Spine Journal最新文献

{"title":"Preoperative anemia is an unsuspecting driver of machine learning prediction of adverse outcomes after lumbar spinal fusion.","authors":"Attri Ghosh, Philip J Freda, Shane Shahrestani, Andre E Boyke, Alena Orlenko, Hyunjun Choi, Nicholas Matsumoto, Tayo Obafemi-Ajayi, Jason H Moore, Corey T Walker","doi":"10.1016/j.spinee.2025.01.031","DOIUrl":"10.1016/j.spinee.2025.01.031","url":null,"abstract":"<p><strong>Background context: </strong>Preoperative risk assessment remains a challenge in spinal fusion operations. Predictive modeling provides data-driven estimates of postsurgical outcomes, guiding clinical decisions and improving patient care. Moreover, automated machine learning models are both effective and user-friendly, allowing healthcare professionals with minimal technical expertise to identify high-risk patients who may need additional preoperative support.</p><p><strong>Purpose: </strong>This study investigated the use of automated machine learning models to predict discharge disposition, length of hospital stay, and readmission postsurgery by analyzing preoperative patient electronic medical record data and identifying key factors influencing adverse outcomes.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>The sample includes electronic medical records of 3,006 unique surgical events from 2,855 patients who underwent lumbar spinal fusion surgeries at a single institution.</p><p><strong>Outcome measures: </strong>The adverse outcomes assessed were discharge disposition (nonhome facility), length of hospital stay (extended stay), and readmission within 90 days postsurgery.</p><p><strong>Methods: </strong>We employed several inferential and predictive approaches, including the automated machine learning tool TPOT2 (Tree-based Pipeline Optimization Tool-2). TPOT2, which uses genetic programming to select optimal machine learning pipelines in a process inspired by molecular evolution, constructed, optimized and identified robust predictive models for all outcomes. Feature importance values were derived to identify major preoperative predictive features driving optimal models.</p><p><strong>Results: </strong>Adverse outcome rates were 25.9% for discharge to nonhome facilities, 23.9% for extended hospital stay, and 24.7% for readmission within 90 days postsurgery. TPOT2 delivered the best-performing predictive models, achieving balanced accuracies ([Sensitivity {true positive rate} + Specificity {true negative rate}]) / 2) of 0.72 for discharge disposition, 0.72 for length of stay, and 0.67 for readmission. Notably, preoperative hemoglobin emerged as a consistently strong predictor in best-performing models across outcomes. Patients with severe anemia (hemoglobin <80g/dL) demonstrated higher associations with all adverse outcomes and common comorbidities associated with frailty (e.g., hypertension, type II diabetes, and chronic pain). Additional patient variables and comorbidities, including body mass index, age, and mental health status, influencing postsurgical outcomes were also highly predictive.</p><p><strong>Conclusions: </strong>This study demonstrates the effectiveness of automated machine learning in predicting postsurgical adverse outcomes and identifying key preoperative predictors associated with such outcomes. While factors like age, BMI, insurance type, and sp","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of body posture on cervical alignment measured in the sagittal plane on conventional radiographs: a systematic review.","authors":"Esther van Santbrink, Valérie Schuermans, Ank van de Goor, Rob de Bie, Toon Boselie, Henk van Santbrink, Anouk Smeets","doi":"10.1016/j.spinee.2025.01.037","DOIUrl":"10.1016/j.spinee.2025.01.037","url":null,"abstract":"<p><strong>Background context: </strong>Cervical sagittal balance parameters are an important aid in surgical decision-making and influence outcome in cervical spine surgery. In current literature, the normative values of these parameters vary highly within and between patients. This variability might be attributed to body posture.</p><p><strong>Purpose: </strong>The primary aim is to review the literature on the influence of body posture, including studies that compare sitting or standing positions possibly varying in arm positions, on cervical alignment measured in the sagittal plane on X-rays.</p><p><strong>Study design: </strong>A systematic review was performed.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, and CINAHL were systematically searched for articles published up to and including May 2024. The primary outcome was variability in cervical alignment in the sagittal plane as measured in altering body postures on X-rays. Quality of the included articles was assessed with the QUADAS-2 tool.