North American Spine Society Journal最新文献

{"title":"Identifying preoperative radiographic metrics to guide surgical selection in lumbar spondylolisthesis and stenosis","authors":"John A. Hipp PhD ,&nbsp;Bradford L. Currier MD ,&nbsp;Trevor F. Grieco PhD ,&nbsp;Job L.C. Van Susante MD","doi":"10.1016/j.xnsj.2025.100784","DOIUrl":"10.1016/j.xnsj.2025.100784","url":null,"abstract":"<div><h3>Background Context</h3><div>“Instability” often drives the decision to add fusion to decompression, yet most instability criteria lean solely on sagittal translation and have never been rigorously validated. The potential of a metric for sagittal plane translation to help decide whether fusion should be added to decompression surgery for symptomatic lumbar stenosis with spondylolisthesis was recently reported. Building on imaging and outcomes from that study, we investigated whether other motion metrics may help to predict postoperative disability and patient‐reported outcomes in lumbar stenosis with spondylolisthesis.</div></div><div><h3>Methods</h3><div>Radiographic metrics were retrospectively calculated from the prospectively collected flexion-extension radiographs of 61 patients with lumbar spinal stenosis and spondylolisthesis. A threshold-limit graphical approach was used to identify metrics and thresholds predictive of the Oswestry Disability Index, leg/buttock pain, and patient satisfaction. Outcomes were compared across groups defined by these threshold levels using statistical analysis.</div></div><div><h3>Results</h3><div>Decompression-only surgery was associated with poorer outcomes in patients exhibiting vertical instability or significant spondylolisthesis changes between flexion and extension. Conversely, decompression-plus-fusion surgery yielded worse outcomes in cases without substantial dynamic spondylolisthesis.</div></div><div><h3>Conclusions</h3><div>A broader definition of spinal instability may be needed when deciding whether to include fusion in treating lumbar stenosis with spondylolisthesis. Preoperative vertical instability and dynamic slip may be important in addition to translational instability. Larger prospective studies are warranted, but these metrics could help guide the decision on whether fusion is necessary and likely to improve outcomes for a common spinal disorder.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100784"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior year hospital admission predicts 30-day hospital readmission after spine surgery","authors":"Ryan T. Lin BS ,&nbsp;Rahul Ramanathan MD ,&nbsp;Jonathan F. Dalton MD ,&nbsp;Christopher J. Como MD ,&nbsp;Isaac Lee ,&nbsp;Christopher Gonzalez BS ,&nbsp;Melissa Yunting Tang MD ,&nbsp;Anthony A. Oyekan MD ,&nbsp;Audrey Y. Chang MD ,&nbsp;Michael Spitnale MD ,&nbsp;Jeremy D. Shaw MD ,&nbsp;Joon Y. Lee MD ,&nbsp;Richard A. Wawrose MD","doi":"10.1016/j.xnsj.2025.100750","DOIUrl":"10.1016/j.xnsj.2025.100750","url":null,"abstract":"<div><h3>Background</h3><div>Reducing hospital readmissions postspine surgery is crucial for improving care quality. Currently, no specific scoring system exists to stratify patients by readmission risk in spine surgery. The objective of this study was to evaluate risk factors for 30-day hospital readmission following elective decompressive spine surgery and develop an ML-based risk-scoring system.</div></div><div><h3>Methods</h3><div>653 patients undergoing elective decompressive spine surgery (with or without fusion) at a single academic center were retrospectively reviewed. Data collected included demographics, surgical details, preoperative admissions, and complications. Univariate logistic and Cox regression analyses identified significant predictors. A supervised ML-based risk scoring system was developed and compared against the institution’s standard risk calculator.