International Journal of Spine Surgery最新文献

{"title":"Anterior Debridement and Fusion With Plating for Cervical Spondylodiscitis: Retrospective Assessment of Clinical Efficacy.","authors":"Yu-Dong Liao, Chen Tu, Jia-Wen Gao, Rui-Feng Ao, Yu-Shen Huang, Ying-Tao Hu, Si-Yuan Zhu, Jian Jin, Zhao-Ming Zhong","doi":"10.14444/8798","DOIUrl":"https://doi.org/10.14444/8798","url":null,"abstract":"<p><strong>Background: </strong>Cervical spondylodiscitis is a rare condition that easily causes neurological deficits. This study aimed to evaluate the safety and efficacy of anterior debridement and fusion (ADF) with plating for cervical spondylodiscitis.</p><p><strong>Method: </strong>We retrospectively analyzed the medical records of 24 patients who underwent ADF with plating and antibiotics for cervical spondylodiscitis at our institution from June 2005 to June 2023. The neurologic status was evaluated using the Japanese Orthopedic Association scoring system and Hirabayashi recovery rate. Radiological parameters were assessed, including C2 to C7 angle, angle and height of the fused segment, and fusion status.</p><p><strong>Results: </strong>Mean follow-up time was 50.1 (range 12-162) months. The Japanese Orthopedic Association score increased from 13.2 preoperatively to 15.8 at the final follow-up, with a mean Hirabayashi recovery rate of 79.3%. Recovery outcomes were excellent in 17 (70.8%) cases, good in 3 (12.5%), acceptable in 1 (4.2%), and unchanged in 3 (12.5%). Postoperative C2 to C7 angles and the angle and height of the fused segment were significantly improved compared with preoperative measures. However, height loss of the fused segments occurred in all cases during the follow-up period, especially in ADF with titanium mesh. One patient received revision with posterior fixation because of a pathological fracture in the cephalic vertebral body of the fused segment in the early postoperative phase. Infection resolution and solid bony fusion were achieved in all patients.</p><p><strong>Conclusion: </strong>ADF with plating can achieve satisfactory clinical outcomes for cervical spondylodiscitis.</p><p><strong>Clinical relevance: </strong>Poor bone quality secondary to infection, excessive intraoperative cervical distraction, and the choice of fusion material may be associated with the loss of fused segmental height and angle, as well as potential instrumentation failure, after ADF with plating.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240113","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":"Advantages of 12° Endoscope in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation.","authors":"Wenbo Wu, Yanqiu Xie, Yinkai Xue, Min Cui, Xianlin Zeng, Yukun Zhang, Cao Yang, Yongchao Wu","doi":"10.14444/8771","DOIUrl":"https://doi.org/10.14444/8771","url":null,"abstract":"<p><strong>Objective: </strong>This study introduces the application of a 12° endoscope in unilateral biportal endoscopic (UBE) decompression surgery for lumbar disc herniation and discusses its advantages in UBE procedures.</p><p><strong>Methods: </strong>From December 2019 to December 2020, 75 patients (33 men and 42 women) were treated with UBE decompression using a 12° endoscope. Patient ages ranged from 26 to 78 years (mean 53.2). Pre- and postoperative visual analog scale (VAS) scores for low back and leg pain were recorded. Surgical outcomes were evaluated using MacNab criteria, with operative time and complications documented.</p><p><strong>Results: </strong>The 12° endoscope demonstrated superior maneuverability with a distortion-free visual field. Compared with 30° endoscopes, it showed better applicability within the anatomical working triangle while providing broader visualization than 0° endoscopes. This enabled effective decompression of the superior articular process medial edge, nerve root canal, and lateral recess. Low back pain VAS scores decreased from 7.3 ± 1.3 to 1.9 ± 1.2 (<i>P</i> < 0.001), while leg pain scores improved from 8.1 ± 1.8 to 1.6 ± 1.0 (<i>P</i> < 0.001). At the 12-month follow-up, MacNab criteria outcomes were excellent in 65.3%, good in 25.3%, and unsatisfactory in 9.3% of cases (<i>χ</i> ² test, <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>The 12° endoscope demonstrates clinical value as a feasible, safe, and effective option for UBE surgery in lumbar disc herniation treatment.