Spine最新文献

{"title":"Osteotomies at the Time of Graduation Surgery: How Much Do We Get From Them?","authors":"Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, John B Emans, Lawrence I Karlin, Amer F Samdani, Ilkka J Helenius, Michael G Vitale, Lindsay M Andras","doi":"10.1097/BRS.0000000000005139","DOIUrl":"10.1097/BRS.0000000000005139","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>Determine if posterior column osteotomies (PCO) at time of conversion from growth friendly instrumentation (GFI) to definitive fusion in early onset scoliosis (EOS) graduates impacts outcomes.</p><p><strong>Summary of background data: </strong>Increasing spinal rigidity following treatment of EOS with GFI can limit curve correction at time of conversion to definitive spinal fusion. PCO are often employed at the time of fusion to improve flexibility. This technique's efficacy has not been studied.</p><p><strong>Methods: </strong>Patients with EOS with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.</p><p><strong>Results: </strong>Eight hundred thirty-two patients met inclusion criteria. One hundred seventy-five (21%) patients had PCO. Age at index surgery was younger (6.6 vs . 7.4 y, P =0.0009), and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Before fusion, curve magnitude was similar between the groups (PCO=61.9°, no PCO=59.3°, P =0.18). On average 4.4 osteotomies (range: 1-12) were performed for the PCO group and EBL (PCO=820 cc vs . no PCO=752 cc, P <0.01) and surgical time (PCO=403 min vs . no PCO=349 min, P <0.01) were greater. Postoperatively, mean curve correction (PCO=16.6°, no PCO=14.4°, P =0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction ( P =0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI ( P =0.12). Postoperative complications at 2 years were similar (PCO=25% vs. no PCO=27%, P =0.63).</p><p><strong>Conclusions: </strong>EOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. More PCOs resulted in more correction, though less than that anticipated in a previously uninstrumented spine.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E161-E166"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-based Cluster Analysis Identifies Three Unique Phenotypes of Patients With Adult Spinal Deformity With Distinct Clinical Profiles and Long-term Recovery Trajectory: A Development Study.","authors":"Peng Cui, Peng Wang, Shuaikang Wang, Di Han, Qingyang Huang, Wei Wang, Xiaolong Chen, Shibao Lu","doi":"10.1097/BRS.0000000000005267","DOIUrl":"10.1097/BRS.0000000000005267","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review of a prospective adult spinal deformity data.</p><p><strong>Objective: </strong>To identify distinct patient clinical profiles and recovery trajectories in patients with adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>Patients with ASD exhibit a diverse array of symptoms and significant heterogeneity in clinical presentations, posing challenges to precise clinical decision-making. Accurate patient selection may provide further insight to personalized management strategies.</p><p><strong>Methods: </strong>Latent profile analysis (LPA) was performed to determine possible patient phenotype. Goodness-of-fit indices were used to determine the optimal cluster profiles. Outcome differences were evaluated using analysis of variance (ANOVA) and subsequent post hoc Tukey test, whereas significant predictors of group membership were identified through multinomial logistic regression.</p><p><strong>Results: </strong>A total of 204 ASD patients (mean age of 60.3 ± 11.8 years, comprising 62.3% females) with complete 1-year and 2-year follow-up outcomes were included. LPA identified three phenotypes: 51 patients in phenotype 1, 73 patients in phenotype 2, and 80 patients in phenotype 3, respectively. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. Patients in phenotype 3, although demonstrated the worst Scoliosis Research Society-22 questionnaire (SRS-22r) domains at baseline, patients in this cluster exhibited the most substantial Δchange in SRS-22r domains except for self-image at both 1-year and 2-year follow-up. Remarkably, a relatively large proportion of patients (58.8%) who were dissatisfied at 1-year follow-up transited to satisfied at 2-year follow-up. Advanced age, longer symptom duration, severe preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, higher preoperative sagittal vertical axis (SVA), fusion extending to sacrum/pelvis, and grade ≥ 3 osteotomy predicted membership in the phenotype 3.