Spine Journal最新文献

{"title":"Obesity is an independent risk factor for postoperative pulmonary embolism after anterior cervical discectomy and fusion.","authors":"Haseeb E Goheer, Christopher G Hendrix, Linsen T Samuel, Alden H Newcomb, Jonathan J Carmouche","doi":"10.1016/j.spinee.2024.09.028","DOIUrl":"10.1016/j.spinee.2024.09.028","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database.</p><p><strong>Purpose: </strong>The purpose of this study was to analyze obesity level's influence on perioperative complication rates in patients undergoing ACDF.</p><p><strong>Study design/setting: </strong>A retrospective cohort, large multicenter database study.</p><p><strong>Patient sample: </strong>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551.</p><p><strong>Outcome measures: </strong>Medical and surgical complications within thirty days of operation.</p><p><strong>Methods: </strong>Patients were categorized into four BMI groups: nonobese (BMI 18.5-29.9 kg/m²), obese class I (BMI 30-34.9 kg/m²), obese class II (BMI 35-39.9 kg/m²), and obese class III (BMI ≥40 kg/m²). A univariate analysis conducted for demographic variables and preoperative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to nonobese patients.</p><p><strong>Results: </strong>About 64,718 patients were identified of whom 33,365 were nonobese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs 0.24%, p=.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 vs 0.15%, p=.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs 0.4%, p<.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129-2.599); OR: 2.213, 95% CI (1.349-3.559); OR: 2.207, 95% CI (1.190--3.892), respectively).</p><p><strong>Conclusions: </strong>Risk for postoperative PEs after an ACDF was significantly higher for obese classes I-III compared to nonobese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"299-305"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expandable versus static transforaminal lumbar interbody fusion (TLIF) cages: comparing radiographic outcomes and complication profiles.","authors":"Alexander M Crawford, Brendan M Striano, Matthew R Bryan, Ikechukwu C Amakiri, Donnell L Williams, Andrew T Nguyen, Malina O Hatton, Andrew K Simpson, Andrew J Schoenfeld","doi":"10.1016/j.spinee.2024.09.030","DOIUrl":"10.1016/j.spinee.2024.09.030","url":null,"abstract":"<p><strong>Background context: </strong>Expandable transforaminal lumbar interbody fusion (TLIF) cages have become popular in recent years due to anticipated advantages of increased disc height, improved segmental lordosis, and ease of implantation. Such benefits have not been conclusively demonstrated in the literature.</p><p><strong>Purpose: </strong>To determine whether expandable cages increase disc height and segmental lordosis in a durable way following surgery and compare complication profiles between cage types.</p><p><strong>Study design/setting: </strong>Retrospective cohort study conducted within a large academic health system involving 31 different spine surgeons.</p><p><strong>Patient sample: </strong>Adults undergoing single-level TLIF for an indication other than infection, tumor, trauma, or revision instrumentation from 2021 to 2023.</p><p><strong>Outcome measures: </strong>Our primary outcomes were changes in segmental disc height, segmental lordosis, and L4-S1 lordosis at 2 weeks, 6 months, and 1 year following surgery relative to baseline. Our secondary outcomes were frequencies of incidental durotomies, surgical site infections, readmissions, death, subsidence, and unplanned return to the operating room.</p><p><strong>Methods: </strong>Radiographic variables were collected from our institutional imaging registry. Demographics and surgical characteristics were abstracted from chart review. Generalized linear modeling was used for each primary outcome, with cage type (expandable vs static) as our primary predictor and age, biologic sex, race, CCI, year of surgery, duration of surgery, invasiveness of surgery, surgeon specialty (Orthopedics vs Neurosurgery), and level of surgery as covariates.</p><p><strong>Results: </strong>Our cohort consisted of 417 patients with a mean age of 62. Static cages were used in 306 patients and expandable cages in 111. Expandable cages were associated with increased changes in disc height relative to static cages at 2 weeks (1.1 mm [0.2-1.9]; p=.01) and 6 months (1.2 mm [0.2-2.3]; p=.02) following surgery, but differences were no longer significant at 1 year (0.4 mm [-0.9-1.8]; p=.4). Expandable cages were found to subside more commonly than static cages (14.1% vs 6.6%; p=.04). No significant differences between cage types were identified in lordotic parameters at any timepoint (p=0.25 to p=0.97).</p><p><strong>Conclusions: </strong>Expandable cages were associated with an initial increase in disc height relative to static cages, but this difference diminished with the first year of surgery, likely due to a higher rate of subsidence within the expandable cohort.