Spine Journal最新文献

{"title":"Safety of non-osseous union of type II odontoid fractures-a multi-institutional cohort study.","authors":"Chady Omara, Anna B Lebouille-Veldman, Alexander G Yearley, Azra Gül, James Withers, Helen Karimi, Emma J Steinbuchel, Harshit Arora, John L Kilgallon, Benjamin R Johnston, Jakob V E Gerstl, James T Kryzanski, Rania A Mekary, Michael W Groff, Ron I Riesenburger, Jeroen G J Huybregts, Timothy R Smith, Jeffrey E Florman, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.spinee.2025.03.013","DOIUrl":"10.1016/j.spinee.2025.03.013","url":null,"abstract":"<p><strong>Background context: </strong>The management of type II odontoid fractures in elderly patients presents significant clinical challenges. Surgical treatment may lead to operative complications, while conservative management may increase the risk of non-osseous union, potentially compromising fracture stability.</p><p><strong>Purpose: </strong>This study aims to evaluate the safety of non-osseous union subtypes in type II odontoid fractures following conservative treatment and to identify risk factors for unstable fractures.</p><p><strong>Study design: </strong>A multi-institutional retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 307 patients with acute type II odontoid fractures treated conservatively between 2005 and 2022 were included. The mean age was 76±17 years, with a median follow-up of 24 months (IQR 9-55 months).</p><p><strong>Outcome measures: </strong>Fracture healing and stability were assessed. Safety of each healing subtype was determined by the incidence of new neurological deficits post collar removal or the need for surgical fixation. Risk factors for unstable fractures were also determined.</p><p><strong>Methods: </strong>Fracture healing was classified as osseous union, fibrous nonunion, or unstable nonunion based on CT and dynamic X-rays at collar removal. Fracture stability was assessed using only dynamic X-rays, with unstable fractures demonstrating active displacement. Neurological outcomes and the necessity for surgical fixation in each group were compared. Multivariable logistic regression was used to analyze risk factors for fracture instability.</p><p><strong>Results: </strong>Unstable nonunion occurred in 25% of patients, while fibrous nonunion occurred in 48% after a median collar wear of 3.7 months (IQR 2.9-6.2 months). New neurological deficits after collar removal were seen in 6% of patients with unstable nonunions during follow-up, but in none of those with fibrous nonunions or osseous unions, even after subsequent trauma. Risk factors for unstable nonunion included male sex (OR 2.14; 95% CI: 1.02-4.49), osteoporosis/osteopenia (OR 2.50; 95% CI: 1.17-5.37), and baseline fracture displacement (OR 4.81; 95% CI: 2.35-9.86).</p><p><strong>Conclusions: </strong>Fibrous nonunion is a viable outcome in conservatively managed type II odontoid fractures, reducing the need for surgery or prolonged collar wear. Risk factors for unstable nonunion included male sex, osteoporosis/osteopenia, and baseline fracture displacement. Unstable nonunions may lead to new neurological deficits occurring after collar removal in a small percentage of cases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744321","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":"Neurocognitive outcomes following adult spinal deformity surgery: a prospective study with 12-month follow-up.","authors":"Tej D Azad, John F Burke, Anmol Warman, Justin K Scheer, Michael M Safaee, Terry Nguyen, Jaemin Kim, Marissa Fury, Justin Lee, Vedat Deviren, Christopher P Ames","doi":"10.1016/j.spinee.2025.03.010","DOIUrl":"10.1016/j.spinee.2025.03.010","url":null,"abstract":"<p><strong>Background context: </strong>A common concern is that the stress induced by adult spinal deformity (ASD) surgery may cause a postoperative decrease in cognitive function, especially in the elderly patients with some component of cognitive impairment. On the other hand, it is possible that ASD surgery could stabilize cognitive function by increasing activity and decreasing pain.</p><p><strong>Purpose: </strong>Here, we evaluate the effect of ASD surgery on cognitive outcome in a prospective study.</p><p><strong>Study design/setting: </strong>This is a prospective study of patients undergoing ASD surgery at a single institution over a five-year period.</p><p><strong>Patient sample: </strong>ASD patients treated with posterior spinal fusion of greater or equal to 7 vertebral segments for adult deformity were included. Only patients with 12 month follow up are included in this study.