Spine最新文献

{"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":"https://doi.org/10.1097/BRS.0000000000005245","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-17","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":"Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Peter S Tretiakov, Max R Fisher, Ankita Das, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Olivia K Blaber, Caroline M Wu, Tyler K Williamson, Zach Thomas, Clifford L Crutcher, Paul Park, Andrew J Schoenfeld, Muhammad M Abd-El-Barr, Peter G Passias","doi":"10.1097/BRS.0000000000005239","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005239","url":null,"abstract":"<p><strong>Background: </strong>Recent studies highlight the increasing adoption of single-position prone lateral(SP-PL) and single-position lateral decubitus(SP-LD) in Minimally Invasive Spine Surgery(MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility.</p><p><strong>Objective: </strong>To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and post-operative complication rates.</p><p><strong>Study design: </strong>Retrospective review of prospectively collected MIS database.</p><p><strong>Methods: </strong>Consecutive series of 152 Patients with baseline(BL) and 1-year(1Y) postoperative radiographic/HRQL data were included. Patients placed in the SP-PL or SP-LD were isolated. Optimal Outcome(OO) was defined as patients who experienced no complication requiring reoperation and achieved Substantial Clinical Benefit(SCB) for NRS-leg or NRS-back. Means comparison analysis assessed differences in radiographic and clinical outcomes. ANCOVA and multivariable backward stepwise logistic regression were used to adjust for confounders.</p><p><strong>Results: </strong>59 SP-PL and 93 SP-LD patients were included. At baseline, cohorts were comparable in terms of age, gender, BMI, and CCI. Peri-operatively, SP-PL patients had a significantly lower operative time(207.22 vs. 317.5 min;P<0.001), LOS(3.1 vs. 3.6 days;P=0.033), EBL(244.5 vs. 376.3 mL;P=0.023), and demonstrated lower perioperative complication rate(25.4% vs. 41.9%;P=0.038). Multivariable analysis indicated that SP-PL patients had a lower likelihood of cardiac perioperative complications(OR 0.012;CI95%: 0.0-0.6;P=0.026). Immediate postoperatively, SP-PL has a greater degree of segmental lordosis improvement from L1-L2 to L5-S1(all;P<0.05). SP-PL patients have a higher likelihood of achieving SCB NRS-Back at 1Y(OR: 8.0;CI95%: 1.5-42.0;P=0.014) and MCID NRS-leg at 1Y(OR:4.6;CI95%:1.002-21.2;P=0.49). The SP-PL cohort had a significantly greater percentage of OO(96.6% vs. 78.5%;P=0.002) and a higher likelihood of achieving OO in adjusted analysis (OR:10.6;CI95%: 2.1-53.3;P=0.004).</p><p><strong>Conclusions: </strong>Patients placed in the SP-PL during minimally invasive spine surgery exhibit a reduced rate of perioperative complications, higher incidence of SCB, and a superior rate of achieving optimal outcome at the one-year follow-up. These findings underscore the SP-PL position as a potentially advantageous approach for minimally invasive lumbar fusion.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839682","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":"Neuromuscular Blockade Reversal with Sugammadex Reduces Cardiac Complications and OR Time for Prone Lumbar Spinal Fusion Compared to Neostigmine.","authors":"Jonathan Dalton, Jeremy Heard, Rachel Huang, Otitochukwu Ezeonu, Bryan Nardone, Ryan Dwosh, Christopher K Kepler","doi":"10.1097/BRS.0000000000005242","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005242","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate inpatient complication profiles of patients receiving neuromuscular blockade reversal via sugammadex versus neostigmine/glycopyrrolate.</p><p><strong>Summary of background data: </strong>Sugammadex is a neuromuscular blockade reversal agent that binds non-depolarizing muscle relaxants. This is a different mechanism from traditional reversal agents such as the combination drug neostigmine (acetylcholinesterase inhibitor)/glycopyrrolate (antimuscarinic agent). Sugammadex has theoretical advantages related to more predictable and rapid reversal, and decreased autonomic side effects. While these agents have been compared in non-spine literature, there is minimal research examining their impact during prone lumbar fusion.</p><p><strong>Methods: </strong>All adult patients who underwent a primary one- or two-level posterior lumbar fusion (L4-S1) at a single academic center (2018-2021) were retrospectively identified. Neuromuscular blockade reversal agents (sugammadex or NG), demographics, surgical characteristics, and surgical outcomes were collected through a Structured Query Language search and confirmed by chart review. Bivariate analysis and multivariate linear regression were performed. Alpha was set at P<0.05.