North American Spine Society Journal最新文献

{"title":"50. Lower neighborhood socioeconomic status influences medical complications, emergency department utilization and costs after 1-2 level lumbar fusion","authors":"","doi":"10.1016/j.xnsj.2024.100388","DOIUrl":"10.1016/j.xnsj.2024.100388","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Socioeconomic status (SES) has been demonstrated to be an important prognostic factor among patients undergoing spine surgery. Measures of socioeconomic disadvantage may enable improved targeting of measures to prevent and recognize potential increased healthcare utilization in these disadvantaged patients. The Area Deprivation Index (ADI) is a validated and weighted index comprised of 17 census-based markers of material deprivation and poverty.</p></div><div><h3>PURPOSE</h3><p>The purpose of this study was to utilize a large nationwide administrative claims database to determine whether patients with high ADI (greater disadvantage) undergoing 1-2 level lumbar fusion (LF) is associated with differences in: 1) medical complications; 2) emergency department (ED) utilization; 3) readmission rates; and 4) costs of care.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>A retrospective query of all primary 1-2 level lumbar fusions for degenerative lumbar pathology was performed using a large United States private insurance claims database from January 1st, 2010 to October 31st, 2020.</p></div><div><h3>PATIENT SAMPLE</h3><p>Cohorts of interest were queried using Current Procedural Terminology (CPT) codes and International Classification of Disease, Ninth/Tenth Revision (ICD-9), ICD-10 codes. ADI is reported on a scale of 0-100 with higher numbers associated with greater disadvantage. Percentile was documented for each zip code for all states. The study group consisted of patients undergoing primary LF in zip codes associated with high ADI (90%+) as established by previously published studies. The control cohort consisted of LF patients who underwent surgery in zip codes not defined by the study group (0-89%). Patients with high ADI were 1:1 propensity score matched to controls by age, gender, and Elixhauser Comorbidity Index (ECI). This yielded 34,442 patients in total, evenly matched between the two cohorts.</p></div><div><h3>OUTCOME MEASURES</h3><p>Primary endpoints of the study were to compare 90-day medical complications, 90-day ED utilization, 90-day readmission rates, and 90-day costs of care.</p></div><div><h3>METHODS</h3><p>Multivariable logistic regression models were used to calculate the odds-ratios (OR) and 95% confidence intervals (95%CI) of ADI on 90-day medical complications, ED utilization, and readmission rates. A Shapiro-Wilks test was performed to assess for normality of distribution followed by Welch's T tests for the continuous variables lengths of stay and costs. P-values less than 0.05 were considered to be statistically significant.</p></div><div><h3>RESULTS</h3><p>Patients undergoing 1-2 level LF with a high ADI incurred significantly higher rates and odds of developing respiratory failures (1.17 vs 0.87%; OR: 1.35, 95%CI: 1.09 - 1.67, p=0.005). The remaining medical complications including pneumonia (2.60 vs 2.55%; OR: 1.02, 95%CI: 0.89 - 1.16, p=0.785), acute kidney injuries (2.61 vs 2.29%; OR: ","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/S2666548424000817/pdfft?md5=b104f2e3d0c987a2bc79af7d5e742401&pid=1-s2.0-S2666548424000817-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843033","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":"Does hydrogen peroxide help mitigate the incidence of Cutibacterium acnes in cervical spine surgeries?","authors":"","doi":"10.1016/j.xnsj.2024.100514","DOIUrl":"10.1016/j.xnsj.2024.100514","url":null,"abstract":"<div><h3>Background</h3><p>Surgical site infection (SSI) is a common yet serious complication of cervical spine surgery. While initially thought to be clinically insignificant, <em>Cutibacterium acnes</em> (<em>C. acnes)</em> is an important cause of infection. The purpose of this study was to investigate the ability of a hydrogen peroxide (H₂O₂) application during standard presurgical skin preparation to reduce the burden of <em>C. acnes</em> in patients undergoing cervical spine surgery.