North American Spine Society Journal最新文献

{"title":"Lumbar pedicle subtraction osteotomy: techniques and outcomes","authors":"","doi":"10.1016/j.xnsj.2024.100516","DOIUrl":"10.1016/j.xnsj.2024.100516","url":null,"abstract":"<div><p>Pedicle subtraction osteotomy has been thoroughly described and studied over the past 2 decades, being applied mainly in the lumbar spine, followed by the thoracic spine. Our better understanding of alignment biomechanics, and the progressive refinements of the surgical technique over time made it a very efficient procedure for the management of fixed sagittal malalignment. However, a long learning curve is mandatory to mitigate the associated risks particularly neurological deficits and achieve satisfactory clinical and radiological outcomes with an acceptable rate of complications.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002099/pdfft?md5=cc627705b747febabd53ce85ed9bf696&pid=1-s2.0-S2666548424002099-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714659","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":"Osteoporotic vertebral compression fracture (OVCF) detection using artificial neural networks model based on the AO spine-DGOU osteoporotic fracture classification system","authors":"","doi":"10.1016/j.xnsj.2024.100515","DOIUrl":"10.1016/j.xnsj.2024.100515","url":null,"abstract":"<div><h3>Background</h3><p>Osteoporotic Vertebral Compression Fracture (OVCF) substantially reduces a person's health-related quality of life. Computer Tomography (CT) scan is currently the standard for diagnosis of OVCF. The aim of this paper was to evaluate the OVCF detection potential of artificial neural networks (ANN).</p></div><div><h3>Methods</h3><p>Models of artificial intelligence based on deep learning hold promise for quickly and automatically identifying and visualizing OVCF. This study investigated the detection, classification, and grading of OVCF using deep artificial neural networks (ANN). Techniques: Annotation techniques were used to segregate the sagittal images of 1,050 OVCF CT pictures with symptomatic low back pain into 934 CT images for a training dataset (89%) and 116 CT images for a test dataset (11%). A radiologist tagged, cleaned, and annotated the training dataset. Disc deterioration was assessed in all lumbar discs using the AO Spine-DGOU Osteoporotic Fracture Classification System. The detection and grading of OVCF were trained using the deep learning ANN model. By putting an automatic model to the test for dataset grading, the outcomes of the ANN model training were confirmed.</p></div><div><h3>Results</h3><p>The sagittal lumbar CT training dataset included 5,010 OVCF from OF1, 1942 from OF2, 522 from OF3, 336 from OF4, and none from OF5. With overall 96.04% accuracy, the deep ANN model was able to identify and categorize lumbar OVCF.</p></div><div><h3>Conclusions</h3><p>The ANN model offers a rapid and effective way to classify lumbar OVCF by automatically and consistently evaluating routine CT scans using AO Spine-DGOU osteoporotic fracture classification system.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002087/pdfft?md5=f7f1b7d64cc4de795abdd991aca59bd4&pid=1-s2.0-S2666548424002087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689227","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":"Development of a natural language processing algorithm for the detection of spinal metastasis based on magnetic resonance imaging reports","authors":"","doi":"10.1016/j.xnsj.2024.100513","DOIUrl":"10.1016/j.xnsj.2024.100513","url":null,"abstract":"<div><h3>Background</h3><p>Metastasis to the spinal column is a common complication of malignancy, potentially causing pain and neurologic injury. An automated system to identify and refer patients with spinal metastases can help overcome barriers to timely treatment. We describe the training, optimization and validation of a natural language processing algorithm to identify the presence of vertebral metastasis and metastatic epidural cord compression (MECC) from radiology reports of spinal MRIs.</p></div><div><h3>Methods</h3><p>Reports from patients with spine MRI studies performed between January 1, 2008 and April 14, 2019 were reviewed by a team of radiologists to assess for the presence of cancer and generate a labeled dataset for model training. Using regular expression, impression sections were extracted from the reports and converted to all lower-case letters with all nonalphabetic characters removed. The reports were then tokenized and vectorized using the doc2vec algorithm. These were then used to train a neural network to predict the likelihood of spinal tumor or MECC. For each report, the model provided a number from 0 to 1 corresponding to its impression. We then obtained 111 MRI reports from outside the test set, 92 manually labeled negative and 19 with MECC to test the model's performance.