International Journal of Spine Surgery最新文献

{"title":"Prone Position for Preoperative Planning in Lumbar Endoscopic and Minimally Invasive Fusion Procedures: Insights From a Magnetic Resonance Imaging Study.","authors":"Miguel Relvas-Silva, José Maria Matos Sousa, Daniel Dias, Bernardo Sousa Pinto, António Sousa, José Fonseca, Miguel Loureiro, André Rodrigues Pinho, Vitorino Veludo, António Serdoura, Maria Dulce Madeira, Pedro Alberto Pereira","doi":"10.14444/8731","DOIUrl":"10.14444/8731","url":null,"abstract":"<p><strong>Background: </strong>Differences in lumbar morphology and nerve root positioning between supine and prone decubitus are poorly analyzed. This study aimed to perform a magnetic resonance imaging (MRI) study to describe lumbar morphology, nerve root, and related structures positioning in the prone position, while comparing with conventional supine MRI, in patients with lumbar symptoms. The second aim was to define safe working zones for lumbar surgical procedures.</p><p><strong>Methods: </strong>This study was a prospective, single-center, observational study. Fifty patients with persistent low back and/or radicular pain that was unresponsive to conservative treatment were consecutively selected. Supine and prone 3 Tesla MRIs were performed. Two independent researchers performed an imaging analysis of predefined variables.</p><p><strong>Results: </strong>Lumbar lordosis significantly changed from 49.3° in the supine position to 52.1° in the prone position (<i>P</i> = 0.005), without a statistically significant difference in lower lumbar lordosis. No consistent changes were found regarding foraminal height, root-to-pedicle or root-to-superior articular process distances. The exiting nerve root was found between 42% and 49% of the foraminal height (as measured from the upper border of the lower pedicle). The left retroperitoneal lateral corridor showed no significant size variation from the supine to the prone position (<i>P</i> = 0.196 and <i>P</i> = 0.600, for L3-L4 and L4-L5 levels, respectively).</p><p><strong>Conclusion: </strong>This study suggests prone positioning may increase global lumbar lordosis, without changing the position of other major anatomical structures. The exiting nerve root positioning can be estimated in relation to foraminal height. These finding may help optimizing planning and minimizing iatrogenic lesions.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"179-187"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774432","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":"Endoscopic Spine Surgery: A French National Survey on Practices, Motivations, and Challenges.","authors":"Xavier Castel, Marc Szadkowski, Henri d'Astorg","doi":"10.14444/8722","DOIUrl":"10.14444/8722","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic spine surgery is a minimally invasive approach that offers several advantages over the traditional open approach, including less tissue trauma, faster recovery, and lower rates of complications. However, the learning curve and the requirement of separate equipment limits the acceptability of this technique for many spine surgeons. Using a short survey, the authors sought to report the current status regarding the use of endoscopy among French spine surgeons and to identify the barriers faced by spine surgeons to adopting endoscopy into their practice.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in which a predefined questionnaire was sent as a Google form to 522 members of the Societe Francaise de Chirurgie du Rachisspine. Respondents were asked to respond within 3 months, with reminders sent regularly to nonresponders. Responses were collected and analyzed.</p><p><strong>Results: </strong>Among all 123 survey respondents, 39 practiced endoscopy and 84 did not practice endoscopy. Most of the surgeons acquired skills by visiting other surgeons (74.4%) or attending cadaver-based workshops (56.4%). A substantial portion of respondents were in between 1 and 3 years of experience (48.7%) and performed 5 to 10 endoscopic procedures per month(30.8%). Although 92.1% of respondents observed better outcomes in their patients with endoscopy, lack of training (26%) and high equipment cost (13.8%) were the most limiting factors reported by surgeons.</p><p><strong>Conclusion: </strong>The results of this survey contribute to the existing literature and highlight the current trends of endoscopic spine surgery in France. Although the benefits of minimally invasive spine surgery are well documented and were confirmed by surgeons in this survey, lack of training and cost of equipment are major barriers that need to be controlled to expand the adoption of this technique.