Spine Journal最新文献

{"title":"64. Replicating prefusion sitting posture following L4-sacrum fusion may cause junctional segment breakdown in patients with limited upper lumbar mobility","authors":"Avinash G. Patwardhan PhD , Robert M. Havey MS , Kenneth R Blank PhD, MS, MHA , Muturi G Muriuki PhD","doi":"10.1016/j.spinee.2025.08.246","DOIUrl":"10.1016/j.spinee.2025.08.246","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>In our previous radiographic study of healthy adults, we observed that a transition from standing to sitting was associated with a loss of lumbar lordosis. The sacrum became more vertical, causing a significant reduction in the sacral slope. The greatest reduction in lordosis was at L4–S1 (28.8° to 17.4°, p<0.01). In patients who undergo instrumented fusion of L4-S1, the proximal mobile segments may be recruited during this transition from standing to sitting to compensate for the loss of lower lumbar mobility. This may subject proximal segments to supra-physiological flexion loading.</div></div><div><h3>PURPOSE</h3><div>In this study, we asked: what alignment changes must take place post L4-S1 fusion, to allow the subject to replicate the prefusion sitting posture? Successful restoration of the sagittal position and angular orientation of L1 (L1 SVA and L1 slope) to their values in the pre-fusion sitting posture was the goal as that would ensure that the postfusion alignments of the thoracic and cervical spine would be maintained as near their alignments in the prefusion sitting posture.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Subject-specific kinematic analysis of standing and sitting EOS radiographic images.</div></div><div><h3>PATIENT SAMPLE</h3><div>Ten healthy volunteers.</div></div><div><h3>OUTCOME MEASURES</h3><div>Sagittal alignment parameters: L1 SVA and L1 slope.</div></div><div><h3>METHODS</h3><div>Lumbosacral sagittal alignments in standing and sitting postures were assessed by analyzing full-length EOS radiographic images of 10 healthy volunteers. Next, we used subject-specific kinematic analysis to investigate the angular compensation that would be necessary in the proximal mobile lumbar (L1-L4) segments to make up for the flexion motion lost secondary to L4-S1 fusion. We then evaluated various strategies to distribute the angular motion amongst L1-L2, L2-L3, and L3-L4 segments that would allow the L1 vertebra to return to its sagittal position and angular orientation to match the pre-fusion sitting posture.</div></div><div><h3>RESULTS</h3><div>Following simulated L4-sacrum fusion, significantly greater L1-L4 flexion was required to replicate the pre-fusion sitting posture: 13° flexion postfusion vs 2° flexion pre-fusion (p<.01). Attempts to restore both the sagittal position and angular alignment of L1 to their pre-fusion values required an increasing proportion of motion compensation to occur at the L3-L4 segment adjacent to L4-S1 fusion compared to more proximal lumbar levels. Residual L1 SVA mismatch of 11±5.0 mm persisted despite all motion compensation occurring at the L3-L4 junctional segment.</div></div><div><h3>CONCLUSIONS</h3><div>We simulated a scenario in which postfusion sitting posture was achieved only through compensatory motions within the remaining mobile lumbar segments. In vivo, a patient may choose to alter his/her postfusion sitting posture in addition to at","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S34-S35"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236416","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":"28. Impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusion","authors":"Katherine Drexelius MD , Steven Baltic MD, MS , Kennedy Gachigi MS , Caleb Lifsey BS , P. Bradley Segebarth MD","doi":"10.1016/j.spinee.2025.08.210","DOIUrl":"10.1016/j.spinee.2025.08.210","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Anterior lumbar interbody fusion (ALIF) is an increasingly common surgical procedure in the United States for a variety of spinal pathologies. As both opioid use and healthcare costs remain major national healthcare crises, it is crucial to understand methods of effective pain management in spine surgery, including regional anesthesia. Transversus abdominis plane (TAP) blocks have become one of the most commonly performed truncal blocks for general surgery procedures of the abdomen and retroperitoneum. There is growing evidence that TAP blocks may result in decreased narcotic use, decreased length of stay, and improved pain scores in the general surgery setting. While TAP blocks are also commonly performed for anterior spinal surgery, literature evaluating outcomes after TAP blocks for ALIF patients is sparse.