Spine最新文献

{"title":"Ten-Year Heterogeneity of Minimal Important Change and Patient Acceptable Symptom State After Lumbar Fusions.","authors":"Leevi A Toivonen, Jenna L C Laurén, Hannu Kautiainen, Arja H Häkkinen, Marko H Neva","doi":"10.1097/BRS.0000000000005065","DOIUrl":"10.1097/BRS.0000000000005065","url":null,"abstract":"<p><strong>Study design: </strong>Cohort study.</p><p><strong>Objective: </strong>To evaluate heterogeneity (fluctuation) in minimal important change (MIC) and patient-acceptable symptom state (PASS) for patient-reported outcomes (PROMs) through 10 years after lumbar fusion.</p><p><strong>Summary of background data: </strong>PROMs have become key determinants in spine surgery outcomes studies. MIC and PASS were established to aid PROM interpretations. However, their long-term stability has not yet been reported.</p><p><strong>Methods: </strong>A consecutive series of elective lumbar fusions were followed up using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain. Improvement was rated by a 4-point Likert scale into \"improved\" or \"nonimproved.\" Satisfaction-to-treatment was rated by the patients' willingness to undergo surgery again. Receiver operating characteristics (ROC) curve analysis estimated MIC (95% confidence interval, CI) as the PROM change that best predicted improvement at distinct time-points. PASS (CI) was estimated as the lowest PROM score at which the patients were still satisfied. Heterogeneity across thresholds was evaluated using the DeLong algorithm.</p><p><strong>Results: </strong>MIC for ODI represented heterogeneity across 10 years, ranging from -21 (-24 to -16) at two years to -8 (-7 to -4) at five years, P<0.001. The areas under the ROC curves (AUCs) (0.79 to 0.85) indicated acceptable to excellent discrimination. Heterogeneity was not significant in the MICs for the pain scores. At one year, MIC for back pain was -24 (-38 to -15), AUC 0.77, and for leg pain, it was -26 (-44 to -8), AUC 0.78. No significant heterogeneity was observed in 10-year PASS scores. At 1-year, PASS for ODI was 22 (15 to 29), AUC 0.85. Similarly, the one-year PASS for back pain was 38 (20 to 56), AUC 0.81, and for leg pain, it was 49 (26 to 72), AUC 0.81.</p><p><strong>Conclusions: </strong>MIC for ODI fluctuated over 10 years after lumbar fusions. PASS values for all PROMs seemed most stable over time. Caution is needed when generic MIC values are used in long-term studies.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"46-52"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301687","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":"Differences at Index Surgery in Operative Complexity and Residual Disease for Earlier and Later Repeat Lumbar Surgery.","authors":"Roland Duculan, Carol A Mancuso, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi","doi":"10.1097/BRS.0000000000005106","DOIUrl":"10.1097/BRS.0000000000005106","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review, single-institution cohort studies.</p><p><strong>Objective: </strong>To compare patients with earlier ( i.e. <1.5 yr) and later ( i.e . >1.5 yr) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery.</p><p><strong>Background: </strong>Grouping patients as earlier or later repeat surgery may reveal different associations when compared with patients with no repeat surgery.</p><p><strong>Patients and methods: </strong>Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent ( i.e . complexity) of surgery was assigned based on a valid index that included decompression, fusion, and instrumentation. Co-existing disease at nonoperated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12 yr) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5 yr) or later surgery (≥1.5 yr) and compared with patients with no repeat surgery in separate multivariable analyses.</p><p><strong>Results: </strong>Among 1334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared with no surgery, earlier surgery was associated with more comorbidity (OR: 1.7, CI: 1.1-2.6, P =0.02), positive depression screen (OR: 1.9, CI: 1.2-2.9, P =0.006), opioid use (OR: 1.8, CI: 1.2-2.8, P =0.008), and greater extent of index surgery (OR: 1.1, CI: 1.0-1.1, P =0.0009). Compared with no surgery, later surgery was associated with preindex lumbar surgery (OR: 1.9, CI: 1.3-2.8, P =0.0005) and disease at nonoperated levels at index surgery (OR: 1.6, CI: 1.0-2.4, P =0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P =0.01).</p><p><strong>Conclusions: </strong>Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared with no repeat surgery. These findings have implications for patient counseling regarding short-term and long-term postoperative spine health.