North American Spine Society Journal最新文献

{"title":"18. Reason for revision surgery after cervical disc arthroplasty based on medical device reports maintained by the United States Food and Drug Administration","authors":"Franziska C.S. Altorfer MD , Michael Kelly MD , Fedan Avrumova BS , Celeste Abjornson PhD , Darren R. Lebl MD","doi":"10.1016/j.xnsj.2024.100356","DOIUrl":"10.1016/j.xnsj.2024.100356","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Cervical disc arthroplasty (CDA) was established in the last two decades as a motion-sparing alternative to anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, achieving comparable patient-reported and clinical outcomes. Despite showing this outcome difference for various CDA models compared to ACDF, few studies have compared CDA models to one another. One study investigated the range of complications for the different CDAs based on reports from the Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database until 2020, showing variability for each device. However, this study has not reported a detailed look at reported revision cases. To date, literature on complications associated with revision surgery for CDA is limited, mainly comparing CDA to fusion instead of comparing different CDA models to one another.</p></div><div><h3>PURPOSE</h3><p>To analyze revision cases due to complications related to CDA reported to the MAUDE database.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective database review.</p></div><div><h3>PATIENT SAMPLE</h3><p>Nationwide database of reported revision cases related to CDA.</p></div><div><h3>OUTCOME MEASURES</h3><p>Factors associated with revision for CDA.</p></div><div><h3>METHODS</h3><p>The MAUDE database was queried for data from January 2005 to September 2023. All the reported complication entries for the nine FDA-approved CDA devices were analyzed. The full-text entries of all complications were analyzed, reported, and grouped depending on the revision surgery performed. For each revision case, the device used, the associated complication, the time until revision, and the type of revision surgery were collected. Those reports with insufficient information or were reported over social media were excluded.</p></div><div><h3>RESULTS</h3><p>In summary, 1,347 entries were analyzed from the MAUDE database, with the highest number of reports made to the database in 2018 (218). A total of 678 cases reported revision surgery for nine different CDA models: Mobi-C (239), M6 (167), Prodisc-C (88), Prestige (60), PCM (44), Bryan (35), Secure (23), Simplify (21) and Discover (1). The top three complications associated with CDA revision were implant migration (23.5%), neck pain (15.5%), and heterotopic ossification (6.6%). The top complication per device was migration for Mobi-C (26.4%), Prodisc-C (21.3%), Prestige (24.6%), PCM (84.1%), Bryan (48.6%), Secure (30.4%) and Discover (100%). For M6 the number one cause of revision was evenly split between osteolysis (18.6%) and neck pain (18.6%), while for Simplify, it was neck pain (23.8%). Of the reports that included the type of revision surgery, 283 (54.7%) were recorded as conversion to fusion.</p></div><div><h3>CONCLUSIONS</h3><p>The MAUDE database highlights complications related to revision cases for CDA, which may not receive sufficient emphasis in existing published studi","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100356"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000490/pdfft?md5=0285d8ea43b5d60faa276998315508cf&pid=1-s2.0-S2666548424000490-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848828","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":"P6. Mechanical stress change of intervertebral disc in rod fracture model after posterior spinal fusion: finite element analysis","authors":"Toru Doi MD","doi":"10.1016/j.xnsj.2024.100410","DOIUrl":"10.1016/j.xnsj.2024.100410","url":null,"abstract":"<div><h3>Background Context</h3><p>Rod fracture is the one of postoperative complications in posterior spinal fusion surgery for adult spinal deformity and its prevalence has been reported as 6.8-38.8%. The reoperation rate of rod fracture after spinal fusion is reported to be 41.2-87%, which is higher in patients with bilateral rod fracture (75-91%) than those with unilateral rod fracture (21-43%). Despite high reoperation rate in patients with rod fracture, especially bilateral rod fracture, the pathological mechanisms including mechanical stress change of intervertebral disc in patients with rod fracture have not been well-studied.