International Journal of Spine Surgery最新文献

{"title":"Biportal Endoscopic Resection of Intradural Meningioma in the Cervical Spine: A Case Report.","authors":"Seok Bong Jung, Nackhwan Kim","doi":"10.14444/8645","DOIUrl":"10.14444/8645","url":null,"abstract":"<p><p>Cervical intradural meningioma are rare central nervous system neoplasms. Surgical resection is the primary treatment due to the tumor's benign nature and clear demarcation from the spinal cord, although the posterior surgical approach can result in complications such as neurological deficits and cerebrospinal fluid leaks. We present a case of a 78-year-old woman with progressive clumsiness, gait disturbance, and weakness. She was diagnosed with an intradural extramedullary meningioma at the C2 to C3 level through magnetic resonance imaging. The tumor was excised using a cervical biportal endoscopic spine surgery approach, a minimally invasive technique that utilizes 2 small portals for endoscope and instrument access. The procedure, performed under general anesthesia, involved a hemilaminectomy and partial laminectomy to access and remove the tumor. Postoperative assessments indicated significant neurological recovery, with the patient regaining independent mobility and fine motor skills. Follow-up magnetic resonance images at 18 months confirmed the absence of tumor recurrence. This case demonstrates the efficacy of cervical biportal endoscopic spine surgery in managing high cervical intradural tumors, highlighting its potential for reducing surgical complications and promoting rapid patient recovery.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"611-616"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146498","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":"Cost-Effectiveness and Clinical Outcomes of Lateral Lumbar Interbody Fusion With Tricalcium Phosphate and Iliac Bone Graft Compared With Posterior Lumbar Interbody Fusion With Local Bone Graft in Single-Level Lumbar Spinal Fusion Surgery in Thailand.","authors":"Panlop Tirawanish, Pochamana Phisalprapa, Chayanis Kositamongkol, Ekkapoj Korwutthikulrangsri, Monchai Ruangchainikom, Werasak Sutipornpalangkul","doi":"10.14444/8615","DOIUrl":"10.14444/8615","url":null,"abstract":"<p><strong>Background: </strong>Nowadays, minimally invasive lateral lumbar interbody fusion (LLIF) is used to treat degenerative lumbar spine disease. Many studies have proven that LLIF results in less soft tissue destruction and rapid recovery compared with open posterior lumbar interbody fusion (PLIF). Our recent cost-utility study demonstrated that LLIF was not cost-effective according to the Thai willingness-to-pay threshold, primarily due to the utilization of an expensive bone substitute: bone morphogenetic protein 2. Therefore, this study was designed to use less expensive tricalcium phosphate combined with iliac bone graft (TCP + IBG) as a bone substitute and compare cost-utility analysis and clinical outcomes of PLIF in Thailand.</p><p><strong>Methods: </strong>All clinical and radiographic outcomes of patients who underwent single-level LLIF using TCP + IBG and PLIF were retrospectively collected. Preoperative and 2-year follow-up quality of life from EuroQol-5 Dimensions-5 Levels and health care cost were reviewed. A cost-utility analysis was conducted using a Markov model with a lifetime horizon and a societal perspective.</p><p><strong>Results: </strong>All enrolled patients were categorized into an LLIF group (<i>n</i> = 30) and a PLIF group (<i>n</i> = 50). All radiographic results (lumbar lordosis, foraminal height, and disc height) were improved at 2 years of follow-up in both groups (<i>P</i> < 0.001); however, the LLIF group had a dramatic significant improvement in all radiographic parameters compared with the PLIF group (<i>P</i> < 0.05). The fusion rate for LLIF (83.3%) and PLIF (84%) was similar and had no statistical significance. All health-related quality of life (Oswestry Disability Index, utility, and EuroQol Visual Analog Scale) significantly improved compared with preoperative scores (<i>P</i> < 0.001), but there were no significant differences between the LLIF and PLIF groups (<i>P</i> > 0.05). The total lifetime cost of LLIF was less than that of PLIF (15,355 vs 16,500 USD). Compared with PLIF, LLIF was cost-effective according to the Thai willingness-to-pay threshold, with a net monetary benefit of 539.76 USD.