</p><p><strong>Clinical relevance: </strong>Key clinical advantages of the 12° endoscope include direct visualization of key anatomical structures, minimized bone resection (particularly at the medial spinous process base), and a reduction in instrument crowding. These technical benefits contribute to effective decompression, improved patient outcomes (as measured by VAS and MacNab criteria), and potentially a shorter learning curve for surgeons adopting the UBE technique.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240070","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":"Sensitivity of Lumbar Total Joint Replacement to Axial and Coronal Plane Misalignment Using Computational Modeling.","authors":"Steven A Rundell, Steven M Kurtz, Hannah Spece, Jeffrey A Goldstein, Scott D Hodges, Ron V Yarbrough","doi":"10.14444/8792","DOIUrl":"https://doi.org/10.14444/8792","url":null,"abstract":"<p><strong>Background: </strong>During lumbar total joint replacement (LTJR), component misalignment during implantation may affect the bearing surface interaction. In this study, validated computational models of the lumbar spine were used to investigate a range of clinically relevant misalignment scenarios.</p><p><strong>Methods: </strong>A finite element model (FEM) of the LTJR, exposed to mode I (normal wear) and mode IV (impingement) wear boundary conditions, was previously validated following the ASME V&V 40 standard. The LTJR FEM was virtually implanted into a previously validated FEM of the lumbar spine (L3-L5) at L4 to L5. The model included vertebrae, major spinal ligaments, erector muscle forces, and intervertebral discs. Misalignment was introduced by adjusting the bilateral implant axial plane convergence angle (20°-40°), anterior-posterior offset (0-4 mm), and coronal plane tilt (±20°). Analyses were conducted using LS-DYNA3D (ANSYS) under boundary conditions simulating bending at the waist. Contact pressures and von Mises stresses were evaluated for each misalignment scenario and compared with those developed during mode I and mode IV impingement scenarios.</p><p><strong>Results: </strong>Axial plane convergence angle had minimal impact on contact stress and von Mises stress magnitude and distribution. Increasing anterior-posterior offset led to higher stresses on the anteriorly shifted component but did not significantly alter the overall stress pattern. Coronal tilt had the most substantial effect on both stress magnitude and distribution.</p><p><strong>Conclusion: </strong>Overall, polyethylene stresses in all misalignment scenarios remained below mode IV impingement levels. Contact areas remained within the intended spherical bearing surfaces without signs of impingement. LTJR contact stresses were found to be reasonably insensitive to misalignment under boundary conditions representing bending at the waist.</p><p><strong>Clinical relevance: </strong>This work assesses the impact of clinically relevant implant misalignment scenarios on the polyethylene stresses associated with damage and wear for a novel LTJR and offers best practice guidelines for surgeons.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214072","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":"Full Decompression of Spinal Stenosis in Stable Adult Isthmic Spondylolisthesis With a Combination of Full Endoscopic Spine Surgery and Unilateral Biportal Endoscopic Spine Surgery: A Case Report.","authors":"Chien-Chieh Wang, Kin-Weng Wong, Po-Kuan Wu, Kuan-Ting Chen, Wen-Shuo Chang, Chi-Sheng Chien, Dae-Jung Choi, Tsung-Mu Wu","doi":"10.14444/8800","DOIUrl":"https://doi.org/10.14444/8800","url":null,"abstract":"<p><strong>Background: </strong>Adult isthmic spondylolisthesis often remains stable in adulthood, but progressive neural compression can occur due to scar tissue, bony overgrowth, and disc degeneration. Conventional endoscopic techniques such as the interlaminar or transforaminal approaches may be limited by anatomical constraints in adult isthmic spondylolisthesis, making complete decompression difficult.