Spine Journal最新文献

{"title":"Postoperative adverse events following two-level hybrid cervical construct relative to two-level anterior cervical discectomy.","authors":"Philip P Ratnasamy, Sahir S Jabbouri, Michael J Gouzoulis, Arya G Varthi, Jonathan N Grauer","doi":"10.1016/j.spinee.2025.07.026","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.026","url":null,"abstract":"<p><strong>Background context: </strong>ACDF has been the mainstay for managing degenerative cervical spine pathology and CDA has emerged as a possible alternative. Limited research exists comparing postoperative adverse events between two-level hybrid constructs and two-level ACDF.</p><p><strong>Purpose: </strong>To evaluate postoperative adverse events, readmissions, and five-year survival to reoperation for patients undergoing two-level cervical hybrid construct (anterior cervical discectomy at one level and fusion [ACDF] and cervical disc arthroplasty [CDA] at an adjacent level) relative to two-level ACDF.</p><p><strong>Study design/setting: </strong>Retrospective database study.</p><p><strong>Patient sample: </strong>Patients undergoing two-level cervical hybrid constructs or two-level ACDF were isolated from the PearlDiver M165Ortho 2010-2021 database, a large national billing claims database containing de-identified health information across all payer types and sites of care in the US.</p><p><strong>Outcome measures: </strong>Incidence of 90-day postoperative adverse events in two-level cervical hybrid construct patients and two-level ACDF patients. Relative odds of 90-day adverse events for hybrid construct patients relative to ACDF patients. 5-year survival to reoperation.</p><p><strong>Methods: </strong>Two-level cervical hybrid construct and two-level ACDF patients were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) scores. Odds of 90-day postoperative adverse events were compared between the two groups using multivariable analysis. Five-year survival to cervical spine reoperation was then assessed.</p><p><strong>Results: </strong>After matching, there were 1417 patients in the hybrid construct group and 5664 in the ACDF group. No significant differences were identified for 90-day individual adverse events, aggregated any adverse events, or readmissions. Further, no significant difference was identified for five-year survival to reoperation.</p><p><strong>Conclusions: </strong>While consideration may be given to two-level cervical hybrid constructs or two-level ACDF, the current large-cohort comparison study could not determine differences in 90-day complications or 5-year reoperations between these surgical options to support one procedure over the other.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620943","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":"Standalone lateral lumbar interbody fusion reduces the risk of adjacent segment surgery.","authors":"Marco D Burkhard, Torben Stepan, Charlotte Jones, John Lama, Nicolas Mjaess, Ali E Guven, Anna-Maria Mielke, Bruno Verna, Federico P Girardi, Frank P Cammisa, Andrew A Sama, Alexander P Hughes","doi":"10.1016/j.spinee.2025.07.008","DOIUrl":"10.1016/j.spinee.2025.07.008","url":null,"abstract":"<p><strong>Background context: </strong>The paraspinal muscles play a key role in adjacent segment disease following lumbar fusion surgery. However, the long-term outcomes of muscle-preserving techniques, such as standalone lateral interbody fusion, compared to open posterior fusion remain unclear.</p><p><strong>Purpose: </strong>To compare long-term rates, reasons, and timing of revision surgery after standalone lateral fusion versus circumferential lateral+open posterior fusion.</p><p><strong>Study design/setting: </strong>Single-center retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients who underwent lateral lumbar interbody fusion with or without open posterior fusion for degenerative conditions between 2006 and 2022.</p><p><strong>Outcome measures: </strong>The primary outcomes were overall revision surgery and revision for adjacent segment disease. Secondary outcomes included surgical time, estimated blood loss, and length of hospitalization.</p><p><strong>Methods: </strong>The institutional database was queried for patients who underwent lateral lumbar interbody fusion with or without posterior pedicle screw instrumentation. Minimum follow-up was 2 years (mean >5 years). Patients with prior lumbar fusions and those undergoing multilevel fusions extending across the thoracolumbar or lumbosacral junctions were excluded. Electronic health records were reviewed for revision surgical procedures in and outside our institution. Kaplan-Meier survival curves and log-rank tests were used, along with multivariable Cox regression to assess the impact of the surgical technique on revision surgery.