</p><p><strong>Results: </strong>Out of 17,628 screened articles, 8 were eligible for inclusion. Articles were excluded based on irrelevant outcomes (n=10,372), duplicates (n=4,315), wrong study design (n=1,462), or the influence of body posture was not described (n=612). Overall cervical alignment ranged from 33.3 degrees lordosis to 3.5 degrees kyphosis. In all studies, statistically significant differences in T1 Slope (T1S), C2C7 Sagittal Vertical Axis (SVA), McGregor Slope (McGS), or C7 SVA were observed with respect to body posture. The observed differences between postures for cervical alignment ranged from 1 to 16.6 degrees.</p><p><strong>Conclusions: </strong>Body posture significantly influences cervical alignment values measured in the sagittal plane on X-rays. Studies investigating this influence are scarce and vary highly in investigated body postures. Standardization of body posture is imperative to enable optimal comparison of cervical sagittal balance parameters within and between patients, but also between studies. Moreover, the high variability observed raises questions about the comparability of measured values in previously published studies.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076171","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":"Radiographic severity of knee osteoarthritis in adult spinal deformity: the effect on rod fracture after long spinal fusion in deformity correction.","authors":"Ki Young Lee, Jung-Hee Lee, Gil Han, Cheol-Hyun Jung, Min Sung Kim","doi":"10.1016/j.spinee.2025.01.028","DOIUrl":"10.1016/j.spinee.2025.01.028","url":null,"abstract":"<p><strong>Background context: </strong>Instrumentation failure, notably rod fracture (RF), may occur even after ideal spinal deformity correction in adult spinal deformity (ASD). As RF is the major reason behind a revision surgery, various risk factors of RF are reported in literature, including pedicle subtraction osteotomy (PSO) technique itself. However, whether hip and knee joint diseases serve as another risk factor for RF remains unexplored.</p><p><strong>Purpose: </strong>To investigate the effects of lower-extremity joint diseases on RF in ASD patients who underwent deformity correction through long-segment fixation with PSO.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Patient sample: </strong>About 96 consecutive ASD patients (mean age, 71.2 years) who underwent deformity correction through PSO and long-segment fixation from T10 to S1 between 2008 and 2019 were included. Those with radiographic data less than 2 years were excluded.</p><p><strong>Outcome measures: </strong>RF was confirmed on radiograph, computed tomography (CT) and bone scan or SPECT images. Coronal and sagittal spinopelvic parameters, lower-extremity osteoarthritis (OA) parameters and clinical outcomes (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) were analyzed.</p><p><strong>Methods: </strong>Radiographic measurements were performed at preoperative, postoperative, and last follow-up visits. Patients were divided into 2 groups: non-RF (n=60) and RF (n=36). Radiographic factors were assessed, correlations between parameters were examined, and multivariate logistic regression analysis was performed to evaluate risk factors for RF.</p><p><strong>Results: </strong>Structural and functional leg length discrepancies (LLDs), pelvic obliquity (PO), and the differences of mechanical axis (MAD) between both extremities had significantly differed between the groups (p<.05). The between-knee differences in the extent of OA, clinically significant MAD and PO, and the incidences of both structural and functional LLD were significantly greater in the RF group than in the non-RF group (p<.05). On correlation analysis, PO was not correlated with coronal radiographic parameters but was correlated with structural and functional LLDs and MAD (p<.05). Logistic analysis revealed that the difference in OA grade between the knee joints, functional LLD, and preoperative lower extremity surgery were significantly associated with RF (p<.05).</p><p><strong>Conclusion: </strong>ASD in the elderly often presents alongside degenerative changes in the lower-extremities, and even with ideal spinal deformity correction, RF may still occur if preexisting joint pathologies are not resolved. In the deformity correction of ASD, it is essential that we not only pursue the restoration of spinopelvic harmony, but also apply perioperative measures for lower-extremity degenerative joint diseases.