North American Spine Society Journal最新文献

{"title":"Laminoplasty compared to laminectomy and fusion for degenerative cervical myelopathy: a cost-utility analysis","authors":"Christopher S Lozano ,&nbsp;Vishwathsen Karthikeyan ,&nbsp;Armaan K Malhotra ,&nbsp;Husain Shakil ,&nbsp;Abdullah Ishaque ,&nbsp;Jasleen Saini ,&nbsp;Yingshi He ,&nbsp;Eva Y Yuan ,&nbsp;Jetan H Badhiwala ,&nbsp;Michael G Fehlings ,&nbsp;Jefferson R Wilson ,&nbsp;Christopher D Witiw","doi":"10.1016/j.xnsj.2025.100753","DOIUrl":"10.1016/j.xnsj.2025.100753","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord dysfunction in adults. Posterior surgical options include laminoplasty (LP), a motion-preserving procedure, and laminectomy with fusion (LF), which offers stabilization but at higher cost. A cost-utility comparison of these approaches is lacking.</div></div><div><h3>Methods</h3><div>We conducted a cost-utility analysis using a 5-year Markov state-transition model from a healthcare payer perspective. The study cohort was drawn from 3 multicenter prospective studies of patients with DCM. To reduce baseline confounding, patients who underwent LF or LP were matched 2:1 using propensity score matching. Quality-adjusted life years (QALYs) were derived from SF-6D utilities calculated from SF-36 scores at baseline and 12 months. Costs and transition probabilities were derived from meta-analysis and registry data. We calculated incremental cost-utility ratios (ICURs) and net monetary benefit (NMB) using a willingness-to-pay (WTP) threshold of $100,000 per QALY. Sensitivity analyses included deterministic variation and 1,000-iteration Monte Carlo microsimulation.</div></div><div><h3>Results</h3><div>240 matched patients were included (87 LP, 153 LF). Baseline mJOA, NDI and SF6D scores were similar between groups. In the base-case, LP cost $24,283, yielding 3.53 QALYs, while LF cost $35,902, yielding 3.72 QALYs, resulting in an incremental cost-utility ratio (ICUR) of $59,796 per QALY, favouring LF. In probabilistic microsimulation, LP had a mean cost of $24,579 (95% confidence interval (CI): $23,933–$25,225) and a mean NMB of $326,281 (95% CI: $322,672–$329,891), while LF cost $35,936 (95% CI: $35,583–$36,288) with a mean NMB of $333,189 (95% CI: $328,629–$337,748). LP was the optimal strategy in 47% of simulations versus 53% for LF.</div></div><div><h3>Conclusions</h3><div>Both LP and LF can be cost-effective for DCM. While the base-case favored LF, probabilistic sensitivity analysis revealed no clear cost-utility advantage with comparable NMBs. Economic considerations alone should not drive surgical decision-making and treatment choice should be tailored to individual patient factors and local resource contexts.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100753"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633291","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":"Preclinical evaluation of lateral interbody fusions using 3D printed PEEK or 3D printed titanium cages","authors":"William Robert Walsh PhD ,&nbsp;Matthew Pelletier PhD ,&nbsp;Dan Wills PhD, BScVet ,&nbsp;Tian Wang PhD ,&nbsp;Max Lloyd BScVet ,&nbsp;Michael Veldman BS ,&nbsp;Nick Cordaro BS ,&nbsp;Mark Brady PhD","doi":"10.1016/j.xnsj.2025.100756","DOIUrl":"10.1016/j.xnsj.2025.100756","url":null,"abstract":"<div><h3>Background</h3><div>PEEK interbody cages are well established. 3D porous PEEK designs can now be produced with additive manufacturing. This study compared the in-vivo response of additive manufactured porous PEEK (3D PEEK) and titanium alloy (3D Ti) cages.</div></div><div><h3>Methods</h3><div>Interbody fusion was performed in 11 adult sheep at 2 levels (L2-3 and L4-5) using 3D PEEK and 3D Ti cages filled with autograft with posterior bilateral pedicle screw fixation. Fusions were evaluated at 8 and 16 weeks via manual palpation, microcomputed tomography (microCT), histology, and histomorphometry.</div></div><div><h3>Results</h3><div>All animals recovered well following surgery with no adverse events. The radiolucent nature of PEEK allowed the fusions to be evaluated using radiographs and microCT. The 3D Ti cages however appeared solid rather than porous in the radiographs and presented artifacts in the microCT scans which precluded definitive determination of the fusions. Range of motion results improved with time for 3D PEEK and 3D Ti while no differences between designs were detected. Histology and histomorphometry confirmed 3D PEEK and 3D Ti supported fusion in this model using autograft.