North American Spine Society Journal最新文献

{"title":"Sacroiliac joint fusion: incidence, timing, and risk factors for contralateral fusion","authors":"Jefferson Waters BA , Ara Khoylyan BS , Kaitlyn Maniscalco BS , William Adams BS , Michael Pheasant MD , Alex Tang MD , Tan Chen MD, FRCSC, FACS","doi":"10.1016/j.xnsj.2025.100614","DOIUrl":"10.1016/j.xnsj.2025.100614","url":null,"abstract":"<div><h3>Background</h3><div>Sacroiliac joint (SIJ) dysfunction is implicated in 15% to 25% of cases of chronic lower back pain, a leading cause of disability globally. Sacroiliac joint fusion (SIJF) has become an increasingly utilized treatment for refractory SIJ pain, with its adoption projected to rise significantly. While SIJF can alleviate symptoms, many patients develop contralateral SIJ pathology requiring subsequent surgery. Understanding the incidence, timing, and risk factors for bilateral SIJF is critical for improving patient outcomes, managing expectation, and guiding surgical decision-making.</div><div>This study aimed to (1) determine the incidence of bilateral SIJF, (2) assess the timing between initial ipsilateral and subsequent contralateral SIJF, (3) identify risk factors associated with progression to contralateral SIJF, and (4) compare the timing to contralateral SIJF between patients presenting with unilateral versus bilateral SIJ dysfunction.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted identifying 323 consecutive SIJFs performed between 2011 and 2024 at an integrated healthcare system. Three clinical cohorts were identified based on progression to SIJF. Cohort 1 included patients who underwent unilateral SIJF only. Cohort 2 patients developed contralateral SIJ pain following initial SIJF, while Cohort 3 patients had bilateral SIJ pain prior to initial SIJF. Demographics and prior spine surgical details were collected and included in multivariate analysis. Kaplan-Meier survival curves were used to evaluate the timing between SIJFs. Comparisons between groups were established with student’s <em>t</em>-test and chi-square analysis. Statistical significance was defined as p < .05.</div></div><div><h3>Results</h3><div>A total of 57 (21%) patients underwent bilateral SIJF. Prior L5-S1 fusion was associated with a higher likelihood of bilateral surgery (OR = 2.55, p = .042), while prior lumbar fusion not involving L5-S1 was protective (OR = 0.20, p = .036). Over 90% of contralateral SIJF cases occurred within 18 months of the initial ipsilateral SIJF procedure. Patients in Cohort 3 progressed more rapidly to contralateral surgery than those in Cohort 2 (6.2 months vs. 12.7 months, p = .004). Average body mass index (BMI) was higher in Cohort 3 patients (31.9 kg/m<sup>2</sup> vs. 28.2 kg/m<sup>2</sup>, p = .038). Cohort 3 also showed a significantly higher incidence of prior single-level L5-S1 fusion (50% vs. 13%, p = .008). Age, sex, and multilevel lumbar fusions were not significantly associated with bilateral SIJF.</div></div><div><h3>Conclusions</h3><div>Contralateral SIJF occurs in 21% of patients who have undergone initial unilateral SIJF, with over 90% of cases occurring within 18 months of the initial ipsilateral fusion procedure. Bilateral SIJ pain prior to initial SIJF and prior L5-S1 fusion are key predictors of contralateral surgery. Patients with bilateral SIJ pain had elevated BMI. The","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100614"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications in patients with sickle cell disease undergoing single-level anterior cervical discectomy and fusion","authors":"Gwyneth C Maloy BA ,&nbsp;Rushabh H Doshi MPH, MSc ,&nbsp;Wesley Day BS ,&nbsp;Meera M Dhodapkar MD ,&nbsp;Scott J Halperin MD ,&nbsp;Rahul H Jayaram BS ,&nbsp;Bhav Jain BS ,&nbsp;Jonathan N Grauer MD ,&nbsp;Arya G Varthi MD","doi":"10.1016/j.xnsj.2025.100617","DOIUrl":"10.1016/j.xnsj.2025.100617","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) is the most common genetic disorder in the United States, affecting approximately 300,000 infants worldwide annually. As advancements in treatment have led to increased life expectancy for individuals with SCD, this population may be considered for anterior cervical discectomy and fusion (ACDF) due to potentially accelerated degenerative disc disease. The current study sought to characterize 90-day postoperative outcomes among SCD patients undergoing ACDF using matched cohorts.