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076165","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":"What is the learning curve for endoscopic spine surgery? A comprehensive systematic review.","authors":"Justin P Chan, Thomas Olson, Beshoy Gabriel, Sohaib Hashmi, Hao-Hua Wu, Hansen Bow, Yu-Po Lee, Nitin Bhatia, Michael Oh, Don Y Park","doi":"10.1016/j.spinee.2025.01.004","DOIUrl":"10.1016/j.spinee.2025.01.004","url":null,"abstract":"<p><strong>Background context: </strong>Endoscopic spine surgery (ESS) is rapidly emerging as a viable minimally invasive technique to successfully treat symptomatic degenerative spinal conditions. Widespread adoption has been limited in part due to the learning curve.</p><p><strong>Purpose: </strong>To systematically review the learning curve for uniportal and biportal ESS and compare the 2 techniques.</p><p><strong>Study design/setting: </strong>A systematic review based on PRISMA guidelines.</p><p><strong>Patient sample: </strong>About 29 studies were included with 18 studies investigating uniportal learning curves and 11 biportal studies. There were 1,493 patients across all uniportal studies. There was a total of 1,005 patients across all biportal studies.</p><p><strong>Outcome measures: </strong>Number of patients, technique type, patient reported outcomes, complications, operative time before the learning curve threshold, operative time after learning curve threshold, number of cases required to meet threshold, number of surgeons in the study, and cases per surgeon were collected and analyzed.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, Medline, and Embase from 2000 to present date. Data was extracted by 3 independent reviewers.</p><p><strong>Results: </strong>The learning curve studies were reviewed and summarized. The overall median number of cases to reach the learning curve threshold was significantly less in uniportal vs biportal studies (20 vs. 37.5, p=.0463). When stratifying by various procedures, there was no significant difference between the techniques with number of cases required or improvement of operative time. Operative time for biportal discectomies decreased by a significantly greater amount vs uniportal. (44.5% vs. 21.4%, p=.0332).</p><p><strong>Conclusions: </strong>The learning curve literature for ESS was systematically reviewed and ways to overcome the learning curve were discussed. The overall median number of cases for the learning curve was significantly fewer in uniportal vs biportal but the improvement in operative time was significantly greater with biportal discectomies, typically the entry level procedure by novice surgeons. Overcoming the learning curve for ESS is a critical factor to widespread adoption and understanding it may aid surgeons in progressing to proficiency while mitigating the risk of complications.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069166","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":"Upright versus recumbent lumbar spine MRI: Do findings differ systematically, and which correlates better with pain? A systematic review.","authors":"Klaus Doktor, Henrik Wulff Christensen, Tue Secher Jensen, Mark J Hancock, Werner Vach, Jan Hartvigsen","doi":"10.1016/j.spinee.2024.12.034","DOIUrl":"10.1016/j.spinee.2024.12.034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Recumbent MRI is the most widely used image modality in people with low back pain (LBP), however, it has been proposed that upright (standing) MRI has advantages over recumbent MRI because of its ability to assess the effects of being weight-bearing. It has been suggested that this produces systematic differences in MRI parameters and differences in the correlation between MRI parameters and pain or disability in patients thus, potentially adding clinically helpful information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This paper aims to review and summarize the available empirical evidence for or against these 2 hypotheses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review of the literature (PROSPERO ID: CRD42017048318). Studies should be based on paired observations of MRI findings in the upright and recumbent positions. Studies needed a minimum of 15 participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient/participant sample: &lt;/strong&gt;People aged 18 or older with or without low back pain ± radiculopathy OUTCOME MEASURES: All continuous, ordinal, and dichotomous parameters based on MRI images. All measures of pain or disability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Studies assessing MRI parameters both in upright and recumbent positions on the same individuals measured on continuous, ordinal, or dichotomous scales were included. For each parameter, the expected direction of the difference between recumbent and upright position was specified as an increase, no