</p><p><strong>Results: </strong>In the NG group, more patients had ≥1 inpatient complication (31.2% vs. 19.9%, P=0.012) and cardiac complication (19.1% vs. 11.3%, P=0.040). NG had higher total (0.40±0.66 vs. 0.28±0.62, P=0.046) and cardiac (0.23±0.50 vs. 0.13±0.37, P=0.009) complication rates per person. Operative time was longer amongst patients reversed with NG (182±55.9 vs. 174±55.9, P=0.039). Multivariable linear regression for inpatient complications demonstrated that sugammadex (estimate=-0.124, P=0.045) was negatively predictive of inpatient complications, while Elixhauser (estimate=0.073, P<0.001) was positively predictive.</p><p><strong>Conclusion: </strong>The current results demonstrate that sugammadex may create less risk for cardiac complications, and is likely associated with more rapid reversal and decreased OR time during prone lumbar fusion. However, additional research is needed to further validate these findings, especially amongst patients with cardiac comorbidities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819263","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":"Establishment of a Rabbit Model of Rib Tethering-Induced Early-Onset Scoliosis: Insights into Lung Evaluation using Design-Based Stereology.","authors":"Yonggang Wang, Dongmin Wang, Guangzhi Zhang, Xuegang He, Kun Wang, Bing Ma, Yong Yang, Xuewen Kang","doi":"10.1097/BRS.0000000000005237","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005237","url":null,"abstract":"<p><strong>Study design: </strong>Experimental Study.</p><p><strong>Objective: </strong>To create an EOS rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age.</p><p><strong>Summary of background data: </strong>Scoliosis affects thoracic and lung development, impacting children's chest and lung growth.</p><p><strong>Methods: </strong>EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted post-fixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology.</p><p><strong>Results: </strong>The mean Cobb angle increased with the rabbits' growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. Alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared to the right lobes.</p><p><strong>Conclusion: </strong>The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis's negative impact on thoracic and lung development, especially on the concave lung.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819261","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":"Relationship Between Paraspinal Sarcopenia and Lumbar Alignment and Facet Joint Osteoarthritis in Patients with Degenerative Lumbar Spinal Stenosis.","authors":"Song Liu, Wenjun Hu, Youxi Lin, Nianchun Liao, Huihong Shi, Jianan Chen, Yanbo Chen, Zhaoqiang Zhang, Bo Gao, Dongsheng Huang, Wenjie Gao, Anjing Liang","doi":"10.1097/BRS.0000000000005238","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005238","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study analysis.</p><p><strong>Objective: </strong>To explore association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe degenerative lumbar spinal stenosis (DLSS).</p><p><strong>Background: </strong>Paraspinal muscles plays an essential role in stabilizing the spine. Paraspinal sarcopenia is progressively recognized as a crucial parameter influencing clinical outcomes in the field of spine surgery. The association between degenerative spinal conditions and paraspinal sarcopenia in patients with severe DLSS has been rarely investigated.</p><p><strong>Materials and methods: </strong>This study was conducted on consecutive patients who underwent posterior lumbar interbody fusion at L4/5 single-level for lumbar spinal stenosis between January 2019 and July 2023. The study assessed paraspinal sarcopenia based on the fatty infiltration and Goutallier classification systems (GCS) of multifidus muscle on preoperative magnetic resonance imaging. The study evaluated the association between demographic/radiographic factors and paraspinal sarcopenia in patients with DSLL. Ordinal logistic regression analysis was then performed to adjust for confounding.</p><p><strong>Results: </strong>A total of 129 patients were included, including 38 patients with mild paraspinal sarcopenia, 52 patients with moderate paraspinal sarcopenia, and 39 patients with severe paraspinal sarcopenia. Correlation analysis indicated that age (r=0.366, P<0.001), pelvic incidence (PI) (r=0.407, P<0.001), lumbar lordosis (LL) (r=0.362, P=0.023) were positively correlated with paraspinal sarcopenia, while weight (r=-0.422, P<0.001), cross-sectional area (CSA) of psoas (r=-0613, P<0.001), facet joint angle (FA) (r=-0.447, P=0.016), and The Hounsfield Unit values of L1-L4 (L1-4 HU) (r=0.298, P=0.005) were negatively correlated with paraspinal sarcopenia. Ordinal logistic regression showed that the Facet joint osteoarthritis (FJOA) (odds ratio=2.82, P=0.017), PI (odds ratio=1.15, P<0.001), age (odds ratio=1.14, =0.001), and female (odds ratio=5.26, P=0.04) were associated with paraspinal sarcopenia.</p><p><strong>Conclusions: </strong>Our study demonstrated FJOA, PI, age, and female were associated with paraspinal sarcopenia. The assessments of paraspinal muscles cross-sectional area were not associated with the severity of fatty infiltration.