</div></div><div><h3>Methods</h3><div>Adult patients undergoing single-level ACDF were identified from the 2010 to 2021 Q1 M151 PearlDiver database. Those with SCD were matched 1:4 to controls based on age, sex, and Elixhauser Comorbidity Index (ECI). The occurrence of 90-day postoperative adverse events, readmissions, and emergency department (ED) visits were assessed. Patient characteristics and postoperative outcomes were compared using Student's t-tests and chi-square tests. Multivariable logistic regression was performed to compare outcomes between the matched cohorts. p &lt; 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>After matching, 82 SCD patients and 324 controls were identified. Patients with SCD had significantly higher odds of adverse events including: any 90-day adverse events (OR 3.06), serious adverse events (OR 2.91), minor adverse events (OR 3.62), readmissions (OR 3.50), and ED visits (OR 3.64) (p &lt; 0.05 for all). In terms of individual adverse events, in decreasing OR order patients with SCD had higher odds of: pneumonia (OR 10.41), acute kidney injury (OR 6.65), deep vein thrombosis (OR 6.73), sepsis (OR 5.30), urinary tract infections (OR 3.43) (p &lt; 0.05 for all).</div></div><div><h3>Conclusions</h3><div>SCD patients undergoing single-level ACDF were found to have significantly higher odds of multiple postoperative complications compared to matched controls. These findings suggest that SCD patients may require more intensive perioperative care and monitoring to minimize such adverse outcomes. Further research is needed to optimize management strategies for this high-risk population.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100617"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord stimulator utilization trends and predictors of unsuccessful trial-to-implant conversion","authors":"Wesley Day BS ,&nbsp;Gwyneth C Maloy BA ,&nbsp;Adam D. Winter BS ,&nbsp;Kenneth B Chapman MD ,&nbsp;Anthony E Seddio BS ,&nbsp;Rushabh H Doshi BS ,&nbsp;Philip P Ratnasamy BS ,&nbsp;Arya G Varthi MD ,&nbsp;Mitchell S. Fourman MD ,&nbsp;Jonathan N Grauer MD","doi":"10.1016/j.xnsj.2025.100616","DOIUrl":"10.1016/j.xnsj.2025.100616","url":null,"abstract":"<div><h3>Background</h3><div>Spinal cord stimulators (SCS) are neuromodulatory devices that may be considered for refractory back or neurologic pain. Trends in SCS utilization and factors associated with failure of trial-to-implant conversion are not well defined.</div></div><div><h3>Methods</h3><div>Using the 2010 - 2022 PearlDiver Mariner Patient Claims Database, adults who underwent SCS trial were identified and categorized into those who did or did not undergo conversion to permanent SCS implantation. Multivariable logistic regression was used to identify clinical (age, sex, Elixhauser Comorbidity Index, and tobacco use) and non-clinical (insurance plan and US geographic region) characteristics associated with lower odds of trial-to-implant conversion.</div><div>The annual incidences of SCS utilization, trial-to-implant conversion, and breakdown of specialties performing SCS implantation (pain specialists, neurosurgeons, orthopedic surgeons) were analyzed.</div></div><div><h3>Results</h3><div>Of 265,756 patients undergoing SCS trial, 178,144 (67%) went on to receive permanent implant while 87,612 (33%) did not. Factors independently associated with lower odds of successful trial-to-implant conversion included: older age (OR: 0.97 per decade increase), male sex (OR: 0.93, relative to female), lower comorbidity burden (OR: 0.96 per 1-point ECI decrease), no documented tobacco use (OR: 0.94), insurance (relative to Commercial, Medicaid [OR: 0.78] and Medicare [OR: 0.85]) and geographic region (relative to Midwest, Northeast [OR: 0.63], West [OR: 0.82], and South [OR: 0.85]) (<em>P</em> &lt; 0.05 for all).