</div></div><div><h3>PURPOSE</h3><div>This retrospective cohort study aims to determine the effect of TAP blocks on perioperative opioid use and hospital length of stay.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 295 patients aged 18 years or older undergoing 1- or 2-level ALIF at a single institution with or without associated posterior percutaneous instrumented fusion. Of these, 102 patients received a preoperative TAP block, while 193 patients did not receive a TAP block.</div></div><div><h3>OUTCOME MEASURES</h3><div>Hospital length of stay and postoperative morphine milliequivalents.</div></div><div><h3>METHODS</h3><div>Following IRB approval, retrospective chart review was performed for patients 18 years or older undergoing 1- or 2-level ALIF with or without associated posterior percutaneous instrumented fusion. Patients undergoing concomitant lateral interbody fusions, open posterior spinal decompression, revision surgery, or 3 or more level surgery were excluded from analysis. Baseline demographics, surgical details, length of stay (LOS), and data on inpatient opioid use (converted to morphine milliequivalents, MME) were collected. Total MME and MME stratified by postoperative day (POD) was collected. Statistical analysis included descriptive statistics, t-tests, and chi-square tests where appropriate. Bivariate and multivariate regression models were used to analyze the relationship of TAP blocks with LOS and narcotic use postoperatively.</div></div><div><h3>RESULTS</h3><div>In total, 295 patients were included, with 102 (34.6%) undergoing TAP block and 193 (65.4%) patients without TAP block. There were no significant differences in baseline patient characteristics, number of levels fused, or prevalence of concomitant posterior instrumented fusion. Use of a TAP block had no statistically significant effect on LOS, and bivariate analysis revealed no effect when groups were analyzed by sex, age, BMI, preoperative opioid use, or number of levels fused. TAP block patients received significantly more MME on POD 0 ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S15-S16"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236518","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":"8. Beyond the ODI: a qualitative analysis of why patients are satisfied after lumbar surgery despite failure to achieve MCID or PASS","authors":"HSS SpineTeam MD , Eric Zhao BS , Pratyush Shahi MBBS, MS , Austin C Kaidi MD, MSc , Farah Musharbash MD , Stephane Owusu-Sarpong MD , Luis F Colon MD , Quante Singleton MD , Tomoyuki Asada MD, PhD , Kasra Araghi BS , Sereen Halayqeh MD , Adin Ehrlich BA , Andrea Pezzi MD , Atahan Durbas MD , Adrian Lui MBBS , Olivia Tuma BS , Rujvee P. Patel MBBS, MPH , Tarek Harhash BS , Kyle W. Morse MD , James Dowdell MD , Sravisht Iyer MD","doi":"10.1016/j.spinee.2025.08.190","DOIUrl":"10.1016/j.spinee.2025.08.190","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Postoperative clinical outcomes after lumbar spine surgery are often evaluated using the Oswestry Disability Index (ODI), with quantitative metrics such as the minimal clinically important difference (MCID) and the patient’s acceptable symptom state (PASS). However, these metrics fail to reflect “qualitative” patient satisfaction, particularly among the subset of patients describing improvements but not achieving MCID or PASS.</div></div><div><h3>PURPOSE</h3><div>To identify different “themes” regarding postoperative clinical satisfaction following minimally invasive lumbar surgery in patients who improved on global rating of change (GRC) but did not achieve ODI MCID or PASS thresholds.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study with a qualitative component for prospectively collected data at a single institution setting.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 956 patients who underwent lumbar surgery with a minimum follow-up of 6 months were evaluated. Of these, 90 patients met the inclusion criteria (ie, improved on GRC and did not achieve ODI MCID or PASS), and 43 of these patients consented to participate in semi-structured interviews.