change, or decrease. Information on the observed distribution of individual differences was extracted from included studies and subjected to meta-analyses if sufficient data was available. Observed differences were then compared with the prespecified expectations. Studies were also screened for information on correlations between patients' pain and/or disability and MRI parameters or differences between patient subgroups defined by patients' pain and/or disability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;About 19 studies were identified, including 5,082 participants with LBP (16 studies) and 166 participants without low back pain (5 studies). Twenty-five MRI parameters were measured on a continuous scale, ten parameters were assessed on an ordinal scale, and 15 parameters were reported as dichotomous data. The observed differences between recumbent and upright MRI were mostly consistent with the prespecified expectations. Correlations between patients' pain or disability level and MRI parameters were reported in only 1 study, and three studies reported comparisons of MRI parameters across subgroups of patients defined by pain or disability characteristics. Higher correlations or larger effect sizes when using the upright position were observed in most results reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For most MRI parameters, the direction of the observed difference between assessment in recumbent and upright positions aligned with the prespecified expectation implied by the wei","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042964","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":"Evaluating variability in decision-making among spine surgeons treating adult spine deformity.","authors":"Mark Abdelnour, Rohail Mumtaz, Mamdoh Al Hawsawi, Feras Qumqumji, Ganesh Swamy, Kenneth Thomas, Alex Soroceanu, Zhi Wang, Alexandra Stratton, Stephen P Kingwell, Eugene Wai, Eve Tsai, Philippe Phan","doi":"10.1016/j.spinee.2025.01.003","DOIUrl":"10.1016/j.spinee.2025.01.003","url":null,"abstract":"<p><strong>Background context: </strong>Significant variability in the management of Adult Spinal Deformity (ASD) has been observed among spine surgeons worldwide. The variability among Canadian spine surgeons, a country with universal public healthcare, remains unknown.</p><p><strong>Purpose: </strong>The study aims to evaluate areas of variability in the perioperative optimization and surgical management of ASD among Canadian spine surgeons.</p><p><strong>Study design/setting: </strong>In this cross-sectional study, 25 Canadian spine surgeons, predominantly orthopedic surgeons (20) and neurosurgeons (5) with varying experience, participated in an online survey focused on Adult Spinal Deformity (ASD).</p><p><strong>Sample: </strong>The study involved 25 Canadian spine surgeons with varying level of experience, representing both orthopedic and neurosurgical specialities.</p><p><strong>Outcome measure: </strong>The study aimed to evaluate the variability in surgical decision-making and perioperative optimization strategies among Canadian spine surgeons when faced with simulated scenarios of ASD pathologies.</p><p><strong>Methods: </strong>The online survey presented 4 vignettes with simulated scenarios of the most common ASD pathologies, including High Grade Spondylolisthesis (HGS), Neglected Adolescent Idiopathic Scoliosis (NAIS), Degenerative Scoliosis (DS), and Flat Back Syndrome (FBS). Questions in the vignettes explored ASD surgical decision-making, while additional questions focused on perioperative optimization. Descriptive statistics were used to analyze multiple-choice responses, and open-text responses were categorized into themes.</p><p><strong>Results: </strong>Variability was observed in the duration conservative treatment across the 4 ASD cases. Surgeons exhibited variability in the use of preoperative osteoporosis treatment. There was varied use of a dedicated anesthesiology team. Surgical goals varied in HGS and NAIS. The primary surgical method was variable in DS and HGS, the type of osteotomy varied in DS and FBS, and level of fixation varied in HGS and NAIS. Consensus was observed in the use of intraoperative monitoring across of all 4 ASD pathologies, the implementation of a team-based approach, and the selection of the primary surgical goal in DS and FBS.