</div></div><div><h3>Results</h3><div>Of 653 patients, 44 (6.7%) experienced a 30-day readmission. Predictors of readmission included prior-year hospital admission, age-adjusted Charlson Comorbidity Index (CCI), traumatic or thoracic surgery, postoperative complications, and length of stay. An ML-based scoring system stratified patients into Low-risk (0–4 points; 2.16% readmission), Moderate-risk (5–9 points; 7.25%), High-risk (10–14 points; 21.57%), and Extreme-risk (15+ points; 39.47%) groups. Compared to the standard hospital score, the new model demonstrated superior performance: higher C-index (0.79 vs. 0.71), higher Somers’ D (0.56 vs. 0.41), and lower Akaike Information Criterion (AIC) (516.78 vs. 546.65).</div></div><div><h3>Conclusions</h3><div>Preoperative admission within 1 year prior to elective decompressive spine surgery significantly predicts 30-day readmission risk. Additional factors include age-adjusted CCI, traumatic or thoracic surgery, complications, and length of hospital stay. The proposed ML-based scoring system demonstrated superior predictive performance compared to the standard hospital readmission risk calculator, serving as a potentially valuable internal quality improvement tool pending external validation.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100750"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of acute postoperative pain and opioid use between lateral transpsoas, anterior, and transforaminal lumbar interbody fusions","authors":"Ekrem M. Ayhan BS ,&nbsp;Thomas Giannasca BS ,&nbsp;Jake Laverdiere BS ,&nbsp;Laura Sanzari MS ,&nbsp;Gina Panek BS ,&nbsp;Aris Yannopoulos MD","doi":"10.1016/j.xnsj.2025.100781","DOIUrl":"10.1016/j.xnsj.2025.100781","url":null,"abstract":"<div><h3>Background</h3><div>The lateral transpsoas lumbar interbody fusion is associated with transient postoperative anterior thigh and inguinal dysesthesias and hip flexor weakness from manipulation of the psoas and interposed lumbar plexus. However, it remains unclear whether this translates to higher pain scores and opioid requirements.</div></div><div><h3>Methods</h3><div>Patients who had undergone one- or two-level extreme/direct (XLIF/DLIF), anterior (ALIF), or transforaminal lumbar interbody fusion (TLIF) between January 2018 and December 2023 for degenerative spinal pathology were included. All cases were further classified as standalone or pedicle screw-fixated, and pedicle screw-fixated was included as a covariate. Outcomes were assessed using multivariable linear or binary logistic regression and included length of stay (LOS), inpatient daily maximum pain scores, inpatient morphine-equivalent daily dosage, and total inpatient morphine milligram equivalents, 30- and 90-day complications, emergency department visits, return to operating room, and readmission, and 90-day and 1-year Oswestry Disability Index (ODI) and EuroQuol-5 Dimension (EQ5D).</div></div><div><h3>Results</h3><div>A total of 936 patients were assessed, including 90 (9.6%) XLIF/DLIFs, 587 (62.7%) TLIFs, and 259 (27.6%) ALIFs. Pedicle screw fixation differed significantly between approaches (TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p&lt;.001). The XLIF/DLIF approach had the shortest operative time compared to ALIF and TLIF (p&lt;.003). Furthermore, XLIF/DLIF approach was associated with lower 90-day ODI than TLIF (<em>β</em>=–21.185; p=.002) and ALIF (<em>β</em>=–9.275; p=.043), higher 90-day EQ5D than TLIF (<em>β</em>=+27.389; p&lt;.001) and ALIF (<em>β</em>=+13.897; p=.001), higher morphine-equivalent daily dosage than TLIF (<em>β</em>=+29.115; p&lt;.001) and ALIF (<em>β</em>=+11.959; p=.006), and shorter LOS than TLIF (<em>β</em>=–45.500 hours; p=.014) and ALIF (<em>β</em>=–24.447 hours; p=.049). No significant differences were observed in maximum pain scores, total inpatient morphine milligram equivalents, complications, readmissions, or return to operating room.</div></div><div><h3>Conclusions</h3><div>Despite a shorter operative time, shorter LOS, and better 90-day ODI and EQ5D, the lateral transpsoas lumbar interbody fusion is associated with higher postoperative inpatient opioid consumption than TLIF and ALIF.