</div><div>The incidence of SCS trialing increased over the years from 17.9 to 22.9 patients per 100,000 covered lives in the database (<em>P</em> &lt; 0.05). The rate of successful trial-to-implant conversion increased from 63.4% in 2010 to 73.3% in 2021 (<em>P</em> &lt; 0.05). The breakdown of physician specialties implanting SCS remained similar over the years.</div></div><div><h3>Conclusions</h3><div>The overall utilization of SCS and trial-to-implant conversion rates have increased over the years. By defining clinical and nonclinical factors associated with failure for conversion from trial to implant, selection processes can be further optimized by specialists performing these procedures.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100616"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the precision and accuracy of augmented reality for pedicle screw placement in the cervical spine","authors":"Lisa M. Tamburini MD,&nbsp;Anthony Viola III DO,&nbsp;Rohan R. Patel BS,&nbsp;Tomer Korabelnikov BS,&nbsp;Raghunandan Nayak BS,&nbsp;Justin S King BS,&nbsp;Scott Mallozzi MD,&nbsp;Isaac L. Moss MD,&nbsp;Hardeep Singh MD","doi":"10.1016/j.xnsj.2025.100618","DOIUrl":"10.1016/j.xnsj.2025.100618","url":null,"abstract":"<div><h3>Background</h3><div>Augmented reality (AR) has gained popularity in spine surgery. Head mounted AR devices superimpose a 3D reconstructed model on patient anatomy which has been shown to assist with accurate placement of lumbar spine pedicle screws. We aimed to evaluate the accuracy and precision of AR in cervical spine pedicle screw placement.</div></div><div><h3>Methods</h3><div>Seven fresh-frozen cadaveric C2-T1 specimens were used. Computed tomography (CT) scans were obtained and uploaded to the AR navigation system. Fiducial markers were utilized to ensure accurate registration. Bilateral C2-C7 pedicle screws were placed. Images containing planned trajectory with tap and navigated screw placement were captured. A post-navigation CT scan was obtained. Time from initial CT scan to navigation and total navigation time were recorded. Radiation dose information was obtained. Linear and angular differences between planned trajectory and navigated screw position as well as navigated screw position and actual screw position were measured on axial and sagittal images. Screw position was graded using the Gertzbein-Robbins classification.</div></div><div><h3>Results</h3><div>82 pedicle screws were placed. The mean angular and linear deviation between the tap trajectory and navigated screw position were 2.63 ± 2.65° and 3.08 ± 2.32° and 1.11 ± 1.04 mm and 1.24 ± 0.84 mm in the axial and sagittal planes. The mean angular and linear deviation between navigated screw and actual screw were 3.68 ± 4.15° and 2.44 ± 2.17° and 1.51 ± 1.53 mm and 1.02 mm ± 0.88 in the axial and sagittal planes. 95% of screws were given a grade of A or B. Average time from CT scan to navigation was 139.4 seconds and average navigation time was 33 minutes and 46 seconds. Average radiation exposure time was 12.76 ± 1.57 seconds and the average dose-length product (DLP) was 551.15 ± 74.04 mGy-cm.</div></div><div><h3>Conclusions</h3><div>AR can assist in accurate placement of pedicle screws in the cervical spine. Deviation from navigated screw position to actual screw position was within clinically acceptable range throughout the cervical spine.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100618"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The anterior intercrest line is a novel, accurate surface marking for identifying the L4/5 disc level: a prospective agreement study with fluoroscopy","authors":"Matthew H. Claydon MBBS, BMedSci, FRACS ,&nbsp;Dean T. Biddau BBiomedSc ,&nbsp;Stephanie G Claydon ,&nbsp;Dean P McKenzie BA (Hons), PhD ,&nbsp;Gregory M. Malham BSc, MB, ChB, DMed, FRACS","doi":"10.1016/j.xnsj.2025.100615","DOIUrl":"10.1016/j.xnsj.2025.100615","url":null,"abstract":"<div><h3>Background</h3><div>There have been no previous reports of reliable surface landmarks for determining the optimal incision site for anterior lumbar spine access without fluoroscopy. We aimed to assess the accuracy of the anterior intercrest line for predicting the surface projection of the L4/5 disc level, compared with the fluoroscopically determined level.