Spine Journal最新文献

{"title":"Back Pain in Patients with Macromastia: What a Spine Surgeon Should Know.","authors":"Youssef Aref, Christopher M Bono, Alireza Najafian","doi":"10.1016/j.spinee.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.009","url":null,"abstract":"<p><p>Large and heavy breasts, termed macromastia, is a common cause of neck and back pain in females that may present as early as puberty. With focus usually elsewhere, macromastia is not usually a primary consideration when a patient initially presents to a spine specialist, particularly a spine surgeon. Axial pain is among the most common indications for breast reduction by plastic surgeons. Breast reduction surgery has been demonstrated to be an effective treatment for many women with back pain from macromastia. Awareness among spine specialists may prevent unneeded spinal intervention prompted by an overestimation of the contribution of vertebral degenerative changes to axial pain in affected women. This review aims to broaden spine providers' understanding of macromastia and its evaluation and treatment, including the role of breast reduction surgery to lessen axial pain.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591969","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":"Low pelvic incidence as a risk factor for vertebral recollapse after percutaneous vertebroplasty in the thoracolumbar region.","authors":"Xiaofei Cheng, Xin Sun, Kai Zhang, Xiaojiang Sun, Yue Xu, Changqing Zhao, Jie Zhao","doi":"10.1016/j.spinee.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.012","url":null,"abstract":"<p><strong>Background context: </strong>Percutaneous vertebroplasty (PVP) is an effective procedure for treatment of osteoporotic vertebral compression fractures (OVCFs). Recollapse of the cemented vertebrae is not unusual and the thoracolumbar junction is the most common region. Nevertheless, not all patients suffering from OVCFs in this region develop recollapse after PVP.</p><p><strong>Purpose: </strong>The aim of this study was to investigate possible risk factors related to recollapse of the cemented vertebrae in the thoracolumbar region.</p><p><strong>Study design/setting: </strong>Retrospective study.</p><p><strong>Patient sample: </strong>A total of 161 patients undergoing PVP.</p><p><strong>Outcome measures: </strong>Clinical outcomes were assessed using Visual Analog Scale (VAS) scores. Radiographic parameters included pelvic incidence (PI), thoracolumbar kyphosis (TLK), kyphotic angle, compression rate, reduction rate, and occurrence of intravertebral cleft (IVC).</p><p><strong>Methods: </strong>Patients were divided into the recollapse group and control group. Patient characteristics, clinical and radiographic parameters were compared between the two groups. Univariate and multivariate logistic regression were used to evaluate the potential risk factors for recollapse. The correlations between the variables were examined. A receiver operating characteristic curve of PI was constructed to discriminate between patients with and without recollapse.</p><p><strong>Results: </strong>There were no significant differences in patient characteristics between the two groups except for bone mineral density (BMD). Occurrence rate of IVC was significantly higher in the recollapse group. VAS scores were significantly decreased after PVP. At last follow-up, they were increased in the recollapse group and maintained in the control group. PI was significantly lower in the recollapse group than in the control group. The univariate logistic regression found four possible risk factors for recollapse, including low PI, IVC, low BMD, and high TLK. Further multivariate logistic regression eliminated high TLK from them. The collinear analysis showed low tolerance and high variance inflation factor for preoperative and postoperative TLK, but not for PI, IVC and BMD. PI was a good predictor of recollapse, and the optimal cut-off value was 43°. The magnitude of preoperative and postoperative TLK was significantly correlated with the value of PI.</p><p><strong>Conclusions: </strong>Recollapse of the cemented vertebrae in the thoracolumbar region was related to low PI, IVC and low BMD. PI less than 43° was a good predictor of recollapse. TLK was dependent on PI and not a risk factor for recollapse. In addition to PVP, patients with low PI, IVC and low BMD may require personalized interventions such as combined internal fixation and trunk orthoses.