</p><p><strong>Methods: </strong>A 70-year-old man presented with bilateral leg pain and neurogenic claudication. Imaging revealed bilateral L4 to L5 lateral recess narrowing, L5 foraminal stenosis, and a bulging L5 to S1 disc compressing the extraforaminal nerve roots. A novel craniocaudal interlaminar approach via unilateral biportal endoscopic spine surgery was used to decompress the central and contralateral foraminal regions. The residual ipsilateral extraforaminal lesion was accessed through a separate full endoscopic transforaminal approach. Three incisions of 7 mm each were used.</p><p><strong>Results: </strong>The patient experienced immediate and significant relief of radicular symptoms and improved function and was discharged the next day. At 18-month follow-up, he remained pain-free and without new-onset back pain or signs of instability.</p><p><strong>Conclusions: </strong>This is the first reported case combining unilateral biportal endoscopic spine surgery and full endoscopic spine surgery. The approach enabled full decompression from central to extraforaminal zones with minimal invasiveness. This dual-endoscopic strategy may serve as a model for treating complex spine cases not amenable to single-approach techniques.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214096","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":"Bilateral Pedicle Screw Fixation Vs Unilateral Pedicle Screw Fixation for Single Level Lateral Lumbar Interbody Fusion: Outcomes, Cost Analysis, and Radiation Exposure.","authors":"Saagar Dhanjani, Timothy Choi, Abdufarrukh Karimov, Kishan S Shah, Micah B Blais, Gregory M Mundis, Ali Bagheri, Behrooz A Akbarnia, Robert K Eastlack","doi":"10.14444/8794","DOIUrl":"https://doi.org/10.14444/8794","url":null,"abstract":"<p><strong>Background: </strong>This study aims to determine whether single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw fixation (UPSF) might offer advantages over bilateral pedicle screw fixation (BPSF) in terms of radiation emission, cost, and outcomes.</p><p><strong>Methods: </strong>The records of 101 patients who underwent single-level LLIF with percutaneous pedicle screw fixation from September 2017 to August 2024 were analyzed. Patients were divided into 2 groups: 42 with UPSF and 59 with BPSF. Demographic data, social history, comorbidities, surgical characteristics, costs (based on manufacturer prices), and radiation metrics (radiation emitted, fluoroscopy time, number of images, and magnification mode used) were collected. Clinical outcomes were assessed using the Numeric Rating Scale (NRS), the Oswestry Disability Index, and procedure satisfaction, while radiographic evaluation employed a novel fusion classification system.</p><p><strong>Results: </strong>There were no significant differences in age, body mass index, social history, comorbidities, or operative level. However, the BPSF group included significantly more women (<i>P</i> = 0.002) and a higher proportion of spondylolisthesis cases (<i>P</i> < 0.001). Oswestry Disability Index and NRS scores were similar, except for greater improvements in NRS back pain at 1 year in the BPSF group (-4.0 vs -1.75, <i>P</i> = 0.008). While the total fluoroscopy time, number of images, and Mag 1 usage were greater in the BPSF group (all <i>P</i> < 0.001), the average radiation emitted did not significantly differ (39.38 milligray for UPSF vs 50.75 milligray for BPSF, <i>P</i> = 0.211). Fusion grades were comparable (<i>P</i> = 0.478), and UPSF costs were 27.7% lower.</p><p><strong>Conclusions: </strong>Our study found that when used according to clinical indications, UPSF results in similar radiation emission and radiographic outcomes, while being 27.7% less expensive than BPSF for single-level LLIF. Additionally, while BPSF was associated with greater improvement in 1 year NRS back scores, no other significant differences in patient-reported outcome measures were observed between the 2 groups.</p><p><strong>Clinical relevance: </strong>This study provides clinically relevant insights for selecting between UPSF and BPSF in single-level LLIF when both are considered appropriate.