</p></div><div><h3>Methods</h3><p>This was a retrospective review of prospectively collected data. Subjects were randomly assigned to either standard surgical preparation plus H₂O₂ (experimental) or without H₂O₂ (control). Prescrub, postscrub, and dermal cultures were obtained to assess the <em>C. acnes</em> burden after cultures on an aerobic and anaerobic growth medium were held for 21 days. Multivariate analysis was conducted to determine factors associated with presence of <em>C. acnes</em>. Outcome measures included the results of intraoperative cultures and the development of a SSI within 90 days postoperatively.</p></div><div><h3>Results</h3><p>Patients (n=86) undergoing elective 2- or 3-level fusion via anterior approach were included. Prior to application of the antiseptic solution, 65% (28/43) of the experimental cohort and 77% (33/43) of the control cohort had positive <em>C. acnes</em> cultures (p=.34). Following application of antiseptic solution, there were no differences in positive <em>C. acnes</em> culture rates between the experimental and control cohorts in the epidermal (30% vs. 28%, p=1.00) or dermal (40% vs. 42%, p=1.00) cultures. No differences in the rates of <em>C. acnes</em> eradication from preantiseptic to postantiseptic application occurred for epidermal (p=1.00) or dermal (p=1.00) skin layers. None of the factors were associated with positive <em>C. acnes</em> epidermal cultures on multivariable logistic regression analysis (p&gt;.05).</p></div><div><h3>Conclusions</h3><p>While there is potential for H₂O₂ to reduce the positive culture rate of <em>C. acnes</em> in cervical spine patients, no difference was seen when compared to standard surgical skin preparation.</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/S2666548424002075/pdfft?md5=fa65d314629e450c6b106af624b6d78b&pid=1-s2.0-S2666548424002075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702562","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":"19. Revision rates after single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: an observational study with 5-year minimum follow-up","authors":"","doi":"10.1016/j.xnsj.2024.100357","DOIUrl":"10.1016/j.xnsj.2024.100357","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Prospective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.</p></div><div><h3>PURPOSE</h3><p>The aims were to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) or Anterior Cervical Discectomy and Fusion (ACDF).</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective case-control observational study.</p></div><div><h3>PATIENT SAMPLE</h3><p>A nationwide United States population database from 2010 to 2021 was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up.</p></div><div><h3>OUTCOME MEASURES</h3><p>Objectives were to compare the rates of all-cause 5-year revisions for those undergoing single level CDA versus ACDF and assess the risk factors associated with requiring revision surgery.</p></div><div><h3>METHODS</h3><p>Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, individual comorbidities, and overall Elixhauser comorbidity index (ECI). Multivariate logistic regression models were used to calculate odds ratios (OR) of revision surgery within 5 years of the primary procedure while controlling for age, sex, and individual comorbidities comprising the ECI. P values less than 0.001 were significant.</p></div><div><h3>RESULTS</h3><p>After successful ratio matching, a total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revision within 5 years was 1.24% for CDA and 9.23% for ACDF (P&lt;0.001). After adjustment, patients undergoing single level ACDF has significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P&lt;0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P&lt;0.0001), depression (OR: 1.23; P&lt;0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003).</p></div><div><h3>CONCLUSIONS</h3><p>In this observational study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients on nationwide reported revision rates up to 5-years from single level CDA or ACDF.</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/S2666548424000507/pdfft?md5=b0ee8d6750684f3244be63f06e1eb317&pid=1-s2.0-S2666548424000507-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840209","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":"P2. Progenitor cells from iliac crest autograft survive transplantation and contribute to spinal fusion","authors":"","doi":"10.1016/j.xnsj.2024.100406","DOIUrl":"10.1016/j.xnsj.2024.100406","url":null,"abstract":"<div><h3>Background Context</h3><p>Posterior lumbar fusion (PLF) is frequently augmented with iliac crest autograft. Although autograft is the gold standard supplement to promote fusion, the molecular mechanism by which it induces bone formation has not been well elucidated. Specifically, it is unknown if progenitor cells within the autograft contribute to the biology of the fusion mass.