Spine Journal最新文献

{"title":"Long-term mechanical failure in well aligned adult spinal deformity patients","authors":"Sleiman Haddad MD, PhD , Caglar Yilgor MD , Eva Jacobs MD, PhD , Lluis Vila MD , Susana Nuñez-Pereira MD, PhD , Manuel Ramirez Valencia MD , Anika Pupak PhD , Maggie Barcheni BS , Javier Pizones MD, Phd , Ahmet Alanay MD , Frank Kleinstuck MD , Ibrahim Obeid MD , Ferran Pellisé MD, PhD , European Spine Study Group","doi":"10.1016/j.spinee.2024.09.019","DOIUrl":"10.1016/j.spinee.2024.09.019","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Mechanical complications (MC) are frequently linked to suboptimal postoperative alignment and represent a primary driver of revision surgery in the context of adult spinal deformity (ASD). However, it's worth noting that even among those deemed \"well aligned,\" the risk of experiencing MCs persists, hinting at the potential influence of factors beyond alignment.</div></div><div><h3>PURPOSE</h3><div>The aim was to assess the incidence of MCs among well-aligned patients and delving into the relevant risk factors and surgical outcomes that come into play within this specific subgroup.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective analysis was conducted using data from a prospective multicenter database dedicated to ASD.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study focused on patients aged 55 years or older, who had a minimum follow-up period of 2 years, and exhibited a Global Alignment and Proportion (GAP) score of 2 points or less (excluding age) within 6 weeks of their index surgery.</div></div><div><h3>OUTCOME MEASURES</h3><div>Mechanical complications such as rod fractures, pseudarthrosis, or junctional kyphosis or failure.</div></div><div><h3>METHODS</h3><div>Patients who developed mechanical complications were identified. Comparative analyses were performed, encompassing both continuous and categorical variables. Furthermore, binary logistic regression tests were employed to pinpoint risk factors, and ROC curves were used to determine the optimal threshold values for these variables.</div></div><div><h3>RESULTS</h3><div>A total of 83 patients met the inclusion criteria for this study, with a mean age of 66 years. On average, they had 10 instrumented levels, and 77% of them had fusion extending to the pelvis. Additionally, 27% of the patients had undergone 3-column osteotomies (3-CO). Among them, 33 patients (40%) experienced at least 1 MC during an average follow-up period of 4 years, which included 14 cases of proximal junctional kyphosis (PJK) and 20 cases of nonunion or rod breakage. 15 patients (18%) required revision surgery specifically for MC. In univariable analyses, patients who developed MC were characterized by higher body weight, poorer baseline general health (as indicated by worse SF-36 scores), and less favorable preoperative coronal and sagittal alignment. They also had longer hospital stays, a greater number of instrumented levels, and achieved less favorable postoperative coronal and sagittal alignment. Interestingly, factors such as 3-column osteotomies, postoperative bracing, and the addition of an anterior approach did not significantly alter the risk of MC in well-aligned ASD patients. Binary regression models revealed that independent risk factors for MC included the residual coronal lumbosacral curve, the number of instrumented levels, and relative spinopelvic alignment (RSA). ROC curves identified an optimal threshold of a residual lumbosacral curve of ≤4","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 337-346"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331034","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":"Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically","authors":"Shiming Xie MD , Liqiang Cui MD , Chenglong Wang MD , Hongjun Liu MD , Yu Ye MD , Shuangquan Gong MD , Jingchi Li PhD","doi":"10.1016/j.spinee.2024.09.021","DOIUrl":"10.1016/j.spinee.2024.09.021","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty in patients with osteoporotic vertebral compressive fracture (OVCF). Studies have demonstrated that intervertebral cement leakage (ICL) can increase the incidence of AVF, but others have reached opposite conclusions. The stress concentration initially increases the risk of AVF, and dispersive concentrated stress is the main biomechanical function of the intervertebral disc (IVD).