</p></div><div><h3>Purpose</h3><p>To clarify mechanical stress change of intervertebral disc in rod fracture model after posterior spinal fusion using 3D-CT finite element analysis (CT/FEA).</p></div><div><h3>Study Design/Setting</h3><p>A comparative biomechanical study.</p></div><div><h3>Patient Sample</h3><p>Seven patients ≥ 20 years old (3 males and 4 females) who underwent lumbar spinal surgery.</p></div><div><h3>Outcome Measures</h3><p>Patients’ characteristics such as age and BMI, and global spinal alignment (eg, sagittal vertical axis [SVA] and pelvic incidence minus lumbar lordosis [PI-LL]) were examined. Posterior spinal fusion models from L3 to S1 with non-rod fracture (NRF, a), unilateral rod fracture (URF, b), and bilateral rod fracture (BRF, c) at L4/5 were created using three-dimensional finite element analysis software. Forward bending loads were applied to each model, and the minimum principal stresses (MPa) of the intervertebral discs at the adjacent level (L2/3) and the rod fracture level (L4/5) were measured in each model using CT-FEA.</p></div><div><h3>Methods</h3><p>The minimum principal stresses of the intervertebral discs at L2/3 and L4/5 were compared among the NRF, URF, and BRF models using the Friedman's test and Bonferroni correction.</p></div><div><h3>Results</h3><p>The mean age was 38.0 ± 11.2 years old and BMI was 22.4 ± 2.9 kg/m². The mean SVA was 30.4 ± 60.9 mm and the PI-LL was 6.7 ± 12.5°. No significant differences in the minimum principal stresses at L2/3 level among three models were observed (NRF, 11.0 MPa; URF, 7.5 MPa; BRF, 6.7 MPa, p=.651. At L4/5 level, no significant differences in the minimum principal stresses between the NRF and URF models or the URF and BRF models were observed; however, the minimum principal stress of the intervertebral disc at L4/5 was significantly higher in the BRF model compared to the NRF model (NRF, 0.7 MPa; BRF, 5.4 MPa, p=.001).</p></div><div><h3>Conclusions</h3><p>The mechanical stress at rod fracture level was significantly higher in bilateral rod fracture model by CT-FEA, which may contribute to the higher reoperation rate in patients with bilateral rod fracture after posterior spinal fusion surgery.</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":"18 ","pages":"Article 100410"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001033/pdfft?md5=d477eaf27757502d43ef25da5527c5de&pid=1-s2.0-S2666548424001033-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849185","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":"P8. A MSSIC Study Reveals Non-Modifiable Risk Factors Were Associated with Post-Operative Hematoma following ACDF","authors":"Matthew Lipphardt MD","doi":"10.1016/j.xnsj.2024.100412","DOIUrl":"10.1016/j.xnsj.2024.100412","url":null,"abstract":"<div><p>This abstract has been previously published as part of the Cervical Research Society 51^st Annual Meeting proceedings. For full access to the abstract, please visit the following URL: <span><span>https://scholarlyworks.beaumont.org/orthopaedic_surgery_posters/16/</span><svg><path></path></svg></span></p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100412"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424001057/pdfft?md5=c872a1613d60f19c612b946e5ac300c4&pid=1-s2.0-S2666548424001057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848664","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":"8. Intravenous infusion of auto serum-expanded autologous mesenchymal stem cells in chronic spinal cord injury patients: 7 case series","authors":"Ryosuke Hirota MD, PhD","doi":"10.1016/j.xnsj.2024.100346","DOIUrl":"10.1016/j.xnsj.2024.100346","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;In the chronic phase, functional recovery of spinal cord injury (SCI) without any therapeutic intervention is highly limited. Therefore, new treatments are desired to enhance residual function, with the important objection of increasing the quality of life in chronic SCI patients. Intravenous infusion of auto serum-expanded autologous bone marrow-derived mesenchymal stem cells (MSCs) for acute SCI patients has shown the safety and potential therapeutic efficacy of this approach. However, the clinical use for the chronic phase of SCI has not been studied.