</p><p><strong>Conclusion: </strong>LLIF with TCP + IBG demonstrated excellent radiographic and comparable clinical health-related outcomes compared with PLIF. In economic evaluation, the total lifetime cost was lower in LLIF with TCP + IBG than in PLIF. Furthermore, LLIF with TCP + IBG was cost-effective compared with PLIF according to the context of Thailand.</p><p><strong>Clinical relevance: </strong>LLIF with less expensive TCP + IBG as bone graft results in better clinical and radiographic outcomes, less lifetime cost, and cost-effectiveness compared with PLIF. This suggests that LLIF with TCP + IBG could be utilized in lower- and middle-income countries for treating patients with degenerative disc disease.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"490-501"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421339","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":"Radiological Spinopelvic Parameters Can Be Risk Factors for Early Total Hip Replacement After Spine Fusion.","authors":"Young-Hyun Yoon, Seong-Hwan Moon, Byung Ho Lee, Kyung-Soo Suk, Si Young Park, Sub-Ri Park, Namhoo Kim, Hak-Sun Kim, Ji-Won Kwon","doi":"10.14444/8681","DOIUrl":"10.14444/8681","url":null,"abstract":"<p><strong>Background: </strong>Interest in the correlation between the spinopelvic complex and its radiographic parameters in early total hip arthroplasty has been increasing. This study investigated whether radiological spinopelvic parameters are risk factors for early total hip replacement (THR) within 1 year of spinal fusion surgery. The primary research question focused on identifying specific spinopelvic changes that may lead to early THR.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent lumbar spinal fusion between 2016 and 2021. The patients were divided into 2 groups: patients who underwent early THR (<i>n</i> = 35) and patients who did not (<i>n</i> = 213). Spinopelvic parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis, thoracolumbar kyphosis (TLK), sagittal vertical axis, and thoracic kyphosis (TK), were measured before and after surgery. The statistical analyses included inverse probability of treatment weighting, independent <i>t</i> tests, <i>χ</i> ² tests, and logistic regression analyses.</p><p><strong>Results: </strong>A total of 248 patients were included in the study. The pre- and postoperative TLK and TK angles were significantly smaller in the early THR group than in the late THR group. Increases in the PI and SS after surgery were significant risk factors. The use of interbody fusion techniques was associated with a higher rate of early THR. The difference in the PI minus lumbar lordosis before and after surgery was also significantly correlated with early THR.</p><p><strong>Conclusions: </strong>Abnormal spinopelvic parameters, especially reduced TLK and TK angles and increased PI and SS, are risk factors for early THR.</p><p><strong>Clinical relevance: </strong>Changes in spinopelvic parameters can lead to rapid hip joint destruction, which highlights the need for careful preoperative evaluation and postoperative monitoring of patients to prevent early THR.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"589-594"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583913","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":"Frequency and Associated Factors of Venous Thromboembolism in Cervical Spine Surgery.","authors":"Masashi Uehara, Shota Ikegami, Hiroki Oba, Yoshinari Miyaoka, Terue Hatakenaka, Daisuke Kurogochi, Shinji Sasao, Tetsuhiko Mimura, Jun Takahashi","doi":"10.14444/8624","DOIUrl":"10.14444/8624","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is a well-known complication after spine surgery. As many cases of cervical spine disease result in severe gait disturbance due to myelopathy, it may harbor a higher risk of VTE than other spinal disorders. However, few studies have focused primarily on cervical spine surgery to date. This investigation sought to determine the prevalence of VTE after cervical spine surgery and identify patient-based risk factors.</p><p><strong>Methods: </strong>The medical data of 341 consecutive patients (240 men and 101 women; mean age, 68.1 years) who underwent cervical spine surgery were retrospectively examined. Logistic regression models were employed to examine the prevalence, characteristics, and risk factors of postoperative VTE.