North American Spine Society Journal最新文献

{"title":"P2. Progenitor cells from iliac crest autograft survive transplantation and contribute to spinal fusion","authors":"Atsuyuki Kawabata MD","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&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":"18 ","pages":"Article 100406"},"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":"Gurmit Singh MD, MHA , Peter Du MD , Spencer Smith BS , Travis Campbell Philipp MD , Jonathan Kark MD , Clifford Lin MD , Jung U. Yoo MD","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":"18 ","pages":"Article 100377"},"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":"33. Comparative clinical outcomes of minimally invasive decompression alone for patients with degenerative scoliosis: a focus on severe cases over 20°","authors":"Tomoyuki Asada MD , Chad Z. Simon , Nishtha Singh , Olivia Tuma BS , Tejas Subramanian BS , Kasra Araghi BS , Amy Lu BS , Eric Mai BS , Ashley Kim BA , Myles Allen MBChB, BS , Maximilian Korsun BS , Joshua Zhang BS , Cole Kwas BA , Sumedha Singh MD, MBBS , Annika Heuer MD , James Dowdell MD , Evan Sheha MD","doi":"10.1016/j.xnsj.2024.100371","DOIUrl":"10.1016/j.xnsj.2024.100371","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><p>Degenerative scoliosis (DS) is a prevalent condition in the elderly population. Minimally invasive (MI) decompression, preserving posterior soft tissues and posterior ligamentous complex, is one of the treatment options for lumbar canal stenosis with DS. While MI decompression is a recognized treatment for lumbar canal stenosis in DS patients, its efficacy specifically in severe DS (Cobb angle >20°) is not well-documented.</p></div><div><h3>PURPOSE</h3><p>This study aimed to evaluate the clinical outcomes of MI decompression with severe. degenerative scoliosis and identify predictors of poor outcomes.</p></div><div><h3>STUDY DESIGN/SETTING</h3><p>Retrospective review of a prospectively collected multi-surgeon registry.</p></div><div><h3>PATIENT SAMPLE</h3><p>Patients who underwent MI lumbar decompression alone were included and divided into DS and control groups based on a Cobb angle threshold of 20°.</p></div><div><h3>OUTCOME MEASURES</h3><p>We compared Patient-Reported Outcomes and Measures (PROMs), including ODI, VAS back, VAS leg, SF-12 PCS and MCS, and PROMIS-PF between groups at the postoperative ≤3 months and ≥1 year postoperatively, focusing on MCID achievement at ≥1 year time point.</p></div><div><h3>METHODS</h3><p>Data on demographics, comorbidities, spinal alignment, normalized total psoas area (NTPA), and surgical levels were collected. Decompression locations were labeled \"scoliosis-related\" when the decompression levels included the range of end vertebrae of the Cobb angle, and \"outside\" when the decompression operative levels did not include the end vertebrae. Matched cohorts were created by variable-ratio greedy matching for comparison, and multivariable regression analysis identified factors impending MCID achievement in ODI for DS patients.</p></div><div><h3>RESULTS</h3><p>A total of 253 patients were included in the study, with 41 patients in the DS group and 212 in the control group, all of whom underwent MI decompression. After matching for age, gender, osteoporosis status, NTPA, and preoperative ODI, the final matched cohort included 33 DS and 58 control patients. At ≥1 year time point, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs control 69.0%, P=0.047) and SF-12 PCS (DS: 41.4% vs control 70.6%, P=0.020). The multivariable analysis conducted in the DS group revealed that scoliosis-related decompression (Odds ratio: 9.9, P=0.028) was an independent factor associated with failure to achieve MCID in ODI at the ≥1-year postoperative time point.</p></div><div><h3>CONCLUSIONS</h3><p>Our findings suggest that in DS patients with a Cobb angle >20 degrees, MI lumbar decompression may yield suboptimal disability and physical function improvements. These results underscore the need for careful surgical planning, particularly regarding decompression at the end vertebrae of the Cobb angle.</p></div><div><h3>FDA Device/Drug Status</h3><p>This abstract","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100371"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000647/pdfft?md5=6dfd52bdd83f677887dedd67931babee&pid=1-s2.0-S2666548424000647-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842406","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":"50. Lower neighborhood socioeconomic status influences medical complications, emergency department utilization and costs after 1-2 level lumbar fusion","authors":"Adam Gordon MD , Faisal Elali BS, BA","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":"18 ","pages":"Article 100388"},"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":"14. Does posterior cord compression by ligamentum flavum adversely affect clinical outcome of anterior cervical discectomy and fusion?","authors":"Sehan Park MD ,&nbsp;Dong-Ho Lee MD, PhD","doi":"10.1016/j.xnsj.2024.100352","DOIUrl":"10.1016/j.xnsj.2024.100352","url":null,"abstract":"<div><p>This abstract has been previously published as part of the 2024 International Meeting on Advanced Spine Techniques proceedings. For full access to the abstract, please visit the following URL: <span><span>https://www.srs.org/Files/IMAST/IMAST2024/Documents/IMAST24-Final-v6-4web.pdf</span><svg><path></path></svg></span>.