Spine Journal最新文献

{"title":"Abdominal aortic calcification is associated with impaired fusion after elective spinal fusion.","authors":"Marco D Burkhard, Thomas Caffard, Lukas Schönnagel, Samuel Medina, Ali E Guven, Anna-Maria Mielke, Bruno Verna, Erika Chiapparelli, Giuseppe Loggia, Alexander C Gregg, Ranqing Lan, Jennifer Shue, Federico P Girardi, Frank P Cammisa, Andrew A Sama, Alexander P Hughes","doi":"10.1016/j.spinee.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.012","url":null,"abstract":"<p><strong>Background context: </strong>The interplay between vascular compromise and spinal pathology has been underexplored in the context of spinal fusion outcomes. Abdominal aortic calcification (AAC) is associated with various degenerative spinal conditions, potentially due to impaired perfusion. However, the relationship between AAC and the success of osseous fusion mass formation following spinal fusion remains unexplored.</p><p><strong>Objectives: </strong>To investigate the association between AAC severity and fusion success following posterior lumbar spine fusion surgery.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient population: </strong>Patients undergoing open posterior lumbar fusion between 2010 and 2021 at a single institution.</p><p><strong>Outcome measures: </strong>Osseous posterolateral fusion (PLF) and interbody fusion (IBF) on computed tomography.</p><p><strong>Methods: </strong>The institutional database was queried for patients who underwent open posterior spinal fusion and had postoperative CT scans at ≥12 months. Preoperative standing lateral lumbar radiographs were assessed for aortic calcification using the AAC-24 classification, which is a score between 0 (no AAC) to 24 (most severe AAC). Fusion success was evaluated using the Lenke (PLF) and Bridwell (IBF) classifications on CT. Binary outcomes of fusion success versus impairment were created for PLF and IBF and a combined outcome of either PLF and/or IBF for a third analysis. Multivariable logistic regression was used to identify predictors of impaired fusion, including AAC, age, sex, BMI, smoking, diabetes, number of levels fused, and fusion to the sacrum.</p><p><strong>Results: </strong>A total of 207 patients were included for analysis. PLF impairment was observed in 28.5%, and IBF impairment in 22.7%. AAC was an independent predictor of impaired PLF (OR 1.10, 95% CI 1.02-1.20; p=.015) and combined PLF/IBF impairment (OR 1.16, 95% CI 1.06-1.29; p=.002). Multivariable analysis revealed, that each one-point increase in the AAC-24 score increased the odds of combined fusion impairment by 16%, and an increase of one standard deviation was associated with approximately a 2-fold increase in risk. Number of levels fused also predicted combined fusion impairment (OR 1.67, 95% CI 1.15-2.48; p=.009). No significant association was found between AAC and IBF impairment alone.</p><p><strong>Conclusions: </strong>AAC is independently associated with posterolateral fusion impairment following spinal fusion surgery. routine preoperative assessment of AAC on lateral spine radiographs may help identify patients at higher risk for impaired fusion and guide surgical decision-making. Further studies are needed to validate these findings and evaluate strategies to mitigate this risk.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057882","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":"Dynamic functional network connectivity remodeling in cervical spondylotic myelopathy: insights into postoperative neural recovery.","authors":"Bingyong Xie, Jiyuan Yao, Haoyu Ni, Zhibin Xu, Sicheng Bian, Haoxiang Wang, Kun Zhu, Peiwen Song, Yuanyuan Wu, Yongqiang Yu, Fulong Dong","doi":"10.1016/j.spinee.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.003","url":null,"abstract":"<p><strong>Background context: </strong>The longitudinal changes in large-scale brain network dynamic functional network connectivity (dFNC) and their role in postoperative recovery remain insufficiently explored.</p><p><strong>Purpose: </strong>To investigate the remodeling of brain dFNC in individuals with cervical spondylotic myelopathy (CSM), focusing on temporal characteristics and their association with neural function recovery.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Patient sample: </strong>The study included 32 CSM patients and 32 age- and sex-matched healthy controls (HCs).