</div></div><div><h3>PURPOSE</h3><div>This study was designed to validate the hypothesis that direct contact between the leaked cement and adjacent bony endplate (BEP) can inhibit this biomechanical function, trigger adjacent vertebral stress concentration and increase the risk of AVF.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective study and corresponding numerical mechanical simulations.</div></div><div><h3>PATIENT SAMPLE</h3><div>Clinical data from 97 OVCF patients treated by bone cement augmentation operations were reviewed in this study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical assessments involved measuring ICL and cement-BEP contact status in patients with and without AVF. Numerical simulations were conducted to compute stress values in adjacent vertebral body's BEP and cancellous bone under various body positions.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Radiographic and demographic data of 97 OVCF patients (with an average follow-up period of 11.5 months) treated using bone cement augmentation operation were reviewed in the present study. The patients were divided into 2 groups: those with AVF and those without AVF. Bone cement leakage status was judged via 2 different methods: with or without IVD cement leakage and with and without adjacent vertebral endplate contact. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. Patients without IVD cement leakage, with IVD cement leakage but without adjacent vertebral endplate cement contact, and with direct adjacent vertebral endplate cement contact were simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to the AVF were computed and recorded in these surgical models.</div></div><div><h3>RESULTS</h3><div>Radiographic analysis revealed that the incidence of AVF was numerically higher, but was not significantly higher in patients with IVD cement leakage. In contrast, patients with direct adjacent vertebral endplate cement contact had a significantly greater incidence of AVF, which has also been proven to be an independent risk factor for AVF. In addition, numerical mechanical simulations revealed an obvious stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral body in the model with endplate cement contact.</div></div><div><h3>CONCLUSIONS</h3><div","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 324-336"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach","authors":"Francesco Petri MD ,&nbsp;Omar K. Mahmoud MD ,&nbsp;Said El Zein MD ,&nbsp;Seyed Mohammad Amin Alavi MD ,&nbsp;Matteo Passerini MD ,&nbsp;Felix E. Diehn MD ,&nbsp;Jared T. Verdoorn MD ,&nbsp;Aaron J. Tande MD ,&nbsp;Ahmad Nassr MD ,&nbsp;Brett A. Freedman MD ,&nbsp;M. Hassan Murad MD ,&nbsp;Elie F. Berbari MD, MBA","doi":"10.1016/j.spinee.2024.09.018","DOIUrl":"10.1016/j.spinee.2024.09.018","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome.</div></div><div><h3>PURPOSE</h3><div>To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Meta-epidemiological study with a systematic review of definitions.</div></div><div><h3>PATIENTS SAMPLE</h3><div>An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms.</div></div><div><h3>OUTCOME MEASURES</h3><div>Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria.</div></div><div><h3>METHODS</h3><div>We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams.</div></div><div><h3>RESULTS</h3><div>The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology.</div></div><div><h3>CONCLUSIONS</h3><div>Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 359-368"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoporosis is not associated with reoperation or pseudarthrosis after anterior cervical discectomy and fusion through 4-years’ follow-up: a retrospective cohort study of US academic health centers","authors":"Anthony N. Baumann DPT ,&nbsp;Robert J. Trager DC ,&nbsp;Davin C. Gong MD ,&nbsp;Omkar S. Anaspure BA ,&nbsp;John T. Strony MD ,&nbsp;Ilyas Aleem MD","doi":"10.1016/j.spinee.2024.09.031","DOIUrl":"10.1016/j.spinee.2024.09.031","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Osteoporosis has been proposed as a risk factor for reoperation after anterior cervical discectomy and fusion (ACDF), yet this potential association has been understudied, with conflicting results to date.