Spine Journal最新文献

{"title":"A novel subtype classification and corresponding surgical strategies for spinal dural cysts–a report of 104 cases","authors":"Guangjian He BA ,&nbsp;Xingsen Xue MA ,&nbsp;Xin Chen BA ,&nbsp;Xing Fang BA ,&nbsp;Hongyan Zhang MA ,&nbsp;Wanjiang Wu MA ,&nbsp;Jiantao Shi MD ,&nbsp;Rong Hu MD ,&nbsp;Jiangkai Lin MD ,&nbsp;Weihua Chu MD","doi":"10.1016/j.spinee.2024.08.005","DOIUrl":"10.1016/j.spinee.2024.08.005","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The nomenclature, classification, and surgical approaches for spinal dural cysts (SDCs) remain a subject of controversy.</div></div><div><h3>PURPOSE</h3><div>The present study proposes a novel subtype classification system and corresponding surgical strategies, with the aim of enhancing comprehension of this entity and standardizing surgical treatment.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective review.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 104 patients with SDCs underwent novel subtype classification and corresponding surgical strategies from January 2015 to December 2021. Fifty-four patients who underwent conventional surgery from January 2012 to December 2014 as the control group for preliminary validation.</div></div><div><h3>OUTCOME MEASURES</h3><div>The outcomes are categorized into 4 levels: excellent, good, unchanged, and deteriorated, based on neurological improvement and pain relief. Grades of excellent and good were identified as improvements. Follow-up magnetic resonance imaging and complications were also evaluated.</div></div><div><h3>METHODS</h3><div>Based on the shared pathogenic factor of dural defects, the dural-associated cysts in the spinal canal are uniformly referred to as SDCs. They are further classified into Type 1 (no nerve roots) and Type 2 (containing nerve roots), with 4 additional subtypes based on the shape of the leak and the flow of leakage. The fissure-shaped leak of Type 1a SDCs is directly sutured, whereas the aperture-shaped leak of Type 1b is repaired using a patch. Low-flow leakage of Type 2a is directly sealed using a combination of adipose tissue and fibrin glue, whereas high-flow Type 2b necessitates suturing at the end of the leak to attenuate cerebrospinal fluid flow prior to sealing.</div></div><div><h3>RESULTS</h3><div>The follow-up period averaged 23.8 months. Excellent or good outcomes were achieved in 100%, 88.9%, 100%, and 97.3% for the 4 subtypes respectively. The overall improvement rate of SDCs was 97.1%, which was significantly higher than that of the conventional surgery group (85.2%, p=.008). MRI follow-up showed a significant reduction in cyst size of 100%, 100%, 97.8%, and 97.3% for the 4 subtypes, respectively. The primary complications included pseudomeningocele in 4 cases (3.8%) and delayed wound healing in 5 cases (4.8%). The complication rate was also significantly lower than that of the control group (8.7% vs 24.1%, p=.008).</div></div><div><h3>CONCLUSIONS</h3><div>Subtyping SDCs based on the variation of leaks and leakage can enable more targeted surgical strategies, which are helpful for improving treatment effectiveness and reducing complications.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2322-2333"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001151","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 outcomes and complications of anterior column realignment (ACR): a systematic review","authors":"Gregory M. Mundis Jr MD ,&nbsp;Hazem Elsebaie MD ,&nbsp;Bahar Shahidi DPT, PhD ,&nbsp;Isaiah Love BS ,&nbsp;Pearce B. Haldeman BS ,&nbsp;Robert K. Eastlack MD ,&nbsp;Behrooz A. Akbarnia MD","doi":"10.1016/j.spinee.2024.08.003","DOIUrl":"10.1016/j.spinee.2024.08.003","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.</div></div><div><h3>PURPOSE</h3><div>To determine the efficacy and complications rates associated with ACR.</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review.</div></div><div><h3>METHODS</h3><div>We queried the MEDLINE, Google Scholar, and EMBASE databases for all literature related to ACR procedure with a publication cutoff start date of January 1, 2010. This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. nonEnglish, nonhuman, case reports and review article publications were excluded.</div></div><div><h3>RESULTS</h3><div>A total of 298 studies were identified. Following screening of title, abstract, and full text, 16 articles were included in the review with a total 756 patients. All the studies included in this systematic review were retrospective case series with a level of evidence IV. Ten studies reported ACR-related complications, with an average rate of 27.2%. The rate of reoperations was reported in 5 studies, for which the average reoperation rate was 9.5%. Cage Subsidence (CS) occurred in 13.7%, Proximal Junctional Kyphosis (PJK) in 12.2%, neurologic injury in 7.3%, and Proximal Junctional Failure (PJF) in 2.7%. The vascular injury rate was 0.5%, with bowel perforation and ureteric injury occurring in 0.2%. For the Patient Reported Outcome Measures (PROMs) and radiological outcome analysis we excluded studies with less than 12 months follow up leaving 8 studies eligible for the analysis. There was a significant improvement of both local Motion Segment Angle (MSA) and Intra Discal Angle (IDA) with a mean segmental correction of 20° lordosis in the 3 studies that reported these parameters.