</div></div><div><h3>Conclusions</h3><div>Range of motion and histology results were similar for 3D PEEK and 3D Ti. Radiographs and microCT could be used to assess the fusions with 3D PEEK due to the radiolucent nature. 3D Ti appeared solid in the radiographs and had image artifact in microCT which precluded definitive evaluation of the fusions. 3D PEEK and 3D Ti cages both support interbody fusion in this preclinical model.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100756"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687217","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":"Frailty as an Independent predictor of perioperative risk and recovery in long-segment thoracolumbar fusion surgery: A retrospective cohort study","authors":"Ishav Y. Shukla BS ,&nbsp;Sukul Mittal BS ,&nbsp;Emerson Lout BS ,&nbsp;Kristen Hall BS, MBA ,&nbsp;Umaru Barrie MD, PhD ,&nbsp;Omar S. Akbik MD ,&nbsp;Salah G. Aoun MD ,&nbsp;Carlos A. Bagley MD, MBA","doi":"10.1016/j.xnsj.2025.100749","DOIUrl":"10.1016/j.xnsj.2025.100749","url":null,"abstract":"<div><h3>Background</h3><div>Frailty, a multifactorial condition reflecting diminished physiological reserve, is associated with worse surgical outcomes and recovery, particularly in complex surgical procedures. This study aims to investigate frailty, as measured by the mFI-5, as a predictor of perioperative risk and recovery in patients undergoing long-segment thoracolumbar fusion for adult spinal deformity (ASD).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis to identify patients undergoing long-segment thoracolumbar fusion for ASD. Our primary outcome measures included anesthesia duration, estimated blood loss (EBL), intraoperative blood transfusion volumes, ICU stay duration, hospital length of stay (LOS), time to ambulation, postoperative complications, readmission rates, and discharge disposition. Patients were categorized as not frail (mFI-5 = 0), partially frail (mFI-5 = 1), or frail (mFI-5 ≥ 2). ANOVA and chi-square tests examined group differences, while multivariable regression, adjusting for age, gender, BMI, and number of levels fused, assessed frailty’s impact on perioperative outcomes.</div></div><div><h3>Results</h3><div>About 235 patients were included; 45.1% were frail, 34.5% were partially frail, and 20.4% were not frail. In multivariable regression analysis, each unit increase in frailty score was associated with longer anesthesia duration (β = 11.1 minutes, p = .023), greater EBL (β = 150.5 mL, p = .026), and higher intraoperative blood transfusion volumes (β = 228.2 mL, p = .002). Frailty also independently predicted prolonged ICU stays (β = 9.0 hours, p = .002), increased hospital LOS (β = 0.6 days, p = .015), and delayed time to ambulation (β = 0.4 days, p = .039). Postoperative complications, readmission rates, and discharge disposition were not significantly different among frailty groups.</div></div><div><h3>Conclusions</h3><div>Frailty independently predicts longer anesthesia duration, greater EBL, increased intraoperative transfusion requirements, and significantly delayed postoperative recovery in ASD patients, including prolonged ICU stays, extended hospital LOS, and delayed ambulation. While targeted perioperative strategies—such as optimizing preoperative comorbidities and enhancing intraoperative monitoring and rehabilitation—may not reduce a patient’s underlying frailty status, our findings suggest that early identification of frailty can help tailor perioperative planning, anticipate recovery trajectories, and support informed decision-making for clinicians and patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100749"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571086","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":"Application of deformity principles in the management of spinal neoplasms: A Primer","authors":"Zach Pennington MD ,&nbsp;Joseph H Schwab MD ,&nbsp;Sheng-fu Larry Lo MD MHS ,&nbsp;C. Rory Goodwin MD PhD ,&nbsp;Matthew L Goodwin MD PhD ,&nbsp;Matthew Colman MD ,&nbsp;Raphaële Charest-Morin MD ,&nbsp;Nicolas Dea MD ,&nbsp;Daniel Lubelski MD ,&nbsp;Ali Ozturk MD ,&nbsp;Jacob