</p></div><div><h3>Results</h3><p>About 37,579 radiology reports were reviewed. About 36,676 were labeled negative, and 903 with MECC. We chose a cutoff of 0.02 as a positive result to optimize for a low false negative rate. At this threshold we found a 100% sensitivity rate with a low false positive rate of 2.2%.</p></div><div><h3>Conclusions</h3><p>The NLP model described predicts the presence of spinal tumor and MECC in spine MRI reports with high accuracy. We plan to implement the algorithm into our EMR to allow for faster referral of these patients to appropriate specialists, allowing for reduced morbidity and increased survival.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424002063/pdfft?md5=01450dbc60198665e1ef96ae67a4c9a2&pid=1-s2.0-S2666548424002063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700355","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":"12. Residual paresthesia and satisfaction after surgery for cervical myelopathy","authors":"","doi":"10.1016/j.xnsj.2024.100350","DOIUrl":"10.1016/j.xnsj.2024.100350","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Surgical intervention for degenerative cervical myelopathy (DCM) is intended to improve or prevent further decline in the patient's physical function and overall quality of life (QOL). Despite improvements in both myelopathy and QOL post-surgery, many patients express dissatisfaction due to the persistence of severe residual paresthesia.</p></div><div><h3>PURPOSE</h3><p>This study seeks to determine the frequency of residual paresthesia following DCM surgery and to evaluate its impact on clinical outcomes and patient satisfaction.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A multi-center, prospective cohort study</p></div><div><h3>PATIENT SAMPLE</h3><p>The study included 187 patients who underwent laminoplasty for DCM.</p></div><div><h3>OUTCOME MEASURES</h3><p>Assessed measures included preoperative factors, variations in clinical scores (JOA scores, VAS of upper extremity paresthesia, VAS of neck pain, NDI, EQ-5D-5l, and JOACMEQ), radiographic parameters (cervical sagittal vertical axis, C2-C7 angle, and C2-7 range of motion), and a 5-level satisfaction scale at 1 year postoperatively.</p></div><div><h3>METHODS</h3><p>Participants were categorized into two groups based on their VAS scores for upper extremity paresthesia at 1-year post-surgery: severe paresthesia (&gt;40 mm) and no/mild paresthesia (≤40 mm). Comparative analysis of preoperative factors, changes in clinical scores and radiographic factors, and satisfaction levels at 1-year post-surgery was performed between the groups.</p></div><div><h3>RESULTS</h3><p>Out of 187 patients, 86 experienced severe residual paresthesia 1-year postoperatively. Preoperative pain scale scores were significantly linked to postoperative residual paresthesia, independent of age, initial paresthesia severity, and other preoperative clinical scores (p=0.032). Mixed-effect modeling indicated that patients with severe residual paresthesia showed significantly less improvement in QOL (p=0.046) and myelopathy (p=0.037) compared to those with no/mild paresthesia. Logistic regression revealed that residual paresthesia was a significant predictor of lower treatment satisfaction, independent of myelopathy and QOL improvements (adjusted odds ratio: 2.5, p=0.010).</p></div><div><h3>CONCLUSION</h3><p>At one year postoperatively, 45% of DCM patients exhibited severe residual paresthesia, correlating with significantly lower satisfaction with their treatment despite improvements in myelopathy and QOL. These findings suggest that a multidisciplinary approach addressing residual paresthesia, including pharmacological management of neuropathic pain, may be essential for improving patient outcomes.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266654842400043X/pdfft?md5=58509d5bfab25d1062167913aad166a2&pid=1-s2.0-S266654842400043X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845338","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":"44. Orientation of lumbar facet joints based on age in white and black patients","authors":"","doi":"10.1016/j.xnsj.2024.100382","DOIUrl":"10.1016/j.xnsj.2024.100382","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Several studies found the age-related changes in the orientation of lumbar facet joints in Asian population. However, there is a paucity of literature on the association between orientation of the lumbar facet joints and age in white and Black population.