</p><p><strong>Results: </strong>A total of 785 patients were analyzed, with 485 undergoing standalone lateral lumbar interbody fusion. Standalone fusion was associated with significantly lower overall revision rates (20.6% vs. 27.3%, p=.030) and adjacent segment revision rates (16.1% vs. 23.3%, p=.012) compared to circumferential fusion. However, pseudarthrosis-related revisions were more frequent in the standalone group (1.9% vs. 0.0%, p=.015). Multivariable Cox regression revealed that standalone fusion reduced the hazard of overall revision surgery (HR = 0.727, p=.037), with the most significant effect observed for proximal adjacent segment revisions (HR=0.455, p<.001). Standalone fusion demonstrated shorter surgical time (83 minutes [IQR 51-145] vs. 266 minutes [IQR 167-342]), lower blood loss (50 mL [IQR 50-100] vs. 300 mL [IQR 100-550]), and shorter hospital stays (3 days [IQR 2-5] vs. 4 days [IQR 3-6]) (all p<.001).</p><p><strong>Conclusions: </strong>Standalone lateral lumbar interbody fusion demonstrates superior long-term revision-free survival, particularly by reducing the risk of proximal adjacent segment revisions. Combined with shorter surgical time and hospitalization, these findings support considering standalone lateral fusion as a valuable option for select patients.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620945","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":"Does Cognition Status Affect Spinal Surgery Outcomes: A Systematic Review and Meta-Analysis.","authors":"Ahmed Ashraf, Janesh Karnati, Xu Tao, Mir Ashraf, Aydin Kaghazchi, Andrew Wu, Harry Hoffman, Sachin Shankar, Sruthi Ranganathan, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.1016/j.spinee.2025.07.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.020","url":null,"abstract":"<p><strong>Background context: </strong>Mild cognitive impairment (MCI) and Dementia have been shown to be independent risk factors for complications after spine surgery. To date, no systematic review has been conducted on the effect of cognitive impairment (CI) on spine surgery outcomes.</p><p><strong>Purpose: </strong>This study aims to perform a systematic review and meta-analysis of previous studies on perioperative outcomes and facility-based measures in cognitively impaired patients undergoing spine surgery.</p><p><strong>Design: </strong>Systematic Review and Meta-analysis PATIENT SAMPLE: 11 articles encompassing approximately 16,070 patients with cognitive impairment were included in this study.</p><p><strong>Outcomes measured: </strong>Data on postoperative outcomes including delirium, urinary tract infection (UTI), myocardial infarction, pulmonary embolism (PE), deep vein thrombosis (DVT), pneumonia, surgical site infection (SSI), wound dehiscence, sepsis, acute kidney injury, reoperation, readmission, intensive care unit (ICU) admission, length of stay, and cost were collected and assessed.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted on July 8th, 2024. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies directly comparing spine surgery outcomes in cognitively impaired populations versus normal cognition were included for meta-analysis. A Random-effect model was used to estimate the pooled odds ratios of relevant outcomes. Lumbar and cervical subgroup analyses were also conducted.</p><p><strong>Results: </strong>A total of 1074 articles were screened as titles and abstracts. 54 studies were included for full-text review, yielding 11 articles to be included in this study. These 11 studies (6 retrospective cohort studies, 5 prospective observational studies) directly analyzed the effect of CI on spine surgery outcomes. Random-effect model demonstrated patients with CI were found to have significantly higher odds of developing UTI (OR 4.32{2.24-8.33}), delirium (OR 2.33{1.68-3.22}), DVT (OR 2.49{1.23-5.03}) pneumonia (OR 3.24{1.94-5.43}), wound dehiscence (OR 1.50{1.08-2.08}), and sepsis (OR 2.18{1.04-4.56}). The presence of cognitive impairment was associated with a two-fold higher odds of ICU admission after surgery (OR 2.05{1.22-3.44}), and 20% increase likelihood of 30-day readmission (OR 1.20{1.03-1.40}) after spine surgery.