</div></div><div><h3>OUTCOME MEASURES</h3><div>Patient-reported outcomes (PROMs) included ODI, visual analog scale (VAS) for back and leg pain, SF-12 physical and mental component (SF-12 PCS, SF-12 MCS), and PROMIS Physical Function scores (PROMIS PF). Satisfaction was assessed with GRC.</div></div><div><h3>METHODS</h3><div>Quantitative changes were evaluated at early (<6 months) and late (≥6 months) follow-ups. Chi-squared for categorical and independent t-tests for continuous variables were utilized. Wilcoxon Signed-Rank tests compared early and late paired GRC, while paired t-tests assessed changes in PROMs. Qualitative semi-structured interviews exploring satisfaction across physical, emotional, and social “themes,” were analyzed using grounded theory. Venn diagrams were utilized to signify the overlap between different qualitative responses.</div></div><div><h3>RESULTS</h3><div>Satisfaction on the GRC scale significantly improved between early and late follow-ups (p < 0.001). High MCID achievement rates for VAS back (79.1%) and leg pain (74.4%) were observed. There was a significant improvement in the VAS back score at 1 year (-2.8 ± 3.4, p = 0.011) compared to the earlier time point. Thematic qualitative analysis reported key contributors to satisfaction: physical improvement, quality of life, healthcare provider interactions, and family support. Overlaps, such as between physical health and quality of life, highlighted the multidimensional nature of postoperative clinical satisfaction.</div></div><div><h3>CONCLUSIONS</h3><div>Patient satisfaction extends beyond quantitative scales like the ODI. Holistic assessment, including subjective factors such as emotional well-being, healthcare provider interactions, and fam","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S6"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236521","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":"87. Current trends in perioperative opioid utilization amongst spine surgeons: an AO Spine International survey","authors":"Josephine Rose Coury MD , Roy Miller MS , Justin Reyes MS , Fthimnir M. Hassan MPH , Ronald A. Lehman MD , Zeeshan Sardar MDMSc","doi":"10.1016/j.spinee.2025.08.270","DOIUrl":"10.1016/j.spinee.2025.08.270","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Approximately 55% of patients undergoing spine surgery report taking opioid medication prior to surgery. Prior literature has demonstrated that preoperative opioid use is associated with a multitude of postoperative complications, including longer hospital stays, increased need for postoperative opioid medication, delayed wound healing, and increased risk of reoperation, infection, and deep vein thrombosis. Despite this known increased risk of complications, no consensus exists on how to best manage opioids in these patients peri-operatively. The purpose of this study was to evaluate AO spine member’s perioperative opioid management in patients on opioid medications.</div></div><div><h3>PURPOSE</h3><div>To evaluate spine surgeon’s practices regarding opioid use prior to elective, instrumented spine surgery.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Web-based survey distributed to AO Spine members.</div></div><div><h3>PATIENT SAMPLE</h3><div>AO Spine Members.</div></div><div><h3>OUTCOME MEASURES</h3><div>Web-based survey.</div></div><div><h3>METHODS</h3><div>An online survey was distributed to AO Spine members. The survey included surgeon demographic, practice setting, and training information as well as questions regarding individual opioid management guidelines in patients undergoing spine surgery.</div></div><div><h3>RESULTS</h3><div>A total of 443 spine surgeons (65.9% orthopaedics, 31.2% neurosurgery) from all five AO Spine regions responded to the survey. Of them, only 17.9% had a threshold for total morphine milligram (MME) taken preoperatively which would exclude a patient from surgery, with a mean threshold of 20.02 (23.36) MME/day. However, 61.1% did state that they require patients to decrease their opioid use for a specific amount of time and by a specific amount before surgery, with the majority requiring 3-4 weeks of decreased opioid use (24.5%) by 50-74% (30.2%). Patient characteristics were reported to have an effect on opioid use protocols included age (48.9%), chronic opioid use (52.5%), type of narcotic used (37.8%), and number of vertebral levels planned for surgery (16.4%). Only 20.9% reported having hospital protocols for patients taking preop opioids while 63.8% had a pain management team to help manage patients taking preop opioids postoperatively. For opioid naive patients, 65.8% of surgeons had a limit on length of postoperative opioid prescriptions with a mean of 5.08 (6.63) weeks.