M. Buchowski MD MS ,&nbsp;Wende Gibbs MD ,&nbsp;Wesley Hsu MD ,&nbsp;Ajit Krishnaney MD ,&nbsp;Ilya Laufer MD ,&nbsp;Mohamed Macki MD ,&nbsp;Addisu Mesfin MD ,&nbsp;Ganesh Shankar MD PhD ,&nbsp;Dan Tobert MD ,&nbsp;John Shin MD MBA ,&nbsp;Daniel M Sciubba MD MBA","doi":"10.1016/j.xnsj.2025.100779","DOIUrl":"10.1016/j.xnsj.2025.100779","url":null,"abstract":"<div><h3>Background</h3><div>With advances in surgical techniques, radiation, and systemic therapy, prognoses and quality of life have improved amongst patients with primary and metastatic vertebral column tumors. Sagittal deformity is known to have an adverse impact on patient quality of life but has been largely ignored in this study population.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted, focusing on articles germane to the study of spinal deformity in the context of oncologic disease. Articles included those focusing on bone health, the association of spinal deformity with oncologic spine disease, and both pelvic and anterior column reconstruction in patients treated for primary tumors.</div></div><div><h3>Results</h3><div>Little to date has focused specifically on the management of spinal deformity in the context of spinal tumors. However, it is known that tumor involvement of the vertebral column is associated with poorer screw purchase, which can be further worsened by radiotherapy. Instrumentation techniques that seek to address underlying deformity must also balance the need for radiographic follow-up, which is improved with novel carbon fiber-reinforced polyetheretherketone implants, and the need for intraoperative contouring. Last, residual deformity is associated with poorer patient reported outcomes and increased mechanical complications in adult spinal deformity, but better study within the spinal oncology population is merited.</div></div><div><h3>Conclusion</h3><div>The potential negative impact of spinal deformity on patient quality of life in the spinal oncology population is now better appreciated amongst spinal oncologists, but studies have been limited to date. Further investigation is merited as survival outcomes continue to improve.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100779"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925044","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":"Social media best practices for the spine care professional","authors":"Zachary A. Cupler DC, MS ,&nbsp;Andrew Trontis MD, MS ,&nbsp;Brandon Lucke-Wold MD, PhD ,&nbsp;Samuel M. Schut DC ,&nbsp;Khoi D. Than MD ,&nbsp;James E. Eubanks MD, DC, MS ,&nbsp;Robert J. Butler DC ,&nbsp;Reem Elwy MRCS ,&nbsp;David Gendelberg MD","doi":"10.1016/j.xnsj.2025.100748","DOIUrl":"10.1016/j.xnsj.2025.100748","url":null,"abstract":"<div><h3>Background</h3><div>Physicians, allied health clinicians, scientists, and industry partners’ use of social media has grown exponentially, permeating across all levels of healthcare delivery and practice. Spine care professionals can interact with both professional and patient audiences across social media platforms.</div></div><div><h3>Methods</h3><div>This article aims to narratively outline social media best practices for the spine care professional.</div></div><div><h3>Results</h3><div>Thirty-two social media best practice statements are presented to help guide spine care professionals. The best practice statements are thematically organized: (1) Compliance and Confidentiality, (2) Professionalism, (3) Security and Access, and (4) Spine Care.</div></div><div><h3>Conclusions</h3><div>Social media represents a broadcasting platform for communication between clinicians and patients alike, presenting with it numerous advantages and challenges. As spine care professionals we must learn how to engage in its utilization in both educational and professional-social environments.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100748"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557350","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":"Obturator inlet and iliac oblique fluoroscopic views allow for placement of longer iliac screws","authors":"Monty Khela BA ,&nbsp;Obiajulu Agha MD ,&nbsp;Mark Xu MD ,&nbsp;Neel Anand MD ,&nbsp;David Gendelberg MD ,&nbsp;Ashraf N. El Naga MD","doi":"10.1016/j.xnsj.2025.100751","DOIUrl":"10.1016/j.xnsj.2025.100751","url":null,"abstract":"<div><h3>Background</h3><div>Achieving strong distal fixation in posterior spinal fusion (PSF) surgeries sometimes necessitates iliac screw placement. However, traditional methods such as freehand and CT navigation techniques face limitations concerning screw length, accuracy, ergonomic challenges, surgical time, and drill deflection. Fluoroscopic iliac screw guidance using the obturator inlet and iliac oblique (OIIO) views may mitigate some of these drawbacks.