</div></div><div><h3>Level of Evidence</h3><div>III</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100781"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world treatment patterns and management gaps of lumbar disc herniation in the United States","authors":"Amit Bhandutia MD ,&nbsp;Min Yang PhD ,&nbsp;Qing Liu MD, PhD ,&nbsp;Yipeng Gao PhD ,&nbsp;Jiaxuan Liu PhD, MPH ,&nbsp;Steven Liu MS ,&nbsp;Amy Guo PhD ,&nbsp;Kinsuk Chauhan MD, MPH","doi":"10.1016/j.xnsj.2025.100757","DOIUrl":"10.1016/j.xnsj.2025.100757","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation (LDH) affects approximately 1% to 3% of the population annually and leads to substantial physical burden, quality-of-life burden, and productivity loss. Commonly used interventions, including pharmacological and epidural steroid injections (ESIs), have limited high-quality evidence to support their effectiveness in the long-term for treating LDH beyond symptom relief. In general, there is a lack of consensus for timing of treatment after LDH onset and limited data on real-world treatment of LDH. The objective of this study was to describe current real-world treatment patterns and inform gaps in clinical management of patients with LDH.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed using data from January 01, 2018 through March 31, 2023 of a United States commercial health insurance claims database (IQVIA PharMetrics Plus). Patients aged 30–70 years with newly-diagnosed LDH and continuous insurance enrollment for ≥6 months before and ≥12 months after index (first) LDH diagnosis were included. Relevant billing codes were used to identify LDH, related treatments (nonpharmacologic, pharmacologic, invasive), and comorbidities. Demographic and clinical characteristics were summarized for the baseline (preindex) period. Treatment patterns were described over the follow-up period, up to 3 years after LDH diagnosis. Time from LDH diagnosis to ESI(s) and surgery(ies) were calculated.</div></div><div><h3>Results</h3><div>A total of 1,086,552 patients with LDH were included, with a mean age of 50.8 years. Patients had a mean follow-up of 27 months after LDH diagnosis. Nearly 20% of patients with LDH underwent ESI, with half of this group undergoing multiple ESIs. Multiple ESIs were associated with a greater likelihood of surgical intervention and repeat surgical intervention compared to those who only underwent single ESI. LDH surgery was performed on 7.2% of patients, approximately 10% of whom had multiple surgeries during follow-up. A large subset (44.1%) of patients who underwent LDH surgery did not have any ESI prior to surgery. General limitations of claims data analyses can include data misclassification, missing claims for diagnoses and procedures that were conducted, missing clinical information (severity of condition, insights into clinical decision making), and some missing patient demographics and characteristics.</div></div><div><h3>Conclusions</h3><div>In this study, approximately one quarter of patients with LDH underwent ESI and/or surgery after conservative treatment. Opportunities exist to provide more guideline-concordant care to patients with LDH. In addition, unmet needs exist in the current treatment options for patients with LDH, potentially including the need for other nonsurgical treatment options for patients who do not fully respond to conservative treatment.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100757"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insertional torque and pullout strength of reinserted screws for sacroiliac joint fusion: Effects of implant dimensions, bone density, and tapping","authors":"Cale J. Hendricks BS ,&nbsp;David W. Polly Jr MD ,&nbsp;Ashley M. Abbott BS ,&nbsp;Yaqoub Y. Yusuf MS ,&nbsp;Rafael A. Garcia BS ,&nbsp;Matthew R. MacEwen PhD ,&nbsp;Arin M. Ellingson PhD","doi":"10.1016/j.xnsj.2025.100623","DOIUrl":"10.1016/j.xnsj.2025.100623","url":null,"abstract":"<div><h3>Background</h3><div>Sacroiliac joint (SIJ) fusion is a common procedure for SIJ pain and dysfunction. Traditional threaded screws offer limited bony integration, prompting the development of additively manufactured, porous implants aimed at enhancing osseointegration. However, data on their insertional mechanics and pullout strength, especially in revision scenarios, remain sparse. This study aimed to investigate the influence of bone density, tapping, and implant size on re-insertional torque and pullout strength.