</p><p><strong>Results: </strong>In this study, 2.6% of cervical spine surgery patients experienced postoperative VTE. In comparisons of VTE and non-VTE groups, significant differences were found for age (79.6 years vs 67.7 years, <i>P</i> < 0.01), 1-week postoperative D-dimer level (10.6 μg/mL vs 2.7 μg/mL, <i>P</i> < 0.01), and cardiovascular disease (44.4% vs 11.1%, <i>P</i> = 0.011). Multivariate analysis identified elevated postoperative D-dimer level and cardiovascular disease as significantly associated with postsurgical VTE with respective odds ratios of 1.54 and 9.52.</p><p><strong>Conclusion: </strong>Postoperative VTE in cervical spine surgery was seen in 2.6% of cases. Patients with elevated postoperative D-dimer level and cardiovascular disease may be at increased risk of VTE and may require additional observation.</p><p><strong>Clinical relevance: </strong>Spine surgeons should take into account that patients with elevated postoperative D-dimer levels and cardiovascular disease may be at increased risk for VTE.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"457-461"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898502","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":"A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems.","authors":"Kanyakorn Riewruja, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, Vit Kotheeranurak, Worawat Limthongkul, Ronpichai Chokesuwattanaskul, Stephen J Kerr, Weerasak Singhatanadgige","doi":"10.14444/8618","DOIUrl":"10.14444/8618","url":null,"abstract":"<p><strong>Background: </strong>Studies were reviewed and collected to compare different image guidance systems for pedicle screw placement (PSP) regarding accuracy and safety outcomes. Included were conventional, navigation, robot-assisted, and recent technology such as augmented reality (AR) guiding systems.</p><p><strong>Methods: </strong>This network meta-analysis obtained human comparative studies and randomized controlled trials (RCTs) regarding PSP found in 3 databases (Cochrane, PubMed, and Scopus). Data extraction for accuracy, safety, and clinical outcomes were collected. The network meta-analysis was analyzed, and a surface under the cumulative ranking curve (SUCRA) was used to rank the treatment for all outcomes.</p><p><strong>Results: </strong>The final 61 studies, including 13 RCTs and 48 non-RCTs, were included in the meta-analysis. These studies included a total of 17,023 patients and 35,451 pedicle screws. The surface under the cumulative ranking curve ranking demonstrated the supremacy of robotics in almost all accuracy outcomes except for the facet joint violation. Regarding perfect placement, the risk difference for AR was 19.1 (95% CI: 8.1-30.1), which was significantly higher than the conventional method. The robot-assisted and navigation systems had improved outcomes but were not significantly different in accuracy vs the conventional technique. There was no statistically significant difference concerning safety or clinical outcomes.</p><p><strong>Conclusions: </strong>The accuracy of PSP achieved by robot-assisted technology was the highest, whereas the safety and clinical outcomes of the different methods were comparable. The recent AR technique provided better accuracy compared with navigation and conventional methods.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"551-570"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856717","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":"Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study.","authors":"Davis Martin, Ryan Schroeder, Collin Toups, Clifton Daigle, Matthew Spitchley, Claudia Leonardi, Berje Shammassian, Amit K Bhandutia","doi":"10.14444/8657","DOIUrl":"10.14444/8657","url":null,"abstract":"<p><strong>Background: </strong>Previous research suggests a relationship between complications associated with anterior cervical discectomy and fusion and level involvement; however, there is limited research comparing postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs). This study aims to compare the outcomes of UCF with MLCF.