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E1-E6"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761012","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":"How Much Improvement in Oswestry Disability Index is Necessary to Make Your Patient Satisfied After Lumbar Surgery?","authors":"Jan Hambrecht, Paul Köhli, Erika Chiapparelli, Krizia Amoroso, Jiaqi Zhu, Ranqing Lan, Ali E Guven, Gisberto Evangelisti, Marco D Burkhard, Koki Tsuchiya, Roland Duculan, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes","doi":"10.1097/BRS.0000000000005044","DOIUrl":"10.1097/BRS.0000000000005044","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of cohort studies.</p><p><strong>Objective: </strong>To clarify the necessary Oswestry Disability Index (ODI) improvement for patient satisfaction 2 years after lumbar surgery.</p><p><strong>Background: </strong>Evaluating elective lumbar surgery care often involves patient-reported outcomes. While postoperative functional improvement measured by ODI is theoretically linked to satisfaction, conflicting evidence exists regarding this association.</p><p><strong>Material and methods: </strong>Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores ≥4 considered satisfactory, was evaluated. Patients with incomplete follow-up were excluded. Statistical analyses included Mann-Whitney U and multivariable logistic regression adjusted for age, sex, and body mass index. Receiver operating characteristic analysis determined threshold values for ODI improvement and postoperative target ODI indicative of patient satisfaction.</p><p><strong>Results: </strong>A total of 383 patients were included (mean age: 65 ± 10 y, 57% females). ODI improvement was observed in 91% of patients, with 77% reporting satisfaction scores ≥4. Baseline ODI (median: 62, interquartile range: 46-74) improved to a median of 10 (interquartile range: 1-10) 2 years postoperatively. Baseline [odds ratio (OR): 0.98, P = 0.015] and postoperative ODI scores (OR: 0.93, P < 0.001), as well as the difference between them (OR: 1.04, P < 0.001), were significantly associated with patient satisfaction. Improvement of ≥38 ODI points or a relative change of ≥66% was indicative of patient satisfaction, with higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). With a sensitivity of 85% and a specificity of 77%, a postoperative target ODI of ≤24 indicated patient satisfaction.</p><p><strong>Conclusion: </strong>Lower baseline ODI and greater improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction. A relative improvement of ≥66% or achieving a postoperative ODI score of ≤24 were the most indicative thresholds for predicting patient satisfaction, proving more sensitivity and specificity than an absolute change of ≥38 points.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"67-73"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071953","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":"Five-year Follow-up of a Prospective Food and Drug Administration Investigational Device Exemption Trial Evaluating a PEEK-on-Ceramic Cervical Disk Replacement.","authors":"Richard D Guyer, Hyun Bae, Domagoj Coric, Pierce D Nunley, Michael Musacchio, Rick C Sasso, Donna D Ohnmeiss","doi":"10.1097/BRS.0000000000005123","DOIUrl":"10.1097/BRS.0000000000005123","url":null,"abstract":"<p><strong>Study design: </strong>Prospective trial comparing the investigation group to propensity-matched historic control group.</p><p><strong>Objective: </strong>To evaluate five-year results of single-level PEEK-on-ceramic cervical total disc replacement (TDR) compared with a propensity-matched anterior cervical discectomy and fusion (ACDF) control group.</p><p><strong>Summary of background data: </strong>Cervical TDR has gained acceptance as a treatment for symptomatic disk degeneration. The design and materials used in these devices continue to evolve.</p><p><strong>Materials and methods: </strong>Data were collected in the Food and Drug Administration Investigational Device Exemption trial for the PEEK-on-ceramic Simplify Cervical Artificial Disc (n=150) with comparison to a propensity-matched ACDF control group (n=117). All patients were treated for single-level cervical disk degeneration with radiculopathy and/or myelopathy. Clinical outcome was based on composite clinical success (CCS), Neck Disability Index (NDI), visual analog scales (VAS) assessing pain, reoperations, and satisfaction. Radiographic measures included segmental range of motion (ROM), disk space height, and heterotopic ossification (HO). Evaluations were performed preoperatively and postoperatively within two and six weeks, and three, six, 12 months, and annually thereafter.