</div></div><div><h3>Methods</h3><div>Prospective agreement study of consecutive patients without transitional anatomy undergoing anterior exposure for either interbody fusion or total disc replacement surgery at L4/5. The primary outcome measure was the distance from the symphysis pubis to the skin markings for the L4/5 level, as determined by the intercrest line method or fluoroscopic method. The anterior intercrest line was determined by placing a silk tie between the bilateral iliac crests palpated in the mid-axillary line. The skin was marked in the anterior midline along this line. The surface projection of the L4/5 disc was determined using lateral fluoroscopy and marked in the anterior midline. The distance between the upper palpable margin of the symphysis pubis and each L4/5 skin mark was measured. The marking modality difference (MMD) was the difference in distance between the 2 methods.</div></div><div><h3>Results</h3><div>Of 81 patients (49 males, 32 females) the MMD was 0.36 ± 1.19 cm. The intraclass correlation coefficient between distances determined by the 2 methods was 0.84, demonstrating high agreement between the techniques. Single predictor and multiple linear regression analyses revealed no significant associations between MMD and age, sex, BMI, or operative position.</div></div><div><h3>Conclusion</h3><div>There was high agreement between the anterior intercrest line method and fluoroscopy for determining the surface projection of the L4/5 disc. The anterior intercrest line is a simple, clinically accurate, and reliable tool for planning the location of the skin incision for anterior exposure of the L4/5 disc level. Using this line would reduce radiation exposure, overall operative times, and costs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100615"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of tranexamic acid in oncologic surgery for spinal metastases: A systematic review","authors":"Ali Haider Bangash MBBS ,&nbsp;Jessica Ryvlin MD ,&nbsp;Mitchell S. Fourman MD ,&nbsp;Yaroslav Gelfand MD ,&nbsp;Saikiran G. Murthy DO ,&nbsp;Reza Yassari MD ,&nbsp;Rafael De la Garza Ramos MD","doi":"10.1016/j.xnsj.2025.100613","DOIUrl":"10.1016/j.xnsj.2025.100613","url":null,"abstract":"<div><h3>Background</h3><div>Tranexamic acid (TXA) has shown efficacy in reducing blood loss in various surgical specialties without increasing thromboembolic risks, but its role in metastatic spinal tumor surgery (MSTS) remains unclear. This systematic review synthesized evidence on the safety and efficacy of TXA in MSTS.</div></div><div><h3>Methods</h3><div>PubMed, Cochrane, and Epistemonikos were searched from inception to February 1, 2025 for studies reporting on TXA use in MSTS. Study quality was assessed using the Methodological index for non-randomized studies (MINORS) tool for non-randomized studies and the the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) for randomized controlled trial (RCT). The impact of TXA on perioperative complications, blood loss, transfusion requirements, and operating time were evaluated. Meta-analysis feasibility was explored based on methodological and patient population uniformity.</div></div><div><h3>Results</h3><div>Out of a total of nine studies, 6 studies reporting on 566 patients (mean age 59 years; 45% female) met the inclusion criteria. The 5 nonrandomized studies exhibited moderate methodological quality on MINORS analysis, while the RCT demonstrated low risk of bias on RoB2 analysis. A meta-analysis was precluded due to high participant and protocol heterogeneity. TXA was not associated with increased perioperative complications, including thromboembolic events. Blood loss impact varied, with 2 studies reporting contrasting results and others finding no significant effect. Transfusion requirements showed inconsistent results across studies. TXA consistently showed no impact on operative time.