</p><p><strong>Methods: </strong>A retrospective medical record review was conducted on 835 anterior cervical discectomy and fusion patients from 2012 to 2022. Patients were classified as UCF, defined as inclusion of C3 to C4 disc space, or MLCF, defined as lacking C3 to C4 disc space. Demographics were compared using <i>χ</i> ² or Fisher exact tests. Clinical characteristics were compared in univariable analysis using <i>χ</i> ² tests, linear-mixed effects models, or generalized linear-mixed models depending on distribution. Significant pre- and intraoperative characteristics were included in multivariable models to minimize confounding.</p><p><strong>Results: </strong>Of the 835 patients included, 562 underwent MLCF and 281 underwent UCF. Median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay in both univariable (1.5 vs 3.1, <i>P</i> < 0.0001) and multivariable analysis (2.3 days [95% CI: 1.8, 3.0] vs 3.3 days [2.6, 4.2], <i>P</i> < 0.0001). MLCF patients reported symptom improvement or resolution more often than UCF patients (0.43 [95% CI: 0.30, 0.62] and 0.46 [95% CI: 0.30, 0.70]). Additionally, a significantly higher rate of dysphagia was reported in the UCF group on both univariate and multivariable analysis, respectively (1.72 [95% CI: 1.18, 2.49] and 1.66 [95%CI: 1.08, 2.56]).</p><p><strong>Conclusions: </strong>To our knowledge, this is the first study to investigate the link between cervical fusion level and outcomes. UCF patients demonstrated greater rates of dysphagia, longer length of stay, and lower likelihood of improvement in neurological symptoms postoperatively both before and after controlling for differences in pre- and intraoperative characteristics.</p><p><strong>Clinical relevance: </strong>This study highlights that UCFs may be associated with worse postoperative outcomes when compared to MLCFs, which can inform surgical decision-making and patient counseling.</p><p><strong>Level of evidence: </strong>The study represents Level 3 evidence due to its retrospective design and potential biases, indicating a need for future prospective randomized controlled trials to validate these findings.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576872","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":"Baseline Neck Disability Index and Patient-Reported Outcomes Measurement Information System Physical Function Predict Postoperative Return to Normal in Cervical Spine Surgery.","authors":"Gregory S Kazarian, Michael E Steinhaus, Sravisht Iyer, Drake LeBrun, Robert Cecere, Takashi Hirase, Francis Lovecchio, Todd J Albert, Darren Lebl, Darren Huang, Harvinder Sandhu, Bernard Rawlins, Frank Schwab, Virginie Lafage, Han Jo Kim","doi":"10.14444/8653","DOIUrl":"10.14444/8653","url":null,"abstract":"<p><strong>Background: </strong>Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative management.</p><p><strong>Purpose: </strong>The objective of this study was to assess whether preoperative patient-reported outcome measures (PROMs) can be used to predict which patients achieve \"normal\" levels of pain and function after surgery.</p><p><strong>Study design: </strong>This was a prospective cohort study.</p><p><strong>Patient sample: </strong>This study included all adult patients undergoing cervical spine surgery by 1 of 7 senior spine surgeons at our institution between 2016 and 2018. Of the 164 patients who were eligible for 6-month follow-up at the time that study data were collected, 139 had available follow-up data and were included in our analysis.</p><p><strong>Outcomes measures: </strong>Patients completed the Neck Disability Index (NDI) as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference computer adaptive tests preoperatively and at 6 months postoperatively.</p><p><strong>Methods: </strong>Patients who achieved postoperative patient-acceptable symptom state (PASS) for NDI (≤17) and the normative mean (50) for PROMIS were identified. The relationship between preoperative PROMs and the probability of achieving PASS and the normative mean was assessed.</p><p><strong>Results: </strong>One hundred thirty-nine patients met inclusion criteria with diagnoses of myelopathy (<i>n</i> = 36), radiculopathy (<i>n</i> = 48), and myeloradiculopathy (<i>n</i> = 49). For NDI, a 1-point worsening in the preoperative score resulted in an OR of achieving PASS of 0.96 (<i>P</i> < 0.001) in the overall population. This association held true for patients with radiculopathy (OR 0.96; <i>P</i> = 0.022) but not myelopathy (OR 0.98; <i>P</i> = 0.35). For PROMIS PF, a 1-point improvement in the preoperative score resulted in an OR of achieving the normative mean of 1.10 (<i>P</i> < 0.001). This association held true for patients with radiculopathy (OR 1.14; <i>P</i> = 0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; <i>P</i> = 0.515).