</p></div><div><h3>PURPOSE</h3><p>To explore the association between orientation of the lumbar facet joints and age in white and Black population.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A cross-sectional study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients aged 20-79, who underwent abdominal and pelvic computed tomography (CT) for the trauma screening in New York City area and whose race was classified as “white” and “Black” on the questionnaire, were recruited in the study from Mar 2019 to Mar 2020.</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>In total, there were 1,343 subjects included, 650 white (339 females, 311 males) and 693 Black (355 females, 338 males) patients. Subjects were recruited based on their subgroups until there was a minimum of 45 measurements at each facet joint level in each of the 24 subgroups. The subgroups were based on gender, race, and 10-year age range. Facet joint orientation angle of both sides was measured and averaged at L1/2, L2/3, L3/4, L4/5, and L5/S1 in the axial planes on CT images. Associations between the angle and age were analyzed.</p></div><div><h3>RESULTS</h3><p>Facet joint angles significantly increased with aging at L1/2 in white population and decreased at all the levels in Black population (p&lt;0.05). Facet joint angles significantly increased with aging at L1/2 in white females and decreased at all the levels in Black females (p&lt;0.05). Facet joint angles significantly increased with aging at L1/2 in white males and decreased with aging at L1/2, L2/3, L3/4, and L4/5 in Black males (p&lt;0.05). At L4/5, age-related decrease was most remarkable in Black females and the angle was the smallest in 70 years of age in Black females.</p></div><div><h3>CONCLUSIONS</h3><p>Lumbar facet joint angles significantly decreased with aging in Black females and males, while not in white females or males. At L4/5, decreasing facet joint angles with aging was most remarkable in Black females. Our results may explain the high prevalence of degenerative spondylolisthesis at L4/5 in Black females.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000751/pdfft?md5=b7af01df9a8f88006e7caeeafb48a2a3&pid=1-s2.0-S2666548424000751-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843252","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":"7. Development of a web application for predicting Asia Impairment Scale at discharge in spinal cord injury patients: a machine learning approach","authors":"","doi":"10.1016/j.xnsj.2024.100345","DOIUrl":"10.1016/j.xnsj.2024.100345","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Precise ASIA Impairment Scale (AIS) prediction at discharge for spinal cord injury (SCI) patients is crucial for guiding treatments, indicating regenerative medicine, and rehabilitation. Machine learning (ML) models are promising to improve such prognostic accuracy and aid clinical decisions.</p></div><div><h3>PURPOSE</h3><p>We aimed to create an ML model that predicts discharge AIS, to identify predictive factors, and to integrate this model into a web application.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>This study used data from a nationwide database in Japan, the Japan Rehabilitation Database (JARD), consisting of records from 1991 to 2015. JARD contains both the SCI patients admitted to the SCI center right after the injury and the SCI patients referred to a rehabilitation hospital following acute phase treatment. In total, 3,703 cases formed the study cohort.</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Patient demographics, SCI-specific characteristics, and neurological evaluations at admission were used for ML model training. Utilizing the PyCaret library for preprocessing and validating the models, the best-performing algorithm was selected based on R², accuracy, and the weighted Kappa coefficient. Shapley additive explanations (SHAP) were used to determine the contribution of individual variables to the model's predictions. Using the optimal ML model and Streamlit, a web application to predict AIS at discharge was deployed.