</div></div><div><h3>Methods</h3><div>This retrospective comparative study was conducted at a university-affiliated tertiary care hospital and Level 1 trauma center, reviewing cases from January 2020 to December 2022. A total of 119 patients who underwent posterior spinal fusion with pelvic fixation were included and categorized into 3 groups: OIIO (<em>n</em> = 20), freehand (<em>n</em> = 46), and CT navigation-assisted (<em>n</em> = 53). Screw length, diameter, and cortical breach rates were assessed using intraoperative and postoperative imaging. Statistical analyses were performed using 1-way ANOVA and Fisher’s Exact test (p &lt; .05).</div></div><div><h3>Results</h3><div>Screw lengths were 97.95 ± 6.95 mm, 78.68 ± 5.17 mm, and 85.27 ± 7.01 mm in the OIIO, freehand, and navigation groups, respectively (p &lt; .0001). Despite the longer screws, the OIIO group had no cortical breaches, compared to 0.58% in the freehand group and 0% in the CT navigation group (p = .5683). No significant differences were observed in iliac screw revision rates across groups (p = .6175), suggesting the OIIO technique is not inferior to freehand and navigation-assisted methods regarding safety and screw length.</div></div><div><h3>Conclusions</h3><div>The OIIO technique allows for favorable screw sizes compared to freehand and navigation-assisted methods without increasing cortical breach risk. This technique provides a safe and ergonomic alternative, particularly in settings where advanced navigation technology is unavailable.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100751"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536057","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":"Can artificial intelligence in spine imaging affect current practice? Practical developments and their clinical status","authors":"Yu-Cherng Chang MD, PhD ,&nbsp;Cinthia Del Toro BS ,&nbsp;Joseph P. Gjolaj MD ,&nbsp;Thiago A. Braga MD ,&nbsp;Ty K. Subhawong MD","doi":"10.1016/j.xnsj.2025.100621","DOIUrl":"10.1016/j.xnsj.2025.100621","url":null,"abstract":"<div><h3>Background</h3><div>As artificial intelligence (AI) increases its footprint in spine imaging, gauging the clinical relevance of new developments poses an increasingly difficult challenge, especially given the majority of developments reflect experimental or early work. With this summary of available AI tools, focusing on those in clinical use, the benefits of AI in spine imaging are explained for radiologists and surgeons to understand the current state of and potentially the decision to adopt AI in clinical practice.</div></div><div><h3>Methods</h3><div>Through a narrative review of publications relating to “artificial intelligence” and “spine imaging” in the PubMed database, this article provides an update on AI applications in spine imaging being utilized in current clinical practice.</div></div><div><h3>Results</h3><div>Current applications of AI in spine imaging range from deep learning image reconstruction and denoising, spine segmentation and biometry, radiological report generation, surgical outcomes prediction, surgical planning, to intraoperative assistance. Developments in deep learning reconstruction (DLR) are most mature and demonstrate improvements to imaging speed and interpretability compared to non-AI alternatives. While clinical implementations exist in other use cases, their performance remains either an area of active investigation or comparable to the level of a human.</div></div><div><h3>Conclusions</h3><div>Uses of AI in spine imaging span multiple applications with early clinical implementation in most areas, suggesting a promising future ahead.