</div></div><div><h3>PURPOSE</h3><div>This study examines the hypothesis that adults with osteoporosis would have an increased risk of reoperation after ACDF compared to matched adults without osteoporosis.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Two matched cohorts (mean age: 62 years; 75% female), each with 1,019 patients, who underwent primary ACDF. Cohorts were determined by the presence or absence of a diagnosis of osteoporosis.</div></div><div><h3>OUTCOME MEASURES</h3><div>Incidence of reoperation occurring over 4 years postoperatively, with our primary outcome being the risk ratio (RR) of reoperation with 95% confidence intervals (CI). Secondary outcomes included risk and mean count of oral opioid prescriptions and risk of pseudoarthrosis.</div></div><div><h3>METHODS</h3><div>We utilized the TriNetX network to identify adults undergoing their first ACDF from 2004 to 2020, excluding those with serious pathology, and divided patients into 2 cohorts: osteoporosis and nonosteoporosis. Patients were propensity matched according to key risk factors for reoperation.</div></div><div><h3>RESULTS</h3><div>Patients with osteoporosis had no statistically significant or meaningful difference in risk of reoperation compared to nonosteoporotic patients over 4-years’ follow-up [95% CI] (17.3% vs 16.5%; RR: 1.05 [0.86, 1.27]; p=.6361). Similarly, there were no significant differences in the risk of pseudoarthrosis (26.5% vs 29.1%; RR: 0.91 [0.79, 1.05]; p=.1820), oral opioid prescription (75.0% vs 76.0%; RR: 0.99 [0.94, 1.04]; p=.6067), or mean oral opioid prescription count (11.5 vs 11.8; p=.7040).</div></div><div><h3>CONCLUSIONS</h3><div>Compared to matched nonosteoporosis controls, osteoporosis was not associated with a statistically significant or clinically meaningful increase in risk of reoperation in adults over 4 years after ACDF. Furthermore, osteoporosis was not associated with a significant or meaningful risk of pseudoarthrosis or oral opioid prescription after ACDF, although more research is needed for corroboration. Additional research is needed to clarify whether those with osteoporosis have meaningful differences in pain and function compared to those without osteoporosis following ACDF.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 290-298"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382164","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":"Biomechanical differences of three cephalic fixation methods for patients with basilar invagination and atlantoaxial dislocation in the setting of congenital atlas occipitalization: a finite element analysis","authors":"Qiang Jian MD ,&nbsp;Shaw Qin JD ,&nbsp;Zhe Hou MD ,&nbsp;Xingang Zhao MD ,&nbsp;Yinqian Wang MD ,&nbsp;Cong Liang MD ,&nbsp;Dean Chou MD ,&nbsp;Xiuqing Qian PhD ,&nbsp;Tao Fan MD, PhD","doi":"10.1016/j.spinee.2024.08.023","DOIUrl":"10.1016/j.spinee.2024.08.023","url":null,"abstract":"<div><h3>Background context</h3><div>In cases of basilar invagination-atlantoaxial dislocation (BI-AAD) complicated by atlas occipitalization (AOZ), the approach to cranial end fixation has consistently sparked debate, generally falling into two categories: C1–C2 fixation and occipitocervical fixation. Several authors believe that C1–C2 fixation carries a lower risk of fixation failure than occipitocervical fixation.</div></div><div><h3>Purpose</h3><div>To study the biomechanical differences among 3 different cranial end fixation methods for BI-AAD with AOZ.</div></div><div><h3>Study design</h3><div>This was a finite element analysis.</div></div><div><h3>Patient sample</h3><div>A 35-year-old female patient diagnosed with congenital BI-AAD and AOZ.</div></div><div><h3>Outcome measures</h3><div>range of motion (ROM), peak von Mise stress (PVMS), cage micro-subsidence, cage micro-slippage.</div></div><div><h3>Method</h3><div>Four finite element models were constructed, including unstable group (BI-AAD with AOZ), C1 lateral mass screw group, occipital plate group, occipitocervical rod group. The flexion and extension (FE), lateral bending (LB) as well as axial rotation (AR) were simulated under a torque of 1.5 Nm. Parameters include C1–C2 ROM, PVMS on screw-rod construct, cage micro-subsidence, cage micro-slippage.