</div></div><div><h3>Methods</h3><div>Mechanical testing was conducted in accordance with ASTM F543, using 10 and 20 PCF polyurethane foam blocks to simulate low and normal-density bone, respectively. A 10 × 35 mm screw fusion device served as the control. For subsequent tests, the 10 × 35 mm screw was removed, and various diameters (10, 11.5, 13.5 mm) and lengths (35, 40, 45 mm) were reinserted under 2 conditions: direct and with tapping. The maximum and final insertional torque, as well as the maximum pullout force, were measured. ANOVA techniques with pairwise comparison and Pearson correlation tests were performed (α = 0.05).</div></div><div><h3>Results</h3><div>Significant effects and interactions were observed for implant size, bone density, and tapping. Larger implant diameter and length were associated with significantly greater insertional torque and pullout strength compared to controls, though excessively large diameters yielded diminishing returns in normal-density bone. Independent of size and tapping, normal-density bone consistently demonstrated greater insertional torque (929.1 ± 6.5 vs. 235.0 ± 6.5N·cm) and pullout strength (1,331.2 ± 14.8 vs. 457.3 ± 14.6 N) than low-density bone (p &lt; .001). Independent of size, tapping improved insertional torque (+33.9%; p &lt; .001) and pullout strength (+108.4%; p &lt; .001) in normal-density bone but reduced pullout strength in low-density bone (−22.4%; p &lt; .001). Final insertional torque strongly correlated with pullout strength (r = 0.946, p &lt; .001).</div></div><div><h3>Conclusions</h3><div>Our findings provide evidence-based insight for optimizing implant selection and surgical technique in revision SIJ fusion procedures using screw fusion devices. Particularly, it is emphasized that both implant dimensions and patient-specific bone quality must be considered to achieve stable and successful outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100623"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical restoration in unilateral facet arthroplasty: a cadaveric evaluation","authors":"Christopher D. Sturm MD ,&nbsp;Sarah Mayer MSc ,&nbsp;Joshua Tandio MSc ,&nbsp;Jeremi M. Leasure MSc ,&nbsp;Oluwatodimu Richard Raji MEng","doi":"10.1016/j.xnsj.2025.100766","DOIUrl":"10.1016/j.xnsj.2025.100766","url":null,"abstract":"<div><h3>Background</h3><div>Facet incompetency can lead to altered spine biomechanics. However, while total posterior arthroplasty techniques in lieu of fusion are of increasing interest, unilateral techniques are yet to be investigated. This study aimed to assess the biomechanical effect of a unilateral facet arthroplasty (UFA) system on motion and loading characteristics at the treated L4-5 level.</div></div><div><h3>Methods</h3><div>Seven cadaveric spines from L3-Sacrum were tested within the multidirectional pure moment bending model between 0 to ± 10 Nm in flexion-extension (FE), flexion-extension with 400 N of compressive follower load (FE-FL), axial rotation (AR), and lateral bending (LB). We measured the L4-L5 angular range of motion, the intradiscal pressure, and the contralateral facet contact force. Each specimen was tested in intact (I), capsulotomy (C), medial facetectomy (MF), total facetectomy (TF), and UFA conditions. We also measured the load transfer at the bone-implant interface in the UFA condition.</div></div><div><h3>Results</h3><div>UFA significantly restored 93% (FE), 77% (FE-FL), 123% (AR), and 106% (LB) of the native range of motion (p&lt;.05). UFA significantly restored the native intradiscal pressure during compressive follower load (I:173±67KPa vs. TF:103± 82KPa vs. UFA:174±69KPa), and partially during contra-axial rotation (I:32±27KPa vs. TF:81±55KPa vs. UFA:59±46KPa). No significant changes were observed in facet contact force. Contra-axial rotation induced the most substantial loads transferred through the bone-implant interface.</div></div><div><h3>Conclusions</h3><div>UFA is most effective at restoring native intervertebral disc load transfer without altering facet loading at the treated level. UFA is equivalent to the intact condition in FE, FE-FL, and LB, but larger in AR, even after reverting 55% of induced instability.