</p><p><strong>Clinical relevance: </strong>Understanding the factors influencing the adoption of endoscopic spine surgery in France provides valuable insights for surgeons and educators. By identifying key barriers and motivations, this study may help guide strategies for improving training, accessibility, and implementation of endoscopic techniques in spinal surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"173-178"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400302","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":"Stem Cells Therapy as a Treatment for Discogenic Low Back Pain: A Systematic Review.","authors":"Randy Randy, Khandar Yosua, Aswin Guntara, Nicko P Hardiansyah","doi":"10.14444/86717","DOIUrl":"10.14444/86717","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is 1 of the most common problems that present in 80% of people. LBP can be caused by some pathologies, with discogenic pain being 1 source. Pain from LBP can become chronic and also cause disability. Treatment options for LBP varied from conservative to operative, and a novel treatment nowadays is using stem cells therapy to treat with pain from LBP.</p><p><strong>Methods: </strong>Database searches from Pubmed and ScienceDirect from inception to 13 September 2023. A total of 283 discogenic LBP cases from 8 articles. This study measured clinical outcomes using a visual analog scale (VAS) and Oswestry Disability Index (ODI) obtained from each study.</p><p><strong>Results: </strong>Functional outcomes in patients treated with stem cell therapy showed significant improvement ODI and VAS (<i>P</i> < 0.00001). Improvement also showed in Pfirrmann grade before and after treatment with stem cells (<i>P</i> = 0.005). Subgroup analyses using bone marrow aspirate concentrate also showed significant differences in both ODI and VAS (<i>P</i> < 0.00001).</p><p><strong>Conclusion: </strong>Stem cells therapy could be beneficial as an option of treatment for discogenic LBP in improving pain and activity of daily living.</p><p><strong>Clinical relevance: </strong>Intradiscal stem cell therapy is a promising alternative for managing discogenic low back pain, offering improvements in pain and function.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"156-167"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956416","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":"Circumferential Correction of Severe Thoracolumbar Kyphosis by Utilizing an Articulating Rod and Lateral Interbody Device: A Technical Note.","authors":"Sumedh S Shah, Malek Bashti, Manav Daftari, James Boddu, Nathaniel B Dusseau, Jason Liounakos, Timur Urakov","doi":"10.14444/8723","DOIUrl":"10.14444/8723","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of severe thoracolumbar kyphosis (TLK) is challenging due to the necessity of achieving adequate sagittal realignment without increasing operative risk or compromising hardware integrity. Performing large corrective maneuvers during deformity correction may increase the risk of neurological complications, especially when correcting hyperkyphosis in the distal thoracolumbar spine. The present article describes the first use of a custom-made articulating rod to manipulate a patient's severe TLK into extension in combination with the expandable lateral interbody device to achieve circumferential deformity correction.</p><p><strong>Clinical presentation: </strong>A 38-year-old woman with a history of spinal trauma 10 years ago developed severe TLK (<70° angulation) after failed posterior spinal stabilization. Due to her debilitating neurological symptoms and profound sagittal deformity, we performed a T9 to L2 navigation-assisted posterolateral fusion followed by a circumferential kyphotic correction utilizing a custom-made articulating rod (Globus Medical, Inc., Audubon, PA) with an expandable device placed in prone-lateral position at T11 to T12. The use of an articulating rod enabled us to safely manipulate the thoracolumbar spine into extension prior to permanent rod fixation. We were able to achieve approximately 40° of thoracolumbar correction. No immediate or late (at 2-year follow-up) postoperative medical or hardware-related complications were reported.</p><p><strong>Conclusion: </strong>The use of an articulating rod with prone-lateral placement of an expandable interbody device allowed for a high degree of circumferential thoracolumbar deformity correction in a patient with severe post-traumatic TLK. Our results indicated the technical feasibility and success of utilizing this treatment strategy for high-grade TLK without medical- or hardware-related failure.</p><p><strong>Clinical relevance: </strong>The use of an articulating rod for correction of complex TLKs may benefit patient outcomes and improve safety.