</p><p><strong>Outcome measures: </strong>We calculated the dFNC states and their temporal characteristics, and the correlation of these measures with improvements in clinical symptoms were assessed as key outcomes.</p><p><strong>Methods: </strong>Group independent component analysis (GICA) was employed to extract whole-brain independent components (ICs). A sliding time window and k-means clustering were utilized to identify dFNC states. Intergroup differences in connectivity were systematically compared, and correlation analyses were conducted to associate temporal variations in dFNC with clinical recovery outcomes.</p><p><strong>Results: </strong>GICA identified ten functional networks, and dFNC revealed four distinct states. Participants predominantly occupied State 1, indicated by higher mean dwell time and fractional time. Preoperatively, CSM patients showed reduced functional connectivity (FC) in the visual, default mode, and frontoparietal networks. Three months postoperatively, these patients partially regained functional connectivity in some dynamic states. Additionally, changes in fractional time (FT) in State 4 were significantly negatively correlated with improvements in neural function.</p><p><strong>Conclusions: </strong>This study offers a dynamic perspective on the remodeling of large-scale brain networks in patients with CSM following surgery. These findings elucidate the neurobiological mechanisms underlying spinal cord recovery postdecompression and suggest novel therapeutic strategies for postoperative rehabilitation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005504","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":"Biceps involvement and degree of motor deficit at diagnosis are independently predictive of timing of postoperative C5 palsy recovery.","authors":"Gregory Toci, Jonathan Dalton, Rachel Huang, Michael Carter, Robert J Oris, Rajkishen Narayanan, Andrew Kim, Julienne Jeong, Brady Stallman, Kenneth McCall, Mark F Kurd, Ian D Kaye, Barrett I Woods, Jeffrey A Rihn, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1016/j.spinee.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.04.006","url":null,"abstract":"<p><strong>Background context: </strong>C5 palsy is a debilitating complication following cervical spine surgery. This is the largest single-institution study evaluating C5 palsy and is specifically aimed at risk factors predictive of recovery timing.</p><p><strong>Purpose: </strong>To assess the impact of demographic, radiographic, and surgical factors on C5 palsy recovery timing.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Adult patients with postoperative C5 palsy following anterior cervical discectomy and fusion (ACDF), posterior cervical decompression and fusion (PCDF), combined ACDF/PCDF, or laminoplasty between 2010 and 2023.</p><p><strong>Outcome measures: </strong>C5 palsy recovery at 6 months and 1 year after surgery, postoperative opioid consumption, cervical alignment measurements including (1) C2-C7 cobb angle, (2) C2-C7 sagittal vertical axis, (3) C2 slope, (4) C2 tilt, and (5) T1slope.</p><p><strong>Methods: </strong>Demographics, surgical and radiographic variables were recorded. Patients were divided based on resolution of symptoms to the level of their preoperative strength versus persistence of symptoms at 6 months and 1 year after surgery. Appropriate statistical analysis was performed with alpha <0.05.</p><p><strong>Results: </strong>93 patients had postoperative C5 palsy (63-PCDF, 21-ACDF, 6-ACDF/PCDF, 3-laminoplasty). Patients whose C5 palsy persisted at 6 months were more likely to be male, older, and have higher Charlson Comorbidity Index. At 1 year, those with persistent symptoms were demographically similar to those with resolution. Preoperative radiographic variables (C2-C7 Cobb angle and SVA, C2 tilt and slope, and T1 slope) were not associated with recovery timing at either timepoint. Multivariable logistic regression identified biceps involvement at C5 palsy diagnosis as independently predictive of persistence of symptoms at 6 months, and degree of both biceps and deltoid weakness as predictive at both timepoints (6 months: odd ratio=1.92; p=0.005; 1 year: estimate-1.90; p=0.011). 71% of all patients recovered within 1 year.</p><p><strong>Conclusions: </strong>The presence of biceps involvement independently predicted persistence of C5 palsy at 6 months. The severity of biceps and deltoid motor deficit independently predicted persistence of C5 palsy both timepoints. Identifying these risk factors can help to inform patient counseling regarding the recovery dynamics of C5 palsy.