Spine Surgery and Related Research最新文献

{"title":"Regional Variations in Surgical Approach and Perioperative Outcomes in Adult Cervical Instrumentation Surgery: A Nationwide Registry Study from the JSIS-DB.","authors":"Shunsuke Katsumi, Hideyuki Arima, Koji Yamada, Mitsuru Yagi, Ryo Mizukoshi, Kimiaki Yokosuka, Junya Katayanagi, Atsushi Tagami, Yusuke Hori, Yukihiro Matsuyama, Hiroshi Taneichi, Tokumi Kanemura, Akira Matsumura, Haruki Ueda","doi":"10.22603/ssrr.2026-0016","DOIUrl":"10.22603/ssrr.2026-0016","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical spinal surgery is performed for various pathologies, including degenerative disease, deformity, trauma, tumor, and infection. However, the surgical approach (anterior vs. posterior) and perioperative safety may vary among regions due to differences in patient characteristics, surgeon experience, and healthcare infrastructure. This study aimed to clarify regional variations in approach selection and perioperative outcomes for cervical surgery in Japan using the nationwide registry of the Japanese Spinal Instrumentation Society Database (JSIS-DB).</p><p><strong>Methods: </strong>This retrospective observational study included adult patients (≥18 years) registered in the JSIS-DB between February 2018 and March 2022 who underwent cervical anterior or posterior fusion surgery. Occipito-cervical and cervico-thoracic fusion procedures were excluded. Patients were classified into 6 geographic regions. Regional differences in patient demographics, surgical characteristics, perioperative outcomes, surgeon experience, and reoperation rates were analyzed using appropriate statistical methods.</p><p><strong>Results: </strong>A total of 2,581 patients were analyzed. Significant regional variation was observed in patient characteristics, American Society of Anesthesiologists physical status classification, surgical approach, operative time, estimated blood loss, surgical urgency, length of hospital stay, complication rates, and surgeon and assistant experience levels (all p<0.05). Anterior procedures were more frequently performed in the Kanto and Kyushu regions, whereas posterior approaches predominated in other regions. Importantly, no significant regional difference was observed in reoperation rates (p=0.254). Reoperations were infrequent nationwide (5.9% overall) and were primarily related to mechanical or decompressive issues rather than major complications.</p><p><strong>Conclusions: </strong>This nationwide registry study demonstrated substantial regional variation in surgical strategies and perioperative complication rates in adult cervical surgery in Japan. Despite these differences, reoperation rates remained consistently low and comparable across regions. These findings indicate that while reoperation rates are uniform, perioperative complication profiles vary geographically. This study provides a comprehensive overview of contemporary cervical fusion practice and highlights the need for further research into the factors driving regional variations.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"674-684"},"PeriodicalIF":1.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Endoscopic Anterior Resection Combined with Intraoperative Computed Tomographic Navigation for Tenosynovial Giant Cell Tumor of the Upper Cervical Spine.","authors":"Kanichiro Wada, Gentaro Kumagai, Kazushige Koyama, Sho Kaneko, Yasuyuki Ishibashi","doi":"10.22603/ssrr.2025-0374","DOIUrl":"10.22603/ssrr.2025-0374","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"648-651"},"PeriodicalIF":1.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Postoperative Neuropathic Pain and Clinical Scores in Patients with Cervical Ossification of the Posterior Longitudinal Ligament.","authors":"Yuji Yokozeki, Masayuki Miyagi, Gen Inoue, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Masahiko Takahata, Tsutomu Endo, Shunji Tsutsui, Masao Koda, Hiroshi Takahashi, Satoshi Kato, Kanji Mori, Hideaki Nakajima, Takeo Furuya, Satoshi Maki, Yoshiharu Kawaguchi, Norihiro Nishida, Kazuo Kusano, Hiroaki Nakashima, Shinsuke Ikeda, Masashi Takaso, Masashi Yamazaki","doi":"10.22603/ssrr.2025-0419","DOIUrl":"10.22603/ssrr.2025-0419","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative neuropathic pain (NeP) is common after surgery for cervical ossification of the posterior longitudinal ligament (cOPLL) and may affect clinical outcomes. The PainDETECT questionnaire (PDQ) is a widely used tool for evaluating NeP, while the Spine PDQ (SPDQ) was developed to improve specificity for spinal disorder-related NeP. This study aimed to evaluate postoperative NeP using PDQ and SPDQ and to examine their associations with clinical scores.