</p><p><strong>Conclusions: </strong>Preoperative PROMs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the normative mean for PROMIS PF, especially for patients with radiculopathy.</p><p><strong>Clinical relevance: </strong>Baseline symptoms and function, including myelopathy or radiculopathy-dominant symptoms and preoperative PROMs, may predict postoperative 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":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394083","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":"Analysis of 1027 Adverse Events Reports for Interspinous Process Devices From the US Food and Drug Administration Manufacturer and User Facility Device Experience Database.","authors":"Gregory S Kazarian, Yusef J Jordan, Mitchell Johnson, Satyaj Bhargava, Robert Cecere, Takashi Hirase, Sheeraz Qureshi, James Dowdell, Evan Sheha, Francis Lovecchio, Sravisht Iyer","doi":"10.14444/8652","DOIUrl":"10.14444/8652","url":null,"abstract":"<p><strong>Background: </strong>Interspinous process devices (IPDs) introduce a new class of complications to surgical decompression without fusion: hardware-related complications. The purpose of this study was to describe the adverse events associated with IPDs.</p><p><strong>Study design: </strong>This was a retrospective review of the Food and Drug Administration Manufacturer and User Facility Device Experience database.</p><p><strong>Methods: </strong>The database was queried from its inception to November 2022 for reports associated with \"Prosthesis, Spinous Process Spacer/Plate.\" Entries were categorized by event type, patient impact, and interventions.</p><p><strong>Results: </strong>A total of 943 surgery-related adverse events were identified. The most common intraoperative events were implant malfunctions (39.7%, <i>n</i> = 374) and fractures (2.2%, <i>n</i> = 21). The most common postoperative events were persistent pain (26.6%, <i>n</i> = 251), implant migration (19.1%, <i>n</i> = 180), and fracture (6.8%, <i>n</i> = 64). The most common resultant outcome of an adverse event was the need for revision surgery (48.8%, <i>n</i> = 460). The need for revision surgery was common in patients who experienced fracture (47.1%), implant migration (84.5%), infection (76.7%), and neurological complications (76.9%). Implant migration, fracture, and implant malfunction, 3 complications that are unique to decompression with an IPD as compared with traditional laminectomy, accounted for 45.9% of revisions (211/460), and revision was required in 33.0% of cases where 1 of these complications was reported (211/640). Implant malfunction made up 21.2% of Coflex complications, 47.3% of Superion complications, and 5.2% of X-Stop complications.</p><p><strong>Conclusions: </strong>The most common adverse events were implant malfunction, inadequate efficacy, implant migration, and fracture. Concerningly, these complications require revision surgery in one-third of cases when they occur. Implant-specific assessments demonstrate a high prevalence of implant malfunctions for the Coflex and Superion implants.</p><p><strong>Clinical relevance: </strong>Interspinous process devices introduce a new class of complications to isolated spinal decompression surgery: implant-related complications. These complications occur both intraoperatively and postoperatively, and they frequently necessitate revision surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355881","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":"Are the Umbilicus and Iliac Crests Truly at the Level of L4 to L5? A Computed Tomography-Based Study of Surface Anatomy of the Anterior Lumbar Spine.","authors":"David Shin, Kai Nguyen, Easton Small, Trevor Case, Mikayla Kricfalusi, Alexander Bouterse, Andrew Cabrera, Ethan Purnell, Wheddy Laguerre, Jacob Razzouk, Omar Ramos, Olumide Danisa, Wayne Cheng","doi":"10.14444/8651","DOIUrl":"10.14444/8651","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether the iliac crests are truly at the level of L4 to L5, accounting for patient demographic and anthropometric characteristics.</p><p><strong>Methods: </strong>We measured the umbilicus and iliac crests relative to the lumbar spine using computed tomography of patients without spinal pathology, accounting for the influences of patient height, weight, body mass index (BMI), sex, race, and ethnicity.