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992454","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":"Understanding the influence of cage and instrumentation strategies with oblique lumbar interbody fusion for grade I spondylolisthesis - A comprehensive biomechanical modeling study.","authors":"Mathieu Chayer, Philippe Phan, Pierre-Jean Arnoux, Zhi Wang, Jeremy J Rawlinson, Olumide Aruwajoye, Carl-Éric Aubin","doi":"10.1016/j.spinee.2025.04.009","DOIUrl":"10.1016/j.spinee.2025.04.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Proper implant selection and placement in oblique lumbar intervertebral fusion (OLIF) are essential to achieve the best possible results for the patient. Key factors such as interbody cage length, height, angle, and material must all be carefully considered to achieve the intended results and minimize complications. Significant challenges remain in selecting the appropriate cage parameters to control spinal alignment while minimizing subsidence risk. Ongoing debates include how long a cage should be to optimize load distribution, as well as how variations in cage angle and placement influence the outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to biomechanically model and investigate how variations in interbody cage dimensions, positioning, and material properties influence indirect decompression, realignment, and resulting stresses involved in cage subsidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Computational biomechanical study of interbody cage and OLIF influence on correction outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A pathological finite element model of the L4-L5 segment presenting a grade I spondylolisthesis was used to simulate 172 different OLIF configurations, evaluating cage position (anterior, central, posterior), angle (6° or 12°), material (PEEK or titanium), length (40 to 60 mm), and height (10 to 14 mm). Bilateral pedicle screw fixation was also tested. The simulated outcomes included disc height, foraminal and spinal canal dimensions, segmental lordosis, vertebral slip, endplate stresses, and displacements under various loading conditions. Statistical comparisons were tested to analyze the influence of model, implant, and surgical parameters on correction outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Longer (left-to-right dimension) cages (60 mm), which overhang on both sides of the vertebrae and sit on the apophyseal ring, significantly reduced vertebral endplate displacements and stresses by 33% compared to shorter cages (40 mm) (p &lt; 0.05). Posterior cage positioning improved the decompression but raised stresses by 45% and reduced segmental lordosis by 28%. Lowering cage height from 14 to 10 mm and increasing the angle from 6° to 12° reduced endplate stresses by 53% and 33%, respectively. BPS fixation decreased stresses by 36% on average. The trends observed concurred with recently published OLIF clinical studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study highlights the biomechanical influence of implant characteristics and positioning on OLIF results and subsidence risks. Competing factors unveil an optimization problem that can be effectively addressed with the help of accurate, robust, and reproducible numerical simulations and regression models. This study further confirms that the developed tools not only accurately simulate the surgical approach and corroborate clinical findings but also offer a relevant framework for in-depth analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significan","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804677","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":"Factors associated with future academic faculty appointment after spine surgery fellowship training.","authors":"Jason Silvestre, Sydney Seeger, Robert A Ravinsky, James P Lawrence, James D Kang, Charles A Reitman","doi":"10.1016/j.spinee.2025.04.005","DOIUrl":"10.1016/j.spinee.2025.04.005","url":null,"abstract":"<p><strong>Background context: </strong>Understanding optimal training environments for future academic leaders is a topic of increasing interest in spine surgery.</p><p><strong>Purpose: </strong>This study determined the association between surgeon factors and future academic faculty appointment after spine surgery fellowship training.</p><p><strong>Study design/setting: </strong>This was a retrospective observational study of spine surgery fellows in the United States (2016-2017 to 2022-2023).