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151388","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":"Comparison of 1-Year Clinical and Radiographic Outcomes Between 2 Expandable Cage Designs in Navigation-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Khanathip Jitpakdee, Chibuikem A Ikwuegbuenyi, Minaam Farooq, Fabian Sommer, Edna Gouveia, Blake I Boadi, Jessica Berger, Ibrahim Hussain, Roger Härtl","doi":"10.14444/8797","DOIUrl":"https://doi.org/10.14444/8797","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) often struggles to provide sufficient lordotic alignment restoration. The choice of cage design, including its height and lordotic angle, is critical. This study compares 2 expandable cage designs in MIS-TLIF: one that increases only disc height (group H) and another that expands both height and lordosis (group HL).</p><p><strong>Methods: </strong>Seventy-five patients who underwent navigation-assisted MIS-TLIF using expandable cages were reviewed. These included 35 cases using expandable cages that increase only height (group H) and 40 cases using cages that expand both height and lordosis (group HL). Clinical outcomes, including a numeric rating scale of back pain, leg pain, and Oswestry Disability Index and radiographic parameters, including disc height, lordotic angle, subsidence, and fusion rates, were evaluated.</p><p><strong>Results: </strong>Both groups showed significant improvements in clinical outcomes, with no differences between groups. Postoperative disc and foraminal height increased significantly. At the 1-year follow-up, group HL demonstrated greater improvements in segmental lordosis (4.0° ± 3.3° vs 1.9° ± 5.4°, <i>P</i> = 0.018) and disc angle (5.8° ± 4.1° vs 1.9° ± 4.2°, <i>P</i> < 0.001) compared with group H. The overall fusion rate was 92%, and the overall subsidence rate was 32%, which decreased to 20% after the first 20 cases. No neurological injuries occurred, and there were no significant differences in complications between the groups.</p><p><strong>Conclusion: </strong>This study demonstrates that MIS-TLIF with expandable cages designed to increase lordosis offers superior improvement in segmental lordosis at the 1-year follow-up, compared with expandable cages that only expand disc height. Both cage designs achieved high fusion rates and showed similar clinical outcomes.</p><p><strong>Clinical relevance: </strong>The surgeon's experience in the use of expandable cages is a critical factor in reducing the risk of cage subsidence, a complication that may adversely affect clinical outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151365","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":"Interlaminar Endoscopic Resection of Giant Hemorrhagic Ganglion Cyst of the Facet Joint at L1 to L2 Level.","authors":"Guntram Krzok, Shailen G Sampath, Mihaly Peca, Sanjay Konakondlam, Jian Shen, Albert E Telfeian","doi":"10.14444/8793","DOIUrl":"https://doi.org/10.14444/8793","url":null,"abstract":"<p><p>Hemorrhagic facet cysts are a rare condition including both synovial and ganglion cysts. Here, the authors present the first-ever reported case of a hemorrhagic ganglion cyst of the facet joint at L1 to L2 causing cauda equina syndrome. In this report, a 72-year-old woman presented with symptoms of cauda equina syndrome requiring urgent surgical consideration. Magnetic resonance imaging and computed tomography showed an extradural mass at the L1 to L2 level. Due to the giant size of the cyst, there was severe compression of the thecal sac and nerve roots. The patient underwent interlaminar contralateral decompression and cystectomy using a uniportal endoscopic approach. The patient had a quick postoperative recovery, with postoperative magnetic resonance imaging of the lumbar spine showing recovery of the facet cyst with no sign of recurrence or stenosis. This case demonstrates the successful surgical technique of interlaminar endoscopic contralateral decompression combined with cystectomy, showing that a hemorrhagic ganglion cyst at the facet at L1 to L2 can be removed completely under endoscopic view.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139016","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":"C2 to C3 Traumatic Lateral Dislocation Combined With C3 Fracture Without Neurological Deficits: A Rare Case and Treatment.","authors":"Hongchao Shi, Haijia Yu, Ye Tian, Yong Wang","doi":"10.14444/8796","DOIUrl":"https://doi.org/10.14444/8796","url":null,"abstract":"<p><strong>Background: </strong>Traumatic cervical spine fractures with dislocation are often caused by high-energy injuries, typically from motor vehicle accidents. Hangman's fracture constitutes 4% to 5% of cervical fractures and is usually accompanied by anteroposterior dislocation and/or neurological deficits. However, lateral vertebral dislocation without neurological symptoms is extremely rare. We present a case of C2 to C3 lateral dislocation with C3 fracture in a patient who only reported neck pain and limited mobility.