</p><p><strong>Conclusions: </strong>LPA enabled the delineation of three distinct phenotypes among ASD patients, each characterized by unique clinical profiles and distinct long-term recovery trajectories. By pinpointing the crucial variables that uniquely distinguish and predict membership in different phenotypes, the study provides valuable guidance for patient stratification.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"593-603"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the Comprehensive Addiction and Recovery Act (CARA) on Buprenorphine Prescribing for Opioid Use Disorder among Medicare Beneficiaries with Back Pain.","authors":"Hyunkyu Ko, Julie M Fritz, Thomas F Higgins, Darrel S Brodke, Brook I Martin","doi":"10.1097/BRS.0000000000005243","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005243","url":null,"abstract":"<p><strong>Study design: </strong>Observational cohort study.</p><p><strong>Objective: </strong>To examine the effects of the Comprehensive Addition and Recovery Act (CARA) on buprenorphine prescribing and opioid use disorder (OUD) among Medicare beneficiaries with back pain.</p><p><strong>Summary of background data: </strong>Enacted in January 2017, CARA extended buprenorphine prescribing authority to Nurse Practitioners (NP) and Physician Assistants (PA) to treat OUD, defined as a physical or psychological dependence on opioids, but adoption varied by state. Leveraging this policy variation, we examined the effect of CARA on buprenorphine prescribing and OUD employing Medicare beneficiaries over age 65 with back pain from 2016 to 2019, and who were eligible for Part D prescription drug benefits. Only buprenorphine and buprenorphine/naloxone combinations that are FDA-approved for OUD treatment were included as our outcome.</p><p><strong>Methods: </strong>A difference-in-difference regression examined the change in buprenorphine prescribing and OUD before and after CARA between states that did and did not expand prescription authority. Subgroup analysis examined treatment effect heterogeneity by gender and race/ethnicity.</p><p><strong>Results: </strong>States that adopted a full scope-of-practice under CARA had a significant increase in buprenorphine prescribing (6.5%, 95%CI: 1.3%, 12.2%) and a reduction in OUD (7.2%, 95%CI: -9.3%, -4.8%) compared to states that did not expand prescribing authority after the policy implementation. States that expanded prescribing authority following CARA had a disproportionate increase in use of buprenorphine and a reduction in OUD among males and Hispanic patients compared to female and White patients. The magnitude of the policy effects increased over time across all groups.</p><p><strong>Conclusions: </strong>CARA was associated with increased buprenorphine prescribing and a reduction in OUD among older adults with back pain. Expanded authorization of prescription of buprenorphine to treat OUD by NPs/PAs in states that have not adopted full scope-of-practice under CARA might effectively reduce OUD, as well as racial/ethnic disparities in buprenorphine prescribing and OUD.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Surgical Outcomes in Separation Surgery Versus Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.","authors":"Jantijn J G J Amelink, Robertus J B Pierik, Olivier Q Groot, John H Shin, Jorrit-Jan Verlaan, Daniel G Tobert","doi":"10.1097/BRS.0000000000005207","DOIUrl":"10.1097/BRS.0000000000005207","url":null,"abstract":"<p><strong>Study design: </strong>Retrospectively matched case-control study.</p><p><strong>Objective: </strong>To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC).</p><p><strong>Summary of background data: </strong>The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods.</p><p><strong>Materials and methods: </strong>Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion, and complications. The Mann-Whitney U test was used for continuous data, and the Fisher exact test for categorical data.</p><p><strong>Results: </strong>Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss [median 500 mL (IQR: 300-1000) vs . 925 mL (IQR: 500-1425); P =0.036] and shorter operating times [median 214 min (IQR: 164-281) vs . 286 min (IQR: 220-328); P =0.028]. Intraoperative blood transfusion occurred in 7 patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group ( P =0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative blood transfusion, reoperations, or survival ( P <0.05).</p><p><strong>Conclusion: </strong>Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control.