</p></div><div><h3>Purpose</h3><p>Using an innovative lineage tracing technology in a murine model of PLF, we tested the hypothesis that progenitor cells from iliac crest autograft survive transplantation and contribute to spinal fusion.</p></div><div><h3>Study Design/Setting</h3><p>In vivo study.</p></div><div><h3>Patient Sample</h3><p>Animals: 8-week-old male or female lineage tracing animals, Sox9-CreERT; Ai14(progenitor cells), Collagen1a1-CreERT;Ai9(osteoblast), and Aggrecan-CreERT;Ai9(chondrocytes) were examined.</p></div><div><h3>Outcome Measures</h3><p>Posterolateral bone formation was quantified by microcomputed tomography, from which 2D and 3D reconstruction were produced. To evaluate the presence of tdTomato+ cells within the area of spinal fusion that survive from the donor graft, IVIS imaging and detailed frozen histologic assessment were performed. Frozen sections were likewise stained with hematoxylin and eosin(H&amp;E) and Safranin O and evaluated under light microscopy.</p></div><div><h3>Methods</h3><p>Autograft harvested from the iliac crest of Sox9-CreERT;tdTomato or Aggrecan-Cre ERT;Ai9 or Collagen1a1 Cre ERT were transplanted into the posterolateral gutters between L3 and L5 of non-Cre containing littermates. Following transplantation, recipient mice received tamoxifen (100mg/kg, i.p. twice weekly) to induce recombination and expression of tdTomato(Cy3) until sacrifice. In order to provide comparative analysis, we conducted autograft transplantation harvested from wild-type mouse into each Cre mouse.</p></div><div><h3>Results</h3><p>Mice receiving bone autograft from either transgenic lineage were found to have markedly greater new bone formation and bony bridging of adjacent pedicles compared to sham controls by 6 weeks post implantation. When evaluated at 2 weeks post implantation, histologic analysis demonstrated safranin O staining within the fusion mass, indicating the presence of chondrocyte. By 6 weeks post implantation, positive tdTomato signal from every lineage reporter (SOX), Aggrecan, and COL1) were visible within the fusion mass and found to localize newly formed bone.</p></div><div><h3>Conclusions</h3><p>Using innovative lineage tracing technology, these data indicate that progenitor cells (SOX9) from iliac crest autograft not only survive transplantation but become osteoblasts (COL1) via within the fusion mass. In addition, the presence of a chondrocyte intermediate suggests that the fusion mass is formed through endochondral ossification. Moreover, our data suggests that the periosteum plays a crucial role as a primary source o","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/S2666548424000994/pdfft?md5=f9542ae4c8caa8bbc06946ccb2dc1f71&pid=1-s2.0-S2666548424000994-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846833","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":"39. Risk factors for sacroiliac joint fusion after instrumented spinal fusion","authors":"","doi":"10.1016/j.xnsj.2024.100377","DOIUrl":"10.1016/j.xnsj.2024.100377","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Chronic back pain after a spinal fusion is multifactorial, but one factor is the development of adjacent segment disease, which occurs at a pooled annual incidence of about 2% a year. Fusion constructs extending to the sacrum increase angular motion and stress across the sacroiliac (SI) joint, which can lead to accelerated degeneration of the joint. The rate of SI joint degeneration after lumbar/lumbosacral fusion has been reported in one prospective study to be upwards of 75%, which was significantly higher than the control group of 38.2%. Because of the high incidence of degeneration after spinal fusions, some surgeons advocate for simultaneous SI joint fusion at the time of the primary spinal fusion. In a retrospective analysis of a prospectively maintained database, none of the patients undergoing simultaneous SI joint fusion with spinal fusion experienced postoperative SI joint pain, while 44.6% of those without simultaneous SI joint fusion did develop such pain. However, most studies have been institution-specific reporting and subsequent systematic reviews. There has been no large-scale database study looking at the risk factors for future SI joint fusion after spinal fusion.</p></div><div><h3>PURPOSE</h3><p>To identify risk factors for SI joint fusion after instrumented spinal fusion.