</p><p><strong>Conclusion: </strong>This study suggests that preoperative CI is associated with worse postoperative health outcomes and inferior facility-based measures in patients undergoing spine surgery. These findings highlight the importance of early recognition and management of cognitive impairment prior to spine surgery, as doing so may mitigate postoperative risks and improve both clinical and facility-based outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621021","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 Impact of Obesity on Radiographic and Clinical Outcomes Following Adult Spinal Deformity Surgery - A Systematic Review and Meta-Analysis.","authors":"Anthony Pajak, Mihir Dekhne, Adrian Liu, Izzet Akosman, Matthew E Cunningham, Han Jo Kim, Francis C Lovecchio","doi":"10.1016/j.spinee.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.004","url":null,"abstract":"<p><strong>Background context: </strong>Given the rising global prevalence of obesity, it is imperative to understand its effects on spine surgery outcomes. The influence of BMI on outcomes after adult spinal deformity (ASD) reconstruction has varied based on the center. The findings of this study may assist in the risk stratification process and informed patient surgeon counseling for ASD surgery.</p><p><strong>Purpose: </strong>The aim of this study was to perform a systematic review and meta-analysis to describe the impact of body mass index (BMI) on clinical and radiographic outcomes after adult spinal deformity (ASD) correction surgery.</p><p><strong>Study design/setting: </strong>A systematic review and meta-analysis.</p><p><strong>Methods: </strong>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Studies reporting complication rates, sagittal alignment parameters, and PROMs for patients stratified by BMI that underwent spinal fusion procedures for the treatment of adult spinal deformity were included. Pooled meta-analyses reporting odds ratios were performed for any complication, mechanical complication, medical complication, and infection variables. Pooled meta-analyses reporting standard mean differences were performed for pelvic incidence-lumbar lordosis (PI-LL) mismatch and sagittal vertebral axis (SVA) parameters in both preoperative and late postoperative settings. A qualitative analysis of PROMs data was conducted.</p><p><strong>Results: </strong>The literature search identified 11 studies that compared outcomes of interest between low and high BMI cohorts, with a total of 3,150 patients. High BMI patient cohorts demonstrated significantly greater odds of developing any complication and mechanical complications. Despite a lack of difference in preoperative radiographic alignment, high BMI patient cohorts demonstrated significantly greater SVA and PI-LL mismatch at the final postoperative timepoint. Odds of pseudoarthrosis, revision, infection, and medical complications were not increased by high BMI. Estimated blood loss and operative time demonstrated no significant mean differences between the high and low BMI cohorts. High BMI cohorts reported higher postoperative ODI and VAS-legs scores compared to low BMI. No significant differences were reported in other PROMs measures.</p><p><strong>Conclusions: </strong>These findings suggest that high BMI patients have an increased risk of developing mechanical complications and worse postoperative sagittal alignment in comparison to low BMI cohorts following ASD correction.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610084","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":"Associations of socioeconomic status and healthy lifestyle with patient satisfaction in patients following adult spinal deformity surgery.","authors":"Peng Cui, Haojie Zhang, Qingyang Huang, Peng Wang, Xiaolong Chen, Shibao Lu","doi":"10.1016/j.spinee.2025.07.013","DOIUrl":"10.1016/j.spinee.2025.07.013","url":null,"abstract":"<p><strong>Background context: </strong>Mounting evidence suggests that both socioeconomic status (SES) and healthy lifestyle play beneficial roles in spine surgical outcomes. However, their combined influence on patient satisfaction remains insufficiently understood in patients with adult spinal deformity (ASD).</p><p><strong>Purpose: </strong>To evaluate the association between SES and healthy lifestyle on patient satisfaction in patients undergoing corrective surgery.</p><p><strong>Study design: </strong>Retrospective review of a single-institution cohort.</p><p><strong>Patient sample: </strong>A total of 263 patients undergoing corrective surgery between January 2017 and November 2022.</p><p><strong>Outcome measure: </strong>Completion of the North American Spine Society Satisfaction Questionnaire (NASS) questionnaire 2 year postoperatively.