</p><p><strong>Level of evidence: </strong>Level IV-treatment benefits.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"612-619"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early NRS Leg and Back Thresholds Predict Clinical Recovery After MIS Transforaminal Lumbar Interbody Fusion for Degenerative Spine Disease.","authors":"Kevin J DiSilvestro, Annika Bay, Cole T Kwas, Tomoyuki Asada, Takashi Hirase, Joshua Zhang, William G Doran, Nishtha Singh, Atahan Durbas, Kasra Araghi, Olivia C Tuma, Maximillian K Korsun, Eric T Kim, Chad Z Simon, Eric R Zhao, Myles R J Allen, Eric Mai, Tejas Subramanian, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1097/BRS.0000000000005202","DOIUrl":"10.1097/BRS.0000000000005202","url":null,"abstract":"<p><strong>Study design: </strong>This retrospective study included patients who underwent primary one-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine conditions.</p><p><strong>Objective: </strong>To identify early predictors of failing to achieve the Oswestry Disability Index (ODI) minimum clinically important difference (MCID) 1 year post-surgery.</p><p><strong>Background: </strong>Early identification of patients at risk of failing to achieve ODI-MCID is crucial for early intervention and improved postoperative counseling. Currently, no specific thresholds guide patient follow-up for optimal recovery.</p><p><strong>Materials and methods: </strong>The assessment included demographic information, surgical details, and patient-reported outcome measures (PROMs). PROMs were collected postoperatively at 2-week, 6-week, and 12-week time points, as well as at 6 and 12 months.</p><p><strong>Results: </strong>The study included 166 patients, with 34% failing to achieve ODI-MCID at 1 year. Early VAS back and leg scores were found to be significant predictors of ODI-MCID achievement. The optimal thresholds identified were 2.25 for early VAS back and 4.25 for early VAS leg. A rerun regression identified the thresholds as independent predictors of ODI-MCID, with odds ratios of 0.31 for both measures.</p><p><strong>Conclusion: </strong>VAS back and leg score thresholds at 6 to 12 weeks can predict ODI-MCID achievement 1 year after MIS TLIF. Patients exceeding the identified thresholds may be at risk of failing ODI-MCID and should be monitored closely.</p><p><strong>Level of evidence: </strong>Level three.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"628-635"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558844","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":"Cost-effectiveness Improves for Operative Versus Non-operative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-year Follow-up.","authors":"Leah Y Carreon, Steven D Glassman, Justin S Smith, Michael P Kelly, Elizabeth L Yanik, Christine R Baldus, Jon D Lurie, Charles Edwards, Lawrence G Lenke, Jacob M Buchowski, Charles H Crawford, Tyler Koski, Virginie Lafage, Munish Gupta, Han Jo Kim, Christopher P Ames, Shay Bess, Frank J Schwab, Christopher I Shaffrey, Keith H Bridwell","doi":"10.1097/BRS.0000000000005186","DOIUrl":"10.1097/BRS.0000000000005186","url":null,"abstract":"<p><strong>Study design: </strong>Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS).</p><p><strong>Objectives: </strong>The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment.</p><p><strong>Background: </strong>A prior cost-effectiveness analysis of the current cohort comparing Op to Non-Op care at 5 years after enrollment showed an incremental cost-effectiveness ratio (ICER) of $44,033 in the as-treated analysis and an ICER of $27,480 in the intent-to-treat analysis.</p><p><strong>Materials and methods: </strong>Data were collected every 3 months for the first 2 years, and then every 6 months for the remainder of the study. Data included the use of Non-Op modalities, medications, and employment status. Costs for index and revision surgeries and Non-Op modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality-adjusted life years (QALYs) were determined using the Short Form-6 Dimensions.</p><p><strong>Results: </strong>There were 101 cases in the Op and 103 in the Non-Op group with complete 8-year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An as-treated analysis including only cases who never had surgery (N = 65) or cases with complete 8-year postoperative data (N = 101) showed that Op treatment was favored with an ICER of $20,569 per QALY gained, which is within willingness-to-pay thresholds. An intent-to-treat analysis demonstrated greater QALY gains and lower costs in the Op group (ICER = -$13,911). However, intent-to-treat analysis is influenced by Non-Op patients who crossed over to Op treatment at variable times during follow-up.