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100621"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513959","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":"Therapeutic exercise following lumbar spine surgery: a narrative review","authors":"Ram Haddas PhD, MBA ,&nbsp;Andréas Remis DPT ,&nbsp;Yair Barzilay MD ,&nbsp;Varun Puvanesarajah MD ,&nbsp;Jake Keller DPT ,&nbsp;Brian M Clifford DPT, OCS, CSCS ,&nbsp;Justin M. Lantz DPT ,&nbsp;John M. Mayer DC, PhD, FACSM","doi":"10.1016/j.xnsj.2025.100620","DOIUrl":"10.1016/j.xnsj.2025.100620","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic exercise is often part of the rehabilitation process following lumbar spine surgery. Despite this utilization, high-quality evidence and specific guidance regarding therapeutic exercise parameters and protocols following lumbar spine surgery remain sparse. The purpose of this manuscript is to provide a narrative review of the current evidence regarding exercise prescription, activity recommendations, and outcome measures following lumbar discectomy, fusion, and total disc replacement surgeries.</div></div><div><h3>Methods</h3><div>A comprehensive narrative review was conducted regarding postoperative exercise for lumbar spine surgery, a summary of the current available literature was provided and interpreted, and future directions for research were identified.</div></div><div><h3>Results</h3><div>The findings of narrative review generally support supervised therapeutic exercise as safe and beneficial following lumbar discectomy, fusion, and total disc arthroplasty surgeries. Initial exercise prescriptions should be individualized according to patient and surgical factors, including prior level of function, comorbidities, and tissue healing timelines, to support recovery goals. These findings can be useful for surgeons and rehabilitation practitioners to provide general guidance and to counsel patients on appropriate therapeutic exercises and activity recommendations following lumbar spine surgery, with a particular focus on the safety of exercise types and when to initiate exercise postoperatively. Physical activity monitoring (eg, wearables) can be used to complement postsurgical therapeutic exercise and enhance outcomes.</div></div><div><h3>Conclusions</h3><div>This review provides the most current evidence regarding the safety and effectiveness of therapeutic exercise following lumbar spine surgery. Given the narrative format of this review, these findings are not intended to serve as clinical practice guidelines or provide specific recommendations about implementation. Thus, pragmatic implementation of exercise following lumbar spine surgery depends on the patient's distinct presentation, surgical factors, expertise and experience of the clinician, available resources, and patient preferences. Future prospective research trials and subsequent systematic reviews are needed to elucidate specific factors regarding the use of therapeutic exercise following lumbar spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100620"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491453","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":"Sleep apnea increases odds of 90-day postoperative complications and healthcare utilization following lumbar discectomy","authors":"Beatrice M Katsnelson BA,&nbsp;Albert L Rancu BS,&nbsp;Adam D Winter MS,&nbsp;Anshu Jonnalagadda BS,&nbsp;Julian Smith-Voudouris BS,&nbsp;Jonathan N Grauer MD","doi":"10.1016/j.xnsj.2025.100765","DOIUrl":"10.1016/j.xnsj.2025.100765","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative adverse events following lumbar discectomy (LD) are important to characterize for patient counseling and risk management, particularly in potentially vulnerable patient populations, such as those with sleep apnea (SA). Although increasing screening and optimization pathways are starting to be put into place for patients with SA in general, specific attention to this condition in relation to LD has not been reported.</div></div><div><h3>Methods</h3><div>Adult patients undergoing isolated, single-level, lumbar laminotomy/discectomy were identified from the 2010 to 2022 PearlDiver Mariner database. Those without versus with SA were matched 4:1 based on age, sex, and Elixhauser comorbidity index (ECI). Ninety-day severe and minor adverse events, emergency department (ED) visits, and readmissions were assessed and compared with multivariate analysis. Overall 90-day reimbursements and 5-year revisions were assessed and compared.