</p><p><strong>Results: </strong>A total of 834 patients (391 men and 443 women) were reviewed. The location of the umbilicus relative to the lumbar spine demonstrated a unimodal distribution pattern clustered at L4, while the iliac crests were most frequently located from L4 to L5. Iliac crests were located above the L4 to L5 disc space 26.5% of the time. Iliac crests were located at the L4 to L5 disc space 29.8% of the time. No correlations were observed between the umbilicus and iliac crests with patient height, weight, or BMI. There was no difference in the location of the umbilicus with respect to patient sex, race, and ethnicity. The locations of the iliac crests were cephalad in women compared with men and in Hispanics compared with African American, Caucasian, and Asian patients.</p><p><strong>Conclusions: </strong>The iliac crests were located above the level of the L4 to L5 disc space approximately 26% of the time. The umbilicus is most frequently at the level of the L4 vertebral body. Patient height, weight, and BMI do not influence the location of the umbilicus or the iliac crests relative to the lumbar spine. Patient sex and ethnicity influence the location of the iliac crests but not the umbilicus relative to the lumbar spine.</p><p><strong>Clinical relevance: </strong>Modern neurosurgical techniques require clearance of the iliac crests during anterior and anterolateral approaches. Understanding the level of the iliac crests is crucial in planning for transpsoas fusion approaches.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355882","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":"Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation.","authors":"Gregory I Sacks, Vincent Destefano, Susan M Fiore, Raphael P Davis, Samuel Ahknoukh, Harry M Mushlin","doi":"10.14444/8650","DOIUrl":"10.14444/8650","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is a common cause of radicular pain with an annual incidence between 5 and 20 cases per 1000 adults. LDH is typically treated by microdiscectomy, of which more than 300,000 are performed in the United States each year. Despite this frequency, 25% to 33% of patients report poor surgical outcomes. This study sought to present a retrospective analysis of patients who underwent microdiscectomy surgery for the treatment of LDH with the aim of identifying demographic, historical, and surgical factors that may contribute to inadequate surgical results.</p><p><strong>Methods: </strong>A retrospective study of 241 patients at Stony Brook Medicine from 2017 to 2022 was performed, 123 of whom had follow-up of 90 days or more and were included for final analysis. Data collection included demographics, medical/surgical history, and surgical methodology. Good outcomes were defined as meeting the absolute point change threshold (ACT)-3.5pt reduction in pain reported by the Numerical Rating System (NRS) or the resolution of either radicular pain or neurological symptoms.</p><p><strong>Results: </strong>Univariate analysis revealed that 100% of patients with prior fusion surgery (<i>P</i> = 0.039) and 73.2% who underwent preoperative physical therapy (PT; <i>P</i> = 0.032) failed to meet the ACT. Additionally, 79.1% (<i>P</i> = 0.021) and 82.8% (<i>P</i> = 0.026) of patients who had PT had residual radicular pain and neurological symptoms, respectively. Multivariate logistic regression confirmed correlations between preoperative PT and failure to meet the ACT (<i>P</i> = 0.030, OR = 0.252) and resolution of radicular (<i>P</i> = 0.006, OR = 0.196) and neurological (<i>P</i> = 0.030, OR = 0.177) complaints. ACT directly correlated with higher preoperative NRS scores in univariate (<i>P</i> = 0.0002) and multivariate (<i>P</i> = 0.002, OR = 1.554) analyses.</p><p><strong>Conclusion: </strong>Our results show that higher preoperative NRS scores, PT, and prior fusion surgery are associated with poorer outcomes. While PT is considered a viable nonoperative treatment for LDH, our findings suggest detrimental effects when preceding surgery, indicating the need for additional research into the effects of PT on patients with high grade LDH.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297560","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}