</p><p><strong>Conclusion: </strong>Op treatment was more cost-effective than Non-Op treatment for ASLS at 8-year follow-up. The ICER continued to improve as compared with the 5-year values ($20,569 vs . $44,033).</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"586-592"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475314","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 \"Preoperative Hounsfield Units Predict Pedicle Screw Loosening in Osteoporotic Patients Following Short Segment Lumbar Fusion\" by Narayanan et al .","authors":"Yancheng Li, Nana Zhang","doi":"10.1097/BRS.0000000000005245","DOIUrl":"10.1097/BRS.0000000000005245","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E178"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839677","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":"Dual Sustained-Release BMP7-Nanoparticle Hydrogel Scaffolds for Enhanced BMSC Neuronal Differentiation and Spinal Cord Injury Repair.","authors":"Xudong Sun, Heng Zhang, Shiyuan Huang, Kuanxin Li, Xuyi Wang","doi":"10.1097/BRS.0000000000005307","DOIUrl":"10.1097/BRS.0000000000005307","url":null,"abstract":"<p><strong>Study design: </strong>Preclinical experimental study.</p><p><strong>Objective: </strong>To explore the use of hydrogels as bioactive scaffolds for encapsulating bone marrow mesenchymal stem cells (BMSCs) to enhance their therapeutic potential in spinal cord injury (SCI). This study further aims to evaluate the added value of a BMP7 nanoparticle delivery system in overcoming the limitations of BMSCs alone for SCI repair.</p><p><strong>Summary of background data: </strong>SCI leads to significant neuron loss and functional impairment. Although BMSC-based stem cell therapies show promise, their efficacy is limited by challenges such as the instability of bone morphogenetic protein (BMP)-7 in inducing neuronal differentiation. High concentrations of BMP7, although effective in promoting neuronal differentiation, may cause inflammation, necessitating the development of a delivery system for sustained and localized release.</p><p><strong>Methods: </strong>BMSCs were isolated from Sprague-Dawley rats, and BMP-7's effects on neuronal differentiation were assessed through western blotting. BMP7-loaded nanoparticles (NPs) and BMSCs were co-loaded into a gelatin methacrylate (Gel-MA) hydrogel scaffold, with a cell loading density of 1 × 10 5 cells/μl. BMP7 was encapsulated at a 0.04% (w/V) concentration, corresponding to approximately 0.4 ng BMP7 per μl of hydrogel. Optimization was performed using mechanical, cytotoxicity, and neuronal marker analyses. Scaffold properties, including water absorption, BMP7 release, and BMSC morphology, were characterized. Therapeutic efficacy was evaluated in a rat SCI model using motor function recovery, histologic analysis, and molecular assessments.</p><p><strong>Results: </strong>BMP-7 effectively promoted BMSC differentiation into neurons while suppressing glial cell development. The BMP7-NPs/Gel-MA scaffold ensured sustained BMP7 release, achieving optimal differentiation at a 0.04% (w/V) BMP7 concentration. In vivo , the scaffold combined with BMSCs enhanced neuronal proliferation and differentiation, stimulated myelin regeneration, reduced lesion volume, and significantly improved motor function recovery.</p><p><strong>Conclusion: </strong>The BMP7-NPs/Gel-MA scaffold provides sustained delivery of BMP-7, effectively directing BMSC differentiation into neuron-like cells while avoiding glial commitment. Combined with BMSCs, it offers a promising therapeutic strategy for SCI repair.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"575-585"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459435","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":"Return to Work After Lumbar Microdiskectomy: A Systematic Review and Meta-analysis.","authors":"Mikhail Saltychev, Elias Villikka, Vilma Madekivi, Katri Pernaa, Juhani Juhola","doi":"10.1097/BRS.0000000000005258","DOIUrl":"10.1097/BRS.0000000000005258","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To investigate evidence on the prevalence and timeline of RTW after lumbar microdiskectomy.