</p><p><strong>Methods: </strong>A total of 234 patients (170 men and 64 women; mean age, 61.9 years) who underwent cOPLL surgery were analyzed and followed for more than 1 year across 13 institutions. NeP was assessed using PDQ (cutoff ≥13) and SPDQ (cutoff ≥0). Clinical outcomes included the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), the visual analogue scale (VAS), and the EuroQol 5-Dimensions 5-Level (EQ-5D-5L). Correlations between NeP scores and clinical outcomes were evaluated. Patients were stratified into four PDQ/SPDQ-based groups: Zone 1: PDQ-/SPDQ-, Zone 2: PDQ+/SPDQ-, Zone 3: PDQ-/SPDQ+, and Zone 4: PDQ+/SPDQ+, and clinical outcomes were compared among the groups.</p><p><strong>Results: </strong>PDQ showed significant correlations with all clinical outcomes. SPDQ correlated with VAS, EQ-5D-5L, and the bladder function and quality of life (QOL) domains of JOACMEQ but not with other JOACMEQ domains. The PDQ+ group demonstrated worse scores across all domains than the PDQ- group. The SPDQ+ group had higher VAS scores and lower EQ-5D-5L and JOACMEQ QOL scores than that of the SPDQ- group, with no differences in other JOACMEQ domains. Zone 4 had the poorest prognosis, whereas Zone 3 showed higher VAS scores than Zone 1 but preserved JOACMEQ and EQ-5D-5L scores.</p><p><strong>Conclusions: </strong>PDQ was associated with detecting pain, functional deterioration, and reduced QOL, while SPDQ reflected pain-related aspects only. Combined PDQ/SPDQ assessment and zone classification may stratify NeP severity and its clinical relevance in patients with postoperative cOPLL.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"666-673"},"PeriodicalIF":1.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal Alignment as a Determinant of Pain and Functional Recovery after Lumbar Surgery: A Systematic Review and Meta-Analysis.","authors":"Tomasz Tykocki, Łukasz Rakasz","doi":"10.22603/ssrr.2025-0388","DOIUrl":"10.22603/ssrr.2025-0388","url":null,"abstract":"<p><strong>Background: </strong>Sagittal alignment is increasingly recognized as a key determinant of functional recovery after lumbar spine surgery; however, its role in degenerative lumbar disease remains variably reported. While alignment principles are well-established in adult spinal deformity, their applicability to routine degenerative procedures has not been quantitatively synthesized.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of 23 original clinical studies (1,837 adults) was performed. Eligible studies reported postoperative sagittal or spinopelvic parameters-pelvic incidence (PI)-lumbar lordosis (LL) mismatch, sagittal vertical axis, LL, pelvic tilt, or segmental lordosis-and at least one validated clinical outcome (Oswestry Disability Index, visual analogue scale/numerical rating scale, 12-Item Short Form Health Survey, EuroQol Five Dimensions, Core Outcome Measures Index, Japanese Orthopaedic Association). Continuous data were converted to log-odds ratios (ORs) (Chinn method) to enable unified pooling. Random-effects models were applied for disability and pain outcomes. Subgroup analyses assessed fusion versus decompression, PI-LL versus other alignment metrics, and short-term versus long-term follow-up.</p><p><strong>Results: </strong>Eight studies contributed disability outcomes, yielding a pooled OR of 0.33 (95% confidence interval [CI] 0.16-0.65), indicating a 67% reduction in the odds of significant postoperative disability in aligned patients. Five studies contributed pain data, producing a pooled OR of 0.39 (95% CI 0.25-0.61), corresponding to a 61% lower likelihood of persistent postoperative pain. Fusion procedures demonstrated stronger alignment-associated benefit (OR 0.34) compared with decompression alone (OR 0.56). PI-LL-based studies showed consistent predictive value (OR 0.48), and the alignment effect increased with long-term follow-up (>12 months; OR ~0.28). Qualitatively, 87% of studies reported positive alignment-outcome associations.</p><p><strong>Conclusion: </strong>Restoration of physiological sagittal alignment significantly improves postoperative disability and pain across degenerative lumbar procedures. Alignment correction should be considered a central element of surgical planning in both fusion and decompression.