</p><p><strong>Conclusion: </strong>Our cross-sectional study revealed variability among Canadian spine surgeons in the management of ASD, potentially influenced by the uncertain ASD progression, the need for evidence-based nonsurgical guidelines, and insufficient evidence on optimal surgical approaches. These findings will help guide future research to ultimately reduce variability and improve ASD patient management and outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014345","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":"Should dry spinal tuberculosis be managed differently than wet spinal tuberculosis?","authors":"Yash Prakash Ved, Tushar Rathod, Deepika Jain, Maulik Kothari","doi":"10.1016/j.spinee.2025.01.002","DOIUrl":"10.1016/j.spinee.2025.01.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;On radiopathological examination of spinal tuberculosis (TB), 2 predominant forms are known: dry and wet types. Wet TB, as the name suggests, has abscess formation as its predominant presenting feature and is the exudative form; dry TB includes caseation and sequestration with minimal exudate. Dry TB often exhibits poorer recovery patterns than the wet counterparts, which can be possibly ascribed to vasculitis, ischemia, or tubercular myelitis, rather than isolated mechanical compression. These pathologic processes may lead to neurological deficit which is less responsive to treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To quantify the recovery and prognosis, and test for the significance of difference between neurological recovery pattern and prognosis of the 2 forms of spinal TB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A retrospective analytical observational study design in the form of a cohort study was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Single-center patient data over 6 years was analyzed. Of 217 patients with spinal TB, 18 had dry TB (Group 1). Two patients were excluded because they presented very late after the onset of neurological deficit, which could have played a role in the nonrecovering nature of motor weakness. The remaining patients had wet TB, of which 22 patients were selected for propensity score matching to form a comparison group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Radiological measures included vertebral body height loss, deformity, canal encroachment, cord diameter, altered cord signal intensity and loss of CSF space. Functional measures were ambulatory status of the patient at final follow-up and neurologic status measured by ASIA (American Spinal Injury Association) and LEMS (Lower Extremity Motor Score) scoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The criteria for dry TB were imaging suggestive of granulation tissue (heterogenous hypo- or hyper-intensity on T2WI sequence), with at least 1 of the 2 factors (1) absence of anterior or posterior epidural abscess formation within the spinal canal (2) a canal encroachment of &lt;30%. The groups were compared with respect to their differences in demographic distribution, symptom complex, mycobacterial drug sensitivity and presence of history of tuberculosis elsewhere in the body. Analysis was done by various tests of significance depending on the type of variable. Bar charts and Pie charts were used for visual representation of the analyzed data. Level of significance was set at 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Dry TB showed partial or no return to ambulation (75% vs. 31.5% in wet, p=.01) at 12-months and took more time to reach final ambulatory level (9.16 months vs. 2.9 months in wet), despite having a lower average Cobb angle (16.5 degrees versus 20.95 in wet (p=.132), lower mean canal-encroachment (24.9% vs. 50.09% in wet, p&lt;.01) and preserved posterior-CSF flow as compared to wet TB (p=.02). At final follow-up, 4/16 (25%) of d","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014841","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":"Chronic low back pain causal risk factors identified by Mendelian randomization: a cross-sectional cohort analysis.","authors":"Patricia Zheng, Aaron Scheffler, Susan Ewing, Trisha F Hue, Sara Jones Berkeley, Saam Morshed, Wolf Mehling, Abel Torres-Espin, Anoop Galivanche, Jeffrey Lotz, Thomas Peterson, Conor O'Neill","doi":"10.1016/j.spinee.2024.12.029","DOIUrl":"10.1016/j.spinee.2024.12.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;There are a number of risk factors- from biological, psychological, and social domains- for nonspecific chronic low back pain (cLBP). Many cLBP treatments target risk factors on the assumption that the targeted factor is not just associated with cLBP but is also a cause (i.e., a causal risk factor). In most cases this is a strong assumption, primarily due to the possibility of confounding variables. False assumptions about the causal relationships between risk factors and cLBP likely contribute to the generally marginal results from cLBP treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The objectives of this study were to a) using rigorous confounding