</div></div><div><h3>CONCLUSIONS</h3><div>Tremendous variability was found amongst spine surgeons in the perioperative management of opioid medications. While many surgeons did not have specific thresholds to exclude patients from surgery, many required a reduction of medication use prior to surgery. Patient factors such as age, chronic opioid use, and narcotic type influence opioid reduction protocols, yet institutional guidelines remain inconsistent. Further research and consensus should be achieve","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S46-S47"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236523","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":"82. Comparison of postoperative proton pump inhibitors vs histamine H2-receptor antagonists use on complication rates following Multilevel lumbar fusions","authors":"Uttsav Patel BA , Kenny Ling MD , Rafael Madera BS , Sean Jang BS , Joseph Kim BS , Brian Lynch MD","doi":"10.1016/j.spinee.2025.08.264","DOIUrl":"10.1016/j.spinee.2025.08.264","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Proton pump inhibitors (PPIs) are commonly used both perioperatively and postoperatively to prevent gastrointestinal complications, but their long-term use is associated with adverse effects, such as an increased risk of fractures, which is particularly concerning for spinal surgery patients. Some studies suggest that PPIs may also raise the risk of pseudarthrosis in cervical spine fusions. In contrast, Histamine H2-receptor antagonists (H2 blockers) may offer a better safety profile and even support bone health. Despite this, their impact on postoperative complications following multi-level lumbar fusion surgeries remains unclear.</div></div><div><h3>PURPOSE</h3><div>This study aims to compare the 90-day and two-year complication rates between postoperative PPI therapy and postoperative H2 antagonist therapy in patients undergoing multi-level lumbar fusion, with a particular focus on complications related to bone healing, fusion success, and overall recovery outcomes.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study using data from TriNetX, a comprehensive healthcare database that includes patients from 2010 to 2024.</div></div><div><h3>PATIENT SAMPLE</h3><div>N/A</div></div><div><h3>OUTCOME MEASURES</h3><div>N/A</div></div><div><h3>METHODS</h3><div>Patients who underwent multi-level lumbar fusion surgery within the TriNetX database were identified, excluding those with prior PPI or H2 blocker use. The cohort was divided into two groups: those who received PPIs and those who received H2 blockers postoperatively. A 1:1 propensity score matching was applied to control for confounders such as age, sex, and comorbidities, resulting in 3,712 patients per group. Logistic regression was used to calculate risk ratios (RRs) for complications at 90 days and 2 years post-surgery.</div></div><div><h3>RESULTS</h3><div>At 90 days, the PPI group showed significantly higher rates of mortality (1.91% vs 1.19%, RR = 1.634, 95% CI = 1.111–2.374, P = 0.011) and pneumonia (2.72% vs 1.83%, RR = 1.501, 95% CI = 1.096–2.053, P = 0.010). Acute kidney injury (4.01% vs 2.96%, RR = 1.368, 95% CI = 1.072–1.756, P = 0.014), myocardial infarction (1.40% vs 0.84%, RR = 1.687, 95% CI = 1.078–2.641, P = 0.020), and urinary tract infections (5.66% vs 4.34%, RR = 1.320, 95% CI = 1.068–1.629, P = 0.009) were also more common in the PPI group. Additionally, the PPI group had a higher risk of dural tear (0.67% vs 0.27%, RR = 2.509, 95% CI = 1.202–5.228, P = 0.011). At 2 years, the PPI group had higher rates of reoperation (8.07% vs 6.48%, RR = 1.245, 95% CI = 1.057–1.466, P = 0.008), pseudarthrosis (16.33% vs 13.20%, RR = 1.227, 95% CI = 1.101–1.367, P = 0.000), and pedicle loosening (7.96% vs 6.00%, RR = 1.327, 95% CI = 1.122–1.570, P = 0.001).