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"354-365"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary Spinal Cord Metastasis from Salivary Duct Carcinoma of the Submandibular Gland: A Case Report.","authors":"Katsuyoshi Ito, Norihiro Isogai, Yutaka Sasao, Masaki Nagashima, Shigeto Ebata, Haruki Funao, Mitsuru Yagi","doi":"10.22603/ssrr.2025-0331","DOIUrl":"10.22603/ssrr.2025-0331","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"645-647"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Specific 3D-Printed Reference Rod for \"Smiley Face Rod\" Repair of Lumbar Spondylolysis in a Patient with High Body Mass Index.","authors":"Takayuki Kitahara, Masatoshi Morimoto, Naoto Ono, Takafumi Ohshima, Yuji Nagao, Saori Soeda, Daiki Nakajima, Makoto Takeuchi, Hiroshi Kageyama, Junzo Fujitani, Hiroaki Manabe, Fumitake Tezuka, Koichi Sairyo","doi":"10.22603/ssrr.2025-0418","DOIUrl":"10.22603/ssrr.2025-0418","url":null,"abstract":"<p><strong>Introduction: </strong>The \"Smiley Face Rod\" (SFR) method is an effective direct repair technique for lumbar spondylolysis. However, three-dimensional rod contouring is technically demanding, particularly in patients with a high body mass index (BMI), where deep soft tissue obscures anatomical landmarks.</p><p><strong>Technical note: </strong>We report a technique using a patient-specific three-dimensional (3D)-printed model to create a sterilized \"Reference Rod\" template. A 27-year-old male with bilateral L5 spondylolysis and severe obesity (BMI 39.8 kg/m²) underwent SFR repair. A 3D model was printed from preoperative computed tomography data. A malleable template rod was contoured on this model to perfectly fit the lamina and spinous process and then sterilized. Intraoperatively, the final titanium rod was bent to match this sterile Reference Rod. This allowed for a \"one-pass\" insertion through the interspinous ligament with optimal bony contact, eliminating intraoperative trial-and-error.</p><p><strong>Conclusions: </strong>The 3D-printed Reference Rod technique is a feasible approach that may facilitate rod contouring for SFR in challenging high-BMI cases by providing a tangible template to address the visualization and geometric limitations of conventional fluoroscopy.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"511-515"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User Engagement and Demographics of a Medical Society-Led Website for Scoliosis: An Analysis using Google Analytics.","authors":"Shuhei Iwata, Toshiaki Kotani, Toru Hirano, Kanichiro Wada, Katsumi Harimaya, Yuichiro Abe, Takahiro Iida, Yuki Taniguchi, Naoyuki Nakamura, Katsuhisa Yamada, Hideki Murakami, Shoji Seki, Taichi Tsuji, Hidetomi Terai, Haruo Misawa, Takuya Yamamoto, Seiji Ohtori","doi":"10.22603/ssrr.2025-0320","DOIUrl":"10.22603/ssrr.2025-0320","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-facing websites operated by medical societies are crucial for disseminating reliable health information; however, their real-world usage and effectiveness are often unquantified. This study investigated the user engagement and demographics of \"Scoliosis Town,\" a patient education website developed by the Japanese Scoliosis Society, to evaluate its performance.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the website's traffic data from June 1, 2018, to March 31, 2023 (58 months), using Google Analytics. Key metrics included the number of users and sessions, user demographics (age and gender), access patterns (device type and acquisition channel), and popular content.</p><p><strong>Results: </strong>The website attracted 2,333,184 users over 3,111,702 sessions. The primary users were female (68.1%), with the 35-44 age group being the largest demographic (29.4%), suggesting the site effectively reached its target audience of patients' mothers. The most frequently viewed pages were those detailing the \"causes\" and \"treatment\" of scoliosis. Most users accessed the site via mobile devices (83.3%), primarily through organic search (88.0%), with traffic peaking on weekday evenings.</p><p><strong>Conclusions: </strong>The Japanese Scoliosis Society patient education website successfully reached its intended demographic of caregivers and was actively used to seek fundamental information about scoliosis. This study demonstrates the value of medical society-led digital platforms and validates web analytics as a powerful tool for assessing real-world patient information needs.