</p><p><strong>Methods: </strong>This was a retrospective review of patients who underwent primary thoracolumbar fusion surgery ≥4 spinal levels between January 2017 and November 2022 with a 2-year follow-up. SES was constructed by latent class analysis using education level, total household income and wealth. An Overall healthy lifestyle was identified using information on the top tertile of physical activity, active social contact and appropriate body mass index (BMI) at the 2-year follow-up based on well-organized questionnaire. A mediation effect analysis was performed to explore whether healthy lifestyle mediated the association between SES and patient dissatisfaction. Additionally, a joint analysis of SES and healthy lifestyle with patient dissatisfaction was investigated.</p><p><strong>Results: </strong>Among 263 patients included in the final analysis, 68 (25.8%) had high SES, 134 (51.0%) had medium SES and 61 (23.2%) had low SES. Compared with patients with high SES, the odds ratio (OR) for dissatisfaction among patients with medium and low SES were 1.32 [95% confidence interval (CI), 1.06-1.76) and 3.01 (95% CI 1.79-4.46), respectively, and the proportion of dissatisfaction mediated by healthy lifestyle was 11.3% (7.9%-25.8%) for patients with medium SES and 17.1% (8.6%-21.9%) for those with low SES. The combined effect of low SES and unhealthy lifestyle showed a progressive increase in the risk of dissatisfaction. Compared with patients with high SES and healthy lifestyle, those with low SES and unhealthy lifestyle had a higher risk of dissatisfaction, with an OR of 3.37 (95% CI 2.74-5.17).</p><p><strong>Conclusions: </strong>While healthy lifestyle factors partially mediate the association between SES and patient satisfaction, broader measures beyond lifestyle interventions may be necessary to address disparities in surgical outcomes. These findings underscore the importance of integrating socioeconomic considerations into clinical strategies to improve outcomes for patients with ASD.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610079","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":"Agreement between high-quality clinical practice guidelines in their treatment recommendations for low back pain: A systematic review.","authors":"Bayden J McKenzie, Romi Haas, Giovanni E Ferreira, Alexandra Gorelik, Sheila Cyril, Jia Xi Han, Stephen Gilbert, Liesl Grobler, Chris G Maher, Rachelle Buchbinder","doi":"10.1016/j.spinee.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.015","url":null,"abstract":"<p><strong>Background: </strong></p><p><strong>Context: </strong>International and national clinical practice guidelines for low back pain often differ in their treatment recommendations. Previous studies have outlined disagreement between recommendations when comparing guidelines of varying quality, challenging the value of producing them. There is a need to quantify agreement between high-quality low back pain guidelines for monitoring recommendation changes over time and guiding future research for treatments with disagreement.</p><p><strong>Purpose: </strong>The aim of this review was to assess agreement between high-quality clinical practice guidelines in their treatment recommendations for low back pain published 1 January 2016 to 14 March 2024.</p><p><strong>Study: </strong></p><p><strong>Design: </strong>Systematic review OUTCOME MEASURES: : Strength and direction of guideline recommendations were pooled for each low back treatment and the level of agreement or disagreement was reported as a percentage. The number of recommendations for individual treatments was also reported.</p><p><strong>Methods: </strong>We searched six databases to identify high-quality clinical practice guidelines defined as those that scored ≥70% in 3 out of 6 AGREE II domains, including 'Rigour of Development'. Two authors independently screened titles and abstracts, then full texts to determine eligibility. Recommendations were stratified by low back pain chronicity and direction and strength of recommendation.</p><p><strong>Results: </strong>Of 4,920 publications screened, 22 high-quality clinical practice guidelines were included. Overall, there were 588 recommendations for 181 treatments (range 1 to 125 recommendations per CPG). In 154 instances clinical practice guidelines made no recommendation about a treatment although in 97 (63%) a recommendation was made by at least one other clinical practice guideline. Agreement could be assessed for 433 recommendations for 122 low back pain treatments. There was complete or partial agreement for almost two-thirds of recommendations; complete agreement (i.e., both direction and strength agreed) for 26%, and partial agreement (i.e., same direction but different strength) for 39% across guidelines. Recommendations generally supported use of patient education, provision of a self-management plan and fear avoidance and physical therapy and did not support use of invasive treatments, electrotherapy or assistive devices. There was disagreement (i.e., direction of a recommendation differed) for 35% of recommendations, mostly pharmacological interventions.