</p></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100352"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000453/pdfft?md5=385c6f45172d52f74d139e7df59e86f4&pid=1-s2.0-S2666548424000453-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843632","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":"5. Are atypical Hangman's fractures becoming typical?","authors":"Hiroyuki Katoh MD, PhD ,&nbsp;Daisuke Sakai MD, PhD ,&nbsp;Masahiko Watanabe MD, PhD","doi":"10.1016/j.xnsj.2024.100343","DOIUrl":"10.1016/j.xnsj.2024.100343","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;p&gt;A traditional Hangman's fracture (HF) is a bilateral fracture traversing the pars interarticularis of C2, but there is wide variability in the fracture patterns that separate the anterior elements of the C2 vertebrae from the posterior elements. One type of fracture that is increasingly being observed is the atypical HF, in which the posterior aspect of the C2 vertebral body, not the bilateral pars, is involved. While a typical HF separates the anterior elements from the posterior elements of the C2 vertebrae and increases the available space for the spinal cord, the space remaining for the spinal cord does not increase secondary to fracture in the case of an atypical HF, leading to a higher risk of neurologic injury.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;p&gt;In this study, we review HFs treated at a single tertiary care university hospital, especially focusing on the fracture pattern and clinical characteristics associated with HFs.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;p&gt;The subjects of this study are the 35 HF cases treated at our institution between 2010 and 2021, comprised of 22 males and 13 females with an average age of 60.6 years. The etiology, fracture pattern, neurological status, and vertebral artery (VA) integrity were retrospectively examined from hospital records.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;The injury was caused by a traffic accident in 12 cases, a fall in 12 cases, tripping in 9 cases, and struck by a falling object in 2 cases. There were 6 cases of spinal cord injury (SCI) in this series, of which 2 cases with polytrauma died soon after arriving at the hospital: one traffic accident case and another case in that was struck by a falling steel plate. According to the Levine and Edwards Classification, there were 23 cases with Type 1, 6 cases with Type 2, 2 cases with Type 2a, and 4 cases with Type 3 injuries (of which 2 are the cases that died). There were 13 typical HFs and 22 atypical HFs in which the posterior aspect of the C2 vertebral body and not the pars was involved in at least one side. The pattern of fracture of atypical HFs, according to the Li classification, was 10 cases of Type A1, 1 case of Type A2, 7 cases of Type B1, and 4 cases of Type B2. There was no significant difference in the number of cases with SCI between the typical and atypical HF cases. Twenty&lt;em&gt;&lt;sup&gt;-&lt;/sup&gt;&lt;/em&gt;four cases had VA integrity examined either through enhanced CT or MR angiography and 7 cases (20%) were diagnosed with VA injury. All 7 cases were closely followed without any intervention and no complications were observed. VA hypoplasia was suspected in 3 cases, and no VA injury was found the remaining 14 cases.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;p&gt;In our series, more atypical cases with vertebral body involvement were observed than traditional HFs, suggesting that atypical HFs m","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100343"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000362/pdfft?md5=8831c0bafe5d0e3ce769431a04c2ad7c&pid=1-s2.0-S2666548424000362-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841869","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":"15. Long-term outcomes of vertebral body sliding osteotomy for the treatment of cervical myelopathy: a minimum of 5-year follow-up","authors":"Dong-Ho Lee MD, PhD ,&nbsp;Sung Tan Cho MD ,&nbsp;Sehan Park MD","doi":"10.1016/j.xnsj.2024.100353","DOIUrl":"10.1016/j.xnsj.2024.100353","url":null,"abstract":"<div><p>This abstract has been previously published