</p></div><div><h3>RESULTS</h3><p>The study divided the dataset into 2,592 training cases and 1,111 testing cases. The best-performing model exhibited an R² of 0.869, an accuracy of 0.814, and a weighted Kappa of 0.940. Eleven significant variables were identified with SHAP, including AIS at admission, days from injury to admission, and the motor score of L3. Using the Streamlit library, this best-performing model was deployed as an open-access web application. (<span><span>http://3.138.174.54:8502/</span><svg><path></path></svg></span>)</p></div><div><h3>CONCLUSIONS</h3><p>The developed ML model accurately predicts the AIS at discharge, using 11 essential variables. It has been integrated into a publicly accessible web application.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000386/pdfft?md5=d34e96581a3d3ea707979096af6848aa&pid=1-s2.0-S2666548424000386-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954600","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":"37. Early versus late decompression for lumbar spinal nerve injury: a propensity score matched analysis","authors":"","doi":"10.1016/j.xnsj.2024.100375","DOIUrl":"10.1016/j.xnsj.2024.100375","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Traumatic lumbar spinal injury often necessitates surgical decompression of the thecal sac, nerve roots, or peripheral nerves. While there is some evidence in the literature to suggest a benefit to early surgery within 24 hours, there has yet to be a consensus and society recommendations for the timing of decompressive surgery for lumbar spine injuries.</p></div><div><h3>PURPOSE</h3><p>To evaluate the effect of early versus late decompressive surgery on inpatient outcomes at a nationwide level in the United States.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort database study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients from the American College of Surgeons National Trauma Data Bank (NTDB) from 2017-2021.</p></div><div><h3>OUTCOME MEASURES</h3><p>The primary outcome measures are all-cause mortality and overall hospital length of stay (LOS). Secondary outcome measures entail hospital complications such as pressure ulcers and acute kidney injury (AKI) and discharge disposition such as routine discharge to home and discharge to skilled nursing.</p></div><div><h3>METHODS</h3><p>The NTDB was queried from 2017-2021 for all patients with a lumbar spinal cord or nerve injury matching the ICD-10-CM code S34. Patients younger than 18 years, who did not undergo surgical decompression, or who were missing outcome data were excluded. Patients were divided in the early surgery group if they underwent decompression within 24 hours and in the late surgery group if they underwent decompression at or after 24 hours. Propensity score matching was performed using the k-nearest neighbors algorithm based on patient age, sex, race, ethnicity, comorbidities, Glasgow Coma Scale, and insurance type. Equal post-match balance was evaluated using a standard mean difference threshold of 0.1. Early and late patients were compared using Student's t-tests and Pearson's chi-square tests.</p></div><div><h3>RESULTS</h3><p>A total of 1499 patients matching the inclusion and exclusion criteria were identified, of which 905 had early surgery and 591 had late surgery. Following propensity score matching, 591 matching patients in the late surgery group were identified. Post-match, the early surgery group had a lower mortality rate (0.17% vs 1.69%, p&lt;0.01) and shorter overall length of stay (2.47 vs 3.79 days, p&lt;0.01), as well as lower rates of unplanned intubation (1.02% vs 2.88%, p=0.02), AKI (0.17% vs 1.35%, p=0.02, stroke (0% vs 0.68%, p=0.045), pressure ulcer (0.68% vs 2.2%, p=0.03), unplanned intensive care unit admission (1.02% vs 4.06%, p&lt;0.01), and ventilator-associated pneumonia (0.34% vs 1.69%, p=0.02) compared to the late surgery group. Additionally, the early surgery group was more likely to be discharged to inpatient rehabilitation (53.64% vs 40.61%, p&lt;0.01) but less likely to be discharged routinely to home (26.73% vs 34.52%, p&lt;0.01) or a skilled nursing facility (4.74% vs 7.61%, p=0.04).</p></div><","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000684/pdfft?md5=931e01252afe84c2de6d52457dcf37bc&pid=1-s2.0-S2666548424000684-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847241","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":"46. Effect of runoff pattern contrast (RPC) on the long-term outcomes of epidural adhesiolysis using steerable catheters: a single-center observational study","authors":"","doi":"10.1016/j.xnsj.2024.100384","DOIUrl":"10.1016/j.xnsj.2024.100384","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Epidural adhesiolytic therapy using a steerable catheter has been covered by insurance in Japan since April 2018, but there is a lack of reports radiologically evaluating its therapeutic effects, leading to uncertainty.