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 3","pages":"504-510"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Global Alignment and Proportion Score with Locomotive Syndrome and Health-Related Quality of Life in Community-Dwelling Middle-Aged and Older Adults: A Retrospective Cross-Sectional Study.","authors":"Yasuhiro Nagatani, Naoki Segi, Sadayuki Ito, Jun Ouchida, Ippei Yamauchi, Shinya Ishizuka, Taisuke Seki, Yasuhiko Takegami, Yukiharu Hasegawa, Shiro Imagama, Hiroaki Nakashima","doi":"10.22603/ssrr.2025-0405","DOIUrl":"10.22603/ssrr.2025-0405","url":null,"abstract":"<p><strong>Background: </strong>The Global Alignment and Proportion score has been validated in surgical cohorts as a predictor of mechanical complications in adult spine deformity, but its significance in the general population is poorly understood. We examined the association of the Global Alignment and Proportion score categories with locomotor syndrome and health-related quality of life in community-dwelling middle-aged and older adults to clarify the role of proportionality of sagittal alignment in musculoskeletal function and quality of life.</p><p><strong>Methods: </strong>Residents of Hokkaido, Japan, who underwent musculoskeletal health screening in 2019 were included in this retrospective cross-sectional study. Based on their Global Alignment and Proportion score classification, participants were divided into three groups: proportioned, moderately disproportioned (moderate), and severely disproportioned (severe). We compared participants' background, bone mineral density, exercise tests, pain levels, locomotor syndrome stage, and Short Form 36-Item Health Survey score data.</p><p><strong>Results: </strong>The mean age of the 217 participants was 64.0±9.5 years; 127 were female. The mean Global Alignment and Proportion score was 6.1±3.4 points, and the proportioned, moderate, and severe groups comprised 27, 106, and 84 participants, respectively. A statistically significant trend was observed in which the number of participants at high risk for locomotive syndrome increased as the Global Alignment and Proportion risk state worsened. In the Short Form 36 Health Survey domains of bodily pain and physical component summary scores, statistically significant trends toward lower scores were observed across groups with worsening Global Alignment and Proportion risk status.</p><p><strong>Conclusions: </strong>We identified an association between poorer Global Alignment and Proportion scores and the presence of locomotive syndrome, as well as lower health-related quality of life, among middle-aged and older adults. These findings suggest that the Global Alignment and Proportion score may be a useful indicator for characterizing musculoskeletal alignment in clinical and public health fields.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"592-599"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Long-Term Transfer Difficulty and Global Caregiver Satisfaction after Neuromuscular Scoliosis Surgery: A Dissociation between Task-Specific Burden and Perceived Benefit.","authors":"Naoyuki Nakamura, Yuichiro Kawabe, Kouji Yamamoto, Masatoshi Oba, Kayo Tsuzawa, Yumika Yokoyama, Kosuke Sumi","doi":"10.22603/ssrr.2025-0410","DOIUrl":"10.22603/ssrr.2025-0410","url":null,"abstract":"<p><strong>Introduction: </strong>Caregiver satisfaction after neuromuscular scoliosis (NMS) surgery is generally high; however, the relationship between task-specific caregiving burden and global treatment satisfaction remains unclear. This study aimed to identify patient- and caregiver-related determinants of transfer difficulty and global satisfaction in the long-term postoperative period.</p><p><strong>Methods: </strong>This cross-sectional follow-up study included individuals who underwent posterior spinal fusion for NMS between 2012 and 2020 and were ≥18 years at survey distribution. Caregivers completed a modified Bridwell questionnaire using 0-10 scales. Multivariate linear regression identified determinants of transfer difficulty and global satisfaction, with false discovery rate (FDR) correction applied.