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819264","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 Surgical Upper Lumbar Changes on Unfused Lower Lumbar Segments in Adolescent Idiopathic Scoliosis.","authors":"Arun R Hariharan, Tracey Bryan, Hans K Nugraha, David S Feldman, John S Vorhies, Craig R Louer, Peter O Newton, Suken A Shah, Harry L Shufflebarger, Nicholas D Fletcher, Baron S Lonner, Michael P Kelly","doi":"10.1097/BRS.0000000000005240","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005240","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To determine the impact of upper lumbar lordosis changes in the fused segment on compensatory kyphotic or lordotic changes in the unfused lower lumbar spine in patients with Adolescent Idiopathic Scoliosis (AIS).</p><p><strong>Summary of background data: </strong>While the distribution of lordosis and interplay between fused/unfused segments has been studied in adults, less is known about this in AIS. We hypothesize that increased FSLL can result in compensatory kyphosis of the unfused distal segments.</p><p><strong>Methods: </strong>A retrospective review of Lenke 1/2 patients who underwent posterior spinal fusion (PSF) to L1, L2, or L3 with a minimum follow-up of two years. Coronal Cobb angles, thoracic kyphosis, lumbar lordosis, and spino-pelvic parameters (T4PA, L1PA, PT, SS, PI, PI-LL, SVA) were measured. Custom MATLAB scripts were used for 3D segmental lordosis calculations. Statistical analysis including linear regression analyses and interaction models assessed the relationship between fused segment lumbar lordosis (FSLL), LIV, and thoracic kyphosis (TK) on lower lumbar compensatory alignment.</p><p><strong>Results: </strong>158 patients met inclusion criteria. Changes in FSLL affected segmental lordosis of unfused segments, including loss of distal lordosis. In the L1 LIV group, increased FSLL increased L1-L2 lordosis (B=0.35 (P=0.003)). In LIV L2, increased FSLL increased L3-4 lordosis (B=0.2 (P=0.001)) and decreased L4-L5 lordosis (B=-0.23 (P=0.012). For LIV L3, increased FSLL caused reduction in lordosis of L4-5 (B=-0.14 (P=0.026)) and L5-S1 (B=-0.14 (P=0.034)). Changes in TK also had varying impacts on the unfused segments. The interaction model with LIV levels reveals that the compensation strategy can vary depending on specific fusion levels, although not significant. Overall sagittal alignment was maintained and PI-LL remained <10°. Pre- and postoperative T4-L1PA had minimal difference to each other indicating maintained sagittal harmony.</p><p><strong>Conclusions: </strong>In this observational study of segmental changes in lumbar lordosis in AIS, post-operative changes in the fused segments can result in iatrogenic changed in the unfused lower segments to maintain spinal balance. Understanding normal segmental lumbar lordosis distribution is critical in surgical planning (i.e. rod contouring) and in understanding the health of the unfused segments long term.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819262","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":"Untreated Osteoporosis in Lumbar Fusion Surgery Patients: Prevalence, Risk-factors and Effect on Bone Metabolism.","authors":"Paul Köhli, Jan Hambrecht, Shu-Han Wang, Jiaqi Zhu, Erika Chiapparelli, Lukas Schönnagel, Ali E Guven, Gisberto Evangelisti, Arne Kienzle, Jennifer Shue, Koki Tsuchiya, Marco D Burkhard, Matthias Pumberger, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BRS.0000000000005231","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005231","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of a prospective single-center study.</p><p><strong>Objective: </strong>To analyze the prevalence and risk factors for untreated osteoporosis in patients undergoing lumbar spinal fusion surgery (LFS) and its impact on bone mineral density (BMD) and bone turnover markers.</p><p><strong>Background: </strong>Osteoporosis is a risk factor for mechanical complications in LFS, which can be mitigated by antiosteoporotic treatment. However, there's limited research on factors leading to untreated osteoporosis before LFS and its impact on preoperative bone status.</p><p><strong>Methods: </strong>A secondary analysis of a prospective study enrolling adults undergoing LFS for degenerative conditions (2014-2024) with preoperative quantitative CT osteoporosis screening was performed. Demographic data and medical history were analyzed for prevalence and risk factors of untreated osteoporosis, while BMD, vitamin D, PTH levels, and bone turnover markers were assessed for the effects of lacking treatment.</p><p><strong>Results: </strong>A total of 445 patients (48% female, median age 64) were included, of which 137 patients (31%) had osteoporosis. Of these, 66 (48%) were untreated and 71 (52%) were treated, with 40 (56%) receiving pharmacological and 31 (44%) non-pharmacologic treatment including vitamin D supplementation and lifestyle modifications. Of the untreated patients, 55 (80%) were identified by preoperative screening. 