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;This study explores safety, feasibility and potential improvement in functional status after intravenous infusion of MSCs in chronic severe SCI patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;We report a case series of 7 chronic SCI patients with AIS grades C and D who received autoserum-expanded autologous MSCs. Statistical analyses were performed using JMP 11.1 for Windows (SAS Institute Inc.). The differences between status prior to MSC infusion and 6 months postinfusion, for both ISCSCI-92 and SCIM-III among the groups were analyzed using one-way analysis of variance followed by Bonferroni's post hoc tests. Data are expressed as mean ± standard error of the mean. Differences were considered statistically significant at p &lt; 0.05.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;The patients included 5 men and 2 women who ranged 20 to 52 years old (mean 39.6 years old). After careful examination, 7 patients with chronic SCI were included in this study based on the following inclusion and exclusion criteria. Inclusion criteria: (1) 180 days or more after onset of SCI, (2) &lt;strong&gt;a&lt;/strong&gt;ge at least 18 years old, (3) rehabilitation can be performed more than 4 units per day, (4) the written informed consent obtained as much as possible from subjects (&lt;strong&gt;i&lt;/strong&gt;f the subject does not have ability to write, the written informed consent obtained from legal representative alone).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;Each participant's status on SCI scales including American Spinal Injury Association (ASIA) impairment scale, International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92), and Spinal Cord Independence Measure-III (SCIM-III) was assessed from 0 to 14 days prior to MSC infusion, and at 90 (± 14) and 180 (± 14) days post-MSC infusion, by at least 2 board-certified orthopedic surgeons who were not blinded. The primary outcome measure of this clinical study was the proportion of cases whose ASIA scale improved one point or more at 180 ± 14 days post-MSC infusion compared to the functional status just prior to MSC infusion (0-14 days). All patients were monitored closely during and within 24 h of the autologous human MSC injections. Oxygen saturation, body temperature, electrocardiogram, blood pressure, pulse and respiratory rate were carefully monitored before and after injection.","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100346"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000398/pdfft?md5=382142ddea8145cd320e79a6c37a887e&pid=1-s2.0-S2666548424000398-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840214","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":"1. Geriatric nutritional risk index can predict 90-day mortality in patients with osteoporotic vertebral fractures","authors":"Toshihiko Ito MD","doi":"10.1016/j.xnsj.2024.100339","DOIUrl":"10.1016/j.xnsj.2024.100339","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Fragility fractures are common in elderly patients and are associated with high mortality and functional disability. The geriatric nutritional risk index (GNRI) is an objective nutritional status assessment tool to predict mortality risk in hospitalized patients. However, whether the GNRI reflects short-term mortality in fragility fracture patients is unclear. This study aimed to examine the nutritional status assessed by the GNRI in patients with fragility fractures and identify cut-off scores that predict mortality risk.</p></div><div><h3>PURPOSE</h3><p>N/A</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>N/A</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>Elderly fragility fracture patients in our hospital from 2021 to 2023 were retrospectively studied. A total of 56 patients (19 men and 37 women, mean age 83.2 ± 6.7 years) were included. All patients were followed up for more than 3 months. Clinical data were extracted from electronic medical records. Mortality within 90 days after admission was studied. GNRI was calculated for all patients on admission as 14.89 × serum albumin (g/dL) + 41.7 × BMI / 22. Using the recipient operating characteristic (ROC) curve, the area under the curve (AUC) that can predict mortality 90 days after admission and the optimal cut-off scores were calculated.</p></div><div><h3>RESULTS</h3><p>The mean GNRI was 97.2 ± 9.2 (76.6-114.7). Three (5.2%) deaths occurred in the cohort; the ROC-AUC value was 0.85, and the cut-off GNRI was 95.6. Sensitivity and specificity were 100% and 64.2%, respectively.</p></div><div><h3>CONCLUSIONS</h3><p>Our results show that nutritional status assessment using GNRI can help predict mortality within 90 days in elderly fragility fracture patients; GNRI can be considered a simple tool to predict mortality risk in fragility fracture patients. In addition, early detection of low nutritional status may improve nutritional status before fracture, reducing mortality risk.