</p></div><div><h3>PURPOSE</h3><p>In this study, we investigated how the depiction of runoff pattern contrast (RPC) in intraoperative imaging (radiculography) affects treatment outcomes and report our findings.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A single-center observational study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 188 cases, consisting of 89 males and 99 females with a mean age of 72.9 years, who underwent epidural adhesiolysis for complaints of lower back pain and leg pain from August 2018 to December 2021. Targeted conditions included lumbar spinal stenosis, intervertebral disc herniation, lumbar spondylolisthesis, nonspecific lower back pain, sacral cyst, failed back surgery syndrome, and multiple operation back.</p></div><div><h3>OUTCOME MEASURES</h3><p>Improvement rate based on the Visual Analog Scale (VAS).</p></div><div><h3>METHODS</h3><p>Evaluation criteria included the presence of early postoperative (1 week) symptom improvement, VAS improvement rates of 50% or more at 6 months and 1 year as effective, and comparison with the presence of RPC in intraoperative contrast radiography.</p></div><div><h3>RESULTS</h3><p>Early postoperatively, 122 cases (65%) reported subjective symptom improvement (P &lt; 0.05), with RPC in 67 cases (55%). At 6 months, 78 cases (42%) showed effectiveness, including RPC in 53 cases (69%). After 1 year, 58 cases (31%) demonstrated effectiveness, with RPC in 47 cases (82%). Additionally, among the 41 cases (21.8%) that required surgery, RPC was absent.</p></div><div><h3>CONCLUSIONS</h3><p>The effectiveness of epidural adhesiolysis is not persistent and is often limited to a specific period. Our results suggest the potential impact of RPC on long-term outcomes, indicating the possibility of predicting treatment effectiveness based on intraoperative contrast imaging findings.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract does not discuss or include any applicable devices or drugs.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000775/pdfft?md5=ba474e65837ad2a1bd210564b65561e8&pid=1-s2.0-S2666548424000775-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850546","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":"16. When to initiate postoperative physical therapy in multilevel posterior cervical-thoracic fusions?","authors":"","doi":"10.1016/j.xnsj.2024.100354","DOIUrl":"10.1016/j.xnsj.2024.100354","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>The role of <strong>p</strong>hysical <strong>t</strong>herapy (PT) in patients undergoing surgery for cervical spondylotic myelopathy is understudied and not well understood. Current literature reports varied effects on outcomes, and thus postoperative standards of care neither address nor include PT in post-op posterior cervico-thoracic fusions.</p></div><div><h3>PURPOSE</h3><p>The aim of this study was to analyze when neck strengthening exercise should be initiated after multilevel posterior cervical-thoracic fusions.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Multicenter retrospective study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A total of 105 adult spine patients.</p></div><div><h3>OUTCOME MEASURES</h3><p>Clinical and radiographic outcomes.</p></div><div><h3>METHODS</h3><p>Retrospective chart reviews were conducted between 2016-2020 on patients who underwent a ≥3 level posterior cervico-thoracic fusion with caudal levels as C7 and T1/T2. Prescription and completion of PT were study inclusion criteria. Demographic, clinical, and radiographic data was collected at structured intervals from preoperative to 2 years postoperative. Percent <strong>i</strong>mprovement for cervical lordosis, T1 slope and C2-C7 sagittal plumbline was compared at 2 weeks and 2 years postop. Visual <strong>a</strong>nalog <strong>s</strong>cale (VAS) for pain and Oswestry Disability Index (ODI) scores were similarly analyzed.</p></div><div><h3>RESULTS</h3><p>In total, 105 patients were included in the study and were divided into two cohorts: those that initiated PT ≤ 6 weeks postop and those who initiated PT &gt; 6 weeks postop. A total of 58 patients were included in the Early PT cohort, and 47 were included in the Late PT cohort. Demographically, the Early PT and Late PT cohorts were similar in age (62.8 vs 61.1 years, respectively) and predominantly female (64.5% vs 67.6%, respectively). No significant difference was reported between the groups in body mass index, with a mean of 30.7 for Early PT and 31.2 for Late PT. While both cohorts showed improvement in radiographic parameters and patient reported outcomes at 2 years postop, there were significant differences in level of improvement between the two groups. The Early PT group had a comparatively better % improvement in cervical lordosis (25.2% vs 14.2%); mean T1 slope (-5.6% vs -2.6%); and mean C2-C7 sagittal plumbline (-15.2% vs -11.7%). Patients who started PT ≤ 6 weeks postop also reported greater VAS % improvement 61.9% vs 41% and Oswestry Disability Index % improvement 46.3% vs 29.6% at 2 years post-op.