturveithan Chandirasegaran, Jia Sheng Ong, Yu Yi Ong, Sin Ying Lee, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.1097/BRS.0000000000005879","DOIUrl":"10.1097/BRS.0000000000005879","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To analyse the correlations between pelvic incidence (PI), segmental lumbar lordosis (LL), and segmental thoracic kyphosis (TK) in AIS patients with major thoracic curves. To evaluate the influence of PI, stratified into low, average and high PI groups, on segmental LL and spinopelvic alignment in AIS patients.</p><p><strong>Summary of background data: </strong>PI is a key anatomic determinant of sagittal spinal alignment. While the relationship between PI and LL is well established, its influence on the distribution of proximal lumbar lordosis (PLL) versus distal lumbar lordosis (DLL) and its relationship with segmental TK in AIS patients remains poorly defined.</p><p><strong>Methods: </strong>This retrospective study included 506 patients with AIS (Lenke types 1-4). Preoperative sagittal radiographic parameters measured were LL, PLL, DLL, TK, and PI. Patients were stratified into low PI (<45°), average PI (45-60°), and high (>60°) PI groups.</p><p><strong>Results: </strong>PI demonstrated a moderate positive correlation with LL (r=0.395, P <0.001), primarily attributable to PLL (r=0.470, P <0.001), but not DLL (r=0.007, P =0.869). PI showed a weak negative correlation with TK (r=-0.199, P <0.001), predominantly due to DTK (r=-0.276, P <0.001). Higher PI groups had a significantly higher LL (low PI: 51.4±10.7°; average PI: 57.4±10.9°; high PI: 63.4±10.8°) ( P <0.001), driven by a corresponding increase in PLL (16.8±8.4° vs. 23.3±9.3° vs. 28.2±8.3° ( P <0.001). In contrast, DLL were comparable between PI groups ( P =0.507).</p><p><strong>Conclusion: </strong>PI significantly influences PLL, but not DLL in AIS patients with major thoracic curves. Although DLL constitutes the majority of LL, it remains relatively constant across varying PI. Increasing PI is associated with reduced TK, primarily driven by a decrease in DTK. These findings highlight the importance of individual PI in planning sagittal rod contouring, as patients with higher PI may require greater proximal lumbar contouring to achieve their native sagittal profile.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025879","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":"ACDF vs PCDF vs Laminoplasty for Multilevel Cervical Myelopathy: A Systematic Review and Meta-Analysis.","authors":"Siddharth Jasti, Tasif Mahmoud, Zvipo M Chisango, Puru Sadh, Albert Sirven, Firas Batrash, Alan H Daniels, Bryce A Basques","doi":"10.1097/BRS.0000000000005880","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005880","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To compare functional, radiographic, and complication outcomes among ACDF, PCDF, and laminoplasty for multilevel cervical spondylotic myelopathy (CSM).</p><p><strong>Summary of background data: </strong>CSM is a major source of patient morbidity in the United States. Three surgical approaches are commonly employed for this degeneration: ACDF, PCDF, and laminoplasty. Comparative data is warranted to guide approach selection.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, PubMed, Embase, CENTRAL, and Scopus were searched through February 2026 to identify comparative studies reporting outcomes among adult patients undergoing ACDF, PCDF, or laminoplasty for multilevel (≥3 levels) CSM. Twelve studies comprising 1,129 patients met inclusion criteria and were organized into three pairwise comparisons: ACDF versus laminoplasty, PCDF versus laminoplasty, and ACDF versus PCDF. Functional, radiographic, and complication outcomes were comparatively assessed. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI). Dichotomous outcomes were pooled as odds ratios (OR) with 95% CI. Heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>JOA score improvement did not differ between ACDF and laminoplasty (MD=-0.20, P=0.43) or ACDF and PCDF (MD=1.06, P=0.21). VAS neck pain favored ACDF over laminoplasty (MD=-1.05, P=0.03). ACDF demonstrated reduced cervical range of motion (MD=-9.14°, P<0.001) compared with laminoplasty. Hospital stay was shorter after ACDF (MD=-2.62 days, P=0.002) and longer after PCDF (MD=1.19 days, P<0.001) relative to laminoplasty. ACDF was associated with lower rates of axial pain (Peto OR=0.21, P=0.007) and C5 palsy (Peto OR=0.27, P=0.049) but higher rates of dysphagia (Peto OR=5.88, P<0.001) compared with laminoplasty. SSI was more frequent after PCDF than laminoplasty (Peto OR=4.27, P=0.01).</p><p><strong>Conclusions: </strong>ACDF, PCDF, and laminoplasty demonstrated similar neurological recovery for multilevel CSM. Procedure-specific differences in cervical range of motion, length of stay, and complication profiles support approach selection guided by preoperative alignment and patient-specific concerns.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026012","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 Aspirin Continuation Is Not Associated With Increased Surgical Morbidity Following Minimally Invasive Anterior-to-Psoas Lumbar Fusion: A Propensity-Matched Analysis.","authors":"Matthew T Kim, Margaret Li, Rehan R Khan, Daman P Dhunna, Seungjun Lee, Brian S Tao, Nader El-Hajj, Regina Abdelnour, Rohith Ryali, Sofia R Khan, Tony Tannoury, Chadi Tannoury","doi":"10.1097/BRS.0000000000005878","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005878","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study with propensity score matching.</p><p><strong>Objective: </strong>To evaluate the impact of perioperative aspirin continuation on surgical and postoperative outcomes following minimally invasive anterior-to-psoas (MIS-ATP) lumbar fusion.</p><p><strong>Summary of background data: </strong>Perioperative aspirin management in spine surgery remains controversial, with concerns centered on bleeding risk versus thrombotic complications associated with discontinuation. Evidence specific to minimally invasive lumbar fusion techniques, particularly the MIS-ATP approach, is limited.</p><p><strong>Methods: </strong>Adult patients who underwent MIS-ATP lumbar fusion with supplemental posterior percutaneous fixation at a single academic medical center (2014-2020) were included. Patients who continued low-dose aspirin through the perioperative period were compared with those who discontinued aspirin preoperatively. Propensity score matching (1:1 nearest-neighbor) incorporated age, sex, BMI, race/ethnicity, fusion levels, comorbidities (hypertension, diabetes mellitus, CAD, COPD, CKD), smoking, alcohol use, and preoperative laboratory values. Primary outcomes included operative time, estimated blood loss (EBL), postoperative day-1 hemoglobin, and length of stay. A subanalysis compared aspirin continuers with patients who held aspirin ≥7 days preoperatively.</p><p><strong>Results: </strong>Of 455 eligible patients, 134 (29.5%) continued aspirin and 321 (70.5%) discontinued. Propensity matching yielded 86 well-balanced pairs (n=172). Operative time (224.7±97.9 vs. 228.6±90.1 min; P=0.79), EBL (244.4±456.0 vs. 278.4±418.7 mL; P=0.62), postoperative day-1 hemoglobin (10.88±1.49 vs. 11.08±1.76 g/dL; P=0.41), and length of stay (4.83±3.72 vs. 4.20±2.49 days; P=0.22) did not differ significantly. Transfusion rates (18.6% vs. 15.1%; P=0.54) and retroperitoneal hematoma (1.2% vs. 1.2%; P=1.00) were comparable. The ≥7-day-hold subanalysis (15 matched pairs) showed no outcome advantage over continuation.</p><p><strong>Conclusion: </strong>Perioperative continuation of low-dose aspirin in appropriately selected patients undergoing MIS-ATP lumbar fusion was not associated with increased surgical morbidity or postoperative complications, supporting an individualized, approach-specific approach to perioperative antiplatelet management.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025660","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}