International Journal of Spine Surgery最新文献

{"title":"Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction.","authors":"Rakesh Kumar, Jean-Christophe Leveque, Philip K Louie, Rajiv Sethi, Venu M Nemani","doi":"10.14444/8641","DOIUrl":"10.14444/8641","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.</p><p><strong>Methods: </strong>3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.</p><p><strong>Results: </strong>The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (<i>n</i> = 62), adult idiopathic scoliosis (<i>n</i> = 30), Scheuermann's kyphosis (<i>n</i> = 2), and other complex conditions (<i>n</i> = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.</p><p><strong>Conclusion: </strong>3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 S1","pages":"S50-S56"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093928","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":"Changes in Alignment at Untreated Vertebral Levels Following Short-Segment Fusion Using Personalized Interbody Cages: Leveraging Personalized Medicine to Reduce the Risk of Reoperation.","authors":"Jeffrey P Mullin, Jahangir Asghar, Ashvin I Patel, Joseph A Osorio, Justin S Smith, Christopher P Ames, John Small, Atman Desai, Adrien Ponticorvo, Rodrigo J Nicolau","doi":"10.14444/8639","DOIUrl":"10.14444/8639","url":null,"abstract":"<p><strong>Background: </strong>An abnormal postoperative lordosis distribution index (LDI), which quantifies the ratio between the lordosis at L4 to S1 and the lordosis at L1 to S1, contributes to the development of adjacent segment disease and increased revision rates in patients undergoing short-segment lumbar intervertebral fusions. Incorporating preoperative spinopelvic parameters and LDI into the surgical plan for short-segment fusion is important for guiding alignment restoration and preserving normal preoperative alignment in unfused segments. This study examined changes in LDI, segmental lordosis, and lordosis of the unfused levels in patients treated with personalized interbody cage (PIC) implants.</p><p><strong>Methods: </strong>This retrospective study evaluated radiographic measurements from 111 consecutively treated patients diagnosed with degenerative spinal conditions and treated with a short-segment fusion of L4 to L5, L5 to S1, or L4 to S1 using PIC implant(s) within 6 months of the fusion procedure. Comparisons of intervertebral lordosis for treated and untreated levels as well as LDI pre- and postoperatively were performed.</p><p><strong>Results: </strong>In patients with a preoperative hypolordotic distribution (LDI < 50%), statistically significant increases were found in LDI postoperatively, approaching the normal LDI range (LDI 50%-80%). Likewise, patients with hyperlordotic distribution preoperatively (LDI > 80%) experienced a decrease in LDI postoperatively, trending toward the normal range, although the changes were not statistically significant. Intervertebral lordosis for the L5 to S1 level increased significantly following the placement of a PIC in the normal and hypolordotic LDI groups. Changes in intervertebral lordosis for L5 to S1 were not significant for patients with preoperative hyperlordotic LDI. Reciprocal changes in intervertebral lordosis at L1 to L4 were not observed in any groups.</p><p><strong>Conclusions: </strong>PIC implants may provide a benefit for patients, particularly those with hypolordotic distributions preoperatively. They have the potential to further improve patient outcomes by helping surgeons to achieve patient-specific lordosis goals, which may help to reduce the risk of adjacent segment disease and revisions in patients undergoing short-segment lumbar intervertebral fusions.</p><p><strong>Clinical relevance: </strong>Personalized implants can help surgeons achieve patient-specific alignment goals, potentially prevent adjacent segment disease, and reduce long-term reinterventions.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S32-S40"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074137","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":"Tomographic Assessment of Fusion Rate, Implant-Endplate Contact Area, Subsidence, and Alignment With Lumbar Personalized Interbody Implants at 1-Year Follow-Up.","authors":"Christopher P Ames, Justin S Smith, Rodrigo J Nicolau","doi":"10.14444/8640","DOIUrl":"10.14444/8640","url":null,"abstract":"<p><strong>Background: </strong>Incongruity between irregularly shaped vertebral endplates and the uniform surfaces of stock interbody fusion cages has been identified as contributing to cage subsidence, pseudarthrosis, and unpredictable alignment. Advances in manufacturing techniques have driven the development of personalized interbody cages (PICs) that can match individual endplate morphology and provide the exact shape and size needed to fill the disc space and achieve the planned correction. This study used computed tomography (CT) imaging to evaluate the implant-endplate contact area, fusion, subsidence, and achievement of planned alignment correction in patients receiving PIC devices.