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":"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":" ","pages":""},"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":"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 Edström, Adrian Elmi-Terander","doi":"10.1016/j.spinee.2024.10.010","DOIUrl":"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).</p><p><strong>Patient sample: </strong>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 1 month after surgery. Predictive performance was assessed using discrimination and calibration metrics.</p><p><strong>Methods: </strong>Patients with missing dysphonia data at the 1-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 1 month after surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.4,"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":"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":"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 orthopedic 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 6 months preoperatively or 2 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=.023). The odds ratio for patients requiring extended LOS was 2.49 (95% CI 1.06-5.86, p=.034) for those with HbA1c ≥6.3%. Multiple regression analysis of LOS identified HbA1c [B= 1.51 (95% CI 0.32-2.70), p=.013] as a positive predictor of LOS and mean PG [B= -0.05 (95% CI -0.10 to (-0.01)), p=.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=.042) for every unit increase in HbA1c. Patients with mean PG ≥165 mg/dL [OR=5.76 (95% CI 1.28-26.01), p=.024] were at increased risk for 90-day revision. Glycemic laboratory values do not seem to predict 90-day wound compl","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"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 5-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":"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":" ","pages":""},"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":"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":"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>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"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":"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":"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 8 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=.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":" ","pages":""},"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":"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 5 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":" ","pages":""},"PeriodicalIF":5.4,"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}

{"title":"Which spinal fixation technique achieves which degree of stability after thoracolumbar trauma? A systematic quantitative review.","authors":"Ann-Kathrin Greiner-Perth, Hans-Joachim Wilke, Christian Liebsch","doi":"10.1016/j.spinee.2024.10.017","DOIUrl":"10.1016/j.spinee.2024.10.017","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Unstable traumatic spinal injuries require surgical fixation to restore biomechanical stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this review was to summarize and quantify three-dimensional spinal stability after surgical fixation of traumatic thoracolumbar spinal injuries using different treatment strategies derived from experimental studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic literature review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Keyword-based search was performed in PubMed and Web of Science databases to identify all in vitro studies investigating stabilizing effects of different surgical fixation strategies for the treatment of traumatic spinal injuries of the thoracolumbar spine. Biomechanical stability parameters such as range of motion, neutral zone, and translation, as well as the experimental design were extracted, collected, and evaluated with respect to the type and level of injury and treatment strategy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 66 studies with human specimens were included in this review, of which 16 studies examined the treatment of incomplete (AOSpine A3) and 34 studies the treatment of complete burst fractures (AOSpine A4). Fixations of wedge fractures (AOSpine A1, n=5 studies), ligament injuries (AOSpine B, n=7 studies), and three-column injuries (AOSpine C, n=7 studies) were investigated less frequently. Treatment approaches could be divided into 5 subgroups: Posterior fixation, eg, posterior pedicle screw systems, anterior fixation, eg, anterolateral plate fixation, combined anterior-posterior fixation, vertebral body replacement with additional instrumentation, and augmentation techniques, eg, vertebroplasty and kyphoplasty. Minor injuries were generally treated with less invasive surgical methods such as augmentative and posterior approaches. Bisegmental posterior pedicle screw fixation led to stabilization of minor compression injuries, whereas in more severe injuries, e.g. AOSpine A4 or AOSpine C, instability remained in at least one motion plane. More invasive fixation techniques such as long segment posterior fixation, circumferential fixation, or vertebral body replacements with circumferential fixation provided total stabilization in terms of range of motion reduction even in more severe injuries. Pure augmentative treatment did not restore multidirectional stability. Neutral zone, which was reported in 25 studies, generally exhibited higher remaining increase than range of motion, which was reported in all 66 studies. Instability characteristics after treatment differed with respect to the spinal region, as thoracic injuries were more likely to remain unstable in flexion/extension, while thoracolumbar and lumbar injuries exhibited remaining instability primarily in axial rotation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The stabilizing effect of surgical treatment depends on the type, severity, and location of injury, as well as the fi","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570254","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":"Semaglutide utilization associated with reduced ninety-day postoperative complications following single-level posterior lumbar fusion for patients with type II diabetes.","authors":"Anthony E Seddio, Michael J Gouzoulis, Rajiv S Vasudevan, Meera M Dhodapkar, Sahir S Jabbouri, Arya G Varthi, Daniel R Rubio, Jonathan N Grauer","doi":"10.1016/j.spinee.2024.10.011","DOIUrl":"10.1016/j.spinee.2024.10.