</p><p><strong>Methods: </strong>This study reports a case of a 42-year-old woman who presented with neck pain after a traffic accident. The patient remained fully conscious throughout the incident, and the patient did not experience any loss of consciousness. Preoperative imaging clearly revealed a split fracture of the right C3 body-pedicle junction and the right vertebral plate, along with anterolateral dislocation of the C2 vertebral body. After a closed reduction of the affected segment, an anterior cervical discectomy and fusion (ACDF) was performed to restore segmental stability of the C2 to C3 level.</p><p><strong>Results: </strong>A satisfied closed reduction was achieved after a fixed cervical traction. An ACDF was performed to successfully restore the segmental stability of the C2 to C3 level without surgical-related complications. The patient reported alleviation of neck pain (visual analog scale score decreased from 7 preoperatively to 2 postoperatively). Postoperative imaging revealed a satisfactory reduction of fracture-dislocation. At a 2-month follow-up after discharge, the patient had returned to work.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility of ACDF as a standalone approach for treating single-stage cervical fractures with associated lateral dislocation following precise and sustained traction reduction. Compared with posterior or combined approaches, the anterior-only technique offers significant advantages, providing a minimally invasive alternative for the management of complex cervical spine trauma.</p><p><strong>Clnical relevance: </strong>This case highlights that prompt recognition and surgical stabilization of C3 vertebral body fracture with C2-C3 spondylolisthesis can prevent neurological deterioration and improve functional recovery. It provides practical evidence to support early surgical decision-making in rare but severe cervical spine injuries.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087615","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":"From Incision to Prescription: Unraveling Pain and Opioid Use in Adult Spinal Deformity Surgery.","authors":"Samantha Schimmel, Molly Monsour, Kiana Yeganeh, Schahin Salmanian, Chloe Chose, Anjali Pradhan, Diego T Soto-Rubio, Cesar Carballo Cuello, Jay I Kumar, Puya Alikhani","doi":"10.14444/8791","DOIUrl":"https://doi.org/10.14444/8791","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformity (ASD) surgery often involves extensive spinal realignment to restore spinopelvic parameters and functional alignment. Unfortunately, patients frequently experience significant postoperative pain, often leading to prolonged opioid use. This study investigates patient- and surgery-related factors associated with opioid use and pain following ASD surgery.</p><p><strong>Methods: </strong>We conducted a retrospective review of ASD cases performed at our institution between 2016 and 2023. All patients underwent multilevel spinal fusion for correction of scoliosis and/or kyphosis.</p><p><strong>Results: </strong>Of the 264 patients, 231 (88%) required opioids postoperatively, and 22.4% remained on opioids at 12 months. Preoperative opioid use (<i>P</i> < 0.001), pelvic incidence (PI) <55° (<i>P</i> = 0.018) due to inability for pelvic retroversion, revision surgery for proximal junctional kyphosis (<i>P</i> = 0.006), and hardware failure (<i>P</i> < 0.001) were associated with prolonged opioid use. Notably, patients who underwent intradiscal osteotomy (IDO) had a shorter duration of opioid use due to more harmonious correction of their lumbar lordosis (<i>P</i> = 0.006). Pain scores were significantly higher in patients who underwent anterior column release (<i>P</i> < 0.001) and who experienced postoperative complications (proximal junctional kyphosis and hardware failure; <i>P</i> < 0.05). In contrast, patients treated with IDO or pedicle subtraction osteotomy reported lower pain (<i>P</i> < 0.05). In multivariable analysis, preoperative opioid use was the strongest independent predictor of 12-month use (OR = 3.95, <i>P</i> = 0.001), while PI > 55° was independently associated with decreased 12-month use (OR = 0.33, <i>P</i> = 0.009).