</div></div><div><h3>Results</h3><div>The ROM of the C1 lateral mass screw group was smaller than that of the other fixation groups in LB and AR, but not FE. Compared with the occipitocervical rod group, the ROM in LB and AR of the occipital plate group was higher, but not in FE. The PVMS of C1 lateral mass screw group was significantly higher than that of the other groups. The ROM and PVMS of the occipitocervical rod group were in between the other 2 groups. Regarding the screws at the cranial end, the PVMS of the 4-screw occipitocervical rod group was significantly lower than that of the other groups. In general, the cage micro-motion follows the ascending order: C1 lateral mass group &lt; occipitocervical rod group &lt; occipital plate group.</div></div><div><h3>Conclusions</h3><div>In cases of BI-AAD with AOZ, the C1 lateral mass screw group provided the least ROM and cage micro-motion, but the screw-rod PVMS was the largest. The advantage of occipital plate fixation lies in the lowest screw-rod PVMS, but the ROM and cage micro-motion is the highest. Four-screw fixation at the cranial end of occipitocervical rod group helps to reduce the PVMS and may prevent screw failure at the cranial end.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 389-400"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299484","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":"Incorporation of whole-body metabolic tumor burden into current prognostic models for nonsmall cell lung cancer patients with spine metastasis","authors":"Yoontae Hong MD ,&nbsp;Yeon-koo Kang MD, PhD ,&nbsp;Eun Bi Park MD ,&nbsp;Min-Sung Kim MD, PhD ,&nbsp;Yunhee Choi PhD ,&nbsp;Siyoung Lee MD ,&nbsp;Chang-Hyun Lee MD, PhD ,&nbsp;Jun-Hoe Kim MD ,&nbsp;Miso Kim MD, PhD ,&nbsp;Jin Chul Paeng MD, PhD ,&nbsp;Chi Heon Kim MD, PhD","doi":"10.1016/j.spinee.2024.09.012","DOIUrl":"10.1016/j.spinee.2024.09.012","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Numerous prognostic models are utilized for surgical decision and prognostication in metastatic spine tumors. However, these models often fail to consider the whole-body tumor burden into account, which may be crucial for the prognosis of metastatic cancers. A potential surrogate marker for tumor burden, whole-body metabolic tumor burden (wMTB), can be calculated from total lesion glycolysis (TLG) obtained from ¹⁸F-Fludeoxyglucose positive emission tomography (¹⁸F-FDG PET) images.</div></div><div><h3>PURPOSE</h3><div>We aimed to improve prognostic power of current models by incorporating wMTB for nonsmall cell lung cancer (NSCLC) patients with spine metastases.</div></div><div><h3>DESIGN</h3><div>Retrospective analysis using a review of electrical medical records and survival data.</div></div><div><h3>PATIENT SAMPLE</h3><div>In this study, we included 74 NSCLC patients with image proven spine metastases.</div></div><div><h3>OUTCOME MEASURES</h3><div>Increase in Integrated Discrimination Improvement (IDI) index after incorporation of wMTB into prognostic scores.</div></div><div><h3>METHODS</h3><div>Enrolled patients’ baseline data, cancer characteristics and survival status were retrospectively collected. Five widely used prognostic scores (Tomita, Katagiri, Tokuhashi, Global Spine Tumor Study Group [GSTSG], New England Spine Metastasis Score [NESMS]), and TLG indexes were calculated for all patients. The relationships among survival time, prognostic models and TLG values were analyzed. Improvement of prognostic power was validated by incorporating significant TLG index into significant current models.</div></div><div><h3>RESULTS</h3><div>Among current prognostic models, Tomita (<em>EGFR</em> wild-type), Katagiri, GSTSG and Tokuhashi were significantly related to patient survival. Among TLG indexes, LogTLG3 was significantly related to survival. Incorporation of LogTLG3 into significant prognostic models resulted in positive IDI index until 3 years in all models.</div></div><div><h3>Conclusions</h3><div>This study showed that incorporation of wMTB improved prognostic power of current prognostic models of metastatic spine tumors.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 306-316"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331032","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 prevalence of congenital cervical stenosis differs based on race.","authors":"Freddy Jacome, Sia Cho, Jason Tegethoff, Justin J Lee, David M Hiltzik, Srikanth N Divi, Alpesh A Patel, Wellington Hsu","doi":"10.1016/j.spinee.2025.01.011","DOIUrl":"10.1016/j.spinee.2025.01.011","url":null,"abstract":"<p><strong>Background: </strong>Congenital cervical stenosis (CCS) is a rare condition involving a narrowed spinal canal due to developmental anomalies. CCS heightens the risk of neurologic deficits and acute spinal cord injury posttrauma, influencing return-to-play decisions for contact athletes. Additionally, CCS patients are prone to cervical myelopathy as degenerative changes progress with age. Limited evidence-based literature exists addressing the epidemiology of CCS, including the effects of race.