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592001","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":"Short-Segment Fusion vs. Isolated Decompression in Lumbar Spinal Canal Stenosis Patients with Cobb Angles Over 20 Degrees.","authors":"Tomoyuki Asada, Chad Z Simon, Atahan Durbas, Myles R J Allen, Kevin DiSilvestro, Takashi Hirase, Nishtha Singh, Patawut Bovonratwet, Annika Heuer, Tejas Subramanian, Eric Mai, Yeo Eun Kim, Maximillian Korsun, Olivia Tuma, Kasra Araghi, Joshua Zhang, Eric Kim, Cole Kwas, Amy Z Lu, Avani Vaishnav, James Dowdell, Evan D Sheha, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.007","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar decompression and short-segment lumbar fusion are standard procedures for short-segment lumbar canal stenosis, even in patients with moderate Cobb angles. Adult degenerative scoliosis is diagnosed at a threshold of 10 degrees, and patients with coronal Cobb angles over 30 degrees are recommended for long fusion due to global spinal deformity. However, there is a lack of research on clinical outcomes in patients with moderate coronal deformity, such as Cobb angles between 20 and 30 degrees.</p><p><strong>Purpose: </strong>This study aims to investigate the radiographic and clinical outcome differences between isolated decompression and short-segment interbody fusion for lumbar spinal canal stenosis in patients with moderate coronal deformity.</p><p><strong>Study design: </strong>A retrospective analysis of a prospectively collected registry PATIENT SAMPLE: Patients with Cobb angle exceeding 20 degrees who underwent 1- or 2- levels of lumbar surgery for lumbar canal stenosis. Patients diagnosed as spinal deformity were excluded.</p><p><strong>Outcome measures: </strong>Patient-reported outcomes included Oswestry Disability Index (ODI), VAS back, VAS leg, Short Form 12 Physical Component Score (SF-12 PCS) and Mental Component Score (SF-12 MCS), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) at preoperative, 12-week postoperative, and 1-year postoperative timepoints. Preoperative and postoperative spinopelvic alignment was assessed using Cobb angle, pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis and PI minus LL.</p><p><strong>Methods: </strong>A propensity score-matched analysis with the overlap weighting was utilized to investigate patient-reported outcomes at 12-week and 1-year postoperatively between the surgery groups. Spinopelvic alignments were compared between preoperative and 1-year postoperative timepoint using a linear mixed-effect model.</p><p><strong>Results: </strong>Before overlap weighting, the two surgery groups showed significant differences in age and diagnosis. No obvious sagittal malalignment was observed (decompression, 7.4° vs. fusion, 11.5°). After propensity score weighting, the fusion groups exhibited significantly better ODI and VAS back at the 1-year timepoint (ODI: fusion, 16.6 vs. decompression, 28.1, P=0.013; VAS back: fusion, 1.5 ± 2.1 vs. decompression, 3.7 ± 1.9, P<0.001). Radiographic assessment showed that the fusion group achieved better PI minus LL compared to decompression group (15° vs. 10°, P=0.008) CONCLUSION: In patients with degenerative scoliosis and a Cobb angle greater than 20 degrees, short-segment lumbar fusion surgery may result in enhanced improvement for short-segment lumbar pathology compared to isolated decompression.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592008","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":"The incidence, providers involved, and patient factors associated with diagnosis of specific lumbar spine pathology subsequent an initial nonspecific low back pain diagnosis.","authors":"Anthony E Seddio, Sahir S Jabbouri, Michael J Gouzoulis, Joshua G Sanchez, Wesley Day, Arya G Varthi, Daniel R Rubio, Jonathan N Grauer","doi":"10.1016/j.spinee.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Low back pain (LBP) is an exceedingly common diagnosis with significant societal and healthcare burden. While nonspecific LBP diagnoses are frequently assigned and often resolve soon thereafter, some patients may subsequently be diagnosed with specific underlying lumbar spine pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize the incidence, providers involved, and factors associated with specific pathology LBP (SP-LBP) diagnosed subsequent an initial nonspecific LBP (NS-LBP) diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adult patients diagnosed with NS-LBP between 2010 - Q1 2022 were abstracted from a large national administrative database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measurements: &lt;/strong&gt;Incidence of subsequent SP-LBP diagnoses, providers involved, and factors associated with SP-LBP diagnoses in the 12-months following initial NS-LBP diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adult patients diagnosed with NS-LBP were identified based on International Classification of Disease (ICD) codes ICD-9-D-724.2 and ICD-10-D-M54.5. These patients diagnosed with new NS-LBP were reported based on incidence per 100,000 covered lives. Exclusion criteria included: patients less than 18 years old, those with any prior NS-LBP diagnosis, any prior SP-LBP diagnoses, and those with trauma, neoplasm, or infection diagnosed within 3-months prior to the initial NS-LBP diagnosis. Patients who subsequently received SP-LBP diagnoses within 12-months following initial NS-LBP were then identified. Patients were characterized based on age, sex, history of