</p><p><strong>Methods: </strong>This retrospective study included patients treated for adult spinal deformity at a single site and implanted with PIC devices at L4 to L5 or L5 to S1 for segmental stabilization and alignment correction, who received 1-year postoperative CT images as part of their standard of care. An evaluation using 3-dimensional thin-section scans was conducted. Implant-endplate contact and signs of fusion were assessed in each CT slice across both endplates. The degree of subsidence as well as measures of segmental and global lumbar alignment were also assessed.</p><p><strong>Results: </strong>Fifteen patients were included in the study, with a mean age of 68.2 years. Follow-up ranged between 9 and 14 months. Twenty-six total lumbar levels were implanted; 20 with PIC devices via the anterior lumbar interbody fusion approach, 2 with stock cages via the anterior lumbar interbody fusion approach, and 4 with PIC devices via the transforaminal lumbar interbody fusion approach. CT analysis of PIC-implanted levels found an overall implant-endplate contact area ratio of 93.9%, a subsidence rate of 4.5%, a fusion rate of 100%, and satisfactory segmental and global lumbar correction compared with the preoperative plan.</p><p><strong>Conclusions: </strong>PIC implants can provide nearly complete contact with endplate surfaces regardless of the individual endplate morphology. Subsidence, fusion, and alignment assessments in this tomographic study illustrated results consistent with the benefits of a personalized interbody implant.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S41-S49"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082094","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":"Radiographic Alignment in Deformity Patients Treated With Personalized Interbody Devices: Early Experience From the COMPASS Registry.","authors":"Roland S Kent, Christopher P Ames, Jahangir Asghar, Donald J Blaskiewicz, Joseph A Osorio, Chun-Po Yen, Jeffrey Mullin, Justin S Smith, John M Small, Michele Temple-Wong, Jeffrey D Schwardt","doi":"10.14444/8636","DOIUrl":"10.14444/8636","url":null,"abstract":"<p><strong>Background: </strong>Literature supports the need for improved techniques to achieve spinopelvic alignment and reduce complication rates in patients with adult spinal deformity (ASD). Personalized interbody devices were developed to address this need and are under evaluation in the multicenter Clinical Outcome Measures in Personalized aprevo (circle R superscript) Spine Surgery (COMPASS (TM suprascript) registry. This report presents interim COMPASS pre- and postoperative sagittal alignment results and complication rates for a subcohort of COMPASS patients diagnosed and surgically treated for spinal deformity.</p><p><strong>Methods: </strong>COMPASS is a postmarket observational registry of patients enrolled either before or after index surgery and then followed prospectively for 24 months. Sagittal alignment was assessed with SRS-Schwab modifiers for pelvic incidence minus lumbar lordosis, pelvic tilt, and T1 pelvic angle. Summed SRS-Schwab modifiers were utilized to assign overall deformity status as mild, moderate, or severe. Complications were extracted from patient medical records.</p><p><strong>Results: </strong>The study included 67 patients from 9 centers. Preoperative severe deformity was observed in 66% of patients. Index surgeries included implantation of a median of 2 personalized interbody devices by anterior, lateral, or transforaminal approaches and with a median of 8 posteriorly instrumented levels. Overall postoperative sagittal alignment improved with a significant decrease in the mean sum of SRS-Schwab modifiers that correlated strongly to improvements in pelvic incidence minus lumbar lordosis. Among 44 patients with preoperative severe overall deformity, 16 improved to moderate and 9 to mild deformity. Complications occurred for 13 patients (19.4%), including 1 mechanical complication requiring revision 9 months after surgery and none related to personalized interbody devices.