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100766"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ``P72. Change of spinal cord alignment within one week after cervical laminoplasty'' [North American Spine Society Journal (NASSJ) 18S (2024) 100476]","authors":"Tatsuya Shibata MD ,&nbsp;Yoshikuni Kida MD, PhD ,&nbsp;Jun Tanaka MD, PhD ,&nbsp;Hideki Ota MD ,&nbsp;Yohei Iguchi MD ,&nbsp;Teruaki Shiokawa MD ,&nbsp;Kyoichi Sanada MD ,&nbsp;Shusuke Hagihara MD ,&nbsp;Sota Sasaki MD ,&nbsp;Akitaka Yoshimura MD ,&nbsp;Takuaki Yamamoto MD, PhD","doi":"10.1016/j.xnsj.2025.100772","DOIUrl":"10.1016/j.xnsj.2025.100772","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100772"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The symbiosis of robotics, enabling technology and minimally invasive surgery1","authors":"Katherine M. Bunch MD, MS ,&nbsp;Garret P. Greeneway MD ,&nbsp;Darius S. Ansari MD ,&nbsp;Chetan Patel MD ,&nbsp;Eric W. Nottmeier MD ,&nbsp;Karthik H.S. Madhavan MD ,&nbsp;Stephen M. Pirris MD ,&nbsp;Andrew A. Sama MD ,&nbsp;Nathaniel P. Brooks MD","doi":"10.1016/j.xnsj.2025.100769","DOIUrl":"10.1016/j.xnsj.2025.100769","url":null,"abstract":"<div><h3>Background</h3><div>Procedural and technical advances in spinal surgery, such as the utilization of minimally-invasive techniques, have evolved alongside the development and distribution of tools such as navigation, robotics, augmented reality (AR), dynamic visualization, and preoperative planning modules. Each innovative advancement in a surgeon’s ability to see, measure, and manipulate human tissue entails an improvement or novel application of existing tools. Similarly, given the enormous economic and opportunity costs associated with the research and development of novel technologies, these efforts must be refined to address existing needs and infrastructure gaps. The successful application of enabling technologies such as robotics, navigation, and minimally-invasive techniques, is therefore dependent upon the expansion of new surgical tools and techniques.</div></div><div><h3>Methods</h3><div>We review numerous technological advances (Navigation, Intraoperative Imaging, Robotics, Augmented Reality, Computational Planning and Visualization) within the field of spine surgery and demonstrate their mutually beneficial, yet dependent, relationship with one another in advancing spine surgery technology through both expert opinion and published literature.</div></div><div><h3>Results</h3><div>We provide an overview of several different domains of enabling technology as they pertain to novel applications in spinal surgery and review current uses, limitations, and areas of potential improvement.</div></div><div><h3>Conclusions</h3><div>The integration of augmented reality, robotics, visualization and navigational technologies, minimally invasive techniques, and other advanced tools have enabled the surgeon to perform both standard and novel procedures in unique ways.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100769"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DCM-72 (dexterity, cutaneous, and muscle-72): A composite scoring system for objective assessment of upper limb dysfunction in patients with degenerative cervical myelopathy","authors":"Harshit Arora MBBS ,&nbsp;Hassan Darabi MD ,&nbsp;Kelsey Karnik PhD ,&nbsp;Jared T. Wilcox MD, PhD ,&nbsp;Jan M. Schwab MD, PhD ,&nbsp;Francis Farhadi MD, PhD","doi":"10.1016/j.xnsj.2025.100775","DOIUrl":"10.1016/j.xnsj.2025.100775","url":null,"abstract":"<div><h3>Background Context</h3><div>Degenerative cervical myelopathy (DCM) is characterized by spinal cord compression, which can present with limb weakness and numbness, loss of fine motor skills, gait disturbance, and bladder dysfunction. The modified Japanese Orthopedic Association (mJOA) and Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy (GRASSP-M) scores evaluate distinct aspects to assess the severity of upper and lower extremity dysfunction. Our study aims to develop an integrative, multidimensional Dexterity, Cutaneous, and Muscle (DCM-72) scoring system to provide a more comprehensive and objective evaluation of upper extremity functional impairment.