International Journal of Spine Surgery最新文献

{"title":"Letter to the Editor: Articles and Accompanying Editorials on Rasch Analysis of High-Value Endoscopic Surgeries-A Message From the ISASS Co-President.","authors":"Morgan P Lorio","doi":"10.14444/8683","DOIUrl":"10.14444/8683","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S89-S90"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576880","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":"Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience.","authors":"Kai-Uwe Lewandrowski, Zhen-Zhou Li, Xinyu Liu, Zhang Xifeng, Brian Kwon, Álvaro Dowling, Martin Knight, Paulo Sergio Terxeira de Carvalho, Choll Kim, Gregory W Basil, Gabriel Oswaldo Alonso Cuéllar, Christian Morgenstern, John Ongulade, Yi Jiang, Kenyu Ito, João Paulo Bergamaschi, Jin-Sung L Kim, Jorge F Ramirez, Joachim Oertel, John C Elfar, Abduljabbar Alhammoud, Nicholas A Bonazza, Benedikt W Burkhardt, Rossano Kepler Alvim Fiorelli, Sergio Luis Schmidt, Morgan P Lorio","doi":"10.14444/8676","DOIUrl":"10.14444/8676","url":null,"abstract":"<p><strong>Background: </strong>The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques.</p><p><strong>Methods: </strong>Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test.</p><p><strong>Results: </strong>The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis.</p><p><strong>Conclusions: </strong>The ISASS webinar series has significantly impacted surgeons' education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement.</p><p><strong>Clinical relevance: </strong>Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis.</p><p><strong>Level of evidence: </strong>Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S66-S82"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640057","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":"Editorial: Embracing Rasch Analysis for Enhanced Spine Surgery Outcomes-The Outsider's Viewpoint.","authors":"Igor Elman","doi":"10.14444/8671","DOIUrl":"10.14444/8671","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S3-S7"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576874","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":"Insights From ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 3: A Polytomous Rasch Analysis on Surgeons' Endorsement of Multiportal Access, Treatment of Lumbar Facet Cyst, Grade I Spondylolisthesis, and Interbody Fusion.","authors":"Kai-Uwe Lewandrowski, Choll Kim, Brian Kwon, John Ongulade, Kenyu Ito, Paulo Sergio Terxeira de Carvalho, Morgan P Lorio","doi":"10.14444/8674","DOIUrl":"10.14444/8674","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The International Society for the Advancement of Spine Surgery hosted the third in a series of webinars focused on innovative endoscopic spine surgery techniques. This session aimed to discuss and evaluate advanced treatments for lumbar spinal stenosis and related conditions utilizing multiportal endoscopic approaches; articulating instruments; unilateral biportal endoscopy; transforaminal techniques for facet cysts, herniated disc, and spinal stenosis; as well as percutaneous endoscopic lumbar interbody fusion (PELIF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar, utilizing polytomous Rasch analysis, and to evaluate the potential for these insights to inform clinical guideline recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An online survey was administered to 868 surgeons during a sponsored webinar hosted by the International Society for the Advancement of Spine Surgery. The survey used Likert-scale ratings to evaluate 5 main topics and additional surgical experiences and was distributed before and after the webinar. Survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate shifts in acceptance and perception.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 793 surgeons who attended the webinar, 229 accessed the prewebinar survey, 154 began it, and 119 completed it, yielding a completion rate of 77.3%. The respondents included 52.9% orthopedic surgeons, 37.0% neurosurgeons, 1.7% fellows, 0.8% residents, and 0.8% medical students. In the postwebinar phase, engagement remained high, with 298 accessing the survey, 169 starting it, and 128 completing it, resulting in a 75.7% completion rate. The postwebinar participant demographics closely resembled the initial distribution, consisting of 53.1% orthopedic surgeons, 35.9% neurosurgeons, 6.2% residents, 3.1% fellows, and 1.6% medical students. The confidence in various endoscopic techniques saw notable changes, particularly for procedures involving transforaminal lateral canal decompression for stenosis, herniated disc, and low-grade spondylolisthesis. Unilateral biportal endoscopy facet joint decompression and PELIF saw an increase in high-level endorsements after the webinar. Polytomous Rasch analysis provided insights into procedural techniques. The study showed consensus on the effectiveness of percutaneous endoscopic decompression of low-grade spondylolisthesis, reflecting evolving surgeon preferences and consensus on best practices. Infit and outfit statistics from the Rasch analysis suggested a good fit between the survey responses and the Rasch model both before and after the webinar, indicating minimal data distortion due to bias except for transforaminal decompression for posterolateral and central herniated nucleus pulposus. Differential item functioning analysis showed no significant bias in item responses b","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S38-S53"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640056","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":"Editors' Introduction: High-Value Endoscopic Techniques: Integrating Surgeon Skill and Experience in Spine Surgery With Rasch Analysis.","authors":"Kai-Uwe Lewandrowski, Morgan P Lorio","doi":"10.14444/8670","DOIUrl":"10.14444/8670","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S1-S2"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576876","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":"Key Takeaways From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 2: Polytomous Rasch Analysis of Learning Curve and Surgeon Endorsement of Biportal, Interlaminar, and Transforaminal Endoscopic Stenosis Decompression, Discectomy, and Laminectomy in Combination With Interspinous Process Spacers.","authors":"Kai-Uwe Lewandrowski, Gregory W Basil, Brian Kwon, Xinyu Liu, Gabriel Oswaldo Alonso Cuéllar, Paulo Sergio Terxeira de Carvalho, Morgan P Lorio","doi":"10.14444/8673","DOIUrl":"10.14444/8673","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The International Society for the Advancement of Spine Surgery hosted the second of a series of 4 webinars on endoscopic spine surgery techniques. The second webinar focused on the application of unilateral biportal endoscopy for discectomy and laminectomy in combination with interbody fusion and interspinous process spacers. This series was intended to identify current trends