</p><p><strong>Conclusions: </strong>This study demonstrates that ASD patients whose treatment included personalized interbody devices can obtain favorable postoperative alignment status comparable to published results and with no complications related to the personalized interbody devices.</p><p><strong>Clinical relevance: </strong>This study contributes to growing evidence that personalized interbody devices contribute to improved sagittal alignment in ASD patients by directly adjusting the orientation of adjacent vertebra.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S6-S15"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056759","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":"Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review.","authors":"Anson G Bautista, Justin L Reyes, Nathan J Lee, Michael W Fields, Zeeshan M Sardar, Lawrence G Lenke, Joseph M Lombardi, Ronald A Lehman","doi":"10.14444/8642","DOIUrl":"10.14444/8642","url":null,"abstract":"<p><p>Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 S1","pages":"S57-S63"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093929","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":"Elective Spinal Transpedicular Ablation of the Basivertebral Nerve of the Vertebral Segment in Adult Spinal Deformity Patients.","authors":"Guy Fogel, Jake Dickinson, Sunny Vuong","doi":"10.14444/8632","DOIUrl":"10.14444/8632","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ablation of the basivertebral nerve (BVNA) innervating the vertebral endplate has become a standard treatment of vertebrogenic chronic low back pain (CLBP) arising from vertebral endplate damage. BVNA treatment of CLBP in clinical trials was successful and durable for pain relief and return to daily activities. This case review adds new information about older patients with adult degenerative spinal deformity (ASD) and associated comorbidities not previously described in clinical trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred and eighteen ASD patients with vertebrogenic CLBP in a community practice setting underwent 503 levels of BVNA (average 4.3 levels). Forty-one patients with minimal comorbidities (Group A) were compared to 77 patients with significant comorbidities (Group B). Visual analog scale (VAS 10 cm) and Oswestry Disability Index (ODI 100-point scale) were obtained before BVNA and at a last follow-up (LFU).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Group A VAS at LFU was an average of 2 cm, a 7 cm improvement. Group B VAS at LFU was 3 cm, a 6 cm improvement. At LFU, Group A ODI mean was 14 points or minimal disability, with a 39-point improvement, and Group B improved 28 points to 29 but remained moderately disabled. At LFU, the lumbar stenosis with laminectomy and BVNA subgroup of 26 had mean VAS 2 cm and ODI 28-point improvement but remained on average 21 points with a final low moderate disability. Eleven laminectomy and BVNA patients had continued posterior column pain related to radiculopathy, and or peripheral neuropathy, and sacroiliac joint pain in 30%. Mobile spondylolisthesis in 21 patients in Group B at LFU had a 6 cm improvement of VAS and 25-point improvement of ODI but remained moderately disabled on ODI. At LFU in group B, there was a 20% incidence of continued stenosis and radiculopathy symptoms. At LFU, Lumbar fusion was recommended in 9. Vertebral compression fracture (VCF) occurred in 9 after BVNA (10%) of Group B. These patients were older (mean 78 years), and all had significant osteoporosis. Eight fractures were within the area of the BVNA, and 1 was an S2 sacral fracture. These VCF patients were treated with vertebroplasty or kyphoplasty and continued preventive care with added teriparatide. At LFU, the VCF subgroup had a modest 6 cm improvement in VAS to 4 cm and continued to have significant severe to moderate disability (Oswestry Disability Index average of 38 points).