</p><p><strong>Results: </strong>At five-year follow-up, CCS was significantly greater with TDR than ACDF (91.1% vs. 74.6%; P <0.01). In the TDR group, the mean NDI score was 63.3 preoperatively, reduced significantly to 23.1 at six weeks, and remained below 20 throughout the five-year follow-up. In the ACDF group, the mean preoperative NDI score was 62.4, decreasing to 33.7 at six weeks, and ranged from 25.9 to 21.5 throughout follow-up. Mean NDI scores were significantly lower in TDR group at all postoperative points ( P <0.05). Mean TDR ROM was 7.3 o preoperatively and 10.1 o at five years. Bridging HO occurred in 9%. With TDR, there were six reoperations (4.0%) versus 11 (9.4%) with ACDF ( P >0.40).</p><p><strong>Conclusions: </strong>PEEK-on-ceramic TDR produced significantly improved outcomes maintained throughout five-year follow-up that were similar or superior to ACDF, supporting TDR in appropriately selected patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037047","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":"Revision Rates After Single-Level Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: An Observational Study With 5-Year Minimum Follow-Up.","authors":"Adam M Gordon, Faisal R Elali, Ahmed Saleh","doi":"10.1097/BRS.0000000000005079","DOIUrl":"10.1097/BRS.0000000000005079","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective case-control study.</p><p><strong>Objectives: </strong>This study aimed to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF).</p><p><strong>Summary of background data: </strong>Prospective studies have compared patient-reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.</p><p><strong>Patients and methods: </strong>A nationwide database was queried for patients undergoing primary single-level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum 5-year follow-up. Patients undergoing CDA were in a 1:5 ratio matched to patients undergoing ACDF by age, sex, comorbidities, and overall Elixhauser comorbidity index (ECI). Objectives were to compare the rates and risk factors of all-cause 5-year revisions for those undergoing single-level CDA versus ACDF. Multivariate logistic regression models computed the odds ratios (ORs) of revisions within 5 years. P values of less than 0.001 were significant.</p><p><strong>Results: </strong>A total of 32,953 patients underwent single-level CDA (N=5,640) or ACDF (N=27,313) with a 5-year minimum follow-up. The incidence of all-cause revisions within 5 years was 1.24% for CDA and 9.23% for ACDF ( P <0.001). After adjustment, patients undergoing single-level ACDF had significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P <0.0001). Additional patient-specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P <0.0001), depression (OR: 1.23; P <0.0001), cardiac arrhythmias (OR: 1.21; P =0.0008), hypertension (OR: 1.20; P =0.0006), and tobacco use (OR: 1.18; P =0.0003).</p><p><strong>Conclusions: </strong>In this study of nearly 33,000 single-level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients regarding 5-year revisions following single-level CDA or ACDF.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"19-25"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447169","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 Between Sleep Disturbance and Low Back Pain: A 3-year Longitudinal Study After the Great East Japan Earthquake.","authors":"Yutaka Yabe, Yoshihiro Hagiwara, Takuya Sekiguchi, Yumi Sugawara, Masahiro Tsuchiya, Shinichirou Yoshida, Ichiro Tsuji","doi":"10.1097/BRS.0000000000005176","DOIUrl":"10.1097/BRS.0000000000005176","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E21"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508375","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":"Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.","authors":"Mohammad Daher, Andrew Xu, Manjot Singh, Renaud Lafage, Breton G Line, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Robert K Eastlack, Munish C Gupta, Gregory M Mundis, Jeffrey L Gum, Kojo D Hamilton, Richard Hostin, Virginie Lafage, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Frank J Schwab, Christopher I Shaffrey, Justin S Smith, Shay Bess, Eric O Klineberg, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005250","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005250","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospectively-collected data.</p><p><strong>Objective: </strong>This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.</p><p><strong>Background: </strong>Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE).</p><p><strong>Methods: </strong>Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds.</p><p><strong>Results: </strong>In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively.</p><p><strong>Conclusion: </strong>In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898299","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":"Adjacent Level Canal Area Changes up to 2 years after Lumbar Spinal Stenosis Decompressive Surgery.","authors":"Helena Brisby, Tor Åge Myklebust, Hasan Banitalebi, Ivar Austevoll, Jorn Aaen, Kjersti Storheim, Christian Hellum, Eric Franssen, Kari Indrekvam, Erland Hermansen","doi":"10.1097/BRS.0000000000005247","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005247","url":null,"abstract":"<p><strong>Study design: </strong>A secondary analysis of data from the NORDSTEN-spinal stenosis trial (SST).</p><p><strong>Objective: </strong>The aim of the present study was to investigate whether the dural sac cross-sectional area (DSCA) on magnetic resonance imaging (MRI) of adjacent segments decreases after decompressive surgery due to lumbar spinal stenosis (LSS) up to 2 years postoperatively, and to investigate possible associations with baseline variables, including preoperative patient and radiological characteristics, and surgical method used.</p><p><strong>Summary of background data: </strong>Decompressive surgery for LSS is currently the most common spinal surgery procedure; however, there is limited knowledge on changes in the DSCA over time adjacent to a decompressed segment.</p><p><strong>Methods: </strong>In the NORDSTEN-SST 437 patients were randomized to decompression with one of three minimally invasive surgical methods for LSS. The patients underwent MRI of the lumbar spine (L2-L5) before surgery and at 3 and 24 months postoperatively. Descriptive statistics of adjacent DSCA and changes in adjacent DSCA are presented. Possible prognostic factors (preoperative factors, radiological measures, and surgical method) for changes in the adjacent DSCA were examined using multivariate regression analyses.</p><p><strong>Results: </strong>322 patients (74%) in the original NORDSTEN-SST had undergone MRI at both 3 and 24 months postoperatively and were included (360 adjacent levels, 263 cranial, and 97 caudal to a decompressed level). Up to 2 years postoperatively, no decrease in adjacent DSCA was observed. No associations were found between the investigated baseline variables, and DSCA change from 0 to 2 years, except for a weak association with baseline adjacent DSCA.</p><p><strong>Conclusion: </strong>Up to 2 years postoperatively, the DSCA did not decrease at adjacent levels after decompressive surgery. None of the investigated baseline variables showed any clinical meaningful prognostic value regarding adjacent DSCA changes 2 years postoperatively. The findings support previous reports that decompression of adjacent levels is not required to prevent subsequent stenosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898296","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 the Article \"Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes\".","authors":"Yixi Wang, Xinkai Luo, Jian Cui, Paerhati Rexiti","doi":"10.1097/BRS.0000000000005251","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005251","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898297","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":"Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis.","authors":"Brandon Edelbach, Dylan Glaser, Ahmad K Almekkawi, James P Caruso, Ghewa Sbaiti, Salah G Aoun, Carlos A Bagley","doi":"10.1097/BRS.0000000000005244","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005244","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review and Network-Meta-analysis.</p><p><strong>Purpose: </strong>This study aimed to systematically review the literature on management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations.</p><p><strong>Background: </strong>Primary osteomyelitis discitis is a challenging condition with varying management strategies.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted. Studies reporting outcomes for treatment of primary osteomyelitis discitis were included. A random-effects network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4-8 weeks, 8-12 weeks, and 12-16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness.</p><p><strong>Results: </strong>Sixty-three articles with 4,233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4-8 week antibiotic duration ranked highest across fixed-effect and random-effects models (SUCRA 0.8207 and 0.8343). The 12-16 week duration ranked highest in the fixed-effect model (SUCRA 0.8460) but dropped substantially in the random-effects model (SUCRA 0.3067). The <4 week duration showed mixed results. The 8-12 week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief.</p><p><strong>Conclusion: </strong>Antibiotic therapy for 4-8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898298","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}