</p><p><strong>Outcome measures: </strong>The primary outcome variable was performance on the Montreal Cognitive Assessment (MoCA) test of dementia and cognitive impairment, collected prospectively preoperatively and at 12-month follow-up. We also collected outcome metrics including the Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-22) with mental health (MH), activity (ACT), pain (P), and self-image (SI) sub-components. Preoperative and postoperative morphine equivalent dose (MED) of narcotic medication was collected using patient surveys and verified using prescription data.</p><p><strong>Methods: </strong>The primary outcome was assessed using a paired t-test. Further analyses included performing univariate and multivariable analyses comparing patients with improved versus nonimproved MoCA scores across demographic, radiographic, surgical, outcome data, and opioid usage.</p><p><strong>Results: </strong>We enrolled 55 patients who met inclusion criteria. There was a significant increase in MoCA scores at 12-month follow-up compared to preoperative MoCA scores (p<.001). Overall, 60% of patients exhibited an increase in MoCA scores, and 47.2% met minimally clinically important difference (MCID). More severely cognitively impaired patients tended to improve to a greater degree than less severely impaired patients (p=.003). While there was no clear association between reduction in postoperative opioid use and cognitive improvement, we observed a possible association between postoperative delirium and cognitive decline among patients with baseline cognitive impairment (p=.01).</p><p><strong>Conclusions: </strong>Our prospective data suggests that ASD surgery is associated with an improvement in cognitive function at one year follow-up. Further work is required to understand the drivers associated with cognitive improvement and worsening after ASD surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744309","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":"Comparison of outcomes after anterior versus posterior surgery for degenerative cervical myelopathy: a pooled analysis of individual patient data.","authors":"Alex B Bak, Mohammed Ali Alvi, Ali Moghaddamjou, Michael G Fehlings","doi":"10.1016/j.spinee.2025.03.027","DOIUrl":"10.1016/j.spinee.2025.03.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Uncertainty exists regarding the optimal surgical approach to treat patients with degenerative cervical myelopathy (DCM). This uncertainty is particularly marked for patients with mild DCM who may be more sensitive to different management techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine the effect of surgical approach on one-year outcomes for DCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Individual patient data meta-analysis of 3 independent, prospective, multicentre clinical trials (ie, CSM-North America, CSM-International, CSM-Protect) that enrolled patients between 2005 and 2018 in academic hospitals, with 1 yr follow up. Statistical analysis was performed from September 13, 2023 to April 2, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;From a total of 1047 adult subjects with DCM, 980 met the eligibility criteria who were surgical candidates with symptomatic and radiologically-evidenced DCM with no prior cervical surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes measures: &lt;/strong&gt;The primary endpoint was change in 36-Item Short Form Health Survey Physical Component Summary score (SF36-PCS; minimum clinically important difference [MCID]=4) at 1 yr compared to preoperatively. Secondary endpoints were change in modified Japanese Orthopedic Association (mJOA; MCID=2) score, Neck Disability Index (NDI; MCID=15) score, SF36 Mental Component Summary (SF36-MCS; MCID=4) score, and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two comparison cohorts were created: i) anterior surgery and ii) posterior surgery. Mean differences (MD) of outcomes with 95% confidence intervals (CI) were estimated using one-stage covariate-adjusted hierarchical mixed-effects meta-analyses with study and treatment exposure as random effects. A priori subgroup analysis in mild DCM patients (mJOA=15-17) was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean patient age was 56.9 years (SD=11.4), with 38.7% that identified as female. 