</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":"18 ","pages":"Article 100339"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000325/pdfft?md5=0eff3d0d4d7557c1f47fcabdc5379459&pid=1-s2.0-S2666548424000325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843050","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":"Hiroyuki Yoshihara MD, PhD ,&nbsp;Colm Mulvany MSc ,&nbsp;Harleen Kaur BA ,&nbsp;Evan Horowitz MD ,&nbsp;Daisuke Yoneoka MSc","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":"18 ","pages":"Article 100382"},"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":"16. When to initiate postoperative physical therapy in multilevel posterior cervical-thoracic fusions?","authors":"Eeric Truumees MD ,&nbsp;Devender Singh PhD ,&nbsp;Matthew J. Geck MD ,&nbsp;Ashley Duncan MBA, RN, CNOR ,&nbsp;Cortney Matthews BS ,&nbsp;John Stokes MD","doi":"10.1016/j.xnsj.2024.100354","DOIUrl":"10.1016/j.xnsj.2024.100354","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;The role of &lt;strong&gt;p&lt;/strong&gt;hysical &lt;strong&gt;t&lt;/strong&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;The aim of this study was to analyze when neck strengthening exercise should be initiated after multilevel posterior cervical-thoracic fusions.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;Multicenter retrospective study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;A total of 105 adult spine patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;Clinical and radiographic outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;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 &lt;strong&gt;i&lt;/strong&gt;mprovement for cervical lordosis, T1 slope and C2-C7 sagittal plumbline was compared at 2 weeks and 2 years postop. Visual &lt;strong&gt;a&lt;/strong&gt;nalog &lt;strong&gt;s&lt;/strong&gt;cale (VAS) for pain and Oswestry Disability Index (ODI) scores were similarly analyzed.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;p&gt;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":"18 ","pages":"Article 100354"},"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":"22. Preoperative thoracic compensation predicts pelvic tilt response and proximal junctional kyphosis in adult spinal deformity surgery: a retrospective study","authors":"Eiji Takasawa MD, PhD ,&nbsp;Toshiki Tsukui MD ,&nbsp;Hirotaka Chikuda MD, PhD","doi":"10.1016/j.xnsj.2024.100360","DOIUrl":"10.1016/j.xnsj.2024.100360","url":null,"abstract":"<div><p>This abstract was previously published in the 2023 Spineweek proceedings. For access to the original publication, please visit the following URL: <span><span>https://www.sosort.org/resources/Documents/Spineweek_2023_oral_abstracts_final-1.pdf</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100360"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000532/pdfft?md5=a7e9d1bb321ebb340c58101e1876686b&pid=1-s2.0-S2666548424000532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845282","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":"Koji Tamai MD ,&nbsp;Hidetomi Terai MD, PhD ,&nbsp;Masayoshi Iwamae MD ,&nbsp;Minori Kato MD ,&nbsp;Hiromitsu Toyoda MD, PhD ,&nbsp;Akinobu Suzuki MD, PhD ,&nbsp;Shinji Takahashi MD ,&nbsp;Yuta Sawada MD ,&nbsp;Yuki Okamura MD ,&nbsp;Yuto Kobayashi MD ,&nbsp;Hiroaki Nakamura MD, PhD","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":"18 ","pages":"Article 100350"},"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":"P16. Impact of preoperative malnutrition on drain output and postoperative complications in elderly patients undergoing open lumbar spine surgery","authors":"Eiji Takasawa MD, PhD ,&nbsp;Toshiki Tsukui MD ,&nbsp;Hirotaka Chikuda MD, PhD","doi":"10.1016/j.xnsj.2024.100420","DOIUrl":"10.1016/j.xnsj.2024.100420","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;To examine the relationships between preoperative malnutrition, subfascial drain output, and in-hospital postoperative complications in elderly patients undergoing open lumbar spine surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;Retrospective single-center cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;Ninety-seven patients aged ≥65 years undergoing open lumbar decompression and/or fusion at a tertiary spine center from 2021 to 2022.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;Occurrence of all-cause postoperative complication during initial hospitalization.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;FDA Device/Drug Statu","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100420"},"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}