</div></div><div><h3>CONCLUSIONS</h3><div>Postoperative PPI therapy is associated with higher complication rates in both the short and long term compared to H2 blockers. Specific","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S43-S44"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236496","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":"16. Beyond smoking: the impact of nontobacco nicotine on lumbar spinal fusion outcomes in a propensity matched analysis","authors":"Daniella Ogilvie MD , Brandon Ogilvie MD , Tej Joshi MD , Heidi Martin Hullinger MD , Ilya Kupershtein MD , Mark R Drzala MD , Mitchell F. Reiter MD, PC","doi":"10.1016/j.spinee.2025.08.198","DOIUrl":"10.1016/j.spinee.2025.08.198","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar spinal fusion is a commonly performed procedure for many conditions. Recently, there has been an increased usage of nontobacco nicotine products such as electronic cigarettes and smokeless tobacco alternatives. As such, their impact on spinal fusion outcomes is unknown.</div></div><div><h3>PURPOSE</h3><div>The purpose of this study was to utilize a large database with a propensity-matched cohort to analyze postoperative outcomes in patients who have non-tobacco nicotine dependence compared to those without nicotine dependence.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This was a large retrospective cohort database analysis utilizing the TriNetX platform.</div></div><div><h3>PATIENT SAMPLE</h3><div>All patients in the TriNetX platform who underwent lumbar spinal fusion (LSF) with a minimum follow-up of 30 days were included for analysis. Patients were stratified into two groups based on preoperative diagnosis of nicotine dependence, excluding those with tobacco-based dependence.</div></div><div><h3>OUTCOME MEASURES</h3><div>Outcomes were measured at 90 days and 2 years. Early outcomes that were measured at 90 days included the following medical complications: myocardial infarction (MI), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, acute kidney injury (AKI), and sepsis. Surgical outcomes included wound complications and hardware infection. Hospital outcomes included emergency department (ED) visits and readmission. Risk and hazard ratios were reported with associated p values. At two years, surgical outcomes were studied, which included, mechanical complications, hardware complications, pseudoarthrosis, infection, adjacent segment disease (ASD), and revision surgery.</div></div><div><h3>METHODS</h3><div>Patients in the TriNetX platform who underwent LSF with a minimum follow-up of 30 days were identified. Patients were then split into two groups, based on their non-tobacco nicotine dependence status identified by ICD-10 Clinical Modification codes, and 1:1 propensity-matched based on sex, age, race, and additional comorbidities. Analysis was performed for the above outcome measures. Analysis was performed for the outcome measures as mentioned.</div></div><div><h3>RESULTS</h3><div>After propensity score matching, 45,343 patients were identified for each cohort. At 90 days, patients with nontobacco nicotine dependence had a 0.878 times decreased risk of DVT (95% CI 0.818 – 0.943, p < 0.001) and a 0.877 times decreased risk of PE (95% CI 0.801 – 0.959, p = 0.004). Additionally, patients with nontobacco nicotine dependence have a 1.089 times higher risk of a subsequent ED visit within 90 days (95% CI 1.089 – 1.166, p < 0.001). At 2 years, patients with non-tobacco nicotine dependence were at 1.159 times higher risk of mechanical complications (95% CI 1.095 – 1.228, p<0.001) and 1.129 times higher risk of ASD (95% CI 1.084 – 1.176, p<0.001). There was a trend toward inc","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S9-S10"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236508","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":"18. Cell Saver in adult spinal deformity surgery: helping or hurting?","authors":"Harsh Jain MBBS , Advith Sarikonda BA, BS , Omar Zakieh MBBS , Sakshi Krishna BS , Alexander Lyons BS , Sameer Sundrani BS , Tag Alsir Osama BS , Austin Montgomery BS , Walter Navid BS , Iyan Younus MD , Ranbir Ahluwalia MD , Tyler Zeoli MD , Soren Jonzzon MD , Hani Chanbour MD , Julian Lugo-Pico MD , Amir M Abtahi MD , Byron F Stephens MD , Scott L. Zuckerman MDMPH","doi":"10.1016/j.spinee.2025.08.200","DOIUrl":"10.1016/j.spinee.2025.08.200","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>While Cell Saver (CS) is meant to give patients back their own blood products, the quality of said blood products has been called into question.