cancer, obesity, opioid use disorder, anxiety, and depression and then compared with patients receiving no additional LBP diagnosis by univariable and multivariable analysis. Provider specialties who initially diagnosed NS-LBP and those involved with subsequent SP-LBP diagnoses were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;NS-LBP was identified for a robust cohort of 6,861,235 patients, yielding an incidence of 4,258 diagnoses per 100,000 covered lives. Subsequent SP-LBP diagnoses were identified for 562,982 (8.21%) within 12-months, of which 62.57% of these SP-LBP diagnoses occurred within 3-months. The most common of these subsequent diagnoses included radiculopathy (3.01% of the overall study population), disc degeneration (2.84%), and disc herniation (1.23%). Patients receiving a subsequent SP-LBP diagnosis were more likely older (per year increase, odds ratio [OR] 1.02), male (OR 1.10), had a history of cancer (OR 1.32), obesity (OR 1.30), opioid use disorder (OR 1.17), anxiety (OR 1.21), or depression (OR 1.17) (p&lt;0.001 for all). NS-LBP was initially diagnosed predominantly by primary care providers (PCPs) in family medicine (44.09%) and internal medicine (27.49%). These PCP providers also contributed to the majority of SP-LBP diagnoses, while specialty providers contributed to a greater degree in SP-LBP","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592012","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":"Machine Learning Models for Predicting Dysphonia Following Anterior Cervical Discectomy and Fusion - A Swedish Registry Study.","authors":"Ali Buwaider, Victor Gabriel El-Hajj, Anna MacDowall, Paul Gerdhem, Victor E Staartjes, Erik Edstr, Adrian Elmi-Terander","doi":"10.1016/j.spinee.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.010","url":null,"abstract":"<p><strong>Background: </strong>Dysphonia is one of the more common complications following anterior cervical discectomy and fusion (ACDF). ACDF is the gold standard for treating degenerative cervical spine disorders, and identifying high-risk patients is therefore crucial.</p><p><strong>Purpose: </strong>This study aimed to evaluate different machine learning models to predict persistent dysphonia after ACDF.</p><p><strong>Study design: </strong>A retrospective review of the nationwide Swedish spine registry (Swespine) PATIENT SAMPLE: All adults in the Swespine registry who underwent elective ACDF between 2006 and 2020.</p><p><strong>Outcome measures: </strong>The primary outcome was self-reported dysphonia lasting at least one month after surgery. Predictive performance was assessed using discrimination and calibration metrics.</p><p><strong>Methods: </strong>Patients with missing dysphonia data at the one-year follow-up were excluded. Data preprocessing involved one-hot encoding categorical variables, scaling continuous variables, and imputing missing values. Four machine learning models (logistic regression, random forest (RF), gradient boosting, K-nearest neighbor) were employed. The models were trained and tested using an 80:20 data split and 5-fold cross-validation, with performance metrics guiding the selection of the best model for predicting persistent dysphonia.</p><p><strong>Results: </strong>In total, 2,708 were included in the study. Twelve key predictors were identified. Four machine learning models were tested, with the RF model achieving the best performance (AUC = 0.794). The most significant predictors across models included preoperative NDI, EQ5D_index, preoperative neurology, number of operated levels, and use of a fusion cage. The RF model, chosen for its superior performance, showed high sensitivity and consistent accuracy, but a low specificity and positive predictive value.</p><p><strong>Conclusions: </strong>In this study, machine learning models were employed to identify predictors of persistent dysphonia following ACDF. Among the models tested, the RF classifier demonstrated superior performance, with an AUC value of 0.790. The RF model identified NDI, EQ5D_index, and number of fused vertebrae as key variables. These findings underscore the potential of machine learning models in identifying patients at increased risk for dysphonia persisting for more than one month after surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592004","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":"Frailty and Malnutrition as Predictors of Major Complications Following Posterior Thoracolumbar Fusion in Elderly Patients: A Retrospective Cohort Study.","authors":"Di Han, Peng Wang, Shuai-Kang Wang, Peng Cui, Shi-Bao Lu","doi":"10.1016/j.spinee.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.004","url":null,"abstract":"<p><strong>Background context: </strong>The number of elderly patients with degenerative spinal deformity (DSD) is increasing, and posterior thoracolumbar fusion surgery is an effective treatment option, but there are often postoperative major complications, which may hinder the benefit for elderly patients. Currently, there is no consensus on the best risk assessment technique for predicting major complications in elderly patients undergoing long-segment fusion surgery.