560 patients (57.1%) received anterior cervical decompressive surgery for DCM. Patients who had anterior decompressive surgery experienced greater improvements in quality of life and disability at 1 yr follow-up than those who underwent posterior decompressive surgery in SF36-PCS (MD=1.57 [95% CI 0.11-3.03], p=.0348) and NDI (MD=3.32 [95% CI 0.58-6.05], p=.017). Dysphagia was more likely after anterior surgery. Pseudoarthrosis and wound infections were more likely after posterior surgery. In a subgroup of patients with mild DCM, patients who underwent anterior decompressive surgery experienced even greater improvements in SF36-PCS (MD=5.45 [95% CI 1.73-9.18], p=.0042), NDI (MD=10.37 [95%CI 3.43-17.31], p=.0035), and mJOA (MD=0.95 [95% CI 0.12-1.77], p=.0238; MCID=1) than posterior surgery patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Anterior surgical decompression for DCM is associated with greater improvements in 1 yr patient-reported quality of life and disability than posterior surgical decompressi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744275","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":"Novel radiologic parameter for assessing decompression adequacy in anterior cervical decompression surgery: the V-line.","authors":"Dong-Ho Lee, Sung Tan Cho, Chang Ju Hwang, Jae Hwan Cho, Sehan Park, Jin Hwan Kim, Wongthawat Liawrungrueang","doi":"10.1016/j.spinee.2025.03.007","DOIUrl":"10.1016/j.spinee.2025.03.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Anterior cervical decompression surgeries, such as Vertebral Body Sliding Osteotomy (VBSO) and Anterior Cervical Corpectomy and Fusion (ACCF), serve as vital surgical options for managing cervical myelopathy. Despite their effectiveness, incomplete expansion of the spinal canal can occur in certain cases. However, many patients still experience positive clinical outcomes after these surgeries, suggesting that assessing outcomes based solely on the lesion's canal-occupying effect may be limited. In cases of anterior-based fusion surgery, changes in cervical alignment can occur postoperatively. Since traditional measures like the canal occupying ratio (COR) consider only the absolute size of the lesion, they may overlook improvements in clinical symptoms due to enhanced lordosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study introduces the V-line, a novel radiologic parameter, to universally evaluate decompression outcomes in these procedures.&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;This retrospective analysis encompassed 93 patients treated for cervical myelopathy due to ossification of the posterior longitudinal ligament through either VBSO (N=76) or ACCF (N=17) OUTCOME MEASURE: Radiological evaluations included C2-7 lordosis, segmental lordosis, and COR. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively, at 1-year postoperatively, and at the final follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The V-line, defined on a plain lateral radiograph in the neutral position, connects the lowest point on the posterior margin of the vertebral body immediately above the osteotomy site to the highest point on the posterior margin immediately below it. The V-line classification was \"V-line (-)\" if the postoperative pathologic lesion contacted the V-line and \"V-line (+)\" if it did not. Patients were categorized based on postoperative COR and the V-line assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The V-line (+) group achieved a higher final JOA score (15.3±1.91) and JOA recovery rate (62.16±32.22) compared to the V-line (-) group, which recorded a final JOA score (14.25±2.33, p=.037) and a JOA recovery rate (24.71±32.00, p&lt;.001). Additionally, postoperative C2-7 lordosis (18.05±9.59, p&lt;.001) and segmental lordosis (18.53±8.49, p=.008) in the V-line (+) group were significantly greater than in the V-line (-) group (10.68±8.38; 11.42±7.87). However, when comparing groups based on postoperative COR, significant differences were observed only in the JOA recovery rate, with no notable differences in final JOA score, C2-7 lordosis and segmental lordosis between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Since the V-line accounts for both the mass effect of the pathological lesion and cervical alignment, this parameter effectively reflects the reduced impact of spinal cord compression when cervical lordosis is restored, even with residual ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744313","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 quality of life of patients after treatment for spinal metastatic disease: development and internal evaluation","authors":"Rene Harmen Kuijten BSc ,&nbsp;Bas Bindels MD ,&nbsp;Olivier Groot MD, PhD ,&nbsp;Eline Huele MD ,&nbsp;Roxanne Gal ,&nbsp;Mark Groot PhD ,&nbsp;Joanne van der Velden MD, PhD ,&nbsp;Diyar Delawi MD, PhD ,&nbsp;Joseph Schwab MD, MS ,&nbsp;Helena Verkooijen MD, PhD ,&nbsp;Jorrit Jan Verlaan MD, PhD ,&nbsp;Daniel Tobert MD ,&nbsp;Joost Rutges MD, PhD","doi":"10.1016/j.spinee.2025.03.016","DOIUrl":"10.1016/j.spinee.2025.03.016","url":null,"abstract":"<div><h3>Background Context</h3><div>When treating spinal metastases in a palliative setting, maintaining or enhancing quality of life (QoL) is the primary therapeutic objective. Clinicians tailor their treatment strategy by weighing the QoL benefits against expected survival. To date, no available model exists that predicts QoL in patients after treatment for spinal metastases.