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"237-243"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multirod posterior occipitocervical instrumentation constructs: a biomechanical analysis and initial case series of 10 patients with complex craniocervical pathology.","authors":"Andrew P Collins, Muzammil Mumtaz, Sudharshan Tripathi, Shruthi K Varier, Alexander W Turner, Aaron J Clark, Vijay K Goel, Alekos A Theologis","doi":"10.1016/j.spinee.2024.09.022","DOIUrl":"10.1016/j.spinee.2024.09.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Stabilization of the occipitocervical (OC) junction with posterior instrumentation plays a vital role in addressing a spectrum of pathologies. Due to limited bone surfaces of the occiput and C1 lamina, achieving union across the OC junction is challenging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To explore the biomechanics and a clinical series of patients treated with multirod constructs across the OC junction using a novel occipital plate with single- and dual-headed, modular tulip heads.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Biomechanical analysis and retrospective case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;OC-C4 range of motion (ROM), maximum von Mises stress on the rods, and adjacent segment ROMs and intradiscal parameters. Patient demographics, revision operations, rod breakages, wound complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A validated occiput-cervical finite element (FE) model was used to simulate OC-C4 cervical fixation under multidirectional pure moment loading. A total of 4 rod configurations were simulated: (A) 2-rod-Ti (4.0 mm titanium rods); (B) 2-rod-CoCr (3.5 mm cobalt chrome rods); (C) 3-rods (4.0 mm titanium rods); (D) 4-rods (4.0 mm titanium rods). The aforementioned measures were compared. A retrospective analysis was also performed of adults at a single institution who underwent posterior cervical multirod constructs across the OC junction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Biomechanically, lowest primary rod stresses were observed for 3- and 4-rod constructs. Compared to 2-rod-Ti (121.8 MPa), 2-rod-CoCr showed a 43.2% stress increase in the rods, while 3- and 4-rods experienced rod stress reductions of 20% and 23.2%, respectively. No appreciable differences in OC-C4 ROM, C4-5 ROM, and C4-5 discal stresses were found between multirod and 2-rod constructs. Maximum occipital and C4 screw stresses were decreased in multirod constructs compared to 2-rods, with least stresses noted in the 4-rod construct. Maximum plate stresses were slightly increased in the 4-rod construct compared to 2- and 3-rod fixation, though the forces were largely similar among the constructs. Ten patients (average age 66.4±10.6 years; 8 males) were assessed clinically. Nine of the ten operations were for primary stabilization of pathological fractures and associated craniocervical and/or atlantoaxial instability using 4-rods across the OC junction. At an average follow-up time of 1.58±0.5 years (range, 1-2.3 years), there were no instrumentation failures, no adjacent segment failures, and no wound complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this proof-of-concept investigation, multiple rods (3- and 4-rods) across the OC junction using a novel occipital plate with single- and dual-headed, modular tulips was safe and effective in stabilizing the OC ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"369-379"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning model for automated diagnosis of degenerative cervical spondylosis and altered spinal cord signal on MRI.","authors":"Aric Lee, Junran Wu, Changshuo Liu, Andrew Makmur, Yong Han Ting, Faimee Erwan Muhamat Nor, Loon Ying Tan, Wilson Ong, Wei Chuan Tan, You Jun Lee, Juncheng Huang, Joey Chan Yiing Beh, Desmond Shi Wei Lim, Xi Zhen Low, Ee Chin Teo, Yiong Huak Chan, Joshua Ian Lim, Shuxun Lin, Jiong Hao Tan, Naresh Kumar, Beng Chin Ooi, Swee Tian Quek, James Thomas Patrick Decourcy Hallinan","doi":"10.1016/j.spinee.2024.09.015","DOIUrl":"10.1016/j.spinee.2024.09.015","url":null,"abstract":"<p><strong>Background context: </strong>A deep learning (DL) model for degenerative cervical spondylosis on MRI could enhance reporting consistency and efficiency, addressing a significant global health issue.</p><p><strong>Purpose: </strong>Create a DL model to detect and classify cervical cord signal abnormalities, spinal canal and neural foraminal stenosis.</p><p><strong>Study design/setting: </strong>Retrospective study conducted from January 2013 to July 2021, excluding cases with instrumentation.</p><p><strong>Patient sample: </strong>Overall, 504 MRI cervical spines were analyzed (504 patients, mean=58 years±13.7[SD]; 202 women) with 454 for training (90%) and 50 (10%) for internal testing. In addition, 100 MRI cervical spines were available for external testing (100 patients, mean=60 years±13.0[SD];26 women).