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective cohort study.</p></div><div><h3>PATIENT SAMPLE</h3><p>PearlDiver BiscayneBay database.</p></div><div><h3>OUTCOME MEASURES</h3><p>Odds ratios.</p></div><div><h3>METHODS</h3><p>Patients were identified from the PearlDiver BiscayneBay database (Colorado Springs, CO, USA). Patients who underwent 1-level (CPT: 22840), 3-6-level (22842), and 7-13-level posterior spinal instrumentation (22843 and 22844) were identified, excluding patients with fusions in the cervical spine (22595 and 22600). Patients were separated based on whether or not they received an SI joint fusion after their spinal fusion (27280 and 27279). The following patient factors and their association with future SI joint fusion were evaluated: age, gender, obesity, fibromyalgia, diabetes, tobacco use, prior SI joint injection, and spinal fusion length. A logistic regression as well as a machine learning logistic regression model was performed to evaluate the associations between patient factors and incidence of SI joint fusion.</p></div><div><h3>RESULTS</h3><p>A total of 539,042 patients underwent posterior instrumentation with 5981 patients also undergoing SI joint fusion at a later date. Factors associated with future SI joint fusion included female gender, patients with obesity, fibromyalgia, diabetes, tobacco use, and prior SI joint injection. Construct lengths of 3-6 and 7-13 were statistically associated with the patient undergoing future SI joint fusion. Prior SI joint injection had the highest odds ratio for undergoing future SI joint fusion (OR: 8.73; 95% CI: 8.28-9.20), followed by 7-13 level fus","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/S2666548424000702/pdfft?md5=8c46245d78b659e765e49855a99b8214&pid=1-s2.0-S2666548424000702-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851263","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":"31. Impact of multirod reinforcement on rod fractures in adult spinal deformity: a retrospective case series with a minimum follow-up of 5 years","authors":"","doi":"10.1016/j.xnsj.2024.100369","DOIUrl":"10.1016/j.xnsj.2024.100369","url":null,"abstract":"<div><p>This abstract contains content that is significantly similar to the authors' previously published abstract in the <em>Journal of Orthopaedic Science</em>. For access to the original publication, please visit the following DOI: <span><span>https://doi.org/10.1016/j.jos.2024.01.010</span><svg><path></path></svg></span>.</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/S2666548424000623/pdfft?md5=7a93382cfdd7b8848c41f8d166d723e5&pid=1-s2.0-S2666548424000623-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841485","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":"List of Contents","authors":"","doi":"10.1016/S2666-5484(24)00217-8","DOIUrl":"10.1016/S2666-5484(24)00217-8","url":null,"abstract":"","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/S2666548424002178/pdfft?md5=c28b24b692fb8c04d93c6d4772e4b638&pid=1-s2.0-S2666548424002178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959801","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":"48. A comparative study of the sagittal and coronal balance of the spine measured using a 3D full-body scanner and whole spine X-ray","authors":"","doi":"10.1016/j.xnsj.2024.100386","DOIUrl":"10.1016/j.xnsj.2024.100386","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Spinal balance analysis is critical to the diagnosis and treatment of ASD, and radiography is the current gold standard. Radiation-free 3D full body scanner has been developed to overcome drawbacks of X-ray such as radiation exposure and limited reflection of actual daily activity.</p></div><div><h3>PURPOSE</h3><p>This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters. This study aims to develop a spinal balance analysis system based on the 3D full body scanner and compare it to X-ray parameters.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>This study is a prospective observational study.</p></div><div><h3>PATIENT SAMPLE</h3><p>Ninety-seven participants recruited from our hospital patient clinic and underwent both 3D body scanning and whole spine X-rays. The participants completed the clinical questionnaire and body composition analyses.