</p><p><strong>Conclusion: </strong>More research is needed to understand reasons for these disagreements as well as the variation across clinical practice guidelines in electing to make a recommendation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610078","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":"Morphological Characteristics of Apical Intervertebral Discs as Predictors of Curve Progression in Adolescents with Idiopathic Scoliosis.","authors":"Conor Boylan, Morgan Jones, David W Polly Jr, Arin M Ellingson","doi":"10.1016/j.spinee.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Quantitative disc analysis offers an objective approach for assessing intervertebral disc morphology in patients with adolescent idiopathic scoliosis (AIS). Such analyses have potential to enhance predictions regarding disease progression and guide clinical decisions on surgical intervention timing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To characterize morphological differences in apical intervertebral discs between AIS patients requiring surgery within five years and those managed non-operatively, and to develop a predictive model for surgical intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This retrospective case-control study was conducted at a single tertiary referral centre specializing in spinal deformity surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;The study analysed data from 99 patients diagnosed with AIS, comprising 50 who underwent surgical correction within five years and 49 managed conservatively, all of whom had baseline MRI scans performed as part of standard care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Key outcome measures included nucleus pulposus (NP) and disc signal intensity, NP area, NP location, transition zone slopes, and disc asymmetry indices derived from MRI analyses. The primary endpoint was the requirement for surgical intervention within five years of initial MRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;MRI scans were retrospectively analysed to quantify disc morphological characteristics at the apex of the spinal curve. Patients requiring surgical correction within five years were compared to non-surgical controls. Predictors of surgical intervention were identified using backward input binary logistic regression to construct an optimized predictive model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients requiring surgery were younger (p=0.004), exhibited larger Cobb angles (p&lt;0.001), and had apical discs more frequently located in the lower thoracic region (p=0.024). Surgical patients demonstrated higher mean NP signal intensity (p=0.011), steeper anterior (p=0.049) and concave (p=0.006) transition zone slopes, and greater overall coronal transition zone symmetry (p=0.022). The resulting statistical model predicted surgical intervention with 81.8% accuracy (p&lt;0.001, AUC=0.894), outperforming prediction based on Cobb angle alone. Predictors in the final model included age, main Cobb angle, and concave transition zone slope.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Quantitative disc analysis reveals distinct morphological features at the apical disc that are predictive of surgical intervention in AIS. A predictive model incorporating these features outperforms traditional metrics such as Cobb angle alone, underscoring the added value of advanced disc morphology evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Incorporating quantitative disc metrics into early AIS evaluation may enhance risk stratification, inform monitoring intervals, and support timely surgical decision-making-fa","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610083","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":"Comparative efficacy of exercise versus passive physical therapy in improving nonspecific neck pain: a multilevel network meta-analysis and dose-response analysis.","authors":"Jingyi Xie, Mingyuan Jin, Jindong Guo, Haoxiang Guo, Xinyu Cai, Bin Wang","doi":"10.1016/j.spinee.2025.07.006","DOIUrl":"10.1016/j.spinee.2025.07.006","url":null,"abstract":"<p><strong>Background context: </strong>Nonspecific neck pain causes chronic pain, functional impairment, and adversely affects quality of life. It remains unclear whether exercise or other nonphysical therapies are more effective in improving nonspecific neck pain (NSNP), and the optimal dosage of exercise for alleviating NSNP has yet to be determined.