</div></div><div><h3>CONCLUSION</h3><div>Based on the limited data available in this systematic review, the ACR technique has significant ability to restore and, when needed, correct the local segmental intervertebral angulation and thereby influencing the overall regional and global sagittal alignment. The associated risk of vascular, bowel, and nerve injury did not seem to be significantly higher in this review than other alternative lumbar interbody fusion techniques. Additional higher quality studies, including a consensus for reporting complications is required to reach definitive conclusions regarding its possible associated risks.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2273-2284"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001186","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":"A phase 3, randomized, double-blind, sham-controlled trial of SI-6603 (condoliase) in patients with radicular leg pain associated with lumbar disc herniation","authors":"Kee D. Kim MD ,&nbsp;Farshad Ahadian MD ,&nbsp;Hamid Hassanzadeh MD ,&nbsp;Jose Rivera MD ,&nbsp;Kenneth Candido MD ,&nbsp;Steven Gershon MD ,&nbsp;Anand Patel MD ,&nbsp;Pragya B. Gupta MD ,&nbsp;Alan E. Miller MD ,&nbsp;Ferdinand J. Formoso DO ,&nbsp;Thomas Fuerst PhD ,&nbsp;Evan Zucker MS ,&nbsp;Takayuki Seo PhD ,&nbsp;Jun Watanabe RPh, EMBA, MSc ,&nbsp;Yukihiro Matsuyama MD ,&nbsp;Kazuhiro Chiba MD, PhD ,&nbsp;Kevin E. Macadaeg MD","doi":"10.1016/j.spinee.2024.08.006","DOIUrl":"10.1016/j.spinee.2024.08.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;SI-6603 (condoliase) is a chemonucleolytic agent approved in Japan in 2018 for the treatment of lumbar disc herniation (LDH) associated with radicular leg pain. Condoliase, a mucopolysaccharidase with high substrate specificity for glycosaminoglycans (GAGs), offers a unique mechanism of action through the degradation of GAGs in the nucleus pulposus. As LDH management is currently limited to conservative approaches and surgical intervention, condoliase could offer a less invasive treatment option than surgery for patients with LDH.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The Discovery 6603 study (NCT03607838) evaluated the efficacy and safety of a single-dose injection of SI-6603 (condoliase) vs sham for the treatment of radicular leg pain associated with LDH.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A randomized, double-blind, sham-controlled, phase 3 study conducted across 41 sites in the United States.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Male and female participants (N=352; aged 30–70 years) with contained posterolateral LDH and unilateral radiculopathy/radicular leg pain for greater than 6 weeks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary endpoint was the change from baseline (CFB) in average worst leg pain score at 13 weeks, assessed using the 100-mm visual analogue scale. Key secondary endpoints were CFB in average worst leg pain score at 52 weeks, herniation volume at 13 weeks, and Oswestry Disability Index (ODI) score at 13 weeks. Safety evaluations included adverse events (AEs) and imaging findings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Participants were randomized 1:1 to receive a single intradiscal injection of condoliase (1.25 units) or sham injection followed by 52 weeks of observation. The primary and key secondary endpoints were assessed using a mixed model for repeated measures (MMRM) analysis and a protocol-specified multiple imputation (MI) sensitivity analysis on the modified intention-to-treat (mITT) population. A prespecified serial gatekeeping algorithm was used for multiple comparisons. Safety endpoints included AEs, laboratory tests, vital signs, imaging (by X-ray and magnetic resonance imaging [MRI]), and occurrence of posttreatment lumbar surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of the 352 randomized participants, 341 constituted the mITT population (condoliase n=169; sham n=172) and the safety population (condoliase n=167; sham n=174). For the primary endpoint, the condoliase group showed significantly greater improvement in CFB in worst leg pain at Week 13 (least squares mean [LSM] CFB: −41.7) compared with sham injection (−34.2; LSM difference: −7.5; 95% confidence interval [CI]: −14.1, −0.9; p=.0263) based on the MMRM analysis. CFB in worst leg pain at Week 52 favored condoliase vs sham, but the difference was not statistically significant (p=.0558), which halted the serial gatekeeping testing algorithm and dictated that the CFB in herniation volume","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2285-2296"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019310","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":"Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric proof-of-concept study","authors":"Miguel A. Ruiz-Cardozo MD, MPH ,&nbsp;Karma Barot BA, MA ,&nbsp;Samuel Brehm BS ,&nbsp;Tim Bui BS ,&nbsp;Karan Joseph BS ,&nbsp;Michael Ryan Kann BE ,&nbsp;Gabriel Trevino PhD ,&nbsp;Michael Olufawo MBA ,&nbsp;Som Singh MD ,&nbsp;Alexander T. Yahanda MD ,&nbsp;Alexander Perdomo-Pantoja MD ,&nbsp;Julio J. Jauregui MD ,&nbsp;Magalie Cadieux MD, MMSc ,&nbsp;Brian J. Ipsen MD ,&nbsp;Ripul Panchal DO ,&nbsp;Kornelis Poelstra MD, PhD ,&nbsp;Michael Y. Wang MD ,&nbsp;Timothy F. Witham MD ,&nbsp;Camilo A. Molina MD","doi":"10.1016/j.spinee.2024.08.012","DOIUrl":"10.1016/j.spinee.