</p></div><div><h3>OUTCOME MEASURES</h3><p>The 3D scanner spinal balance parameters were defined as the angles between two points relative to the plumb line, the horizontal distances between two points, the angle between three points, and shoulder gradient. The X-ray spinal balance parameters were C2-7 sagittal vertical axis (SVA), T1 slope, sagittal vertical axis (SVA), odontoid hip axis angle (ODHA), clavicle angle, T1 coronal tilt, lumbar lordosis, sacral slope, and pelvic incidence-lumbar lordosis (PI-LL) mismatch. Body composition scores were body mass index (BMI), percentage body fat (PBF), and skeletal muscle index (SMI). Patient-reported clinical symptoms included the visual analog scale (VAS, 0-10) score of low back pain and the modified Oswestry Disability Index (mODI, 0-45).</p></div><div><h3>METHODS</h3><p>Five inflection points were automatically labeled by AI from the 3D scanner data and spinal balance parameters were subsequently calculated. Correlation analysis was conducted to compare spinal balance parameters obtained from a 3D full-body scanner and X-ray imaging. The same analysis was also conducted to identify correlation between spinal parameters and clinical symptoms. Partial correlation analysis and multiple regression analysis were conducted to determine the impact of body composition on spinal balance.</p></div><div><h3>RESULTS</h3><p>The study indicated statistically significant correlations between sagittal parameters of X-ray and 3D body scanner. The correlation coefficient of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (p-value &lt;0.001). The correlation coefficient between aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (p &lt;0.001). For coronal spinal balance, the shoulder gradient calculated by AI was compared to the clavicle angle from the X-ray, resulting in a correlation coefficient of 0.373 (p &lt;0.001). In contrast, the differences between 3D scanning and radiography were unaffected b","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/S2666548424000799/pdfft?md5=5afe3831f5fcd2c339b6e0a214fd6834&pid=1-s2.0-S2666548424000799-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852981","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":"P18. Postoperative complications in anterior cervical surgery: is there a higher incidence of dysphagia and respiratory complications with long-segment anterior cervical surgery?","authors":"","doi":"10.1016/j.xnsj.2024.100422","DOIUrl":"10.1016/j.xnsj.2024.100422","url":null,"abstract":"<div><h3>Background Context</h3><p>In anterior cervical spine surgery, complications such as dysphagia and respiratory disorders can be problematic.</p></div><div><h3>Purpose</h3><p>This study investigates whether the length of fixation in anterior cervical spine surgery is associated with perioperative dysphagia and respiratory complications.</p></div><div><h3>Study Design/Setting</h3><p>Retrospective study.</p></div><div><h3>Patient Sample</h3><p>N/A</p></div><div><h3>Outcome Measures</h3><p>N/A</p></div><div><h3>Methods</h3><p>The subjects were 105 cases who underwent anterior cervical spine surgery at our hospital since April 2013. Cases involving surgery for trauma or infection were excluded. Cases with fixation of two or fewer vertebrae were classified as Group S, and those with fixation of three or more vertebrae as Group L. In our hospital, when anterior fixation of 3 or more vertebrae is performed, airway management is generally conducted in the ICU by emergency physicians, with the timing of extubation determined based on the cuff leak test, lateral cervical spine X-rays, and fiberscope if necessary.</p><p>The parameters examined were the frequency of dysphagia, the frequency of serious respiratory complications such as reintubation or tracheostomy, and pneumonia, as well as the number of days required for discharge or transfer postoperatively.</p></div><div><h3>Results</h3><p>There were 61 cases in Group S and 44 in Group L. The average number of fixed vertebrae was 1.5 in Group S and 3.5 in Group L. There was no significant difference in average age or sex between the two groups. Surgeries for ossification of the posterior longitudinal ligament were significantly more frequent in Group L. The proportion of severe dysphagia requiring gastrostomy tube for nutritional management was significantly higher in Group L (Group S; 3%, Group L; 13%). The number of cases requiring treatment for severe pneumonia, reintubation, or tracheostomy was one in Group S and four in Group L. One case in Group S developed severe pneumonia early postoperatively and required reintubation, and three cases in Group L required airway resecuring due to laryngeal edema post-extubation. The number of days required for discharge or transfer postoperatively was 11.9 days in Group S and 24.7 days in Group L, but cases with respiratory complications required an average of 58.8 days of hospital management.