</p><p><strong>Outcome measures: </strong>Automated detection and classification of spinal canal stenosis, neural foraminal stenosis, and cord signal abnormality using the DL model. Recall(%), inter-rater agreement (Gwet's kappa), sensitivity, and specificity were calculated.</p><p><strong>Methods: </strong>Utilizing axial T2-weighted gradient echo and sagittal T2-weighted images, a transformer-based DL model was trained on data labeled by an experienced musculoskeletal radiologist (12 years of experience). Internal testing involved data labeled in consensus by 2 musculoskeletal radiologists (reference standard, both with 12-years-experience), 2 subspecialist radiologists, and 2 in-training radiologists. External testing was performed.</p><p><strong>Results: </strong>The DL model exhibited substantial agreement surpassing all readers in all classes for spinal canal (κ=0.78, p<.001 vs κ range=0.57-0.70 for readers) and neural foraminal stenosis (κ=0.80, p<.001 vs κ range=0.63-0.69 for readers) classification. The DL model's recall for cord signal abnormality (92.3%) was similar to all readers (range: 92.3-100.0%). Nearly perfect agreement was demonstrated for binary classification (grades 0/1 vs 2/3) (κ=0.95, p<.001 for spinal canal; κ=0.90, p<.001 for neural foramina). External testing showed substantial agreement using all classes (κ=0.76, p<.001 for spinal canal; κ=0.66, p<.001 for neural foramina) and high recall for cord signal abnormality (91.9%). The DL model demonstrated high sensitivities (range:83.7%-92.4%) and specificities (range:87.8%-98.3%) on both internal and external datasets for spinal canal and neural foramina classification.</p><p><strong>Conclusions: </strong>Our DL model for degenerative cervical spondylosis on MRI showed good performance, demonstrating substantial agreement with the reference standard. This tool could assist radiologists in improving the efficiency and consistency of MRI cervical spondylosis assessments in clinical practice.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"255-264"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost-effectiveness analysis of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain.","authors":"Matthew Smuck, Zachary L McCormick, Chris Gilligan, Mary K Hailey, Michelle L Quinn, Anthony Bentley, Kaylie Metcalfe, Benjamin Bradbury, Dylan J Lukes, Rod S Taylor","doi":"10.1016/j.spinee.2024.09.016","DOIUrl":"10.1016/j.spinee.2024.09.016","url":null,"abstract":"<p><strong>Background context: </strong>Randomized trials have demonstrated the superiority of intraosseous basivertebral nerve ablation (BVNA) compared with sham and standard care in terms of improvements in pain, disability, and health-related quality of life in patients with vertebrogenic chronic low back pain (cLBP).</p><p><strong>Purpose: </strong>To assess the cost effectiveness of BVNA in patients with vertebrogenic cLBP compared to standard care alone.</p><p><strong>Study design/setting: </strong>A model-based economic analysis.</p><p><strong>Patient sample: </strong>Base case analysis used INTRACEPT, a randomized trial comparing BVNA with standard care in 140 patients with vertebrogenic cLBP, recruited from 23 sites across the United States, with a follow-up, up to 5 years. Scenario analyses compared data from the Surgical Multicenter Assessment of Radiofrequency Ablation for the Treatment of Vertebrogenic Back Pain (SMART) randomized trial against a sham control, and a single-arm study.</p><p><strong>Outcome measures: </strong>Costs and quality-adjusted life years (QALYs) were calculated to determine the incremental cost-effectiveness ratio (ICER).</p><p><strong>Methods: </strong>A cost-effectiveness model was built in Microsoft Excel to evaluate the costs and health outcomes of patients undergoing BVNA using the Intracept Procedure (Relievant Medsystems) to treat vertebrogenic cLBP from a US payor perspective. Alternative scenario sensitivity analyses and probabilistic sensitivity analyses were conducted to assess the robustness of the model results. QALYs were discounted at 3.0% per year.</p><p><strong>Results: </strong>Base case analysis showed that BVNA relative to standard care alone was a cost-effective strategy for the management of patients with vertebrogenic cLBP, with an ICER of US$11,376 per QALY at a 5-year time horizon from introduction of the procedure. Modeling demonstrated a >99% probability that this was cost effective in the US, based on a willingness-to-pay threshold of US$100,000 to US$150,000. Various sensitivity and scenario analyses produced ICERs that all remained below this threshold.</p><p><strong>Conclusions: </strong>BVNA with the Intracept Procedure offers patients with vertebrogenic cLBP, clinicians, and healthcare systems a cost-effective treatment compared to standard care alone.