Spine Journal最新文献

{"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":"https://doi.org/10.1016/j.spinee.2024.10.017","url":null,"abstract":"<p><strong>Background context: </strong>Unstable traumatic spinal injuries require surgical fixation to restore biomechanical stability.</p><p><strong>Purpose: </strong>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.</p><p><strong>Study design/setting: </strong>Systematic literature review.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 five subgroups: Posterior fixation, e.g. posterior pedicle screw systems, anterior fixation, e.g. anterolateral plate fixation, combined anterior-posterior fixation, vertebral body replacement with additional instrumentation, and augmentation techniques, e.g. 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.</p><p><strong>Conclusions: </strong>The stabilizing effect of surgical treatment depends on the type, severity, and location of injury, as well as ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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":"https://doi.org/10.1016/j.spinee.2024.10.011","url":null,"abstract":"<p><strong>Background context: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Study design/setting: </strong>A retrospective cohort study utilizing the 2010 - Q2 2022 M161Ortho PearlDiver Mariner Patient Claims Database.</p><p><strong>Patient sample: </strong>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 multi-level fusion procedures, and those with trauma, neoplasm, or infection diagnosed within three months of surgery.</p><p><strong>Outcome measures: </strong>Incidence of 90-day aggregated any, severe, and minor adverse events (AAE, SAE, and MAE, respectively), emergency department (ED) visits, and hospital readmissions.</p><p><strong>Methods: </strong>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 non-semaglutide T2DM-insulin and non-semaglutide 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.</p><p><strong>Results: </strong>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<0.001 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<0.001), SAE (OR 0.43, p=0.004), MAE (OR 0.34, p<0.001)","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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":"Liposomal Bupivacaine Reduces Post-Operative Pain and Opioids Consumption in Spine Surgery: A Meta-Analysis of 1,269 Patients.","authors":"Mohammad Daher, Manjot Singh, Joseph E Nassar, Jack C Casey, Tucker C Callanan, Bassel G Diebo, Alan H Daniels","doi":"10.1016/j.spinee.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.013","url":null,"abstract":"<p><strong>Background context: </strong>Postoperative pain management in spine surgery remains a challenge. Liposomal bupivacaine (LB) has emerged as an alternative or adjunct to opioid-based analgesia. However, existing studies evaluating LB efficacy in spine surgery yield conflicting results and a meta-analysis compiling the literature is lacking.</p><p><strong>Purpose: </strong>The purpose of this meta-analysis was to evaluate pain outcomes, opioid use, and LOS following LB administration after spine surgery STUDY DESIGN: Meta-analysis METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored up to May 2024. Data on medical complications, postoperative pain, postoperative opioid consumption, and length of stay were extracted. Mean differences (MD) with 95% CI were used for continuous data, and odds ratios (OR) were calculated for dichotomous data.</p><p><strong>Results: </strong>This meta-analysis comprised eleven studies consisting of 1269 patients (677 in the LB group, 592 in the control group). No statistically significant difference was observed in complication rates. The LB group exhibited significantly lower pain scores at postoperative day 2 (MD=-0.31; 95% CI: -0.52- -0.09, p=0.006), lower postoperative opioid consumption (MD=-0.42; 95% CI: -0.79- -0.06, p=0.02), and shorter length of stay (MD=-0.57; 95% CI: -0.94- -0.20, p=0.002).</p><p><strong>Conclusion: </strong>In the immediate postoperative period after spine surgery, the utilization of liposomal bupivacaine was associated with improved pain outcomes, decreased opioid consumption, and shortened length of stay. Although further research is warranted, these findings suggest that LB may offer a valuable adjunct to pain management strategies in patients undergoing spine surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570205","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, J Levi Chazen, Ek T Tan, Darren R Lebl","doi":"10.1016/j.spinee.2024.10.020","DOIUrl":"https://doi.org/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 three-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 <2mm (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":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"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}