</div></div><div><h3>Results</h3><div>Of a total of 200,515 LD patient, SA was identified for 24,975 (12.5%). After matching, there were 74,391 without sleep apnea and 18,734 with sleep apnea. Patients with SA had independently higher odds-ratio (OR) of experiencing most 90-day postoperative adverse events, as well as aggregated severe (OR: 1.60) and minor (OR: 2.66) adverse events (p&lt;.0001 for each). Patients with SA were also at higher odds of 90-day ED visits (OR: 2.76) and median overall 90-day reimbursement ($3,300.00 vs.. $3,106.00) (p&lt;.0001 for both). Further, patients with SA were more likely to undergo 5-year subsequent lumbar surgery (p=.01).</div></div><div><h3>Conclusions</h3><div>While increasing attention has been given to SA around surgical interventions, the current study defined that over a tenth of LD patients had diagnosed SA and were at greater odds of severe and minor adverse events, as well as reoperations, in their postoperative period. This translated to greater health care utilization and cost. Consequently, patients with SA ought to receive supplemental risk counseling and postoperative resource planning when considered for LD.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100765"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679119","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 utilization of a novel Outpatient Appropriateness Fragility Score to predict inpatient stay following biportal lumbar endoscopic decompression","authors":"Thomas E. Olson M.D. ,&nbsp;Carlos Maturana M.D. ,&nbsp;Christopher D. Hamad M.D. ,&nbsp;Alex M. Upfill-Brown M.D. ,&nbsp;William L. Sheppard M.D. ,&nbsp;Don Young Park M.D.","doi":"10.1016/j.xnsj.2025.100752","DOIUrl":"10.1016/j.xnsj.2025.100752","url":null,"abstract":"<div><h3>Background</h3><div>Biportal endoscopic spine surgery offers advantages such as reduced postoperative pain and faster recovery, often enabling same-day discharge. However, the patient-specific factors influencing the need for inpatient admission remain unclear. This study evaluates variables contributing to overnight stays following biportal lumbar endoscopic decompression and proposes a predictive fragility score.</div></div><div><h3>Methods</h3><div>A retrospective analysis of prospectively collected data was conducted on 84 consecutive patients undergoing one- or two-level lumbar endoscopic decompression at a single U.S. academic center. Patients with trauma, tumor, infection, or revision procedures were excluded. Cohorts were divided by discharge status: same-day discharge (outpatient) versus one or more night hospital stay (inpatient). A novel fragility score (4–21 points) incorporating age, body mass index (BMI), comorbidities, and procedure type was developed. Sarcopenia was assessed using the psoas muscle index (PMI), defined as the ratio of psoas to vertebral cross-sectional area on preoperative imaging. Cutoff values were analyzed via Youden’s <em>J</em> statistic and receiver operating characteristic analysis.</div></div><div><h3>Results</h3><div>Same-day discharge patients were significantly younger (55.3 vs. 68.5 years; p=.0003) and had lower American Society of Anesthesiologists (2.0 vs. 2.7; p&lt;.0001) and Charlson Comorbidity Index scores (1.6 vs. 3.5; p&lt;.0001). No significant BMI difference was observed (p=.4341). Outpatients more frequently underwent discectomy; inpatients more commonly received ULBD and two-level decompression (p&lt;.0001, p=.0014). A fragility score ≥11 predicted inpatient stay with an area under the curve (AUC) of 0.810, outperforming Modified 5-Item Frailty Index (AUC 0.640). PMI did not differ between groups (p=.6732), with AUCs of 0.417 overall, and 0.482 (males), 0.487 (females). Fragility score and PMI were weakly correlated (<em>r</em>=–0.130).</div></div><div><h3>Conclusions</h3><div>The proposed Outpatient Appropriateness Fragility Score effectively predicts inpatient admission after biportal lumbar decompression. Factors such as age, comorbidities, and surgical extent are more predictive than BMI or sarcopenia. This tool may guide preoperative planning and optimize resource utilization.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100752"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633310","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}