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"168-172"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657916","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":"High Uptake Detection for Spinal Degenerative Changes: A Comparison Between Bone Scintigraphy and Single Photon Emission Computed Tomography Combined With High-Resolution Computed Tomography.","authors":"Mara Ioana Dimitriu, Robin Brugger, Nikki Rommers, Martin Jaeger, Victoria Schimmelpenning, Helena Milavec","doi":"10.14444/8729","DOIUrl":"10.14444/8729","url":null,"abstract":"<p><strong>Background: </strong>Nuclear imaging modalities are increasingly advancing spinal diagnostics. This study evaluates the prevalence of high uptake in bone scan and single photon emission computed tomography combined with high-resolution computed tomography (SPECT/CT) in the spine and sacroiliac joint (SIJ) and compares the diagnostic performance of BS to SPECT/CT in detecting metabolic activity linked to neck and back pain.</p><p><strong>Objective: </strong>The primary objective was to assess the sensitivity, specificity, and diagnostic accuracy of BSs compared with SPECT/CT for spine and SIJ evaluation.</p><p><strong>Methods: </strong>This retrospective study evaluated data from patients with spinal complaints who underwent spine-focused SPECT/CT alongside whole-body BS at a tertiary institution.</p><p><strong>Results: </strong>A total of 110 patients were included, with 48 cervical spine, 34 thoracic spine, and 91 lumbar spine and SIJ SPECT/CT scans. For the cervical spine, BS sensitivity, specificity, and accuracy were 41.5%, 100%, and 50%, respectively. For the thoracic spine, these values were 50.0%, 100%, and 73.5%, respectively. For the lumbar spine, they were 72.9%, 100%, and 79.1%. For the SIJ, sensitivity, specificity, and accuracy were 38.2%, 96.5%, and 74.7%, respectively.</p><p><strong>Conclusions: </strong>Bone scans demonstrated reasonable sensitivity and high specificity, particularly for lumbar spine and SIJ evaluation, making them a useful screening tool in resource-constrained settings. However, SPECT/CT showed superior performance in detecting osteometabolic activity and provided more detailed functional and structural insights for diagnosing and managing degenerative spinal conditions.</p><p><strong>Clinical relevance: </strong>This study highlights the potential complementary role of bone scans in spinal diagnostics.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"139-144"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Review of Lateral and Oblique Lumbar Interbody Fusion: Technique, Outcomes, and Complications.","authors":"Jae-Young Hong, Jaewan Soh","doi":"10.14444/8759","DOIUrl":"https://doi.org/10.14444/8759","url":null,"abstract":"<p><p>Minimally invasive spinal surgery has made tremendous progress. The retroperitoneal lateral lumbar interbody fusion and oblique lumbar interbody fusion techniques are increasingly used to treat a variety of lumbar spinal conditions. As with other minimally invasive techniques, the theoretical advantages include reduced blood loss, improved postoperative pain due to less retraction and smaller incisions, faster recovery, and eliminating the need for an approach surgeon. It allows the placement of a large cage that spans the apophyses and enables the achievement of indirect decompression as well as coronal and sagittal deformity correction. As experience grows and the techniques evolve further, indications might be expanded beyond their current limitations. However, as these techniques continue to grow in popularity, evidence-based risk-stratification systems are required. This study reviews the literature about the development and application of lateral lumbar interbody fusion and oblique lumbar interbody fusion, with a discussion of its outcomes, approach-related complications specific to the lateral technique, and areas of new research.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"246-260"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019396","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":"Posttraumatic Spinal Cord Tethering and Syringomyelia: A Retrospective Investigation of Patients With Progressive Disease and Surgical Revisions.","authors":"Crescenzo Capone, Denis Bratelj, Susanne Stalder, Phillip Jaszczuk, Marcel Rudnick, Rajeev K Verma, Tobias Pötzel, Michael Fiechter","doi":"10.14444/8716","DOIUrl":"10.14444/8716","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord tethering and syringomyelia after trauma are well-known pathologies in patients suffering from spinal cord injury (SCI). In symptomatic cases, various surgical options are available, but untethering and expansion duraplasty is the currently preferred treatment strategy. However, patient outcomes are usually limited by rather high rates of surgical revisions. The aim of the present study was to identify risk factors in SCI patients who underwent multiple surgeries for symptomatic spinal cord tethering and syringomyelia.