{"title":"Anterior column realignment better restores sagittal alignment but carries higher risk of mechanical failures than lateral lumbar interbody fusion in patients with degenerative sagittal imbalance.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Hyun-Jun Kim, Chong-Suh Lee","doi":"10.1016/j.spinee.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.005","url":null,"abstract":"<p><strong>Background of context: </strong>Anterior column realignment (ACR), a modified lateral lumbar interbody fusion (LLIF), is an emerging, less invasive technique that allows greater lordosis correction by releasing anterior longitudinal ligament. However, long-term results have been poorly documented with regard to mechanical failure, such as proximal junctional kyphosis (PJK) and rod fracture (RF), and clinical outcomes.</p><p><strong>Purpose: </strong>To compare the outcomes, primarily mechanical failure, in patients with degenerative sagittal imbalance (DSI) treated with ACR versus LLIF alone.</p><p><strong>Study design/setting: </strong>Retrospective study PATIENT SAMPLE: Patients ≥ 60 years of age; severe DSI defined by pelvic incidence (PI) - lumbar lordosis (LL) ≥ 20°; performance of ≥ 2-level LLIF; and ≥ 5 total fused levels including the sacrum.</p><p><strong>Outcome measures: </strong>Mechanical failure such as PJK and RF; radiographic results; clinical outcomes METHODS: Enrolled patients were divided into two groups, based on whether their anterior reconstruction was accomplished with ACR or LLIF alone: ACR and LLIF groups. Mechanical failures were compared between the two groups as a composite outcome including PJK and /or RF. PJK was defined as proximal junctional angle (PJA) >28° and Δ PJA >22°. Only RFs developing at the level with corresponding procedures (ACR or LLIF) were included in the analysis. Logistic regression was performed to compare the relative risk of mechanical failure between the ACR and LLIF groups. The radiographic and clinical outcomes were also compared between the groups.</p><p><strong>Results: </strong>The final study cohort consisted of 210 patients. The mean age was 69.6 years, and there were 190 females (90.5%). There were 124 patients in the ACR group and 86 patients in the LLIF group. Perioperative changes for all sagittal parameters were significantly greater in the ACR group than in the LLIF group. Overall mechanical failure rates were significantly higher in the ACR group than in the LLIF group (32.3% vs. 14.0%, P = 0.003). Multivariate regression analysis with adjusting potential confounders revealed that ACR carried a significantly higher risk of mechanical failure than LLIF (Odds ratio = 5.6, 95% confidence interval = 2.0 - 15.6, P < 0.001). The final clinical outcomes were worse in the ACR group than in the LLIF group.</p><p><strong>Conclusion: </strong>ACR restored the sagittal malalignment more powerfully than did LLIF. However, compared to the LLIF, ACR was associated with a greater risk of mechanical failures and revision surgery. The final clinical outcomes in the ACR group were inferior to those in the LLIF group. Therefore, ACR should be left as a last resort for the cases where it is expected that an adequate correction cannot be achieved using LLIF alone. If ACR has to be performed, it is necessary to establish feasible surgical strategies to avoid mechanical failures.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570182","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":"Letter to the editor regarding “MRI-based vertebral bone quality score is a comprehensive index reflecting the quality of bone and paravertebral muscle” by Li et al","authors":"Manuel Moser MD ,&nbsp;Alexander P. Hughes MD","doi":"10.1016/j.spinee.2024.05.020","DOIUrl":"10.1016/j.spinee.2024.05.020","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538296","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":"2024 NASS presidential address: Empathy vs. Efficiency in the age of AI in spine care.","authors":"Zoher Ghogawala","doi":"10.1016/j.spinee.2024.10.002","DOIUrl":"10.1016/j.spinee.2024.10.002","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570177","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":"Development of Machine Learning Model for Predicting Prolonged Operation Time in Lumbar Stenosis undergoing Posterior Lumbar Interbody Fusion: A Multi-center study.","authors":"Runmin Li, Lin Wang, Xinghao Wang, Marcin Grzegorzek, An-Tian Chen, Xubin Quan, Zhaohui Hu, Xiaozhu Liu, Yang Zhang, Tianyu Xiang, Yingang Zhang, Anfa Chen, Hao Jiang, Xuewen Hou, Qizhong Xu, Weiheng He, Liang Chen, Xin Zhou, Qiang Zhang, Wei Huang, Haopeng Luan, Xinghua Song, Xiaolin Yu, Xiangdong Xi, Kai Wang, Shi-Nan Wu, Wencai Liu, Yusi Zhang, Jialiang Zheng, Chengliang Yin, Qiang Liu, Haizhen Ding, Chan Xu, Hongmou Zhao, Liang Yan, Wenle Li","doi":"10.1016/j.spinee.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.spinee.2024.10.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Longer posterior lumbar interbody fusion (PLIF) surgeries for individuals with lumbar spinal stenosis are linked to more complications and negatively affect recovery after the operation. Therefore, there is a critical need for a method to accurately predict patients who are at risk for prolonged operation times.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This research aimed to develop a clinical model to predict prolonged operation time for patients undergoing PLIF procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This study employs a machine-learning approach to analyze data retrospectively collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;3233 patients diagnosed with lumbar spinal stenosis (LSS) had posterior lumbar interbody fusion (PLIF) at 22 hospitals in China from January 2015 to December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was operation time. Prolonged operation time defined as exceeded 75% of the overall surgical duration, which mean exceeding 240 minutes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 3233 patients who underwent PLIF surgery with lumbar spinal stenosis (LSS) were divided into one training group and four test groups based on different