with contemporary modern endoscopic spine surgery techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar utilizing polytomous Rasch analysis, as well as to evaluate the potential for these insights to inform clinical guideline recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A survey was available to 667 potential respondents during the Zoom webinar, collecting data on surgeon endorsements using a Likert scale. The polytomous Rasch model was employed to analyze responses while considering the complexity of decisions against surgeon expertise, developing a logarithmic measurement scale, allowing objective statistical analysis of categorical variables, highlighting incongruent or out of order items vs congruent and in order items, and driving improvement in clinical guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 667 surgeons who participated in the webinar, 224 accessed, 122 started, and 61 completed the prewebinar survey, achieving a 50.0% completion rate. Respondents comprised primarily orthopedic surgeons (70.5%) and neurosurgeons (24.6%), with fellows and medical students each making up 1.6%. These surgeons estimated that mastering the learning curve of endoscopic spine surgery required an average of 18.08 cases corroborated by postwebinar responses averaging 15.78 cases. Descriptive statistics revealed an acknowledgment of a learning curve in mastering endoscopic spine surgery, with a slight increase in recognition postwebinar (81.8% up from 80.3%). The data underscored the importance of cadaver courses and high-volume surgical practice before the webinar and highlighted the value of mentorship afterward, indicating a preference shift toward more interactive learning. The confidence in various endoscopic techniques saw notable changes, particularly for procedures involving interlaminar lateral canal decompression and the combined use of transforaminal endoscopic decompression with interspinous process spacers, which saw an increase in high-level endorsements postwebinar. Polytomous Rasch analysis provided insights into training methods and procedural techniques, with mentorship and cadaver courses emerging as key elements for mastering the learning curve. The analysis also highlighted a general consensus on the effectiveness of percutaneous endoscopic interlaminar decompression for lateral canal stenosis, reflecting evolving surgeon preferences and consensus on best practices. Infit and outfit statistics from the Rasch ","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S23-S37"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640059","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":"Letter to the Editor: Hierarchy of Evidence.","authors":"Mauricio G Pereira","doi":"10.14444/8677","DOIUrl":"10.14444/8677","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S83-S84"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576882","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":"Letter to the Editor: Rasch Analysis and High Value Spinal Endoscopy-Another Perspective.","authors":"Daniel K Resnick","doi":"10.14444/8682","DOIUrl":"10.14444/8682","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S87-S88"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583909","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":"Management of Spinal Langerhans Cell Histiocytosis in Children: A Systematic Review.","authors":"Macherla Haribabu Subramaniam, Victor Moirangthem, Muralidharan Venkatesan","doi":"10.14444/8662","DOIUrl":"10.14444/8662","url":null,"abstract":"<p><strong>Background: </strong>Spinal Langerhans cell histiocytosis can manifest as solitary site unifocal form or as systemic form in children. The management options for solitary spinal site unifocal form are many. They include spontaneous resolution of the lesion and supervised treatment, steroid injection of the lesion, systemic chemotherapy, radiation therapy and surgery. Multiple options create a decision-making dilemma for the treating specialist. The authors sought to formulate a management algorithm of spinal Langerhans cell histiocytosis based on Garg's grading of radiographic vertebral body collapse.</p><p><strong>Materials and methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2020 guidelines were followed in conducting the review and studies were filtered from established medical databases. Articles published between 2003 and 2022 were included after applying strict inclusion and exclusion criteria. The first and second authors reviewed the abstracts of filtered studies before including them. The study was registered with Prospero. The bias assessment of included studies was assessed using the MINOR's criteria.</p><p><strong>Results: </strong>Eight retrospective case series were analyzed. Within these studies, a total of 116 children (mean age 7.4 years) had undergone treatment. The mean follow-up period was 52.1 months. Among these patients, there were 37 tumors in the cervical spine, 40 in the thoracic spine, 25 in the lumbar spine, and a single tumor in the sacrum. Systemic chemotherapy has been found to reduce the risk of radiographic vertebral body collapse (p < 0.05). Surgery provides optimal outcomes in patients with Garg's grade IB , II spinal tumors and restores vertebral body height (p < 0.05). No case series were found pertaining to grade III. Reconstitution of vertebral body height, an important radiological parameter indicating the endpoint or healing of the lesion, was early achieved with surgery followed by systemic chemotherapy, bracing, and supervised management.</p><p><strong>Conclusion: </strong>Observation can be preferred in Garg's grade IA. Grade IB and II tumors respond well to surgery. Treatment for grade III tumors needs to be tailored on an individual basis.</p><p><strong>Grade of recommendation: </strong>C.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677186","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":"Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses.","authors":"Luke J Weisbrod, Brandon L Staple, Danielle M Westmark, Andrew P Gard, Daniel L Surdell","doi":"10.14444/8661","DOIUrl":"10.14444/8661","url":null,"abstract":"<p><strong>Background: </strong>Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility.</p><p><strong>Methods: </strong>Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome.</p><p><strong>Results: </strong>Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR -0.89, 95% CI [-1.69, -0.09], <i>I</i> ² = 54.88%, <i>P</i> = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], <i>I</i> ² = 0%, <i>P</i> = 0.816), and nearly statistically significant decrease in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], <i>I</i> ² = 0%, <i>P</i> = 0.05).</p><p><strong>Discussion: </strong>These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.</p><p><strong>Clinical relevance: </strong>This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677187","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}