</p><p><strong>Patient sample: </strong>N/A.</p><p><strong>Outcome measures: </strong>The primary outcome of interest was future academic faculty appointment, which was assigned if the spine surgeon was employed at a teaching hospital. Demographic, bibliometric, and training characteristics of spine surgery fellows were obtained.</p><p><strong>Methods: </strong>Bivariate analyses were performed to determine the association between surgeon factors and future academic faculty appointment.</p><p><strong>Results: </strong>There were 654 spine surgery fellows and 243 were appointed to academic faculty positions (37.2%). There was no difference in the rate of future academic faculty appointment between male and female spine surgeons (36.7% vs. 45.7%, p=.368). Allopathic graduates were more likely to obtain academic faculty positions than osteopathic graduates (40.6% vs. 12.5%, p<.001). Compared to spine surgeons in private practice, spine surgeons in academic practice had more peer-reviewed publications during medical school (1±3 vs. 0±2, p<.001) and orthopedic surgery residency training (5±13 vs. 3±5, p<.001). Several characteristics of spine surgery fellowship programs were associated with future academic faculty appointment including geographic region (p=.013), Accreditation Council for Graduate Medical Education (ACGME) accreditation status (p<.001), and a greater volume of annual fellows (p=.003).</p><p><strong>Conclusions: </strong>Several factors were associated with future academic faculty appointment in spine surgery including higher scholarly output during medical school and orthopedic residency. These data may ultimately help trainees and fellowship selection committees in spine surgery align on desired academic career objectives.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804674","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":"Preoperative teriparatide intervention is cost-effective for osteoporotic patients undergoing lumbar fusion: a break-even cost analysis.","authors":"Muhammad Waheed, Dhiraj Patel, Paul Anderson, Rakesh D Patel, Ilyas Aleem","doi":"10.1016/j.spinee.2025.04.007","DOIUrl":"10.1016/j.spinee.2025.04.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar spinal fusion is a common procedure increasingly being performed in older patients many of whom have poor bone quality. Poor bone quality is associated with increased risk of bone related complications and need for revision surgery. Preoperative bone health optimization has been proposed to address this poor bone health using anti-osteoporosis medications. However, there remains ongoing controversy regarding the use of bisphosphonates and teriparatide for osteoporotic patients and few studies have explored the cost-effectiveness of teriparatide in lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The aim of the study is to determine the cost-effectiveness, quantified in terms of absolute risk reduction (ARR) and number needed to treat (NNT), of teriparatide to prevent symptomatic pseudarthrosis following lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Economic analysis, Level of Evidence 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;The present break-even analysis considers simulated patients with and without osteoporosis undergoing primary posterior lumbar spinal fusion. The analysis is independent of the total number of annual surgeries and can be applied to any sized cohort of patients with osteoporosis undergoing primary posterior lumbar spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;We calculated the final break-even cost rate of pseudoarthrosis, the absolute risk reduction, and the number need to treat to prevent one symptomatic pseudoarthrosis event while breaking even on cost utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The MEDLINE database was queried for prior literature regarding the cost of teriparatide and revision lumbar fusion surgery for symptomatic pseudarthrosis in the United States as well as the rate of symptomatic bony nonunion in osteoporotic patients undergoing spinal fusion. Two break-even cost analyses were performed utilizing the surgical cost alone and the total overall cost to calculate the ARR in pseudarthrosis required to deem teriparatide as cost-effective. The ARR was then used to calculate the number of patients that would require teriparatide, NNT, to prevent one pseudarthrosis event while breaking-even on overall cost expenditure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;When