</p><p><strong>Purpose: </strong>The comparative efficacy of exercise and passive physical therapies in alleviating NSNP was evaluated, and the optimal exercise dosage was determined.</p><p><strong>Study design/setting: </strong>Multilevel Network Meta-analysis study (ML-NMA) included adult patients (≥18 years old) with NSNP.</p><p><strong>Methods: </strong>Four electronic databases were searched from the inception of each database to November 2024. Two independent reviewers extracted the data and evaluated the risk of bias. A ML-NMA integrated with a dose-response meta-analysis was performed for comprehensive comparisons.</p><p><strong>Results: </strong>Resistance combined with coordination training demonstrated the highest efficacy (Hedges' g=-0.76, 95% credibility interval (CrI): -0.99 to -0.52; surface under the cumulative ranking curve (SUCRA=0.87; k=2), followed by aerobic combine with resistance training (g=-0.92, 95% CrI: -1.16 to -0.68; SUCRA=0.71; k=3). Passive therapies, including laser therapy (g=-0.58, 95% CrI: -0.79 to -0.37; SUCRA=0.61; k=11) and manual therapy (g=-0.64, 95% CrI: -0.79 to -0.49; SUCRA=0.55; k=43), showed moderate yet significant benefits. The analysis revealed a nonlinear inverse dose-response relationship between exercise intervention and NSNP reduction, with a significant negative correlation. The optimal weekly dosage for NSNP relief was 420 metabolic equivalent of tasks min/week (METs-min/week), whereas 210 METs-min/week achieved minimal clinically important differences.</p><p><strong>Conclusion: </strong>This research suggests that resistance combined with coordination training and aerobic combined with resistance training, may be effective exercise-based interventions for NSNP. For patients with exercise intolerance, passive physical therapies, particularly laser and manual therapies, could serve as alternatives. To potentially optimize treatment effects, the findings indicate that clinicians might consider an exercise dose around 420 METs-min/week as a potential reference.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610081","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":"Clinical Characteristics and Surgical Outcomes of Spinal Infections in Intravenous Drug Users and Non-Intravenous Drug Users.","authors":"Mitsuhiro Nishizawa, Mladen Djurasovic, Steven D Glassman, John R Dimar, Charles H Crawford, Jeffrey L Gum, R Kirk Owens, Justin Mathew, Benjamin A Kostic, Leah Y Carreon","doi":"10.1016/j.spinee.2025.07.025","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.025","url":null,"abstract":"<p><strong>Background context: </strong>Intravenous Drug Use (IVDU) is a significant risk factor for spinal infections. However, spinal infection in IVDU patients compared to Non-IVDU remains poorly described in the literature.</p><p><strong>Purpose: </strong>To assess the characteristics, surgical outcomes, and complications of spinal infections in patients IVDU and Non-IVDU patients.</p><p><strong>Study design: </strong>Retrospective observational cohort PATIENT SAMPLE: Consecutive series of patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis at a single multi-surgeon tertiary institution.</p><p><strong>Outcome measures: </strong>post-operative complications, causative pathogens, recurrence rates.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients who underwent surgery for spinal infections, including spondylodiscitis, epidural abscess, and facet joint septic arthritis. Demographics, comorbidities, causative pathogens, and postoperative complications were compared between IVDU and Non-IVDU patients.