</div></div><div><h3>Methods</h3><div>Within this prospective, 2 center study, a total of 123 participants, comprising of 94 subjects with confirmed DCM and 29 controls with cervical radiculopathy were enrolled. A composite DCM-72 score was developed incorporating several upper extremity functional assessments with 24 total points allocated to each of the 3 components: dexterity, sensation, and muscle strength. Descriptive statistics were used with a p≤0.05 indicating statistical significance.</div></div><div><h3>Results</h3><div>The mean age of the participants is 60.2±12.1 years, with a female-to-male ratio of 1:1.2. The average DCM-72 scores for the dominant and nondominant upper extremities are 28.0±6.0 and 27.3±6.5. Analysis of variance with posthoc analysis identified significant differences between mild-severe and moderate-severe cases as stratified by mJOA subclassification. The proposed composite DCM-72 severity score ranges are defined as: 68.5-72 (normal), 64.3-68.4 (mild), 56.7-62.3 (moderate), and &lt;56.7 (severe).</div></div><div><h3>Conclusion</h3><div>The DCM-72 score effectively stratifies upper extremity dysfunction in patients with DCM through a set of well-established quantitative assessments offering objective performance evaluations as compared to existing scoring systems. DCM-72 can further assist clinicians to monitor outcome trajectories to support decision-making and prognostication and further serves as a candidate tool to improve sensitivity for interventional trial testing.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100775"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical trends and future projections of cervical disc arthroplasty and removal cervical disc arthroplasty in the United States Medicare population","authors":"Tarun Mattikalli BS,&nbsp;Jeremy Steinberger MD,&nbsp;Konstantinos Margetis MD, PhD","doi":"10.1016/j.xnsj.2025.100774","DOIUrl":"10.1016/j.xnsj.2025.100774","url":null,"abstract":"<div><h3>Background</h3><div>Cervical disc arthroplasty (CDA) has become an increasingly utilized alternative to anterior cervical discectomy and fusion (ACDF), offering potential benefits such as motion preservation and reduced incidence of adjacent segment disease. However, long-term utilization trends and future procedural burden remain unclear.</div></div><div><h3>Methods</h3><div>Medicare fee-for-service (FFS) cervical disc arthroplasty (CDA) volumes were extracted from the Medicare Part B National Summary between 2009 and 2022, excluding 2020, and uplifted to account for Medicare Advantage enrollment. Statistical models developed included ordinary least squares (OLS), generalized linear models (GLM), and segmented regression to detect any inflection points in utilization. Autoregressive and alternative GLMs such as Poisson and negative binomial were used for validation. For each procedure type, the model that best aligned with observed trends and statistical fit (AIC, R²) was used to generate forecasts through 2035.</div></div><div><h3>Results</h3><div>Primary CDA utilization demonstrated an inflection point in 2018, after which growth stabilized. Post 2018 OLS modeling estimated a 6.2% annual growth rate, reaching an estimated 9,422 procedures by 2035 (95% CI: 5,494–16,159). Removal CDA exhibited consistent exponential growth, with GLM estimated 22.9% annual increase and a projected volume of 1,773 procedures by 2035 (95% CI: 1,183–2,656).</div></div><div><h3>Conclusions</h3><div>Primary CDA may be entering a mature adoption phase with modest projected growth, while removal CDA is expected to grow more substantially. These projections reflect trends in an older population, which may not generalize to younger individuals undergoing CDA. Our findings reinforce the need for continued surveillance, resource planning, and better understanding of long-term CDA complications in the increasingly aging population.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100774"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}