observing surgical cost alone, daily-use teriparatide was determined to be positively cost effective at initial rates of pseudarthrosis &gt;53.4% in osteoporotic patients. Utilization of the total overall cost in our break-even model showed daily-use teriparatide to be cost effective when the initial nonunion rate exceeded 30.6%. Teriparatide was not cost-effective at lower initial rates of pseudarthrosis for osteoporotic patients. In both scenarios of investigating total overall cost and surgical cost alone, the ARR decreases as the cost of symptomatic pseudarthrosis treatment rises. At higher costs of revision surgery and higher initial pseudarthrosis rates, teriparatide becom","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804676","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":"Accelerated biological aging in patients with degenerative spine diseases: the impact of modifiable lifestyle factors on phenotypic age.","authors":"Mitsuru Yagi, Ryo Mizukoshi, Ryosuke Maruiwa, Norihiro Isogai, Haruki Funao, Retsu Fujita","doi":"10.1016/j.spinee.2025.04.001","DOIUrl":"10.1016/j.spinee.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>Aging is influenced by genetic, environmental, and lifestyle factors, and chronological age alone may fail to capture one's true biological aging. Degenerative spinal disease (DSD) is associated with accelerated health decline, which could manifest as an increased Phenotypic Age (PhenoAge).</p><p><strong>Purpose: </strong>This study aimed to investigate the association between Phenotypic Age (PhenoAge) and degenerative spine disease (DSD) in a Japanese population using a cross-sectional analysis complemented by a follow-up analysis, while also exploring the impact of modifiable lifestyle factors on biological aging.</p><p><strong>Design/setting: </strong>A cross-sectional design was employed using data from a large health examination program in Japan.</p><p><strong>Patient sample: </strong>A total of 10,205 individuals who underwent health examinations formed the reference cohort. Separately, 2 distinct clinical cohorts were analyzed: an OA cohort of 306 patients with hip or knee osteoarthritis who underwent arthroplasty, and a DSD cohort of 397 patients with adult spinal deformity (ASD) or lumbar spinal stenosis (LSS) who also underwent surgery.</p><p><strong>Outcome measures: </strong>PhenoAge was calculated using clinical biomarkers, and the difference between PhenoAge and chronological age was expressed as PhenoAgeAccel. Additional inflammatory and metabolic markers (e.g., CRP, WBC) were evaluated alongside lifestyle factors such as smoking status, body mass index, and physical activity.</p><p><strong>Method: </strong>Propensity score matching was used to compare PhenoAge between patients and controls. Linear regression examined the influence of lifestyle factors on PhenoAgeAccel. A subgroup analysis assessed differences between ASD and LSS, as well as between hip OA and knee OA. Individuals re-examined in 2023 were followed to evaluate the 3-year change in PhenoAgeAccel.</p><p><strong>Results: </strong>Japanese participants had a mean PhenoAgeAccel of -8.0±4.0 years (p<.01, Cohen's d=0.8). DSD patients showed a 4.2-year elevation in PhenoAge over controls, accompanied by higher CRP and WBC levels (both p<.01 Cohen's d=0.65). Subgroup analyses revealed no significant differences in PhenoAge between ASD versus LSS or hip OA versus knee OA. Smoking (β=0.6; p<.01) and obesity (β=1.5; p<.01) raised PhenoAgeAccel, while physical activity lowered it (β=-0.2; p=.03). Nonrisk individuals improved by -0.5 years, whereas risk individuals worsened by +0.5 years over 3 years.</p><p><strong>Conclusion: </strong>These findings suggest that PhenoAge may serve as a more sensitive marker of biological aging in DSD patients, although the retrospective design and potential confounding variables warrant cautious interpretation.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804672","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":"Health literacy and patient-reported outcomes in preoperative patients undergoing lumbar spine surgery: a cross-sectional study.","authors":"Issei Higashino, Nobuhiro Takiguchi, Shohei Egi, Seiichi Odate, Kazuaki Morizane, Kazuki Uemura","doi":"10.1016/j.spinee.2025.04.010","DOIUrl":"10.1016/j.spinee.2025.04.010","url":null,"abstract":"<p><strong>Background context: </strong>Health literacy (HL) plays an important role in health outcomes (e.g., Activities of Daily Living and Quality of Life) among patients with chronic diseases and elderly persons. The association between functional HL and health outcomes in patients with lumbar degenerative disease has also been revealed. Comprehensive HL includes 3 levels of functional, communicative, and critical HL that may affect the health outcomes of patients undergoing lumbar spine surgery. However, the association between comprehensive HL and health outcomes in patients undergoing lumbar spine surgery has not yet been investigated.