</p><p><strong>Methods: </strong>We retrospectively investigated 25 patients who received at least 2 untethering surgeries of the spinal cord. All patients were treated by untethering and expansion duraplasty and/or clinically followed between 2012 and 2022 at the Swiss Paraplegic Center.</p><p><strong>Results: </strong>A higher location of SCI correlates with a more rapid development of symptomatic spinal cord retethering in need of surgical revision (<i>r</i> = 0.406 and <i>P</i> = 0.044). Interestingly, the extent of spinal cord tethering is lower in those patients who underwent an early surgical intervention (<i>r</i> = 0.462 and <i>P</i> = 0.030), which points toward an increased vulnerability of the spinal cord at higher levels. Ninety-two percent of the patients displayed a potentially chronic inflammatory condition with a mean level of C-reactive protein of 28.4 ± 4.1 mg/L, while the white blood cell count was identified as an independent predictor for surgical interventions in symptomatic cases.</p><p><strong>Conclusions: </strong>Revision surgery in posttraumatic spinal cord tethering and syringomyelia patients is associated with the location of SCI and the extent of spinal cord tethering. It appears that chronic inflammatory conditions might play an important role in promoting spinal cord retethering and thus warrant further investigation.</p><p><strong>Clinical relevance: </strong>SCI patients with chronic inflammatory conditions and SCI at upper levels should be clinically monitored more carefully as they appear to be more susceptible to progressive forms of posttraumatic spinal cord tethering and syringomyelia.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"216-223"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956414","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":"Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages.","authors":"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe","doi":"10.14444/8726","DOIUrl":"10.14444/8726","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.</p><p><strong>Results: </strong>Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (<i>P</i> = 0.002), anterior DH from 5.9 to 10.7 mm (<i>P</i> < 0.001), PDH from 3.4 to 7.7 mm (<i>P</i> < 0.001), and average DH from 4.6 to 9.2 mm (<i>P</i> < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, <i>P</i> < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (<i>P</i> < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (<i>r</i> = 0.272, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.</p><p><strong>Clinical relevance: </strong>Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"188-199"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574140","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":"Recovery Trajectories After Lumbar Fusion Stratified by Baseline Patient-Reported Outcomes Measurement Information System Physical Function Disability Levels.","authors":"Justin J Turcotte, Jane C Brennan, Andrea H Johnson, Chad M Patton","doi":"10.14444/8755","DOIUrl":"https://doi.org/10.14444/8755","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified patient and surgical factors associated with patient-reported outcomes measurement information system (PROMIS)-physical function (PF) minimal clinically important difference (MCID) rates after lumbar fusion, but investigation into the timing of MCID achievement remains limited. This study aimed to assess whether time to MCID achievement differed across patients presenting with mild, moderate, or severe disability as measured using the PROMIS-PF instrument.</p><p><strong>Methods: </strong>A retrospective review of 144 patients undergoing 1- to 3-level lumbar fusion from 2020 to 2023 was performed. All patients completed PROMIS-PF surveys at baseline and 1 year postoperatively. Patients were classified as mild (PROMIS-PF > 40), moderate (30-40), or severe (<30) disability based on baseline PROMIS-PF T-scores. MCID achievement rates and time to MCID were compared across groups using univariate and multivariate analyses. Multivariate Cox proportional hazard models were used to assess the relationship between baseline disability and MCID achievement rates over time.