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"201-210"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis.","authors":"Luca Ambrosio, Gianluca Vadalà, Elisabetta de Rinaldis, Sathish Muthu, Stipe Ćorluka, Zorica Buser, Hans-Jörg Meisel, S Tim Yoon, Vincenzo Denaro","doi":"10.1016/j.spinee.2024.09.007","DOIUrl":"10.1016/j.spinee.2024.09.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar disc herniation (LDH) is a leading cause of low back pain (LBP) and leg pain and may require surgical treatment in case of persistent pain and/or neurological deficits. Conventional discectomy involves removing the herniated fragment and additional material from the disc space, potentially accelerating disc degeneration and contributing to chronic LBP. Conversely, by resecting the herniated fragment only, sequestrectomy may reduce postoperative LBP while increasing the risk of LDH recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare discectomy versus sequestrectomy in terms of risk of reherniation, reoperation rate, complications, pain, satisfaction, and perioperative outcomes (operative time, blood loss, length of stay [LOS]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of PubMed/MEDLINE and Scopus databases was performed through May 1, 2024 for both randomized and nonrandomized studies. The search was conducted according to PRISMA guidelines. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. The quality of the evidence was evaluated according to the GRADE approach. Relevant outcomes were pooled for meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 16 articles (1 randomized controlled trial with 2 follow-up studies, 6 prospective studies, and 7 retrospective studies) published between 1991 and 2020 involving 2009 patients were included for analysis. No significant differences were noted between discectomy versus sequestrectomy in terms of risk of reherniation (OR: 0.85, 95% CI: 0.57 to 1.26, p=.42), reoperation rate (OR: 0.95, 95% CI: 0.64 to 1.40, p=.78), and complications (OR: 1.03, 95% CI: 0.50 to 2.11, p=.94). Although LBP (MD: -0.06, 95% CI: -0.39 to 0.28, p=.74) and leg pain intensity (MD: 0.11, 95% CI: -0.21 to 0.42, p=.50) were similar postoperatively, significantly better outcomes were reported by patients treated with sequestrectomy at 1 year (leg pain: MD: 0.37, 95% CI: 0.19 to 0.54, p&lt;.0001) and 2 years (LBP: MD: 0.19, 95% CI: 0.03 to 0.34, p=.02; leg pain: MD: 0.20, 95% CI: 0.09 to 0.31, p=.0005). Sequestrectomy also resulted in a higher patient satisfaction (OR: 0.60, 95% CI: 0.40 to 0.90, p=.01) and shorter operative time (MD: 8.71, 95% CI: 1.66 to 15.75, p=.02), while blood loss (MD: 0.18, 95% CI: -2.31 to 2.67, p=.89) and LOS (MD: 0.02 days, 95% CI: -0.07 to 0.12, p=.60) did not significantly differ compared to discectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Based on the current evidence, discectomy and sequestrectomy do not significantly differ in terms of risk of reherniation, reoperation rate, and postoperative complications. Patients treated with sequestrectomy may benefit from a marginally higher pain improvement, better satisfaction outcomes, and a shorter operative time, although the clinical relevance of these differences needs to be validated in","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"211-226"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient acceptance of reoperation risk for lumbar decompression versus fusion.","authors":"Alexa K Pius, Yemisi D Joseph, Danielle M Mullis, Susmita Chatterjee, Jyotsna Koduri, Josh Levin, Todd F Alamin","doi":"10.1016/j.spinee.2024.09.003","DOIUrl":"10.1016/j.spinee.2024.09.003","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar decompression and lumbar fusion are effective methods of treating spinal compressive pathologies refractory to conservative management. These surgeries are typically used to treat different spinal problems, but there is a growing body of literature investigating the outcomes of either approach for patients with lumbar degenerative spondylolisthesis and stenosis. Different operations are associated with different risks and different potential needs for reoperation. Patient acceptance of reoperation rates after spinal surgery is currently not well understood.</p><p><strong>Purpose: </strong>The purpose of this study is to identify patient tolerance for reoperation rates following lumbar decompression and lumbar fusion surgery.</p><p><strong>Design: </strong>A qualitative and quantitative survey intended to capture information on patient preferences was administered.</p><p><strong>Patient sample: </strong>Written informed consent was obtained from patients presenting to 2 spinal clinics.</p><p><strong>Outcome measures: </strong>Patients were asked their threshold tolerance for reoperation rates in the context of choosing a smaller (decompression) versus larger (fusion) spinal surgery.