</div></div><div><h3>Purpose</h3><div>To develop and internally evaluate a model predicting QoL for patients after treatment for spinal metastases, across the spectrum of (local) treatment modalities.</div></div><div><h3>Study Design/Setting</h3><div>Cohort study of prospectively collected data.</div></div><div><h3>Patient Sample</h3><div>Patients with spinal metastases referred to a single tertiary referral center in the Netherlands between January 1^st, 2016, and December 31^st, 2021.</div></div><div><h3>Outcome Measures</h3><div>The primary outcome was achieving a minimal clinically important difference (MCID) on QoL using the EQ-5D-3L index score 3 months after the referral visit (at the outpatient clinic or emergency department).</div></div><div><h3>Methods</h3><div>Five prediction models using machine learning were developed: random forest, stochastic gradient boosting, support vector machine, penalized logistic regression, and neural network. Performance was assessed using cross-validation during development and bootstrapping for internal evaluation with discrimination (area under the curve (AUC)), calibration, and decision curve analysis. This study was funded by the AOSpine under the Discovery &amp; Innovation award (AOS-DIA-22-012-TUM). A total amount of CHF 40,000 ($45,000) was received.</div></div><div><h3>Results</h3><div>In total, 953 patients were included in the study, of which 308 (32%) achieved the MCID at 3 months. Discrimination was fair and comparable between the models, but the random forest model outperformed the other models on calibration and was therefore chosen as the final model (AUC 0.78; confidence interval (CI): 0.71 to 0.85; calibration intercept: -0.06; CI: -0.31 to 0.25; calibration slope: 1.05; CI: 0.70 to 1.44), with the following predictors ranked by importance: baseline EQ-5D-3L index score, Karnofsky Performance Scale, primary tumor histology, opioid use, and presence of brain metastases.</div></div><div><h3>Conclusions</h3><div>We developed and internally evaluated a random forest model that predicts clinically meaningful improvement of QoL 3 months after the baseline visit at the outpatient clinic for patients with spinal metastases. Future studies should externally evaluate the random forest model to confirm its robustness and generalizability in daily practice.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 7","pages":"Pages 1371-1385"},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744317","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":"Racial disparities in anterior cervical discectomy and fusion: an analysis of 67,621 patients.","authors":"Brian Q Truong, Linsen T Samuel, Haseeb E Goheer, Zachary T Lyon, Jonathan J Carmouche","doi":"10.1016/j.spinee.2025.03.024","DOIUrl":"10.1016/j.spinee.2025.03.024","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Racial disparities have been demonstrated in the analysis of perioperative outcomes in minority populations in the field of spine surgery when compared to nonminorities. However, there are limited studies investigating the role of racial disparities in cervical spine surgery in a recent, large patient sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We assessed race and ethnicity as an independent risk factor in outcome disparities following anterior cervical discectomy and fusion (ACDF) among Black or African American (AA), Asian or Pacific Islander (AP), Hispanic (HA), and Native American or Alaska Native (NA) patients compared to White or Caucasian (CA) patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A retrospective cohort, large multicenter database study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;The American College of Surgeons National Surgical Quality Improvement Program database was queried for ACDFs from 2011 to 2021 by Common Procedural Terminology codes (22551, 22552, 22585, and 22554). Patients were categorized into five cohorts based on race and ethnicity: Asian American or Pacific Islander, Black or African American, Hispanic, Native American or Alaskan Native, and White or Caucasian.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The outcome measures for this study were surgical complications, perioperative, and postoperative outcomes within 30-days postoperative.