</div></div><div><h3>Conclusion</h3><div>There is limited evidence to draw definitive conclusions regarding the safety and efficacy of TXA in metastatic spine tumor surgery. The best available evidence suggests that the complication rate is not higher in cases involving TXA use. The benefit in decreasing blood loss was variable. High-quality research is imperative to clarify the role of TXA in this complex patient population, as well as for the establishment of refined treatment protocols.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100613"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like peptide-1 receptor agonist use prior to spinal surgery results in reduced postoperative length of stay: A propensity-score matched analysis","authors":"Samuel N. Goldman BS ,&nbsp;Kyle Mani BE ,&nbsp;Thomas Scharfenberger BS ,&nbsp;Emily Kleinbart BA ,&nbsp;Aaron T. Hui BS ,&nbsp;Rafael De la Garza Ramos MD ,&nbsp;Mitchell S. Fourman MD, MPhil ,&nbsp;Ananth S. Eleswarapu MD","doi":"10.1016/j.xnsj.2025.100612","DOIUrl":"10.1016/j.xnsj.2025.100612","url":null,"abstract":"<div><h3>Background</h3><div>While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated benefits in reducing complications following total knee and hip arthroplasty, their effects in spinal surgery remain unclear. Prior studies have reported mixed results across select spinal fusion procedures, and the impact of GLP-1 RAs on perioperative outcomes has not been well-defined. This study evaluates the association between preoperative GLP-1 RA use and key perioperative outcomes in spinal surgery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, propensity score-matched analysis of adult patients (≥18 years) undergoing spinal decompression and/or fusion at an urban academic spine service over the past 5 years. Patients prescribed a GLP-1 RA preoperatively comprised the exposure cohort. A 1:4 nearest-neighbor propensity score matching algorithm was then used to identify comparable controls without GLP-1 RA use, based on age, sex, body mass index (BMI), primary procedure code, comorbidities (diabetes, hypertension, hyperlipidemia, heart disease, smoking status, kidney disease, and anxiety), and the use of prevalent diabetic medications (insulin, metformin, sulfonylureas, and SGLT-2 inhibitors). Primary outcomes included length of stay (LOS), operating room (OPR) time, 90-day reoperation, 90-day readmission, and nonroutine discharge. Binary outcomes were assessed using multivariate logistic regression, while the Mann-Whitney U test was used for continuous variables.</div></div><div><h3>Results</h3><div>The final matched cohort included 1385 patients (GLP-1 RA: <em>n</em> = 277; control: <em>n</em> = 1,108), with anterior cervical discectomy and fusion being the most common procedure (<em>n</em> = 333, 24%). The GLP-1 RA cohort was predominantly female (<em>n</em> = 172, 62.1%), with a mean age of 61.4 years and mean BMI of 33.8 kg/m². Both cohorts exhibited high rates of comorbidities, including diabetes and hypertension. GLP-1 RA use was associated with a significant reduction in median postoperative LOS (3 days vs. 4 days; p = 0.036), particularly among patients undergoing lumbar fusion. No significant differences were observed in OPR time, 90-day reoperation, 90-day readmission, or nonroutine discharge rates.</div></div><div><h3>Conclusions</h3><div>Preoperative GLP-1 RA use was associated with a statistically significant reduction in postoperative LOS among patients undergoing spinal decompression and/or fusion. Further prospective, multi-institutional studies are warranted to validate these findings and to determine whether this reduction translates into clinically and financially meaningful benefits, including improved long-term outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100612"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood socioeconomic disadvantage is not associated with adverse outcomes following elective spine surgery in older Veterans","authors":"Andrea L. Strayer PhD, ARNP ,&nbsp;Yubo Gao PhD ,&nbsp;Michael A. Jacobs MS ,&nbsp;Heather Davila PhD, MPA ,&nbsp;Carly A. Jacobs MPH ,&nbsp;Susanne Schmidt PhD ,&nbsp;Leslie R.M. Hausmann PhD, MS ,&nbsp;Paula K. Shireman MD, MS, MBA ,&nbsp;George Wehby PhD ,&nbsp;Daniel