control compare associations between modifiable causal risk factors identified by Mendelian randomization (MR) studies with associations in a cLBP population and b) estimate the association of these risk factors with cLBP outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Cross sectional analysis of a longitudinal, online, observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;1,376 participants in BACKHOME, a longitudinal observational e-Cohort of U.S. adults with cLBP that is part of the NIH Back Pain Consortium (BACPAC) Research Program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Pain, Enjoyment of Life, and General Activity (PEG) Scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Five risk factors were selected based on evidence from MR randomization studies: sleep disturbance, depression, BMI, alcohol use, and smoking status. Confounders were identified using the ESC-DAG approach, a rigorous method for building directed acyclic graphs based on causal criteria. Strong evidence for confounding was found for age, female sex, education, relationship status, financial strain, anxiety, fear avoidance and catastrophizing. These variables were used to determine the adjustment sets for the primary analysis. Potential confounders with weaker evidence were used for a sensitivity analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants had the following characteristics: age 54.9±14.4 years, 67.4% female, 60% never smokers, 29.9% overweight, 39.5% obese, PROMIS sleep disturbance T-score 54.8±8.0, PROMIS depression T-score 52.6±10.1, Fear-avoidance Beliefs Questionnaire 11.6±5.9, Patient Catastrophizing Scale 4.5±2.6, PEG 4.4±2.2. In the adjusted models, alcohol use, sleep disturbance, depression, and obesity were associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. The adjusted effect estimates- the expected change in the PEG outcome for every standard deviation increase or decrease in the exposure (or category shift for categorical exposures) were the largest for sleep disturbance and obesity. Each SD increase in the PROMIS sleep disturbance T-score resulted in a mean 0.77 (95% CI: 0.66, 0.88) point increase in baseline PEG score. Compared to participants with normal BMI, adjusted mean PEG score was slightly h","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015077","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":"Appropriate use criteria for neoplastic compression fractures.","authors":"Charles H Cho, Jeffrey M Hills, Paul A Anderson, Thiru M Annaswamy, R Carter Cassidy, Chad M Craig, Russell C DeMicco, John E Easa, D Scott Kreiner, Daniel J Mazanec, John E O'Toole, George Rappard, Robert A Ravinsky, Andrew J Schoenfeld, John H Shin, Gregory L Whitcomb, Charles A Reitman","doi":"10.1016/j.spinee.2024.12.028","DOIUrl":"10.1016/j.spinee.2024.12.028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Clinical outcomes are directly related to patient selection and treatment indications for improved quality of life. With emphasis on quality and value, it is essential that treatment recommendations are optimized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) is to determine the appropriate (ie, reasonable) multidisciplinary treatment recommendations for patients with metastatic neoplastic vertebral fractures across a spectrum of more common clinical scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A Modified Delphi process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Systematic Review OUTCOME MEASURES: Final rating for cervical fusion recommendation as either \"Appropriate,\" \"Uncertain,\" or \"Rarely Appropriate\" based on the median final rating among the raters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The methodology was based on the AUC development process established by the Research AND Development (RAND) Corporation. The topic of neoplastic vertebral fracture was selected by NASS for its Clinical Practice Guideline development (CPG). In conjunction, the AUC work group determined key modifiers and adopted the standard definitions developed by CPG, with minimal modifications. A literature search and evidence analysis performed by the CPG were reviewed by the AUC work group. A separate multidisciplinary rating group was assembled. Based on the literature, provider experience, and group discussion, each scenario was scored on a 9-point scale on 2 separate occasions, once without discussion and then a second time following discussion based on the initial responses. The median rating for each scenario was then used to determine if indications were rarely appropriate (1-3), uncertain / maybe appropriate (4-6), or appropriate (7-9). Consensus was not