</p></div><div><h3>CONCLUSIONS</h3><p>Patients who underwent a 3- or more-level posterior cervico-thoracic fusion and started PT at or before 6 weeks postop exhibited greater radiographic and patient reported outcomes benefits than those starting PT more than 6 weeks postop. The results of this study support the early initiation of neck strengthening PT in most uncompl","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000477/pdfft?md5=820e61eb7287eaf3b212eef968a72b74&pid=1-s2.0-S2666548424000477-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844032","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":"P16. Impact of preoperative malnutrition on drain output and postoperative complications in elderly patients undergoing open lumbar spine surgery","authors":"","doi":"10.1016/j.xnsj.2024.100420","DOIUrl":"10.1016/j.xnsj.2024.100420","url":null,"abstract":"<div><h3>Background Context</h3><p>Despite ongoing controversy regarding routine drain use in open lumbar spine surgery, postoperative drainage remains commonly utilized worldwide. With an increase in spine surgery among the elderly population, optimization of perioperative management including nutrition has become an important focus. However, the impact of preoperative nutritional status on drain output and postoperative complications remains unclear.</p></div><div><h3>Purpose</h3><p>To examine the relationships between preoperative malnutrition, subfascial drain output, and in-hospital postoperative complications in elderly patients undergoing open lumbar spine surgery.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective single-center cohort study.</p></div><div><h3>Patient Sample</h3><p>Ninety-seven patients aged ≥65 years undergoing open lumbar decompression and/or fusion at a tertiary spine center from 2021 to 2022.</p></div><div><h3>Outcome Measures</h3><p>Occurrence of all-cause postoperative complication during initial hospitalization.</p></div><div><h3>Methods</h3><p>Patients were divided into malnutrition and normal nutrition groups based on the Geriatric Nutritional Risk Index (GNRI&lt;98); %drain output was defined as drain output volume divided by total perioperative blood loss. Patient demographics, surgical details including drain output, and postoperative complications were collected and compared between groups. Multivariable logistic regression analysis was performed to identify predictors of in-hospital postoperative complications.</p></div><div><h3>Results</h3><p>Of 97 patients, 17 cases (18%) had malnutrition before surgery. Patients with malnutrition were older (78 years vs 75 years) with lower BMI (21 vs 25) but no significant difference in sex, diabetes prevalence, or anticoagulant/antiplatelet medication. Drains were removed based on duration and output on postoperative days 2-3 in this cohort. There was no difference in surgical procedure (decompression, 59% vs 44%), fused segments (2.1 vs 2.3), operating time (2.6 hours vs 3.1 hours), intraoperative blood loss (174 mL vs 267 mL), drain output (327 mL vs 276 mL), and total perioperative blood loss (501 mL vs 544 mL) between groups. However, the malnutrition group had a higher %drain output (68% vs 57%) and increased in-hospital postoperative complications (59% vs. 13%), including surgical site infection, urinary tract infection, and delirium (p&lt;.05). After adjusting for confounding factors, preoperative malnutrition (OR 23.6) and %drain output (OR 0.95) were independent predictors of in-hospital postoperative complications.</p></div><div><h3>Conclusions</h3><p>Preoperative malnutrition increased the risk of in-hospital postoperative complications directly as well as indirectly via increasing %drain output. Our findings highlight the need to optimize nutritional status before lumbar spine surgery in the elderly population.</p></div><div><h3>FDA Device/Drug Statu","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001136/pdfft?md5=df57d008e887cadf9c033006cae168bf&pid=1-s2.0-S2666548424001136-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846332","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}