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Clinical trials of BVNA treatment of CLBP found success and durability for pain relief and daily activities. Patients with ASD without comorbidities showed durable pain relief of vertebrogenic CLBP and return of daily activities similar to clinical trials. In those with comorbidities, the result was an improvement in pain and disability that could be diminished by the complications related to the comorbidities. This is new information about BVNA for older patients with spinal deformi","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056809","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":"Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance.","authors":"Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny","doi":"10.14444/8602","DOIUrl":"10.14444/8602","url":null,"abstract":"<p><strong>Background: </strong>Surgical correction of adolescent idiopathic scoliosis from the posterior approach can be performed by the \"all screws\" technique; hybrid technique with screws and hooks; hybrid technique or with screws, hooks, and tapes; or selective fusion (SF) or nonselective fusion (NSF). The aim of the present investigation was to analyze the influence from different operative techniques on frontal curve correction and sagittal profile in patients with adolescent idiopathic scoliosis.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on 55 consecutive patients with scoliosis who had been treated by posterior instrumented fusion. We collected demographic data and analyzed pre- and postoperative radiographs. Statistical analysis was performed using SPSS version 25. Because data showed normal distribution, <i>t</i> tests were performed.</p><p><strong>Results: </strong>Twenty-two patients were treated using the hybrid technique with screws and hooks; 25 were treated using the hybrid technique with screws, hooks, and tape; and 8 were treated using the all screws technique. An SF was performed in 32 patients and NSF in 23 patients. There was no significant difference with regard to curve correction of the main curve between the different techniques. Correction of the minor curve was significantly higher in NSF than in SF patients. In SF, there was a correction of the minor curve of 43.9%. Impact on sagittal balance showed no significant differences between NSF and SF.</p><p><strong>Conclusion: </strong>The different operative techniques did not show a difference with regard to the correction of the main curve. NSF showed a significantly higher degree of correction of the minor curve than SF. However, we still found a correction of 43.9% of the noninstrumented minor curve in SF. Thus, SF and hybrid techniques do not lead to inferior radiographic outcome.</p><p><strong>Clinical relevance: </strong>SF and hybrid techniques are safe and effective techniques that could be used as an alternative to NSF and all screw fixation in the operative treatment for scoliosis.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"322-328"},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923533","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":"Feasibility and Analgesic Efficacy of Thoracolumbar Dorsal Ramus Nerve Block Using Multiorifice Pain Catheters for Scoliosis Surgery: A Prospective Cohort Study.","authors":"Tara M Doherty, Ailan Zhang, Alla Spivak, Ellen Kiley, Damon DelBello, Apolonia E Abramowicz, Jeff L Xu","doi":"10.14444/8601","DOIUrl":"10.14444/8601","url":null,"abstract":"<p><strong>Background: </strong>Approximately 38,000 scoliosis surgery correction operations are performed annually in the United States; these operations are associated with considerable postoperative pain which can be difficult to manage. This is largely attributed to an incision spanning multiple vertebral segments with paraspinal muscle dissection and retraction to facilitate the implantation of segmental hardware and rods. Frequently utilized analgesic modalities include intravenous patient-controlled analgesia and epidural analgesia, often in combination. We sought to ascertain the feasibility and analgesic efficacy of continuous thoracolumbar dorsal ramus nerve (TDRN) block using surgically placed multiorifice catheters.</p><p><strong>Methods: </strong>Forty-two patients diagnosed with idiopathic scoliosis who underwent a posterior spinal fusion (PSF) were enrolled after consent was obtained. Patients were managed utilizing a standardized Enhanced Recovery After Surgery) protocol including a perioperative opioid-sparing regimen. Data were collected at specified time intervals during the recovery period. These data points included pain scores using the Numeric Rating Scale. Parenteral or both oral and parenteral opioid consumption doses were also collected every 4 hours. Any significant postoperative adverse events were recorded as well.</p><p><strong>Results: </strong>A total of 42 patients had surgically placed TDRN catheters, and 40 patients were included in this study. The patients all reported low to moderate pain scores with low opioid consumption postoperatively, while the TDRN catheter delivery of local anesthetic analgesics did not result in significant complications.