</div></div><div><h3>PURPOSE</h3><div>In patients undergoing adult spinal deformity (ASD) surgery, we evaluated the impact CS on:1) intraoperative transfusions, 2) postoperative hematocrit, and 3) complications.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study</div></div><div><h3>PATIENT SAMPLE</h3><div>A retrospective cohort study was performed for patients undergoing ASD surgery from 2009-23. Inclusion criteria were: ≥5-level fusion, sagittal/coronal deformity, and ≥2-year follow-up. The primary exposure was use of CS.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary outcomes were: 1) intraoperative transfusions, 2) postoperative hematocrit, and 3) overall complications. Secondary outcomes were intraoperative hypotension, defined as total minutes mean arterial pressure (MAP) was <65mmHg, length of stay (LOS), and discharge status.</div></div><div><h3>METHODS</h3><div>A retrospective cohort study was performed for patients undergoing ASD surgery from 2009-23. Inclusion criteria were: ≥5-level fusion, sagittal/coronal deformity, and ≥2-year follow-up. The primary exposure was use of CS. Primary outcomes were: 1) intraoperative transfusions, 2) postoperative hematocrit, and 3) overall complications. Secondary outcomes were intraoperative hypotension, defined as total minutes mean arterial pressure (MAP) was <65mmHg, length of stay (LOS), and discharge status. Bivariate and multivariable analysis controlling for age, sex, body mass index and operative time were performed.</div></div><div><h3>RESULTS</h3><div>Of 288 patients undergoing ASD surgery with a mean age of 63±18 years, 209 (73%) used CS. Mean CS given back was 428±404 ml. CS use was associated with a longer operative time (442±149 vs 382±150 minutes, p=0.003) and higher blood loss (1490 vs 765 ml, p<0.001).The CS group paradoxically had higher intraoperative transfusion rates (68% vs 32%, p<0.001) and blood product usage (3±4 vs 1±2 units, p<0.001). Postoperative hematocrit was not different between groups (30±4 vs 30±5, p=0.936). On multivariable regression, CS was independently associated with increased transfusions (OR=2.94, 95%CI: 1.56-5.53, p<0.01) and medical complications (OR=2.72, 95%CI:1.01-7.00, p=0.038). Regarding secondary outcomes, multivariable regression analysis showed that Cell Saver was associated with longer intraoperative hypotension (β=16.8, 95%CI:3.8-29.7, p=0.011) and higher odds of having MAP<65mmHg for ≥90 minutes (OR=3.3, 95%CI:1.1-9.7, p=0.032).</div></div><div><h3>CONCLUSIONS</h3><div>While controlling for operative time, Cell Saver use in ASD surgery was independently associated with increased intraoperative transfusions, medical complications, and prolonged hypotension without an improvement in postoperative hematocrit levels. Th","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S10-S11"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236513","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":"19. Partial uncinatectomy combined with anterior cervical discectomy and fusion for the treatment of one-level cervical radiculopathy: analysis of clinical efficacy and sagittal alignment","authors":"Yansheng Huang MD , Sibo Wang PhD","doi":"10.1016/j.spinee.2025.08.201","DOIUrl":"10.1016/j.spinee.2025.08.201","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Biomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated.</div></div><div><h3>PURPOSE</h3><div>This study aims to assess the comparative clinical efficacy, sagittal alignment outcomes, and safety of ACDF with and without partial UT, utilizing zero-profile implants.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective cohort study comparing clinical and radiological outcomes, and complication rates, following single-level anterior cervical discectomy and fusion with and without partial uncinatectomy.</div></div><div><h3>PATIENT SAMPLE</h3><div>Eighty-seven patients who underwent single-level ACDF between July 2014 and December 2018 were retrospectively included, divided into groups with (n=37) and without (n=50) partial uncinatectomy.</div></div><div><h3>OUTCOME MEASURES</h3><div>Outcome measures included preoperative and postoperative clinical scores (VAS, NDI, JOA), radiological parameters of cervical sagittal alignment (C2-7 SVA, St-SVA, T1 slope, cervical lordosis, FSU angle), fusion rate, and the incidence of postoperative complications (dysphagia, adjacent segment degeneration, subsidence).