as part of the 2023 Spineweek proceedings. For full access to the abstract, 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 100353"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666548424000465/pdfft?md5=213341fada5cfdc7804f2ffafbd3067b&pid=1-s2.0-S2666548424000465-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850485","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":"P32. Morphological analysis of OPLL progression in cervical spinal cord injury cases treated with posterior fusion","authors":"Kento Inomata MD ,&nbsp;Kota Suda MD, PhD ,&nbsp;Keiichi Nakai MD ,&nbsp;Miki Komatsu MD, PhD ,&nbsp;Satoko Matsumoto Harmon MD, PhD","doi":"10.1016/j.xnsj.2024.100436","DOIUrl":"10.1016/j.xnsj.2024.100436","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background Context&lt;/h3&gt;&lt;p&gt;The patients with cervical ossification of the posterior longitudinal ligament (OPLL) have a high frequency in Asian, with a reported incidence of 6.3% in Japan. The presence of OPLL is a risk factor for cervical spinal cord injury, with some cases resulting from minor trauma such as falls. In previous studies, the characteristics of OPLL after surgery were mentioned, however, there is no consensus on cervical spinal cord injury with OPLL after fusion surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;To investigate the natural progress of ossification in cervical spinal cord injury cases with OPLL treated by posterior fusion surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design/Setting&lt;/h3&gt;&lt;p&gt;Study design is retrospective study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Sample&lt;/h3&gt;&lt;p&gt;The subjects included 42 cases of cervical spinal cord injuries with OPLL that underwent posterior fusion surgery between 2017 and 2021 and were amenable to follow-up with CT for more than 6 months.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome Measures&lt;/h3&gt;&lt;p&gt;N/A.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We investigated the presence or absence of union of the OPLL at the level of the spinal cord injury on postoperative CT and the presence or absence of ossification of the anterior longitudinal ligament (OALL) on CT at the time of injury. We measured the thickness of OPLL at the level of injury by CT at the time of injury and 6 months after surgery and calculated the difference in the thickness of OPLL. We divided the subjects into two groups: one with the union of OPLL after surgery and one without union. We performed comparative analyses between the two groups and binary logistic regression analyses on the differences in thickness of OPLL, DM, and OALL. In addition, we assessed the rates of union for OPLL and OALL longitudinally at intervals of 3 months, 6 months, 1 year, and 2 years postoperatively.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The mean age at the time of injury was 69.0 (44-87) years, the mean observation period was 15.9 (6-63) months, including 38 males and 4 females, the mean BMI was 25.0 (19.0-34.6) kg/m&lt;sup&gt;2&lt;/sup&gt;, and 14 cases had DM. At the final observation, 30 cases (71.4%) got the union of OPLL at the level of the injury, and the mean time from injury to the union of OPLL was 8.4 (2-28) months. Thirty patients had OALL on CT at the time of injury. The mean difference in the thickness of the OPLL between the time of injury and 6 months after surgery was -0.07 (-1.2-0.6) mm, with no diameter enlargement. There were no significant differences between the 2 groups in age, gender, BMI, presence of DM, and the difference in the thickness of OPLL. In the group with the union of OPLL, they had OALL at the time of injury significantly by Pearson's chi-square test (p=.007). We found OALL as an independent factor in the binary logistic regression analysis. the rate of transformation into continuous type both OPLL and OALL at intervals of 3 months, 6 months, 1 year, and 2 years were as follo","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"18 ","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266654842400129X/pdfft?md5=7996a8affd61ce0fcf8f7eed3d0ce549&pid=1-s2.0-S266654842400129X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853578","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":"Maria Cecilia Madariaga DO ,&nbsp;Nicholas A. O'Malley DO, MS ,&nbsp;Hannah Groff DO ,&nbsp;Matthew Alben DO ,&nbsp;Aidan Papalia DO, MBA ,&nbsp;Joshua Fogel PhD ,&nbsp;Jeffrey Thompson DO ,&nbsp;Alexios Apazidis MD","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":"19 ","pages":"Article 100514"},"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":"Adam M. Gordon MD ,&nbsp;Faisal Elali BS, BA","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":"18 ","pages":"Article 100357"},"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}