</p><p><strong>Methods: </strong>A survey was administered to patients at 2 spinal clinics-1 surgical and 1 nonsurgical. A consecutive series of new patients over multiple clinic days who agreed to participate in the study and filled out the survey are reported on here. Patients were asked to assess, contemplating a problem that could either be treated with lumbar decompression or lumbar fusion, the level at which 1) the likelihood that needing a repeat surgery within 3 to 5 years would change their mind about choosing the decompression operation and cause them to choose the fusion operation and then 2) the likelihood of needing a repeat surgery within 3 to 5 years that would be acceptable to them after the fusion operation. The distribution of patient responses was assessed with histograms and descriptive statistics.</p><p><strong>Results: </strong>Ninety patients were surveyed, and of these, 73 patients (81.1%) returned fully completed questionnaires. The median reoperation acceptance rates after a decompression was <60%, while the median acceptable revision rate when contemplating the fusion surgery was 10%.</p><p><strong>Conclusions: </strong>Patient acceptance for the potential need for revision surgery is higher when considering a decompression compared to a fusion operation. Reoperation risk rates along with the magnitude of the surgical intervention are important considerations in determining patients' surgical preferences. Understanding patient preferences and risk tolerances can aid clinicians in shared decision-making, potentially improving patient satisfaction and outcomes in the several lumbar pathologies which can be ameliorated with either decompression or fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"227-236"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of anterior cervical dynamic implants: motion-sparing or a delayed fusion?","authors":"Yukai Huang, Dingyu Du, Jie Tian, Dean Chou, Longyi Chen, Hailong Feng, Jinping Liu","doi":"10.1016/j.spinee.2024.09.006","DOIUrl":"10.1016/j.spinee.2024.09.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Use of an anterior cervical dynamic implant (ACDI) is generally considered a nonfusion technique for treating cervical degenerative disorders. However, there is limited research focused on evaluating the long-term clinical and radiographic outcomes of ACDI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To analyze the long-term clinical and radiographic outcomes of ACDI in the treatment of degenerative cervical disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients sample: &lt;/strong&gt;Patients with degenerative cervical disorders who underwent anterior cervical discectomy and dynamic cervical implant (DCI) implantation between May 2012 and August 2020 at our institution were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) scores and patient reported satisfaction rate. Imaging assessment parameters included intervertebral height (IH), intervertebral disc height (IDH), C2-7 range of motion (ROM), segmental ROM, the degree of DCI subsidence and anterior migration, heterotopic ossification (HO) as well as adjacent segment degeneration (ASD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;JOA and VAS scores were obtained through questionnaire. The patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied at the final follow-up. The position of the implants, IDH and IH were evaluated on lateral radiographs. ROM at C2-7, ROM at operated level were measured on dynamic radiographs. Cervical 3-dimensional computer tomography (CT) and magnetic resonance image (MRI) images were used to assess the presence of HO and ASD. The clinical and radiologic variables between the preoperative period and different follow-up time point were statistically analyzed by unpaired t-tests or chi-square tests. Statistical significance was defined as p&lt;.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 92 patients (51 males and 41 females) were included in this study. Among them, there were 36 cases of cervical spondylotic myelopathy, 26 cases of cervical radiculopathy, and 30 cases of myeloradiculopathy. The mean age was 55.1±12.6 years. The number of operated levels was single level in 57 patients, 2 levels in 31 patients, and 3 levels in 4 patients. The average follow-up period was 81.3 months (range: 35-135 months). The mean JOA scores showed a gradual increase at 1 month, 1 year, and the final follow-up (12.0±0.7,13.5±0.8, and14.4±1.1 respectively) compared to the preoperative score (9.1±0.9, p&lt;.01). VAS scores significantly decreased at 1 month, 1 year, and the final follow-up (4.1±0.7, 2.3±0.9, and 2.0±0.8 respectively) compared to the preoperative score (7.2±l .2, p&lt;.01). At the final follow-up, the patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied (79%, 10%, 10%, 1% respectively). Revision surge","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"244-254"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postoperative mechanical complications with the ethnicity-adjusted global alignment and proportion score in degenerative scoliosis: does paraspinal muscle degeneration matter?","authors":"Peiyu Li, Jie Li, Abdukahar Kiram, Zhen Tian, Xing Sun, Xiaodong Qin, Benlong Shi, Yong Qiu, Zhen Liu, Zezhang Zhu","doi":"10.1016/j.spinee.2024.09.029","DOIUrl":"10.1016/j.spinee.2024.09.