</p><p><strong>Clinical relevance: </strong>A regional technique utilizing TDRN catheters could be a valuable component of the postoperative pain management protocols for PSF surgery, and additional studies are warranted.</p><p><strong>Conclusion: </strong>This study evaluated the feasibility and analgesic efficacy of TDRN catheters for postoperative pain control following multilevel PSF for idiopathic scoliosis. Continuous local anesthetic delivery through TDRN catheters is a feasible and safe technique for postoperative pain control in these patients. Selective blockade of the dorsal rami might have benefits over epidural analgesia or other regional techniques.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"329-335"},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923530","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":"Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Renal Cell Carcinoma.","authors":"Hani Chanbour, Jeffrey W Chen, Gabriel A Bendfeldt, Lakshmi Suryateja Gangavarapu, Matthew E LaBarge, Mahmoud Ahmed, Iyan Younus, Soren Jonzzon, Steven G Roth, Silky Chotai, Brian I Rini, Leo Y Luo, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.14444/8608","DOIUrl":"10.14444/8608","url":null,"abstract":"<p><strong>Background: </strong>In patients undergoing spine surgery for renal cell carcinoma (RCC), we sought to: (1) describe patterns of postoperative targeted systemic therapy and radiotherapy (RT), (2) compare perioperative outcomes among those treated with targeted systemic therapy to those without, and (3) evaluate the impact of targeted systemic therapy and/or RT on overall survival (OS) and local recurrence (LR).</p><p><strong>Methods: </strong>A single-institution, retrospective cohort study of patients undergoing spine surgery for metastatic RCC from 2010 to 2021 was undertaken. Treatment groups were RT alone, targeted systemic therapy alone, dual therapy consisting of RT and targeted systemic therapy, and neither therapy. Multivariable Cox regression controlled for age, race, sex, insurance, and preoperative targeted systemic therapy.</p><p><strong>Results: </strong>Forty-nine patients underwent spine surgery for RCC. Postoperatively, 4 patients (8%) received RT alone, 19 (38.8%) targeted systemic therapy alone, 12 (24.5%) dual therapy, and 13 (28.6%) neither. All groups were similar in demographics, preoperative Karnofsky Performance Score (<i>P</i> = 0.372), tumor size (<i>P</i> = 0.413), readmissions (<i>P</i> = 0.884), complications (<i>P</i> = 0.272), Karnofsky Performance Score (<i>P</i> = 0.466), and Modified McCormick Scale (<i>P</i> = 0.980) at last follow-up. Higher 1-year survival was found in dual therapy (83.3%) compared with other therapies. OS was significantly longer in patients with dual therapy compared with other therapies (log-rank; <i>P</i> = 0.010). Multivariate Cox regression (HR = 0.08, 95% CI = 0.02-0.31, <i>P</i> < 0.001) showed longer OS in dual therapy compared with other therapies. Seven patients (14.3%) experienced LR, and a similar time to LR was found between groups (log-rank; <i>P</i> = 0.190).</p><p><strong>Conclusion: </strong>In patients undergoing metastatic spine surgery for RCC, postoperative dual therapy demonstrated significantly higher 1-year survival and OS compared with other therapies.</p><p><strong>Clinical relevance: </strong>Multidisciplinary management of metastatic RCC is necessary to ensure timely implementation of targeted systemic therapy and RT to improve outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 3","pages":"343-352"},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535595","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":"Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology.","authors":"Elizabeth A Lechtholz-Zey, Mina Ayad, Brandon S Gettleman, Emily S Mills, Hannah Shelby, Andy Ton, John J S Shin, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.14444/8568","DOIUrl":"10.14444/8568","url":null,"abstract":"<p><strong>Background: </strong>As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity.</p><p><strong>Methods: </strong>A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications.</p><p><strong>Results: </strong>There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock.</p><p><strong>Conclusions: </strong>Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery.</p><p><strong>Clinical relevance: </strong>In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"277-286"},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11535765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433043","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}