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Baseline characteristics were analyzed using analysis of variance (ANOVA) for continuous variables or chi-squared test for categorical variables with Bonferroni correction. Controlling for racial demographic and comorbidity differences via model selection by Akaike information criterion by backward stepwise regression, race and ethnicity were isolated as possible independent risk factors for short-term patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;67621 patients (54679 CA, 7358 AA, 1429 AP, 399 NA, and 3756 HA) were included in this study. AA race was an independent risk factor for medical complications (OR: 1.330, 95% CI [1.137-1.549], p &lt; .001), operative time (β: 12.162 minutes, 95% CI [10.565-13.758], p &lt; .001), length of stay (β: 0.514 days, 95% CI [0.431-0.597], p &lt; .001), postoperative discharge time (β: 0.439 days, 95% CI [0.388-0.491], p &lt; 0.001), 30-day reoperation (OR: 1.379, 95% CI [1.142-1.654], p &lt; .001), and a nonhome discharge destination (OR: 2.256, 95% CI [2.022-2.514], p &lt; .001). AP race was an independent risk factor for operative time (β: 14.293 minutes, 95% CI [10.854-17.732], p &lt; .001). HA ethnicity was an independent risk factor for a nonhome discharge destination (OR: 1.395, 95% CI [1.171-1.652], p &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared to CA patients, AA, AP, HA, and NA ACDF patients experience greater comorbidity burden and/or unfavorable 30-day surgical outcomes. These findings support the need for the exploration of interdisciplinary care focused on addressing kno","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744319","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":"Class 2/3 obesity leads to worse outcomes following minimally invasive transforaminal lumbar interbody fusion.","authors":"Pratyush Shahi, Tejas Subramanian, Kasra Araghi, Maximilian K Korsun, Sumedha Singh, Nishtha Singh, Olivia C Tuma, Tomoyuki Asada, Annika Bay, Eric R Zhao, Adin M Ehrlich, Sereen Halayqeh, Tarek Harhash, Andrea Pezzi, Adrian Lui, Evan D Sheha, James E Dowdell, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1016/j.spinee.2025.03.020","DOIUrl":"10.1016/j.spinee.2025.03.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;There is lack of evidence regarding the impact of class 2/3 obesity (body mass index [BMI] ≥35) on outcomes following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To analyze clinical outcomes, return to activities, fusion rates, and complication/reoperation rates following MI-TLIF in class 2/3 obese patients and compare them with other BMI groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients who underwent primary single-level tubular MI-TLIF for degenerative conditions of lumbar spine and had a minimum of 1-year follow-up were included. Patients were divided into 4 cohorts based on their BMI: normal (BMI 18.5 to &lt;25), overweight (25 to &lt;30), class 1 obesity (30 to &lt;35), and class 2/3 obesity (BMI ≥35).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;(1) operative variables: operative time, estimated blood loss (EBL), postoperative length of stay (LOS); (2) patient reported outcome measures (PROMs) (Oswestry Disability Index [ODI]; Visual Analog Scale [VAS] back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); (3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; (4) return to activities; (5) fusion rates; and (6) complication and reoperation rates. Two postoperative timepoints were defined: early (&lt;6 months) and late (≥6 months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Differences between the 4 BMI cohorts in demographics and outcome measures were analyzed with appropriate statistical tests. Subgroup analyses were performed to compare outcomes between (1) class 2 and class 3 obesity groups and (2) patients with and without metabolic syndrome. Regression analyses were performed to analyze the relationship of BMI groups and metabolic syndrome with PASS achievement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three hundred and ninety patients were included (119 normal, 160 overweight, 67 class 1 obesity, 44 class 2/3 obesity). There was no significant difference in intraoperative variables. Although no significant difference was seen between the groups in PROMs at &lt;6 months, class 2/3 obesity group had significantly worse PROMs, lower PASS achievement rates, and lower MCID achievement rates in VAS leg and SF-12 PCS at ≥6 months. There were no significant differences in the MCID achievement rates in ODI and VAS back and responses on the GRC scale. Although class 2/3 obesity group had a lower fusion rate (67% vs. &gt;87% in other groups), this difference was not statistically significant. Class 2/3 obesity group had significantly higher postoperative LOS (62 hours vs. &lt;50 hours in other groups) and took significantly greater number of days to return to driving (74 days vs. &lt;40 days in other groups). No significant difference was found in return to work and discontinuation of narcotics. The groups had similar compli","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744274","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 fate of cerebrospinal fluid after unrecognized incidental durotomy in cervical spine surgery.","authors":"Hyunik Cho, Young-Hyun Yoon, Kyung-Soo Suk, Ji-Won Kwon, Byung-Ho Lee, Namhoo Kim, Si-Young Park, Hak-Sun Kim, Seong-Hwan Moon","doi":"10.1016/j.spinee.2025.03.008","DOIUrl":"10.1016/j.spinee.2025.03.008","url":null,"abstract":"<p><strong>Background context: </strong>Cerebrospinal fluid (CSF) leakage due to incidental durotomy may not be recognized during cervical spine surgery. Thereafter large volume of CSF leakage may be found through inserted drainage.</p><p><strong>Purpose: </strong>To examine the natural progress of large volume of CSF leakage after cervical spine surgery which were not managed by either revision surgery for dural repair or lumbar drainage.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 3215 patients who underwent cervical spine surgery by a single surgeon between 2015 and 2022.</p><p><strong>Outcome measures: </strong>The volume of the leaked CSF was measured on the T2 sagittal MRI using PACS volume measuring tool. Spontaneous absorption rate of CSF at 6-month postoperative period was calculated for each patient.</p><p><strong>Methods: </strong>For risk factor analysis, the incidence of unrecognized incidental durotomy was assessed according to types of surgery, revision surgery, presence of ligamentous ossification or smoking history. MRIs were taken in all 31 patients postoperatively and at 6 months follow up.</p><p><strong>Results: </strong>The total incidence of unrecognized incidental durotomy was 1.09% (31/2949). Posterior laminectomy and fusion had 2.14%, followed by open-door laminoplasty (1.41%), and anterior surgery (0.34%). Revision surgery had significantly higher incidence of CSF leakage (4.67%) compared to primary cases (0.95%). Patients with ligamentous ossification showed higher incidence of CSF leakage (5.57%) compared to the patients without it (0.48%). The average spontaneous absorption rate was 95.0%.</p><p><strong>Conclusion: </strong>Leaked CSF was spontaneously absorbed within 6 months without any reoperation for dural repair or lumbar drainage. Risk factors for unrecognized incidental durotomy were posterior laminectomy and fusion, revision surgery, or existence of ligamentous ossification.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732557","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":"Integrating a randomized controlled trial with a parallel observational cohort study in cervical spine surgery insights from the foraminotomy ACDF cost-effectiveness trial (FACET).","authors":"Nádia F Simões de Souza, Anne E H Broekema, Remko Soer, Katalin Tamási, Antoinette D I van Asselt, Michiel F Reneman, J Marc C van Dijk, Jos M A Kuijlen","doi":"10.1016/j.spinee.2025.03.002","DOIUrl":"10.1016/j.spinee.2025.03.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;In most randomized controlled trials (RCT), data is primarily and often only available for individuals who have agreed to be randomized, with little, if any, consideration for those who elected not to participate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study evaluated the value of including a concurrent observational cohort of patients who declined randomization in the Foraminotomy ACDF Cost-Effectiveness Trial (FACET-RCT) but still underwent anterior or posterior cervical surgery. The goal was to determine if the FACET-RCT results could be generalized by comparing baseline characteristics and clinical outcomes between the randomized trial and observational cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A nationwide RCT with a parallel observational cohort recruiting patients from routine care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Between January 2016 and May 2020, 389 patients with cervical radiculopathy were screened, and 358 were eligible. Of these, 265 (74%) were randomized in the FACET-RCT for either posterior or anterior cervical surgery, while 80 (22%) opted out of randomization and were followed in an observational cohort. Only 13 (4%) patients declined participation in both FACET-RCT and cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Demographic