</p><p><strong>Results: </strong>Twenty (13.9%) patients presented with mild disability, 92 (63.9%) with moderate disability, and 32 (22.2%) with severe disability. The overall rate of 1-year postoperative MCID achievement was 59%. After adjusting for American Society of Anesthesiologists scores and Charlson Comorbidity Index, severe baseline disability was associated with increased odds of early MCID achievement (<90 days; OR = 2.95, <i>P</i> = 0.015) and shorter days to MCID achievement. In the adjusted Cox models, patients with severe baseline disability demonstrated increased MCID achievement at any time over the 1-year postoperative period when compared with the mild disability (HR = 3.52, <i>P</i> = 0.005) and moderate disability (HR = 1.85, <i>P</i> = 0.020) groups.</p><p><strong>Conclusion: </strong>Patients presenting with severe disability were more likely to achieve clinically significant improvements in function across time points during the 1-year postoperative period. Furthermore, these patients demonstrated higher rates of early MCID achievement and less time to MCID than those with moderate or mild baseline disability. Utilization of PROMIS-PF may assist with preoperative patient selection and expectation setting.</p><p><strong>Clinical relevance: </strong>In the clinical setting, establishing realistic recovery expectations is a critical aspect of the surgeon-patient relationship. The data presented in the current study may be used in preoperative consultations to provide patients with a depiction of their potential improvement in physical function over time based on their baseline level of function. Postoperatively, the data may serve as a benchmark for assessing an individual's recovery trajectory compared to historically similar patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"207-215"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014421","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":"Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis.","authors":"Aneysis D Gonzalez-Suarez, Allen Green, María José Cavagnaro, Emily Moya, Corinna Zygourakis, Atman M Desai","doi":"10.14444/8732","DOIUrl":"10.14444/8732","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for postoperative pain management after spinal fusion surgeries, but their potential impact on fusion outcomes and wound healing remains controversial.</p><p><strong>Objective: </strong>To use a national database and consistent selection criteria to compare the postoperative outcomes of patients who first received NSAIDs ≤ 72 hours, 72 hours to 90 days, and 90 days to 1 year after posterior lumbar fusion (PLF) surgery, to those who never received NSAIDs within the first year of surgery.</p><p><strong>Methods: </strong>Using the Merative Marketscan Research Databases, we analyzed PLF patients aged 18 to 90 years who underwent either single- and multilevel fusions. A subanalysis focused specifically on single-level fusions. Using the inverse probability of treatment weighting to adjust for confounders, we compared the outcomes of patients first administered NSAIDs at 3 different postoperative timeframes (≤72 hours, 72 hours to 90 days, and 90 days to 1 year) to patients who did not receive NSAIDs within 1 year of surgery. The outcomes evaluated included 30-day readmissions, length of stay, pseudoarthrosis, hardware failure, and wound complications up to 1 year after surgery.</p><p><strong>Results: </strong>Single- and multilevel PLF patients who received >90-day courses of NSAIDs 72 hours to 1 year postoperatively had greater odds of pseudoarthrosis, with those receiving short, ≤30-day courses of NSAIDs 72 hours to 90 days postoperatively additionally having greater odds of wound complications. Meanwhile, patients who started≤30-day courses of NSAIDs within 72 hours of surgery experienced reduced length of stay and lower rates of wound complications.</p><p><strong>Conclusion: </strong>Administration of long courses of NSAIDs >72 hours to 1 year after PLF surgery is associated with higher odds of pseudoarthrosis, while short courses of NSAIDs administered 72 hours to 90 days of surgery are additionally associated with higher odds of wound complications. Conversely, patients who received NSAIDs within 72hours of surgery may experience a slightly reduced length of hospital stay, with short courses of NSAIDs protecting against wound complications.</p><p><strong>Clinical relevance: </strong>This study suggests that the timing and duration of postoperative NSAID use after posterior lumbar fusion can significantly affect outcomes, particularly fusion integrity and wound healing. These findings may help guide pain management protocols to balance effective analgesia with minimizing surgical complications.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"224-236"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732105","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}