</p><p><strong>Purpose: </strong>This study constructs a risk assessment model using the Modified 5-Item Frailty Index (mFI-5) and serum albumin and evaluates its predictive value.</p><p><strong>Study design: </strong>This is a retrospective analysis of a prospectively established database of DSD.</p><p><strong>Patient sample: </strong>Consecutive patients (aged 65 and older) who underwent open posterior thoracolumbar fusion surgery for DSD between April 2018 and December 2023 were included.</p><p><strong>Outcome measures: </strong>Outcome measures included postoperative major complications, length of hospital stay [LOS], readmission and reoperation within 30 days, discharge disposition, physiological function recovery.</p><p><strong>Methods: </strong>The study reviewed consecutive patients who underwent open posterior thoracolumbar fusion surgery for DSD. Patients were divided into three groups based on the presence or absence of frailty or frailty combined with malnutrition. Spearman ρ analysis was used to assess the correlation between mFI-5 and serum albumin levels. Univariate analyses and multivariate logistic regression were conducted to explore the relationship between frailty and malnutrition defined by mFI-5 and serum albumin and major postoperative complications. Finally, the Receiver Operating Characteristic (ROC) curve was used to evaluate the predictive value of this model for major complications.</p><p><strong>Results: </strong>Compared to the Normal group (n = 59), both the Frailty group (n = 121) and the Frailty and Malnutrition group (n = 50) had higher rates of major complications (21.5% vs. 8.5%, p = .035; 28% vs. 8.5%, p = .002). Multivariate logistic regression showed that frailty and malnutrition status, higher ASA score, and more bleeding were independent predictors of major postoperative complications. The ROC curve demonstrated that frailty combined with malnutrition defined by mFI-5 and serum albumin had a larger area under the curve compared to mFI-5 or serum albumin alone (AUC: 0.676; 95% CI: 1.101-14.129; p < .001).</p><p><strong>Conclusions: </strong>Compared to considering frailty or malnutrition alone, the combined assessment of frailty and malnutrition using mFI-5 and serum albumin is valuable in predicting major complications in elderly patients undergoing posterior thoracolumbar fusion surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591926","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":"Glycemic Laboratory Values Are Associated With Increased Length of Stay and 90-Day Revision Risk Following Surgical Management of Adult Spinal Deformity.","authors":"Benjamin M Varieur, Theresa L Chua, Daniel G Tobert, Harold A Fogel, Stuart H Hershman","doi":"10.1016/j.spinee.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Diabetes mellitus (DM) is a common comorbidity among patients undergoing spinal fusion for adult spinal deformity (ASD) surgery. An elevated Hemoglobin A1c (HbA1c) and elevated postoperative glucose have been shown to increase the risk of complications following spine and other orthopaedic surgeries; however, data is limited for ASD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate glycemic control and ASD surgery to inform surgical decision making, medical optimization, and patient education.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Total of 106 adult patients undergoing surgical correction for ASD with an HbA1c drawn within six months preoperatively or two weeks postoperatively and valid plasma glucose levels throughout postoperative hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Length of stay, 90-day wound complication, 90-day readmission, 90-day revision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients undergoing spinal fusion of seven or more levels between 2021 and 2023 at two large academic medical centers were identified using institutional data acquisition software. Medical charts were then manually reviewed to obtain and confirm demographic, laboratory, and surgical characteristics and outcomes. Laboratory characteristics included preoperative HbA1c, mean postoperative glucose (PG), and maximum PG. Surgical characteristics and outcomes included procedure time, estimated blood loss (EBL), length of inpatient stay (LOS), transfusion requirement, 90-day complications, 90-day revision, and 90-day readmission. Bivariate analysis was performed followed by simple and multiple regression analysis. Odds ratios were established relative to the laboratory threshold values informed by receiver operating characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 872 original procedures identified, 106 patients (12.2%) were adults with preoperative HbA1c and postoperative plasma glucose measurements who underwent surgery for a diagnosis of ASD. Median patient age was 67 years (IQR 59-72 years), 59 (55.7%) were female, and 96 (90.6%) were of Caucasian race. Median LOS was 7 days (IQR 5-10 years) and median HbA1c was 5.9% (IQR 5.3%-6.5%). Higher preoperative HbA1c was correlated with increased LOS (R=0.22, P=0.023). The odds ratio for patients requiring extended LOS was 2.49 (95% CI 1.06-5.86, P=0.034) for those with HbA1c ≥6.3%. Multiple regression analysis of LOS identified HbA1c [B= 1.51 (95% CI 0.32-2.70), P=0.013] as a positive predictor of LOS and mean PG [B= -0.05 (95% CI -0.10-(-0.01), P=0.019] as a weakly negative predictor of LOS. Upon simple logistic regression, the odds ratio for 90-day revision was 1.81 (95% CI 1.02-3.19, P=0.042) for every unit increase in HbA1c. Patients with mean PG ≥165 mg/dL [OR=5.76 (95% CI 1.28-26.01), P=0.024] were at increased risk for 90-day revision. Glycemic laboratory values do not seem to predict 90-day woun","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591997","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":"Is it safe to treat osteoporotic burst thoracolumbar fracture using percutaneous vertebroplasty? A minimum of five-year follow-up study.","authors":"Hsi-Hsien Lin, Pei-I Hung, Kuan-Jung Chen, Wei Hsiung, Ming-Chau Chang","doi":"10.1016/j.spinee.2024.10.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.019","url":null,"abstract":"<p><strong>Background context: </strong>Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures remains controversial. A previous study has shown that an osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty.</p><p><strong>Purpose: </strong>To determine whether these outcomes persist over a long term, we continued to observe patients in their short-term study over a long-term period.</p><p><strong>Study design: </strong>Prospective study.</p><p><strong>Patient sample: </strong>Patients with osteoporotic vertebral fractures were classified as Dennis type I and II and AO type A1-A4, and no neurological deficits were observed.</p><p><strong>Outcome measures: </strong>Oswestry disability index and visual analog scale (VAS¹) for pain were outcome measures. Radiological outcomes were vertebral body height and kyphotic angle. Complications included cement leakage, adjacent fractures, and transition to instrumented fusion.</p><p><strong>Methods: </strong>Between June 2015 and December 2016, 96 patients with osteoporotic vertebral fractures who met the inclusion criteria were prospectively enrolled. Preoperative, postoperative, and latest follow-up clinical outcomes were assessed using the Oswestry disability index and VAS. The radiological outcomes included vertebral body height, kyphotic angle, and adjacent fractures. Patients with intractable pain and neurological deficits during the follow-up were indicated for surgical treatment using decompression and instrumented fusion.</p><p><strong>Results: </strong>Fifty-one patients with osteoporotic compression fractures and 45 with osteoporotic burst fractures were included in this study. Mean follow-up duration was 74 months, and posterior vertebral body height, kyphotic wedge angle, and VAS score were not altered during the follow-up period. Three (5.9%) patients in an osteoporotic compression fracture group and three (6.7%) in a osteoporotic burst fracture group developed persistent pain, further collapse, and neurological deficits, and were indicated for surgical treatment. No significant differences were observed in the rates of adjacent fractures. Percentage of patients who required surgical treatment was not significantly different between the groups.</p><p><strong>Conclusions: </strong>Osteoporotic burst fractures with asymptomatic spinal canal compromise treated with percutaneous vertebroplasty are safe and effective for pain management during long-term follow-up.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591999","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":"Correlation between severity of preoperative low back pain and postoperative outcomes in lumbar disc herniation surgery: A retrospective cohort study.","authors":"Koji Nakajima, Junya Miyahara, Hideki Nakamoto, So Kato, Yuki Taniguchi, Yoshitaka Matsubayashi, Naohiro Kawamura, Akiro Higashikawa, Yujiro Takeshita, Masayoshi Fukushima, Takashi Ono, Nobuhiro Hara, Naoki Okamoto, Sakae Tanaka, Yasushi Oshima","doi":"10.1016/j.spinee.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.022","url":null,"abstract":"<p><strong>Background context: </strong>Low back pain (LBP) frequently occurs in patients with lumbar disc herniation (LDH), however the extent to which discectomy ameliorates it and how preoperative LBP influences postoperative outcomes remains unclear.</p><p><strong>Purpose: </strong>To evaluate the improvement in LBP and its impact on postoperative patient-reported outcome measures (PROMs).</p><p><strong>Study design/setting: </strong>Multicenter retrospective observational study.</p><p><strong>Patient sample: </strong>Patients undergoing discectomy for LDH at eight hospitals from April 2017 to March 2021.