</p><p><strong>Purpose: </strong>To examine the impact of comprehensive HL on patient-reported outcomes (PROs) of pain-related disabilities and health-related quality of life in patients undergoing lumbar spine surgery.</p><p><strong>Study design/setting: </strong>Cross-sectional study.</p><p><strong>Patient sample: </strong>Patients aged 18 years or older who presented to a general hospital-based spine center for the surgical treatment of lumbar degenerative disease.</p><p><strong>Outcome measures: </strong>Oswestry Disability Index 2.0 (ODI), EuroQol-5D-5L (EQ-5D-5L).</p><p><strong>Methods: </strong>Between June 2023 and May 2024, consecutive patients aged 18 years or older presenting to the spine center were approached for participation in this cross-sectional study. Patients completed a questionnaire concerning sociodemographic characteristics; Functional, Communicative, and Critical Health Literacy (FCCHL); and PROs, including ODI and EQ-5D-5L. A multivariable linear regression analysis with potential confounders was performed to examine the relationship between FCCHL and PROs.</p><p><strong>Results: </strong>Of 128 eligible patients, 124 (97%) were included in the statistical analysis. Higher total FCCHL score was significantly associated with better PROs (ODI (regression coefficient, -10.6; [95% confidence interval, -17.6, -3.6]), EQ-5D-5L (0.093 [0.022, 0.165])) in a linear dose-response manner. Functional HL was not associated with PROs; however, communicative and critical HL were both associated with PROs.</p><p><strong>Conclusions: </strong>Higher comprehensive HL, including functional, communicative, and critical HL, was associated with better PROs, characterized by lower ODI and higher EQ-5D-5L scores, in a linear dose-response manner in patients undergoing lumbar spine surgery. Our study suggests that comprehensive HL is important to prevent disabilities in daily life due to lumbar degenerative disease.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804675","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":"Effect of enhanced surgical recovery program for thoracolumbar spine surgery on opioid use, length of hospital stay, and hospital readmissions: evaluation of 51,236 cases.","authors":"Christopher R Good, Shay Bess, Lindsay D Orosz, Stephen S Scibelli, Breton Line, Gina Remington, Cecile Roman, Daniel Luckett, Ehsan Jazini","doi":"10.1016/j.spinee.2025.04.011","DOIUrl":"10.1016/j.spinee.2025.04.011","url":null,"abstract":"<p><strong>Background context: </strong>Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and postoperative phases of surgery. Smaller studies suggest several benefits of spine surgery ESR; this study evaluates the effects of ESR for thoracolumbar (TL) fusion surgery on a national scale.</p><p><strong>Purpose: </strong>Determine if ESR is associated with a reduction in daily morphine milligram equivalents (MME), length of hospital stay (LOS), and 30-day readmission (READMIT) rates compared to non-ESR controls.</p><p><strong>Study design: </strong>Multicenter, retrospective, case-control study of a prospectively adopted healthcare system ESR program from October 2018 to December 2021.</p><p><strong>Patient sample: </strong>Consecutive adult patients undergoing TL fusion with known ESR participation status and without a primary diagnosis of tumor, infection, or trauma were included.</p><p><strong>Outcomes measures: </strong>Primary outcomes include daily MME, LOS, and 30-day READMIT rates. Outcomes were analyzed for single-level, multi-level, and all TL fusions.</p><p><strong>Methods: </strong>Data from TL fusion procedures performed within a large healthcare system were extracted from hospital-based electronic medical records derived from 1352 surgeons within 138 facilities. Patients were divided as ESR (cases) or non-ESR (controls) based upon enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia, and (5) early postoperative nutrition and ambulation. Outcomes were compared between groups.