data was collected, and primary outcomes included treatment success, evaluated using the Odom criteria as well as reduction in arm pain, assessed with a Visual Analogue Scale (VAS) at 6 weeks, and every 6 months up to 2 years postsurgery. Secondary outcomes included VAS for neck pain, neck disability, work ability, quality of life, treatment satisfaction, and need for revision surgeries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Baseline characteristics were compared between the FACET-RCT and cohort using logistic regression. Primary and secondary outcomes were analyzed for differences between study designs using mixed-model analyses adjusted for confounders. The primary noninferiority endpoint of the FACET-RCT was evaluated in both the cohort and combined data from both cohort and FACET-RCT at 2 years of follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients in the cohort were slightly younger than those in the FACET-RCT (mean age of 48.4 versus 51.2 years; mean difference [MD], -2.5; 95% confidence interval [CI], -4.8 to -0.2; p=.04). In sub-analyses stratified by surgical approach (anterior vs. posterior surgery), fewer patients in the observational cohort who underwent posterior surgery reported severe neck pain at baseline compared to their counterparts in the FACET-RCT (OR, 0.38; 95% CI: 0.14 to 0.92; p=.04). No other significant baseline differences were found. No significant differences in treatment success (OR, 1.3; 95% CI: 0.3 to 6.0; p=.75) and arm pain reduction (MD, -3.9; 95% CI: -9.2 to 1.5; p=.16) were observed between study designs. The primary noninferiority endpoint was achieved in the combined data from both the cohort and FACET-RCT, with a na","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732548","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":"Neighborhood socioeconomic disadvantage predicts extended length of stay and nonhome discharge but not readmissions or reoperations after anterior cervical discectomy and fusion.","authors":"Ignacio Pasqualini, Alp Turan, Shujaa T Khan, Ahmed K Emara, Mustafa M Mahmood, Omolola Fakunle, Theodore Rudic, Tariq Said, Mitchell K Ng, Assem A Sultan, Jason Savage, Dominic W Pelle","doi":"10.1016/j.spinee.2025.03.003","DOIUrl":"10.1016/j.spinee.2025.03.003","url":null,"abstract":"<p><strong>Background context: </strong>Socioeconomic disadvantage has been associated with worse outcomes across various surgical disciplines. However, the impact of neighborhood-level disadvantage on outcomes after anterior cervical discectomy and fusion (ACDF) remains poorly studied.</p><p><strong>Purpose: </strong>To evaluate the association of neighborhood socioeconomic disadvantage, as measured by Area Deprivation Index (ADI), with patient demographics, lengths of stay, discharge dispositions, and 90-day reoperation and readmission rates following ACDF.</p><p><strong>Study design/setting: </strong>Prospective cohort study of consecutive patients undergoing primary ACDF at a tertiary academic medical center from October 2018 to October 2020.</p><p><strong>Patient sample: </strong>About 395 patients with primary ACDF were included. Patients were assigned ADI scores based on home zip codes and categorized into quartiles: low (≤25), mild (26-50), moderate (51-75), and severe (76-100) disadvantage.</p><p><strong>Outcome measures: </strong>Length of stay >3 days, nonhome discharge, 90-day readmissions, and 90-day reoperations. Demographics, comorbidities, and procedural details were also collected.</p><p><strong>Methods: </strong>Univariate and multivariate analyses compared outcomes across ADI quartiles. Multivariate logistic regression evaluated the impact of ADI on outcomes while controlling for other factors.</p><p><strong>Results: </strong>Compared to the low deprivation group, patients with severe deprivation were younger, more likely to be black, unmarried, uninsured, and current smokers (all p<.001). Higher ADI quartile independently predicted extended length of stay (OR 2.09, 95% CI 1.34-3.41, p<.001) and nonhome discharge (OR 1.83, 95% CI 1.17-3.01, p=.011). No significant differences were found in 90-day readmissions or reoperations based on ADI.</p><p><strong>Conclusions: </strong>Greater neighborhood socioeconomic disadvantage is independently associated with prolonged hospitalization and lower likelihood of home discharge after ACDF. These findings highlight the importance of considering social determinants of health in risk stratification and care optimization for patients undergoing spine surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732550","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}