E. Hall MD, MDiv, MHSc ,&nbsp;Mary Vaughan Sarrazin PhD ,&nbsp;Katherine E. Hadlandsmyth PhD","doi":"10.1016/j.xnsj.2025.100611","DOIUrl":"10.1016/j.xnsj.2025.100611","url":null,"abstract":"<div><h3>Background</h3><div>In the US, over half of all cervical and lumbar arthrodesis spine surgeries are for people ≥60 years of age. The extent to which adverse outcomes vary by social (eg, disadvantaged neighborhoods) and demographic factors have been scarcely investigated in spine surgery. We investigated the association of social, demographic, and clinical factors with complications, 30-day readmission, and 30-day mortality in older Veterans undergoing elective spine surgery.</div></div><div><h3>Methods</h3><div>Veterans (N=5,277) aged ≥65 years who underwent inpatient elective spine surgery for degenerative disease in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) comprised our retrospective cohort. VASQIP (2013–2019) data were merged with other Veterans Health Administration (VHA) and Medicare administrative data. Multivariable logistic regression models were estimated to assess the associations of social (rurality, Area Deprivation Index [ADI]) and clinical (frailty, comorbidity) factors with complications, 30-day readmission, and 30-day mortality. The ADI is a neighborhood-level socioeconomic disadvantage ranking using 17 variables (eg, housing quality). We defined highly disadvantaged as ADI&gt;85.</div></div><div><h3>Results</h3><div>Veterans aged 65–74 years comprised 82.7%; 77.9% identified as White, 15.1% as Black, and 7.0% as another race; and 97.1% were male. Over one-third (38.9%) lived in rural areas and 12.3% lived in highly disadvantaged neighborhoods. Readmission and mortality were 10.0% and 0.6%, respectively, and 6.0% experienced complications. Rurality and ADI&gt;85 were not associated with complications, 30-day readmission, or 30-day mortality. Frailty, comorbidity, class-3 obesity, and operative stress were associated with adverse outcomes.</div></div><div><h3>Conclusions</h3><div>Social (rurality, ADI&gt;85) and demographic variables were not associated with complication, 30-day readmission, or 30-day mortality in older Veterans following elective spine surgery. While clinical factors (frailty, co-morbidity, class-3 obesity, and operative stress score) were associated with adverse outcomes, Veterans in this study did not experience disparities in medical outcomes due to social vulnerability. Untangling mechanisms connecting social and clinical factors may improve outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100611"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical radiculopathy management with physical, chiropractic, and acupuncture therapy: Factors associated with different therapy utilization patterns","authors":"Anthony E. Seddio BS,&nbsp;Beatrice M. Katsnelson BA,&nbsp;Michael J. Gouzoulis BS,&nbsp;Sahir S. Jabbouri MD,&nbsp;Anshu Jonnalagadda BS,&nbsp;Wesley Day BS,&nbsp;Daniel R. Rubio MD,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2025.100610","DOIUrl":"10.1016/j.xnsj.2025.100610","url":null,"abstract":"<div><h3>Background</h3><div>Cervical radiculopathy (CR) is a common cervical spine pathology. Following diagnosis, patients may seek conservative management including physical therapy (PT), chiropractic therapy (CT), and acupuncture therapy (AT). Literature supporting alternative management strategies remains limited and mixed, however, their utilization continues to rise.</div></div><div><h3>Methods</h3><div>Patients with a first-time diagnosis of CR were identified from the M165Ortho PearlDiver database. Exclusion criteria included: &lt;18 years of age, concurrent cervical myelopathy, therapy use prior to diagnosis, those with trauma, neoplasm or infection, and &lt;90-days follow-up. Utilization rates and mean PT, CT, and AT sessions within 90-days of CR diagnosis were compared. Clinical and nonclinical predictors of alternative therapy utilization patterns were compared by multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of 789,970 identified CR patients, PT was noted for 132,929 (16.8%), CT for 34,354 (4.4%), and AT for 