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The global alignment and proportion (GAP) score was developed to predict mechanical complications (MCs) after adult spinal deformity surgery but showed limited sensitivity in the Asian population. Considering variations in sagittal parameters among different ethnic groups, our team developed the ethnicity-adjusted GAP score according to the spinopelvic parameters of 566 asymptomatic Chinese volunteers (C-GAP score). Notably, degenerative scoliosis (DS) patients with MCs following corrective surgery have more severe paraspinal muscle degeneration. For DS patients with various sagittal alignments, the unevenly distributed degeneration of paraspinal muscle may exert different influences on MC occurrence and largely affect the accuracy of the C-GAP score in clinical assessment. Therefore, incorporating paraspinal muscle degeneration indices within the C-GAP score may improve its accuracy in predicting MC occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We aimed to clarify the influence of paraspinal muscle degeneration on the C-GAP score predicting MC occurrence following DS surgery and modify the C-GAP score with paraspinal muscle degeneration parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A retrospective case-control study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sample size: &lt;/strong&gt;A total of 107 adult degenerative scoliosis patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Demographic information, postoperative sagittal spinopelvic parameters, the GAP score, the C-GAP score, and paraspinal muscle degeneration parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 107 DS patients undergoing posterior spinal fusion surgery (≥4 vertebrae) with a minimum of 2 years follow-up (or experiencing MCs within 2 years) were retrospectively reviewed. Their C-GAP score was calculated based on our previous study and patients were divided into 3 C-GAP categories, \"proportioned\" (P), \"moderately disproportioned\" (MD), and \"severely disproportioned\" (SD). Relative cross-sectional area (cross-sectional area of muscle-disc ratio×100, rCSA) and fat infiltration rate, FI% at L1/2, L2/3, L3/4, and L4/5 discs were quantitatively evaluated using magnetic resonance imaging (MRI). In each C-GAP category, patients were additionally divided into the MC group and the non-MC group to analyze their paraspinal muscle degeneration. A multivariable logistic regression model consisting of the CSA-weighted average FI% (total FI%) and the C-GAP score, C-GAPM was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was used to evaluate the predictability of the GAP score, the C-GAP score, FI%, and C-GAPM. This project was supported by the National Natural Science Foundation of China (No.82272545) and Special Fund of Science and Technology Plan of Jiangsu Province (No.BE2023658).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For all 107 patients, FI% at L1/2, L2/3, L3/4, and L4/5 discs and the total FI% of the MC group (n=32) were significantly high","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"347-358"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian Spine Outcomes and Research Network.","authors":"Husain Shakil, Nicolas Dea, Armaan K Malhotra, Ahmad Essa, W Bradley Jacobs, David W Cadotte, Jérôme Paquet, Michael H Weber, Philippe Phan, Christopher S Bailey, Sean D Christie, Najmedden Attabib, Neil Manson, Jay Toor, Andrew Nataraj, Hamilton Hall, Greg McIntosh, Charles G Fisher, Y Raja Rampersaud, Nathan Evaniew, Jefferson R Wilson","doi":"10.1016/j.spinee.2024.09.033","DOIUrl":"10.1016/j.spinee.2024.09.033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015-2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ-5D) at 12 months postsurgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 preoperative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04-1.07), then symptom duration (OR 0.65; 95% CI 0.44-0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03-0.78), living independently (OR 2.17; 95% CI 1.22-3.85), symptom duration (OR 0.62; 95% CI 0.40-0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67-0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright X-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings suggest patients with shorter symptom dura","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":"276-289"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}