district areas. The training group included 1569 patients, while Test1 had 541, Test2 had 403, Test3 had 351, and Test4 had 369 patients. Variables consisted of demographics, perioperative details, preoperative laboratory examinations and other Additional factors. Six algorithms were employed for variable screening, and variables identified by more than two screening methods were incorporated into the final model. In the training cohort, a 10-fold cross-validation (CV) and Bayesian hyperparameter optimization techniques were utilized to construct a model using eleven machine learning algorithms. Following this, the model was evaluated using four separate external test sets, and the mean Area Under the Curve (AUC) was computed to determine the best-performing model. Further performance metrics of the best model were evaluated, and SHapley Additive exPlanations(SHAP) were used for interpretability analysis to enhance decision-making transparency. Ultimately, an online calculator was created.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the various machine learning models, the Random Forest achieved the highest performance in the validation set, with AUROC scores of 0.832 in Test1, 0.834 in Test2, 0.816 inTest3, 0.822 in Test4) compared with other machine learning models. The top contributing variables were number of levels fusion, pre-APTT, weight and age. The predictive model was further refined by developing a web-based calculator for clinical application. (https://wenle.shinyapps.io/PPOT_LSS/) CONCLUSIONS: This predictive model can facilitate identification of risk for prolonged operation time following PLIF surgery. Predictive calculators are expected to improve preoperative planning, identify patients with high risk factors, and hel","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478950","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":"Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian spine outcomes and research network.","authors":"Husain Shakil, Nicolas Dea, Armaan K Malhotra, Ahmad Essa, W Bradley Jacobs, David W Cadotte, Jérôme Paquet, Michael H Weber, Philippe Phan, Christopher S Bailey, Sean D Christie, Najmedden Attabib, Neil Manson, Jay Toor, Andrew Nataraj, Hamilton Hall, Greg McIntosh, Charles G Fisher, Y Raja Rampersaud, Nathan Evaniew, Jefferson R Wilson","doi":"10.1016/j.spinee.2024.09.033","DOIUrl":"10.1016/j.spinee.2024.09.033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015-2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ-5D) at 12 months postsurgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 preoperative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04-1.07), then symptom duration (OR 0.65; 95% CI 0.44-0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03-0.78), living independently (OR 2.17; 95% CI 1.22-3.85), symptom duration (OR 0.62; 95% CI 0.40-0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67-0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright X-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings suggest patients with shorter symptom dura","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478951","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":"Ambulatory surgery center versus outpatient hospitals: a comparison of reimbursements for patients undergoing anterior cervical discectomy and fusion.","authors":"Michael Herrera, Brittany Sacks, Charles Laurore, Wasil Ahmed, Justin Tiao, James Meyers, Brocha Z Stern, Jashvant Poeran, Saad Chaudhary","doi":"10.1016/j.spinee.2024.09.032","DOIUrl":"10.1016/j.spinee.2024.09.032","url":null,"abstract":"<p><strong>Background context: </strong>While some studies have demonstrated that ambulatory surgery centers (ASCs) are associated with reduced costs of orthopedic procedures, there is no consensus in the current literature as to the impact of ASCs versus hospital-based outpatient departments (HOPDs) on anterior cervical discectomies and fusions (ACDFs).</p><p><strong>Purpose: </strong>This study sought to (1) compare immediate procedure reimbursements, patient out-of-pocket expenditures, and surgeon reimbursements for ACDFs performed at ASCs versus HOPDs and (2) identify factors predicting facility utilization.</p><p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>We identified ACDF procedures performed at an ASC or HOPD in commercially-insured patients aged 18 to 64.</p><p><strong>Outcome measures: </strong>Payment variables were calculated from claims within 3 days preoperatively and postoperatively.</p><p><strong>Methods: </strong>Multivariable regression models assessed (1) associations between the surgery setting and payment variables and (2) factors associated with the surgery setting.</p><p><strong>Results: </strong>We included 18,191 ACDFs (14.8% ASC, 85.2% HOPD). In multivariable analyses, ACDFs performed in an ASC (versus HOPD) were associated with 9.8% higher immediate procedure reimbursements (95% CI:7.5%-12.2%), 17.2% higher patient out-of-pocket expenditures (95% CI:11.8-22.8), and 11.7% higher surgeon reimbursements (95% CI:9.18-14.2; all p<.01) (all p<.001). Surgery setting utilization varied by region, insurance-related factors, comorbidities, and procedural complexity.</p><p><strong>Conclusions: </strong>We found that ASCs had significantly higher reimbursements compared to HOPDs. Regional variations in ASC utilization imply there are opportunities for standardization of care.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394695","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}