</p><p><strong>Purpose: </strong>To investigate the anatomical differences and prevalence of CCS as it pertains to race and ethnicity.</p><p><strong>Study design: </strong>Single center retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>A total of 343 patients with cervicalgia between the years of 1999 and 2023.</p><p><strong>Outcome measures: </strong>Radiographic measurements of anatomical parameters were collected and CCS was defined as a sagittal canal diameter (SCD) of less than 10 mm at 2 or more vertebral levels (C3-7) at the pedicle.</p><p><strong>Methods: </strong>We screened 5,395 cervical MRIs from a single institution. Exclusion criteria included patients under 18 and over 50 years, prior cervical spine surgery, congenital fusions, spinal malignancy, or active smoking history. For each patient, axial measurements were taken at each level, including coronal vertebral body length, anteroposterior vertebral body length, pedicle width, pedicle length, laminar length, anteroposterior lateral mass length, posterior canal distance, apex-to-vertebral body, lamina-disc angle (LDA), lamina-pedicle angle, and anteroposterior spinal cord diameter.</p><p><strong>Results: </strong>CCS prevalence varied significantly among ethnic groups; Black (39.3%), Asian (33.6%), and Hispanic (22%) patients demonstrated significantly higher CCS rates than White patients (7.5%) (x² [3, N=343] = 30.04, p<.05). Blacks and Asians showed consistently smaller SCDs at all pedicle levels compared to Whites, who had the largest SCDs overall (p<.001). Average SCDs were 11.4 mm (White), 10.4 mm (Black), 10.5 mm (Asian), and 11 mm (Hispanic). Additionally, LDAs were larger in Asians, Blacks, and Hispanics compared to Whites, leading to a significantly decreased cross-sectional canal area (p<.001).</p><p><strong>Conclusions: </strong>Our study indicates a statistically significant correlation between race/ethnicity and CCS prevalence. Black and Asian patients had the highest CCS rates, smallest SCDs, and largest LDAs. These anatomical differences may predispose these subjects to the development of cervical myelopathy compared to those with normal spinal canal diameters. Increased knowledge base of the epidemiology of this condition may lead to personalized clinical management and possibly early intervention to prevent spinal cord injuries in these patients.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123034","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":"Disparity in resource utilization of motion-sparing anterior cervical spine surgery: an analysis of NSQIP® and PearlDiver® database.","authors":"Muhammad Umar Jawad, Haroon M Kisana, Victoria N Greenstein, Donnell B McDonald, Norman B Chutkan","doi":"10.1016/j.spinee.2025.01.017","DOIUrl":"10.1016/j.spinee.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>Widespread racial, gender-related, socioeconomic and insurance-related disparities have been widely implicated in the utilization of new and improved surgical techniques including various aspects spinal surgery. A comprehensive analysis of such disparities is lacking for motion-preserving techniques in cervical spine surgery.</p><p><strong>Purpose: </strong>To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery.</p><p><strong>Study design/ setting: </strong>Retrospective review of large database PATIENT SAMPLE: NSQIP® database from 2010 to 2021 and PearlDiver® database from 2010 to 2022 were queried. CPT codes for cervical disc arthroplasty (CDA), and anterior cervical discectomy and fusion (ACDF) were utilized to isolate the case records (Table 1 and 3).</p><p><strong>Outcome measures: </strong>Preoperative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment.</p><p><strong>Methods: </strong>Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively.</p><p><strong>Results: </strong>A total of 5,912 and 32,625 CDA cases and 69,701 and 526,851 ACDF cases were isolated from NSQIP® and PearlDiver®, respectively. 