</p></div><div><h3>Conclusions</h3><p>Cases with short-segment anterior cervical surgeries had relatively few complications and could be discharged early. Long-segment anterior cervical spine surgeries are associated with higher rates of postoperative complications, including severe dysphagia in 13% of cases and significant respiratory issues in 9%. Cases with these complications required long-term hospitalization. These findings emphasize the necessity of careful monitoring and management following long-range anterior surgeries.</p></div><div><h3>FDA Device/Drug Status","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/S266654842400115X/pdfft?md5=422ca835c52f9bfac85d1fbc6c0dfd80&pid=1-s2.0-S266654842400115X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841930","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":"23. Mechanical stress induces degeneration and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis","authors":"","doi":"10.1016/j.xnsj.2024.100361","DOIUrl":"10.1016/j.xnsj.2024.100361","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Ligamentum flavum (LF) hypertrophy is characterized histologically by LF degeneration, including the loss of elastic fibers and the increase collagen. In patients with lumbar spinal canal stenosis (LSCS), chronic inflammation and subsequent fibrosis induced by mechanical stress play an important role in LF hypertrophy and degeneration. Several molecules, such as transforming growth factor (TGF)-β1, inflammatory cytokines, and matrix metalloproteinase (MMPs) participate in the pathological processes; however, the mechanisms underlying the induction of these molecules and process of degeneration have not been fully elucidated. Angiopoietin-like protein 2 (Angptl2), a tissue remodeling factor, is induced by various stress conditions and regulates TGF-β1, inflammatory cytokines such as interleukin (IL)-6, and MMPs. Therefore, Angptl2 induced by mechanical stress may contribute to the pathogenesis of LSCS.</p></div><div><h3>PURPOSE</h3><p>Analyzing the role of Angptl2 and elucidating the mechanism of degenerative processes of ligamentum flavum caused by mechanical stress.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</p></div><div><h3>PATIENT SAMPLE</h3><p>This study was conducted after approval was obtained from the Kumamoto University Ethics Committee and written informed consent was received from each patient. LF samples for this study were provided by patients who underwent lumbar surgery with LSCS or non-LSCS such as disc herniation and cauda equina tumors. For in vitro experiments, LF fibroblasts were isolated from LF tissue and cultured.</p></div><div><h3>OUTCOME MEASURES</h3><p>N/A</p></div><div><h3>METHODS</h3><p>Total RNA was extracted from LF tissue. <em>Angptl2, TGF-β1, IL-6, MMP-2, collagen,</em> and <em>elastin</em> mRNA expression was evaluated by real-time polymerase chain reaction (PCR). Anti-human Angptl2 TGF-β1, IL-6 and MMP-2 antibody was used for immunohistochemistry. For in vitro experiments, LF fibroblasts were isolated from LF tissue and cultured. LF fibroblasts were applied to stretching stimulation (10% elongation, 10 cycles/min) for 12 h, and Angptl2 expression was investigated by PCR and ELISA. Recombinant Angptl2 protein (5 μg/ml) was added to the cells, followed by 6 h incubation, after which the RNA was extracted, and <em>TGF-β1, IL-6, MMP-2</em> and <em>collagen</em> mRNA expression was evaluated by PCR. To evaluate activating Smad signaling, p-Smad3 was analyzed by western blot after Angptl2 stimulation. MMP-2 expression was evaluated by Recombinant IL-6 protein(300ng/ml). The concentration of elastin in the supernatant was measured using a competitive ELISA kit, after 300ng/ml IL-6 protein stimulation adding 1mg elastin protein.</p></div><div><h3>RESULTS</h3><p><em>Angptl2, TGF-β1, IL-6, MMP-2 and collagen</em> mRNA expression in hypertrophied LF tissue from the LSCS group were significantly increased relative to that in LF tissue from the non-LSCS group. On the other hand, there","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/S2666548424000544/pdfft?md5=10e2bc0d0eb3d6f369e8862d65d9402b&pid=1-s2.0-S2666548424000544-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844706","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}