</div></div><div><h3>METHODS</h3><div>This retrospective cohort study included 87 patients who underwent single-level ACDF between July 2014 and December 2018. Based on surgical technique, patients were divided into two groups: ACDF with partial UT (n=37) and ACDF without UT (n=50). Detailed perioperative data, radiological parameters, clinical outcomes, and complications were analyzed. Key cervical alignment metrics, including C2–7 sagittal vertical axis (SVA) and sella turcica–C7 SVA (St-SVA), were measured preoperatively and at follow-up. Pain and functionality were evaluated using visual analogue scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Statistical significance was set at p<0.05.</div></div><div><h3>RESULTS</h3><div>Both groups demonstrated substantial postoperative improvements in pain relief and neurological function. Preoperative VAS arm scores were significantly higher in the UT group (p=0.038), reflecting a more severe symptom burden. Postoperatively, no differences were observed in neck pain VAS, NDI, or fusion rates between groups. At final follow-up, however, patients in the UT group showed reduced recovery in cervical sagittal alignment, with significantly higher residual C2–7 SVA and St-SVA values compared to the non-UT group (p=0.034 and p=0.033, respectively). Both groups experienced comparable rates of com","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S11"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236514","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":"92. The anterior intercrest line is a novel accurate surface marking for identifying the L4/5 disc level: a prospective agreement study with fluoroscopy","authors":"Dean Biddau BS","doi":"10.1016/j.spinee.2025.08.275","DOIUrl":"10.1016/j.spinee.2025.08.275","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Anterior exposure for lumbar surgery is increasingly used in contemporary spine practice. There have been no previous reports of reliable surface landmarks for determining the optimal incision site for anterior access without fluoroscopy</div></div><div><h3>PURPOSE</h3><div>To assess the accuracy of the anterior intercrest line for predicting the surface projection of the L4/5 disc level, compared with the fluoroscopically determined level.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A prospective agreement study of consecutive patients undergoing anterior lumbar exposure for either interbody fusion or total disc replacement surgery at L4/5</div></div><div><h3>PATIENT SAMPLE</h3><div>The study included all patients undergoing primary anterior lumbar disc surgery at our institution from November 2022 to January 2024. Indications for surgery were severe degenerative disc disease, radiculopathy, or Grades 1–2 degenerative or isthmic spondylolisthesis. Exclusion criteria for surgery were disc disease involving ≥ 3 levels, Grades 3–4 spondylolisthesis, significant iliac artery or aortic pathology, morbid obesity (body mass index [BMI] > 35 kg/m2), previous complex/extensive retroperitoneal surgery, or abdominal/pelvic radiotherapy. Exclusion criterion for this study was transitional lumbosacral anatomy. Outcome measures: The primary outcome measure was the distance from the symphysis pubis to the skin markings for the L4/5 level, as determined by the intercrestal line method or fluoroscopic method.</div></div><div><h3>OUTCOME MEASURES</h3><div>Agreement of anterior inter-crest line for predicting the surface projection of the L4/5 disc level</div></div><div><h3>METHODS</h3><div>The anterior inter-crest line was denoted by placing a silk tie anteriorly between the bilateral iliac crests palpated in the midaxillary line. The skin was then marked in the abdominal midline along this line. Next, the surface projection of the L4/5 disc was determined using lateral fluoroscopy and marked on the skin in the anterior midline. The distance between the upper palpable margin of the symphysis pubis and each L4/5 skin mark was measured, and the marking modality difference (MMD) was calculated as the difference in distances between the two methods.