71% of osteoporotic men versus 35% of osteoporotic women were untreated (P<0.001). Multivariable logistic regression confirmed male sex as an significant contributing factor (OR 4.3, 95% CI 1.9-10.1, P<0.001) for untreated osteoporosis. Treated osteoporotic patients had higher BMD (P<0.001), higher VitD levels P=0.023) and lower levels of bone resorption parameters (P=0.004) than untreated patients.</p><p><strong>Conclusion: </strong>Untreated osteoporosis is common before LFS, especially in men, with the untreated having lower BMD and higher bone resorption marker levels than treated patients. Identification of osteoporotic cases and subsequent osteological optimization could potentially reduce the risks of adjacent fractures or screw loosening.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772408","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 \"Does Spinal Cord-Canal Mismatch Adversely Affect the Clinical Outcomes of Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Myelopathy?\" by Park, et al.","authors":"Weijing Fang, Zhan Wang","doi":"10.1097/BRS.0000000000005230","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005230","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772464","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":"Should We Operate on Octogenarians with Cervical Myelopathy or Radiculopathy?","authors":"Omar Zakieh, Maryam Jawid, Mitchell Bowers, Mason Young, Scott L Zuckerman, Julian G Lugo-Pico, Raymond J Gardocki, Amir M Abtahi, Byron F Stephens","doi":"10.1097/BRS.0000000000005232","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005232","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort.</p><p><strong>Objective: </strong>Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes.</p><p><strong>Summary of background data: </strong>As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians.</p><p><strong>Methods: </strong>Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients <80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain.</p><p><strong>Results: </strong>There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P=0.548), 90-day readmission (10.3% vs. 6.9%, P=0.548), and 12-month reoperation (3.4% vs. 2.3%, P=0.736) between octogenarians and non-octogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P=0.393), improvement in 3- and 12- month PROMs and MCID achievement.</p><p><strong>Conclusion: </strong>Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and non-octogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772484","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":"Accuracy and Value of Time-resolved MRA for Spinal Vascular Malformations.","authors":"Xiao-Er Wei, Jin-Yu Zhu, Ming-Hua Li, Jianyong Wei, Liming Wei, Yueqi Zhu, Yuehua Li","doi":"10.1097/BRS.0000000000005233","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005233","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective.</p><p><strong>Objective: </strong>To explore the value of time-resolved CE-MRA in evaluating and locating the SVM prior to digital subtraction angiography (DSA).</p><p><strong>Summary of background data: </strong>Spinal vascular malformations (SVM) can be detected with time-resolved contrast-enhanced MRA(CE-MRA).</p><p><strong>Materials and methods: </strong>178 patients with suspected SVM who underwent time-resolved CE-MRA examination and DSA were included in this study. DSA served as the reference standard. The type of SVM, feeding arteries, fistula/nidus, and proximal segment of draining veins were evaluated on time-resolved CE-MRA. The diagnostic performance and classification performance of time-resolved CE-MRA in the diagnosis of SVM is summarized in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). The difference of catheterized vessels during spinal vascular DSA between actual and estimated number was also analyzed.</p><p><strong>Results: </strong>147 patients were diagnosed with SVM (20 cervical, 118 thoracolumbar, and 9 deep lumbosacral) and 31 patients were diagnosed with non-SVM according to DSA findings. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy of time-resolved CE-MRA for subtype of SVM were 0.961, 0.961, 0.993, 0.806 and 0.961, respectively. The overall accuracy of time-resolved CE-MRA for the diagnosis of SVM was 0.821, and was 0.783, 0.793, and 0.778 for cervical, thoracolumbar, and deep lumbosacral SVM, respectively. The actual number of catheterized vessels during spinal vascular DSA with time-resolved CE-MRA as the reference was lower than the estimated number of catheterized vessels in both SVM and non-SVM patients (P<0.001).</p><p><strong>Conclusion: </strong>Time-resolved CE-MRA could accurately evaluate SVM and reduce the number of catheterized vessels during spinal vascular DSA.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772462","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}