1,916 (0.2%) within 90-days. CT demonstrated the highest number of sessions (7.81 ± 6.37), followed by PT (7.36 ± 5.54), and AT (5.89 ± 4.97) (p &lt; .05). Predictors of CT utilization, relative to PT were lower age (odds ratio [OR]: 0.84), lower comorbidity burden based on Elixhauser Comorbidity Index (OR: 0.91), region (South OR: 2.05, Northeast OR: 1.93, Midwest OR: 1.92), and insurance (Medicaid OR: 0.30 and Medicare OR: 0.92) (p &lt; .001 for all). Predictors of AT utilization, relative to PT were lower age (OR: 0.93, p &lt; .001), male sex (OR: 1.14, p = .004), region (West OR: 3.31, p &lt; .001, Northeast OR: 2.76, p &lt; .001, Midwest OR: 1.27, p = .002), and insurance (Medicaid OR: 0.29 and Medicare OR: 0.59, p &lt; .001).</div></div><div><h3>Conclusions</h3><div>Within 90-days following newly diagnosed CR, only a minority of patients utilized any form of therapy, despite typically being thought of as a first-line conservative management strategy. Among CR patients who did pursue therapy, PT was more commonly utilized than both CT and AT. The significance of nonclinical drivers of alternative therapeutic strategies suggests a lack of therapeutic consensus at a national level, potential inequities to access, and room for algorithm-driven care pathways.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100610"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual health and chronic low back pain: A qualitative study","authors":"David van Schaik ,&nbsp;Hanae Channa ,&nbsp;Maaike Fobelets ,&nbsp;Maarten Moens ,&nbsp;Thierry Scheerlinck ,&nbsp;Lisa Goudman","doi":"10.1016/j.xnsj.2025.100609","DOIUrl":"10.1016/j.xnsj.2025.100609","url":null,"abstract":"<div><h3>Background</h3><div>Chronic low back pain presents a major challenge to society and healthcare systems, with significant financial and personal consequences. Beyond physical limitations, it affects relationships and sexual well-being—an often-overlooked aspect. Reduced sexual activity and satisfaction can strain intimacy, heighten psychological stress, and amplify pain perception. Despite its importance, sexual health remains underdiscussed in clinical care, and research on this topic is limited. A holistic approach addressing both physical and psychological aspects, including sexual well-being, is essential.</div></div><div><h3>Methods</h3><div>This qualitative study included 12 sexually active patients (aged 18–90) with CLBP but without sexual dysfunction. Semi-structured interviews were conducted in January 2023, developed from existing literature by a multidisciplinary team. A single researcher conducted interviews (in person, by phone, or via video), lasting up to 60 minutes. An inductive thematic analysis using NVivo® involved transcript familiarization, coding, and theme development. Findings were reviewed and validated by the research team.</div></div><div><h3>Results</h3><div>All 12 patients completed interviews, with data saturation reached after 10. While CLBP had minimal impact on overall relationships, nearly all participants reported reduced sexual desire. However, most adapted by adjusting intercourse techniques, experimenting with positions to minimize strain. A gender difference emerged: male participants emphasized partner satisfaction but did not express guilt when unable to engage, whereas female participants reported feelings of guilt.</div></div><div><h3>Conclusion</h3><div>Chronic low back pain led to reduced desire and the need to adapt sexual practices. Despite these challenges, many participants reported positive relationships, often thanks to empathetic partners and finding alternatives during intercourse. As a result, sexual activity and satisfaction were not affected contradicting existing literature that suggests lower desire typically leads to lower satisfaction. However, discussing sexual issues with healthcare providers was difficult, with participants preferring experienced specialists and face-to-face consultations, while finding peer support groups valuable for emotional support.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100609"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}