</p><p><strong>Summary of background data: </strong>Although lumbar microdiskectomy is a widely used and well-studied procedure, there is lack of evidence on the postoperative prevalence and schedule of return to work after this type of surgery.</p><p><strong>Methods: </strong>Search at Medline, Embase, Cinahl, Scopus, and Web of Science. Assessment of risk of systematic bias using Quality in Prognosis Studies (QUIPS). Random effects meta-analysis and meta-regression. Adults undergoing lumbar microdiskectomy due to degenerative disc herniation, excluding spinal stenosis, percutaneous diskectomy, artificial disk, arthroplasty, laminectomy, fusion, or symptoms of cauda equina.</p><p><strong>Results: </strong>Of identified 2285 records, 31 were included in meta-analysis. Most of the studies had a low risk of systematic bias. Pooling 21 studies, the mean prevalence of postoperative return to work was 78% (95% CI 71%-83%). Pooling 13 studies the mean time of return to work was 4.79 (95% CI 3.88-5.70) weeks. The meta-regression of the prevalence of return to work by the duration of follow-up resulted in a significant but small coefficient of 0.02 (95% CI 0.01-0.03, P =0.006). There was considerable heterogeneity for all three models.</p><p><strong>Conclusion: </strong>The results of this review suggest that ~70% to 80% of patients who undergo a microsurgical procedure for disc herniation return to work within the first month and a half. It also seems that returning to work after this period is quite unlikely. The duration of preoperative symptoms did not affect significantly the prevalence of RTW. Information about these trends should be taken into account both in the planning phase of the procedure and in setting goals for postoperative rehabilitation.</p><p><strong>Level of evidence: </strong>Level II-systematic review of surveys that allow matching to local circumstances.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E167-E177"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012166","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":"Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants: Five-Year Follow-Up.","authors":"Vikas Patel, S Craig Meyer, Don Kovalsky, Harry Lockstadt, Jim Farris, Robert Limoni, Abhineet Chowdhary, Philip Yuan, Casey Langel, Andy Kranenburg, Gabriel Tender","doi":"10.1097/BRS.0000000000005170","DOIUrl":"10.1097/BRS.0000000000005170","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, multicenter, single-arm study with five-year follow up.</p><p><strong>Objective: </strong>To report long-term (five years) safety, effectiveness, and radiographic outcomes after sacroiliac (SI) joint fusion (SIJF) with 3D-printed triangular titanium implants (TTI) and compare them with solid titanium plasma spray coated implants.</p><p><strong>Summary of background data: </strong>A large literature base supports minimally invasive SIJF with TTI for chronic SIJ dysfunction.</p><p><strong>Materials and methods: </strong>SIJF with TTI was performed in 51 subjects and scheduled follow-up occurred at 3, 6, 12, 24, and 60 months. Postoperative visits included quality of life questionnaires and functional tests. A high-resolution CT scan was performed at either 6 or 12 months, and again at 60 months. All CT scans were interpreted by an independent musculoskeletal radiologist.</p><p><strong>Results: </strong>Five-year follow-up was available in 36 of 51 subjects (71%). At five years, improvements in SI joint pain [58.1 points (0-100 scale)], SIJ-related disability [Oswestry disability index (ODI), 25.4 points) and quality of life (EuroQOL 5D: 0.24 points and EuroQOL visual analog scale: 13.4 points) were sustained and showed no signs of diminution. The percentage of patients using opioids for SIJ pain decreased markedly from baseline (57%) to five years (17%). Physical function tests showed persistent improvements from baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device. Independent analysis of CT scans showed bone opposed to implants in all cases, and evidence of bone bridging in 90% of cases, and no evidence of radiolucency or other adverse bone reactions.</p><p><strong>Conclusions: </strong>Prospective five-year follow-up showed that SIJ fusion using 3D-printed TTI resulted in immediate, marked, and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use, and a low rate of revision surgery. Radiographic evidence showed implant integration and joint fusion.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"620-627"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354322","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}