</p><p><strong>Results: </strong>Of 51,236 TL fusion cases (45% male, mean age of 63 years), 24,391 participated in an ESR program and 26,845 did not. For single-level TL fusions, ESR was associated with decreased MME (β= -8.76, p<.001), LOS (β= -8.85, p<.001), and READMIT (OR=0.77, 95% CI: 0.67-0.88) compared to controls. For multi-level TL fusions, ESR was associated with decreased MME (β= -7.32, p<.001) and LOS (β= -12.14, p<.001) compared to controls. For all TL fusions, ESR was associated with decreased MME (β= -7.94, p<.001), LOS (β= -10.54, p<.001), and READMIT (OR=0.91, 95% CI: 0.84-0.98) compared to non-ESR controls.</p><p><strong>Conclusions: </strong>This national healthcare system analysis of over 50,000 TL spine fusion cases by 1,352 surgeons at 138 centers across the US confirms that ESR adoption is associated with decreased daily MME, LOS, and READMIT compared to non-ESR controls. Surgeons should consider adoption of ESR programs to improve patient care.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804673","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":"Impact of spinal alignment on adjacent segment disease and degeneration after short-segment lumbosacral fusion.","authors":"Giuseppe Loggia, Mazda Farshad, Moritz Jokeit, Jonas Widmer, Stefani Dossi, Marco D Burkhard","doi":"10.1016/j.spinee.2025.03.032","DOIUrl":"10.1016/j.spinee.2025.03.032","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Adjacent segment disease (ASDis) and degeneration (ASDeg) are common complications following lumbar fusion, ranging from asymptomatic radiographic changes to debilitating symptoms requiring revision surgery. While the impact of spinopelvic alignment (SPA) on postoperative outcomes and ASDis prevention is well-studied in long-construct fusions, its role in short-segment lumbosacral fusions, particularly over the long term, remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the association between global and distal lumbar SPA with the development of ASDis and ASDeg in the long-term follow-up of patients undergoing short-segment lumbosacral fusion. Secondary outcomes were patient reported outcome measures (PROMs) in relation to adjacent segment changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective single-center cohort study with minimum follow-up of 5 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;A total of 86 patients who underwent L4-S1 spinal fusion between 2003 and 2015, with a mean follow-up of 12±4 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was the development of adjacent segment changes, classified into 2 groups: (1) surgically-treated ASDis, and (2) ASDeg, defined as radiographic evidence of adjacent segment changes without surgical intervention. Secondary outcomes included PROMs: the Oswestry Disability Index (ODI) and the European Quality of Life 5 Dimensions 5 Level (EQ5D5L).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Pre- and postoperative standing radiographs were annotated and the following global lumbar SPA parameters analyzed: Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), PI-LL-mismatch, lumbar pelvic angle (LPA). Additionally, the following distal lumbar SPA parameters were analyzed: Distal lordosis (DL) between L4-S1, lordosis distribution index (LDI=DL/LL), PI-DL-difference, DL-PI-ratio, adjacent segment lordosis (ASL). Postoperative ODI and EQ5D5L were assessed via a telephone interview.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 86 patients with a mean follow-up of 12±4 years the incidence of ASDis was 27.9% (n=24), while 7.0% (n=6) showed ASDeg. No significant differences in pre- and postoperative global lumbar SPA were found in patients who developed ASDis or ASDeg compared to patients who did not. PI (53.6° vs. 59.6°) and preoperative SS (34.9° vs. 40.3°) trended to be lower in the ASDis group compared to controls, although non-significant. Pre- and postoperative distal lumbar SPA parameters did not differ between groups. Patients with adjacent segment changes, regardless of whether they underwent revision surgery, reported worse PROMs. ODI scores were elevated in both the ASDis group (28, IQR 15-42) and the ASDeg group (34, IQR 14-47) compared to controls (10, IQR 2-24; p=.005). EQ5D5L scores were lower in both the ASDis (70, IQR 53-83) and the ASDeg groups (60, IQR 55-85) compared to controls (8","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789305","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}