</p><p><strong>Outcome measures: </strong>Data were collected on patients' backgrounds, operative factors, and PROMs, including the Numeric Rating Scale (NRS) for pain in the low back, buttock, or leg, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction.</p><p><strong>Methods: </strong>Patients were categorized into mild (NRS 0-3), moderate (NRS 4-7), or severe (NRS 8-10) LBP groups. Inverse probability weighting with propensity scores was used to adjust for demographic and clinical differences between groups. Chi-square tests and one-way analysis of variance were conducted to compare background data and clinical characteristics. Additionally, multivariate logistic regression was performed to identify risk factors for less than 50% improvement in LBP.</p><p><strong>Results: </strong>This study included 928 patients: 270 mild, 343 moderate, and 315 severe. After adjustment, preoperative NRS scores were significantly different across groups, with scores of 1.6 (SD 1.3), 5.6 (SD 1.0), and 8.8 (SD 0.9), respectively. Postoperative NRS scores also varied significantly, with worse outcomes observed in the severe group compared to the mild group, yet similar to the moderate group. A total of 46.8% of the mild group, 86.6% of the moderate group, and 72.9% of the severe group achieved a 50% decrease in NRS scores of LBP. Preoperative EQ-5D and ODI scores were significantly worse in the severe group compared to the mild or moderate groups, but postoperative scores were not significantly different between the severe and moderate groups. No significant differences in postoperative satisfaction were observed among the groups. Being female was a significant risk factor for less than 50% improvement in LBP (odds ratio = 1.56, p = 0.022).</p><p><strong>Conclusions: </strong>Discectomy significantly improved LBP in patients with LDH, including those with moderate or severe LBP. Patients with severe LBP showed similar improvements in PROMs as those with moderate LBP. Female gender emerged as a significant risk factor for less than optimal improvement in LBP.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570190","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":"Transcriptomic imputation identifies tissue-specific genes associated with cervical myelopathy.","authors":"Carina Seah, Mert Karabacak, Konstantinos Margetis","doi":"10.1016/j.spinee.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.014","url":null,"abstract":"<p><strong>Background context: </strong>Degenerative cervical myelopathy (DCM) is a progressive spinal condition that can lead to severe neurological dysfunction. Despite its degenerative pathophysiology, family history has shown to be a largely important factor in incidence and progression, suggesting that inherent genetic predisposition may play a role in pathophysiology.</p><p><strong>Purpose: </strong>To determine the tissue-specific, functional genetic basis of hereditary predisposition to cervical myelopathy.</p><p><strong>Study design: </strong>Retrospective case-control study using patient genetics and matched EHR from the Mount Sinai BioMe Biobank.</p><p><strong>Methods: </strong>In a large, diverse, urban biobank of 32,031 individuals, with 558 individuals with cervical myopathy, we applied transcriptomic imputation to identify genetically regulated gene expression signatures associated with DCM. We performed drug-repurposing analysis using the CMAP database to identify candidate therapeutic interventions to reverse the cervical myelopathy-associated gene signature.</p><p><strong>Results: </strong>We identified 16 genes significantly associated with DCM across five different tissues, suggesting tissue-specific manifestations of inherited genetic risk (upregulated: HES6, PI16, TMEM183A, BDH2, LINC00937, CLEC4D, USP43, SPATA1; downregulated: TTC12, CDK5, PAFAH1B2, RCSD1, KLHL29, PTPRG, RP11-620J15.3, C1RL). Drug repurposing identified 22 compounds with the potential to reverse the DCM-associated signature, suggesting points of therapeutic intervention.</p><p><strong>Conclusions: </strong>The inherited genetic risk for cervical myelopathy is functionally associated with genes involved in tissue-specific nociceptive and proliferative processes. These signatures may be reversed by candidate therapeutics with nociceptive, calcium channel modulating, and antiproliferative effects.</p><p><strong>Clinical significance: </strong>Understanding the genetic basis of DCM provides critical insights into the hereditary factors contributing to the disease, allowing for more personalized and targeted therapeutic approaches. The identification of candidate drugs through transcriptomic imputation and drug repurposing analysis offers potential new treatments that could significantly improve patient outcomes and quality of life by addressing the underlying genetic mechanisms of DCM.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570249","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}