</p><p><strong>Results: </strong>Sixty-two caregivers responded (63% response rate). In the patient-related model, higher adult body weight (β=-0.14, p_FDR=0.077) and greater residual Cobb angle (β=-0.082, p_FDR=0.065) showed trends in transfer difficulty scores, though neither reached the p_FDR<0.05 threshold. Among caregiver-reported domains, difficulty with changing clothes (β=0.75, p_FDR=0.081) demonstrated a similar trend. Global satisfaction was significantly associated with better respiratory status (β=0.36, p_FDR=0.023) and improved swallowing (β=-0.16, p_FDR=0.047). Transfer difficulty showed no association with global satisfaction (β=-0.007, p_FDR=0.90).</p><p><strong>Conclusions: </strong>These findings represent exploratory associations observed at a single time point in adulthood and do not imply causal relationships. Transfer difficulty in adulthood appears to be primarily associated with body size and residual spinal deformity, whereas global satisfaction is primarily associated with improvements in respiratory and swallowing function. These findings indicate a dissociation between task-specific caregiving burden and global treatment satisfaction, suggesting that caregivers may affirm long-term treatment value despite ongoing physical challenges.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"613-619"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Monotherapy versus Polypharmacy in Cervicobrachial Symptoms: A Nationwide Multicenter Analysis.","authors":"Sadayuki Ito, Hiroaki Nakashima, Norimitsu Wakao, Takeo Furuya, Toshitaka Yoshii, Hideyuki Arima, Yu Yamato, Shiro Imagama, Yasuaki Imajo, Hiroshi Miyamoto, Gen Inoue, Masayuki Miyagi, Shunsuke Kanbara, Yoichi Iizuka, Hirotaka Chikuda, Kei Watanabe, Kazuyoshi Kobayashi, Mikito Tsushima, Masashi Miyazaki, Mitsuru Yagi, Satoshi Suzuki, Masahiko Takahata, Michio Hongo, Masao Koda, Keiji Nagata, Kanji Mori, Akinobu Suzuki, Takashi Kaito, Kenta Murotani, Naohisa Miyakoshi, Hiroshi Hashizume, Yukihiro Matsuyama, Mamoru Kawakami, Hirotaka Haro","doi":"10.22603/ssrr.2025-0304","DOIUrl":"10.22603/ssrr.2025-0304","url":null,"abstract":"<p><strong>Introduction: </strong>Cervicobrachial symptoms are common causes of disability worldwide, yet the cost-effectiveness of combination therapy versus monotherapy remains unclear. In this nationwide multicenter study, we aimed to compare the economic value of multiple-drug therapy with that of monotherapy for cervicobrachial symptoms.</p><p><strong>Methods: </strong>This prospective observational study, conducted through the Japanese Society for Spine Surgery and Related Research, included 261 adults with cervicobrachial symptoms across 28 institutions (July 2020 to July 2022). Patients received monotherapy (n=112) or multiple-drug therapy (n=149) using five pre-specified agents: loxoprofen, celecoxib, acetaminophen, tramadol-acetaminophen, and pregabalin. The primary outcome was quality-adjusted life years (QALYs), calculated from monthly EuroQol 5-Dimension 5-Level assessments over six months. The secondary outcomes were drug costs and incremental cost-effectiveness ratios (ICERs), evaluated against Japan's reference threshold of 5,000,000 JPY per QALY.</p><p><strong>Results: </strong>Mean QALY gains were similar between the monotherapy (0.00267±0.00544) and multiple-drug therapy (0.00284±0.00774) groups, with no statistically significant difference (p>0.05). However, total drug costs were substantially higher with multiple-drug therapy (19,243 JPY vs. 8,275 JPY). ICERs were more favorable for monotherapy (3,093,957 JPY/QALY) than for multiple-drug therapy (6,781,101 JPY/QALY). Among agents used as monotherapy, loxoprofen (744,409 JPY/QALY) and acetaminophen (781,293 JPY/QALY) showed the most favorable cost-effectiveness profiles, whereas tramadol-acetaminophen (6,370,451 JPY/QALY) and pregabalin (10,995,651 JPY/QALY) had the least favorable cost-effectiveness. Most QALY gains occurred during the first three months in both groups.</p><p><strong>Conclusions: </strong>Multiple-drug therapy approximately doubled pharmaceutical costs without providing additional QALY gains over six months. Monotherapy, particularly with non-steroidal anti-inflammatory drugs or acetaminophen, offers superior cost-effectiveness and should be prioritized as first-line treatment. These findings underscore the need for restraint in polypharmacy and provide real-world evidence to guide clinical decision-making and national healthcare policy.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"567-576"},"PeriodicalIF":1.6,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}