</div></div><div><h3>RESULTS</h3><div>A total of 83 patients were assessed for inclusion; two patients were excluded because of transitional anatomy. The mean patient age was 48±13 years (range, 19 to 77 years), and 60% were male (n=49). The MMD between the fluoroscopically determined L4/5 level and the inter-crest line was 0.36±1.19 cm [95% confidence interval (CI), 0.10 to 0.62; range, −2.5 to 5 cm]. The intraclass correlation coefficient between distances determined by the two methods was 0.84 [95% CI, 0.76 to 0.89], demonstrating high agreement between the techniques. Multiple linear regression analyses revealed no significant associations between MMD and age, sex, BMI, or ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S49"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236528","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":"45. Return to work activities of daily living and disability improvement of an FDA IDE trial of decompression and dynamic sagittal tether stabilization versus decompression and transforaminal lumbar interbody fusion","authors":"William F. Lavelle MD, MBA , Rick C. Sasso MD , Hyun W. Bae MD , Jeffrey L. Gum MD , Alan T. Villavicencio MD , Mick J Perez-Cruet MD , S. Tim Yoon MD, PhD , W. Jacob Lavelle , Kee D. Kim MD , Michael Y. Wang MD, MBA , Ravi S. Bains MD , Michael Stauff MD , Sigurd H. Berven MD , Harel Deutsch MD , Jeffrey S. Fischgrund MD , Adam L. Shimer MD , Reginald J. Davis MD, FACS , Elizabeth Yu MD , Todd F. Alamin MD , Louis C Fielding MS , William C Welch MD, FACS, FICS","doi":"10.1016/j.spinee.2025.08.227","DOIUrl":"10.1016/j.spinee.2025.08.227","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) is commonly treated with decompression and fusion. An investigational procedure, Spondyloplasty, incorporates direct surgical decompression and stabilization with a dynamic sagittal tether (DST). The primary objective of surgery is resolution of symptoms so patients can return to work and their normal activities of daily living.</div></div><div><h3>PURPOSE</h3><div>Assess return to work (RTW) and activities of daily living (ADL) receiving either decompression and DST stabilization (Spondyloplasty) compared to decompression and transforaminal lumbar interbody fusion (D+TLIF) at 24 months.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Interim analysis from a multicenter, concurrently controlled study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients undergoing treatment (Spondyloplasty or D+TLIF) of Grade I Meyerding lumbar DS and LSS. Propensity score (PS) selected patients with 24-month follow-up were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>Time to return to work and activities of daily living, Oswestry disability index (ODI), VAS Back Pain and VAS Leg/Hip Pain (Worst Side).</div></div><div><h3>METHODS</h3><div>PS-selected FDA IDE study subjects (NCT03115983) with 24-months follow-up were included in this analysis. Study records queried for work status preoperatively and various time points up to 24 months, as well as time to ADL and RTW, and change in disability (ODI, VAS Back and VAS Leg/Hip [Worst Side]) at 24 months vs preoperatively.</div></div><div><h3>RESULTS</h3><div>Of 299 enrolled subjects, 287 were PS-selected (140= Spondyloplasty and 147= D+TLIF). Both groups demonstrated significant durable improvements in pain and disability. The Spondylopasty group had significantly lower ODI at 6-week and 3-month follow-ups (p<0.05). At 24 months, there were no statistical differences seen between groups in ODI, VAS Back Pain or VAS Lip/Hip (Worst Side), although the Spondyloplasty group demonstrated larger improvement effect sizes in all measures. The patient-reported outcomes showed the return to ADL and RTW (among patients working preoperatively) for the Spondyloplasty group was greater at every postoperative time point compared to the D+TLIF group. At 24 months, return to ADL was >95% for Spondyloplasty versus <80% for D+TLIF; and the RTW was >90% for Spondyloplasty versus < 75% D+TLIF.</div></div><div><h3>CONCLUSIONS</h3><div>The primary objective of surgery for symptomatic DS is resolution of symptoms so patients can return to their normal ADL and work. Both Spondyloplasty and D+TLIF treated patients demonstrated significant reductions in disability at 24-month follow-up. The Spondyloplasty group had quicker recovery, including lower disability at immediate postoperative intervals and significantly faster RTW and ADL. Decompression and stabilization with DST procedure (Spondyloplasty) may be a mini","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S24-S25"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236322","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}