mandatory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Medical management was essentially always appropriate. Radiation therapy was appropriate 50% of the time and uncertain otherwise, and directly related to radiosensitivity of the tumor. Ablation was never rated appropriate with agreement, and about 50% of the time was rated as uncertain. For cement augmentation, the scenarios without stenosis or neurological changes, stable fractures with less than 80% height loss and intact posterior wall, and higher VAS pain scores accounted for 88% probability of an appropriate rating. Otherwise, cement augmentation was uncertain 68% of the time. Surgery was rated as appropriate with agreement in 35%, and uncertain or appropriate with disagreement in 59% of scenarios. The most important variables determining final rating for surgery (in order) were stability, spinal stenosis, and prognosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Multidisciplinary appropriate treatment criteria were generated based on the RAND methodology. Recommendations were made for medical treatment, ablation, radiation, cement augmentation, and surgery based on 432","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015076","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":"Difference in stiffness-related functional disability between decompression alone and decompression with short segments fusion (1 or 2 levels) in the lower lumbar region: a propensity scores matching study.","authors":"Hyun-Jun Kim, Jin-Sung Park, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1016/j.spinee.2024.12.036","DOIUrl":"10.1016/j.spinee.2024.12.036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Stiffness-related functional disability (SRFD) is a well-known complication after long-segment fusion surgery. However, SRFD following decompression with short-segment fusion (1 or 2 levels) compared with decompression alone surgery in the lower lumbar region, which accounts for a significant portion of lumbar range of motion, is poorly documented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to compare SRFD after decompression alone (D-A) surgery and decompression with short-segment fusion (D+F) surgery in the lower lumbar region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients who underwent D-A or D+F surgery at the lower lumbar region (L4 to S1) between 2016 and 2022, with a follow-up period of over 2 years, were reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measure: &lt;/strong&gt;The visual analog scale (VAS) for the back and leg, Oswestry disability index (ODI), specific functional disability index (SFDI) for SRFD, and lumbar range of motion (LROM) were evaluated as clinical and radiological outcomes preoperatively and at 1 and 2 years postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We divided the lower lumbar region into three segments: L4-5, L5-S1, and L4-5-S1. Out Of the initial 425 patients, 32 pairs in the L4-5 segment, 36 pairs in the L5-S1 segment, and 27 pairs in the L4-5-S1 segment were included in the final cohort after conducting propensity score matching (1:1). Outcomes were compared between the two groups within each segment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean follow-up periods were 27.2, 26.1, and 26.5 months in each group, respectively. In L4-5, there was no difference in the VAS scores for leg pain, ODI, SFDI, and LROM. However, the VAS for back pain was significantly higher in the D+F group preoperatively and at 2 years postoperatively (6.4±2.0 vs. 3.6±2.3, p=.001; 3.6±2.7 vs. 2.1±1.9, p=.046). In the L5-S1, VAS for back pain was significantly higher in the D+F group preoperatively and at 2 years postoperatively (6.2±2.0 vs. 4.4±1.9, p=.001; 4.2±1.7 vs. 3.5±1.3, p=.034). The LROM was significantly lower in the D+F group at 1- and 2-year postoperatively (33.3±8.0° vs. 38.4±9.2°, p=.015; 32.4±7.3° vs. 36.8±9.4°, p=.032). However, the SFDI was higher in the D+F group only at 1 year postoperatively (22.4±7.7 vs. 19.2±5.2, p=.037). In the L4-5-S1, SFDI was significantly higher in the D+F group at 1- and 2-year postoperatively (1 yr: 22.7±7.7 vs. 17.1±7.9, p=.011; 2 yrs: 22.3±7.6 vs. 17.9±7.2, p=.001), LROM was significantly lower in the D+F group (1 yr: 24.1±8.3° vs. 37.0±8.4°, p=.001; 2 yrs: 25.0±6.9° vs. 38.2±6.4°, p=.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For the L4-5 segment, there were no differences in LROM and SFDI between the D-A and D+F groups. At L5-S1, significant differences were noted in both parameters at 1-year postoperatively, but SFDI showed no significant differences by the 2-year mark, despite diffe","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015078","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}