'Younger' age, 'Asian Pacific Islander' race and elective surgery (p<.001), were associated with undergoing CDA in NSQIP® database. Presence of Type 1 diabetes, smoking and hypertension (HTN) (p<.001) were associated with undergoing ACDF in NSQIP®. PearlDiver® database showed 'Younger' age, higher area-level 'Family Income', and a higher mean percent of patients with 'private health insurance' (p<.001) were associated with undergoing CDA. Higher area level unemployment was associated with ACDF.</p><p><strong>Conclusion: </strong>Wide spread racial, gender-related, and socioeconomic disparities have been observed. Identification of these disparities is sentinel for implication of change in health-care policy mitigating issues such as underinsurance leading to establishment of health equity.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123990","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":"Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network","authors":"William Chu Kwan MD, PhD, FRCSC ,&nbsp;Tamir Ailon MD, MPH, FRCSC ,&nbsp;Nicolas Dea MD, MSc, FRCSC ,&nbsp;Nathan Evaniew MD, Msc, FRCSC ,&nbsp;Raja Rampersaud MD, FRCSC ,&nbsp;W. Bradley Jacobs MD, FRCSC ,&nbsp;Jérome Paquet MD, FRCSC ,&nbsp;Jefferson R. Wilson MD, PhD, FRCSC ,&nbsp;Hamilton Hall MD, FRCSC ,&nbsp;Christopher S. Bailey MD, FRCSC ,&nbsp;Michael H. Weber MD, PhD, FRCSC ,&nbsp;Andrew Nataraj MD, MSc, FRCSC ,&nbsp;David W. Cadotte MD, PhD, FRCSC ,&nbsp;Philippe Phan MD, MSc, FRCSC ,&nbsp;Sean D. Christie MD, FRCSC ,&nbsp;Charles G. Fisher MD, MHSC, FRCSC ,&nbsp;Supriya Singh MD, FRCSC ,&nbsp;Neil Manson MD, FRCSC ,&nbsp;Kenneth C. Thomas MD, FRCSC ,&nbsp;Jay Toor MD, FRCSC ,&nbsp;Raphaële Charest-Morin MD, FRCSC","doi":"10.1016/j.spinee.2024.09.024","DOIUrl":"10.1016/j.spinee.2024.09.024","url":null,"abstract":"<div><h3>Background Context</h3><div>Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.</div></div><div><h3>Purpose</h3><div>Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.</div></div><div><h3>Design</h3><div>This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN).</div></div><div><h3>Patient Sample</h3><div>Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021.</div></div><div><h3>Outcome Measures</h3><div>Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale.</div></div><div><h3>Methods</h3><div>Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups.</div></div><div><h3>Results</h3><div>Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, −3%, −10%, −14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI=0.81–0.90). No patient demographic or surgical factors influenced satisfaction.</div></div><div><h3>Conclusions</h3><div>Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 265-275"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision surgery rates following transforaminal lumbar interbody fusion in patients with and without osteoporosis.","authors":"Ashley Knebel, Manjot Singh, Michael J Farias, Brian McCrae, Lauren Fisher, Joseph E Nassar, Bassel G Diebo, Alan H Daniels","doi":"10.1016/j.spinee.2025.01.015","DOIUrl":"10.1016/j.spinee.2025.01.015","url":null,"abstract":"<p><strong>Background context: </strong>Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques.</p><p><strong>Purpose: </strong>To compare complications and radiographic alignment in osteoporotic versus nonosteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study.</p><p><strong>Outcome measures: </strong>The following data were observed for all cases: patient demographics, radiographic alignment, and complications.</p><p><strong>Methods: </strong>Adult patients with 2-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to 2-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF.</p><p><strong>Results: </strong>In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At 2 years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from preoperation (6.55° vs. -0.02°, p=.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment disease (p=.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=.008) than patients without osteoporosis, most commonly for adjacent segment disease.</p><p><strong>Conclusion: </strong>In this single-center multisurgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081745","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}