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Semaglutide (the active agent in medications such as Ozempic) has emerged as an increasingly popular medication in the management of diabetes due to its superior clinical efficacy compared with other medications. Patients undergoing surgery, such as posterior lumbar fusion (PLF), may be on these medications for type II diabetes mellitus (T2DM). While the correlation of T2DM with inferior PLF outcomes is known, considering the potential impact of semaglutide on the odds of postoperative complications has not previously been characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the potential correlation of semaglutide on 90-day postoperative adverse events following single-level PLF for those with T2DM who are or are not concurrently taking insulin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;A retrospective cohort study utilizing the 2010 to Q2 2022 M161Ortho PearlDiver Mariner Patient Claims Database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;T2DM patients (with or without concurrent insulin use) undergoing single-level PLF (with or without interbody fusion) were identified using Current Procedural Terminology (CPT) codes. Exclusion criteria included: patients less than 18 years of age, those undergoing concurrent cervical, thoracic, anterior, or multilevel fusion procedures, and those with trauma, neoplasm, or infection diagnosed within three months of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Incidence of 90-day aggregated any, severe, and minor adverse events (AAE, SAE, and MAE, respectively), emergency department (ED) visits, and hospital readmissions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with a prior diagnosis of T2DM not using insulin (T2DM-insulin) and T2DM concurrently using insulin (T2DM+insulin) undergoing PLF were identified. Patients within each group who utilized semaglutide in the year prior to surgery were identified and matched 1:4 with nonsemaglutide T2DM-insulin and nonsemaglutide T2DM+insulin patients, respectively, based on age, sex, Elixhauser Comorbidity Index (ECI), obesity, tobacco use, metformin use, and sodium-glucose transport protein 2 inhibitor (SGLT2i) use. The incidence of 90-day adverse events between groups was compared by univariate and multivariate analyses. Bonferroni correction was utilized to reduce the risk of type I error.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of all T2DM patients undergoing PLF, semaglutide use was noted for 227 (0.73%) of T2DM-insulin patients, and 244 (2.17%) of T2DM+insulin patients. Once matched, there were 191 and 148 in the semaglutide groups, respectively. For the PLF T2DM-insulin analysis, those using semaglutide were at significantly lower odds of AAE (odds ratio [OR] 0.43), MAE (OR 0.45), and ED visits (OR 0.34) (p&lt;.001 for all), but not of SAEs or readmissions. For the PLF T2DM+insulin analysis, those using semaglutide were at significantly lower odds of AAE (OR 0.40, p&lt;.001), SAE (OR 0.43, p=.004), MAE (OR 0.34, p&lt;.001), and E","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570221","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":"Robotic pedicle screw placement with 3D MRI registration: moving towards radiation free robotic spine surgery.","authors":"Franziska C S Altorfer, Michael J Kelly, Fedan Avrumova, Marco D Burkhard, Darryl B Sneag, Gracyn Campbell, Joseph L Chazen, Ek T Tan, Darren R Lebl","doi":"10.1016/j.spinee.2024.10.020","DOIUrl":"10.1016/j.spinee.2024.10.020","url":null,"abstract":"<p><strong>Background context: </strong>Preoperative imaging for lumbar spine surgery often includes magnetic resonance imaging (MRI) for soft tissues and computer tomography (CT) for bony detail. While CT scans expose patients to ionizing radiation, whereas MRI scans do not. Emerging MRI techniques allow CT-like 3-dimensional (3D) visualization of bony structures, potentially removing the need for ionizing radiation from CT scans.</p><p><strong>Purpose: </strong>This study aims to explore the accuracy of robot-assisted lumbar pedicle screw placement based on preoperative CT-like 3D MRI as the data source for robotic registration.</p><p><strong>Study design: </strong>Human cadaveric study.</p><p><strong>Methods: </strong>CT-like 3D MRI scans of the lumbar spine were acquired in ten human cadavers. A robotic navigation platform was used to plan and navigate pedicle screw placement based on the CT-like 3D MRI. Postoperative CT scans assessed the accuracy of screw positioning compared to preoperative planning based on the Gertzbein-Robbins scale (GRS) and by direct measurement (mm).</p><p><strong>Results: </strong>A total of 100 lumbar pedicle screws were robotically placed in ten cadavers (L1 through L5 bilaterally) based on CT-like 3D MRI. On postoperative CT evaluation, 99.0% of the positioned screws achieved an acceptable grade on the GRS (Grade A: n=89 or Grade B: n=10), with 89.0% classified as Grade A and 10.0% as Grade B. Meaning that 89.0% of screws were fully contained within the pedicle (GRS A), and 10% had a minor cortical breach <2 mm (GRS B). The median deviation from the planned trajectory was 0.2 mm (axial IQR: 0.1 to 0.5 mm; sagittal: IQR: 0.1 to 0.4 mm), in both axial and sagittal planes.</p><p><strong>Conclusion: </strong>This study showed that image registration of CT-like 3D MRI for robotic-assisted spine surgery is technically feasible and that accurate pedicle screw placement can be achieved without preoperative CT. Each CT-like 3D MRI was successfully registered for robotic navigation.</p><p><strong>Clinical significance: </strong>The results suggest that CT-like 3D MRI has the potential to be a radiation-free alternative for preoperative planning and navigation in lumbar spine instrumentation procedures.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570213","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}