</p><p><strong>Results: </strong>Among 255 patients, 88 (35%) were IVDU. Compared to Non-IVDU patients, they were significantly younger (47.2 ± 10.3 vs 59.6 ± 13.4 years, p<0.001) and had a lower BMI (26.6 ± 5.9 vs 29.7 ± 8.7, p=0.001) but a lower incidence of diabetes (16% vs 52%, p<0.001), steroid use (0% vs 9%, p=0.002), and chronic kidney disease (9% vs 29%, p≤0.001). While the lumbar spine was the most commonly affected region, followed by the thoracic spine, cervical spine infection was significantly more frequent in IVDU patients (19% vs 8%, p=0.013). Additionally, concomitant endovascular infections were more commonly observed in IVDU patients (19% vs 8%, p=0.015). As causative pathogens, MRSA and Serratia were significantly more prevalent in IVDU patients (MRSA; 50% vs 27%, p<0.001, Serratia; 10% vs 0%, p<0.001). IVDU patients had significantly higher rates of readmission (67% vs 46%, p=0.002) and complication rates within one year, including spinal infection recurrence (20% vs 6%, p=0.001), endovascular infections (17% vs 5%, p=0.006), and uncontrolled pain (26% vs 0%, p<0.001). IVDU (OR = 2.94, 95% CI: 1.24-7.24, p = 0.016) was independently associated with treatment failure, defined as recurrence or mortality.</p><p><strong>Conclusion: </strong>Compared to Non-IVDU patients, IVDU patients had higher rates of cervical spine involvement, concomitant endovascular endocarditis, and MRSA and Serratia infection, as well as increased readmissions and complications, including recurrence, endovascular infections, and uncontrolled pain.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610080","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 Influence of Social Determinants on Clinical Presentation in Patients Surgically Treated for Metastatic Spinal Disease.","authors":"Bram T van Munster, Jantijn J G J Amelink, Olivier Q Groot, Tom M de Groot, Jorrit-Jan Verlaan, Daniel G Tobert","doi":"10.1016/j.spinee.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.07.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spinal metastases can result in compression of the spinal cord with neurological symptoms in an acute setting. Surgical intervention is often necessary to mitigate the risk of irreversible neurological impairment. Therefore, an enhanced risk assessment for acute presentation in patients with spinal metastases could be highly valuable. Social Determinants of Health (SDOH) are non-medical variables that influence health outcomes. The impact of SDOH on patient presentation prior to surgery in patients with spinal metastases remains unexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to investigate (1) whether patients with unfavorable SDOH present more often with acute neurological symptoms in the setting of spinal metastases undergoing surgery and (2) whether patients with unfavorable SDOH present more often with acute neurological symptoms as the first symptom of spinal metastases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study PATIENTS SAMPLE: Patients aged 18 years or older, who underwent surgical treatment for spinal metastases at two affiliated tertiary centers in Boston between January 1&lt;sup&gt;st&lt;/sup&gt;, 2017, and December 31&lt;sup&gt;st&lt;/sup&gt;, 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was presentation with acute neurological symptoms of spinal metastases within 14 days prior surgery. We defined acute neurological symptoms using the American Spinal Injury Association (ASIA) impairment scale to determine if a patient exhibited any neurological deficit (score of A, B, C, or D).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We identified in total 555 patients: 162 (29%) presented with acute neurological symptoms ≤14 days before surgery, while 393 (71%) did not present with acute neurological symptoms before surgery. The SDOH were evaluated using a multivariate regression for presentation with preoperative acute neurological symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Two SDOHs were associated with an increased risk to present with acute neurological symptoms prior to surgery: patients without a partner, who were divorced (OR, 2.50 [95% CI, 1.17 to 5.35]; p=0.018), and patients who were not employed (OR=2.46 [95%CI=1.11-5.43]; p=0.025). Additionally, patients were also more likely to present with acute neurological symptoms prior to surgery with: a higher ECOG score (OR=4.82 [95%CI=2.78-8.51]; p&lt;0.001), a higher Bilsky score (OR=4.58 [95%CI=2.33-9.80]; p&lt;0.001), a greater number of spinal metastases (OR=2.44 [95%CI=1.41-4.35]; p=0.002), and the absence of visceral metastases (OR=0.58 [95%CI=0.37-0.90]; p=0.017). No factors, including SDOHs, were observed that influenced acute neurological symptoms as the initial symptom in spinal metastases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients with spinal metastases who are eligible for surgical treatment, unfavorable SDOHs are associated with acute neurological presentation. Identifying unfavorable SDOHs may support risk stratification efforts","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610085","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}