</p><p><strong>Conclusion: </strong>This study highlights several key risk factors for prolonged opioid dependence and elevated postoperative pain in ASD surgery, including preoperative narcotic use, postoperative PI < 55°, revision surgery for mechanical complications, and specific osteotomy techniques. The protective effect of IDO in reducing pain and opioid duration is most likely due to more harmonious correction of lumbar lordosis and an improvement in lumbar lordosis-PI mismatch.</p><p><strong>Clinical relevance: </strong>These findings underscore the importance of preoperative optimization, opioid-sparing pain management strategies, and enhanced recovery pathways to mitigate long-term opioid reliance and improve patient outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055963","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":"Incidental Durotomy Significantly Increases the Risk of Postoperative Infection Following Lumbar Spine Surgery for Degenerative Conditions: A Systematic Review and Meta-analysis.","authors":"Tamara Babasiz, Jannik Leyendecker, Maximilian Weber, Philipp Egenolf, Jürgen Hampl, Ayla Yagdiran, Peer Eysel, Krishnan Sircar","doi":"10.14444/8790","DOIUrl":"https://doi.org/10.14444/8790","url":null,"abstract":"<p><strong>Background: </strong>Accidental dural tear (ADT), an unintended intraoperative breach of the dura mater, is a recognized complication in lumbar spine surgery for degenerative conditions. Postoperative surgical site infections are serious adverse outcomes in this context. However, the role of ADT in increasing postoperative infection risk remains insufficiently defined. This systematic review and meta-analysis aimed to comprehensively assess the association between ADT and the occurrence of postoperative infection.</p><p><strong>Methods: </strong>A systematic literature search was performed in PubMed, ScienceDirect, and CENTRAL from inception to 6 August 2024. Studies involving degenerative lumbar surgery and reporting data on both incidental durotomy and postoperative infections were included. Study quality, including risk of bias analysis, was appraised by 2 independent observers. Subsequently, 2 meta-analyses were conducted, estimating the pooled incidence of infection among patients with ADT and another calculating pooled odds ratios to evaluate infection risk.</p><p><strong>Results: </strong>Fourteen studies comprising 376,164 patients met the inclusion criteria. The incidence of ADT ranged from 1.9% to 11.8%, with higher rates observed in revision surgeries. Key risk factors included obesity, diabetes, revision surgery, advanced age, and extended operative time. The meta-analysis comprised 7 studies, including 7500 patients with dural tears and 189,058 patients without dural tears. The pooled incidence of postoperative infection among patients with ADT was 13.1% (95% CI: 6.8%-23.8%), which was significantly higher compared with 5.4% (95% CI: 3.1%-7.5%) among patients without ADT (<i>P</i> = 0.00078). Substantial heterogeneity was observed across studies (<i>I</i> ² = 76.5% for ADT patients and 96.0% for non-ADT patients; Tau² = 0.63). A separate meta-analysis of 5 studies reported a pooled odds ratio of 3.86 (95% CI: 2.48-6.3, <i>P</i> < 0.00001), indicating a significantly increased infection risk associated with ADT.</p><p><strong>Conclusion: </strong>ADTs during lumbar spine surgery for degenerative conditions are associated with a significantly increased risk of postoperative infections. Although this relationship is multifactorial, affected by surgical complexity and patient comorbidities, these findings underscore the importance of heightened vigilance in infection prevention and control following ADT to reduce infection-related morbidity.</p><p><strong>Clinical relevance: </strong>Incidental dural tear during lumbar spine surgery for degenerative conditions significantly increases the risk for postoperative infection and should be a focus of preventive strategies.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040876","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}