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>The accurate and safe positioning of cervical pedicle screws is crucial. While augmented reality (AR) use in spine surgery has previously demonstrated clinical utility in the thoracolumbar spine, its technical feasibility in the cervical spine remains less explored.</div></div><div><h3>Purpose</h3><div>The objective of this study was to assess the precision and safety of AR-assisted pedicle screw placement in the cervical spine.</div></div><div><h3>Study Design</h3><div>In this experimental study, 5 cadaveric cervical spine models were instrumented from C3 to C7 by 5 different spine surgeons. The navigation accuracy and clinical screw accuracy were evaluated.</div></div><div><h3>Methods</h3><div>Postprocedural CT scans were evaluated for clinical accuracy by 2 independent neuroradiologists using the Gertzbein-Robbins scale. Technical precision was assessed by calculating the angular trajectory (°) and linear screw tip (mm) deviations in the axial and sagittal planes from the virtual pedicle screw position as recorded by the AR-guided platform during the procedure compared to the actual pedicle screw position derived from postprocedural imaging.</div></div><div><h3>Results</h3><div>A total of forty-one pedicle screws were placed in 5 cervical cadavers, with each of the 5 surgeons navigating at least 7 screws. Gertzbein-Robbins grade of A or B was achieved in 100% of cases. The mean values for tip and trajectory errors in the axial and sagittal planes between the virtual versus actual position of the screws was less than 3 mm and 30°, respectively (p&lt;.05). None of the cervical screws violated the cortex by more than 2 mm or displaced neurovascular structures.</div></div><div><h3>Conclusions</h3><div>AR-assisted cervical pedicle screw placement in cadavers demonstrated clinical accuracy comparable to existing literature values for image-guided navigation methods for the cervical spine.</div></div><div><h3>Clinical Significance</h3><div>This study provides technical and clinical accuracy data that supports clinical trialing of AR-assisted subaxial cervical pedicle screw placement.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2417-2427"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037481","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":"Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy","authors":"Sehan Park MD ,&nbsp;Gumin Jeong BA, MA ,&nbsp;Chang Ju Hwang MD, PhD,&nbsp;Jae Hwan Cho MD, PhD,&nbsp;Dong-Ho Lee MD, PhD","doi":"10.1016/j.spinee.2024.08.027","DOIUrl":"10.1016/j.spinee.2024.08.027","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Anterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR).</div></div><div><h3>PURPOSE</h3><div>To compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Propensity score-matched retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients with CMR who underwent ACDF or LPF and were followed up for at least 2 years.</div></div><div><h3>OUTCOME MEASURES</h3><div>C2–C7 lordosis, C2–C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed.</div></div><div><h3>METHODS</h3><div>The radiographic and clinical outcomes of the 2 groups were compared.</div></div><div><h3>RESULTS</h3><div>Eighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2–C7 lordosis (p&lt;.001) and ROM (p&lt;.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2 to C7 lordosis (p&lt;.001), while ACDF caused a significant decrease in cervical ROM (p&lt;.001). ACDF effectively improved neck pain VAS (p&lt;.001) and NDI (p&lt;.001), while neck pain did not significantly improve after LPF (p=.103). Furthermore, neck pain VAS (p=.026) and NDI (p=.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=.502; NDI, p=.085). Arm pain VAS and JOA score both significantly improved after LPF (p=.003 and 0.043, respectively) or ACDF (p&lt;.001 and 0.039, respectively), and postoperative results were not significantly different between the 2 groups.</div></div><div><h3>CONCLUSION</h3><div>LPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR.</div></div><div><h3>LEVEL Of EVIDENCE</h3><div>III.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2253-2263"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269551","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":"One-year patient reported outcomes after single-level lumbar fusion at orthopedic specialty hospital compared to tertiary referral center","authors":"Rajkishen Narayanan MD,&nbsp;Teeto Ezeonu BA,&nbsp;Jeremy C. Heard BS,&nbsp;Yunsoo Lee MD,&nbsp;Azra Dees,&nbsp;Goutham Yalla BS,&nbsp;Jose A. Canseco MD, PhD,&nbsp;Mark F. Kurd MD,&nbsp;Ian David Kaye MD,&nbsp;Barrett I. Woods MD,&nbsp;Alan S. Hilibrand MD,&nbsp;Alexander R. Vaccaro MD, PhD, MBA,&nbsp;Gregory D. Schroeder MD,&nbsp;Christopher K. Kepler MD, MBA","doi":"10.1016/j.spinee.2024.08.024","DOIUrl":"10.1016/j.spinee.2024.08.024","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The objectives of this study were (1) to determine if changes in patient reported outcome measures (PROMs) after elective lumbar spinal fusion surgery differ between patients who undergo surgery at an orthopedic specialty hospital (OSH) and those who undergo surgery at a tertiary referral center (TRC) and (2) to characterize differences in short-term outcomes between hospitals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Adult patients (≥18 years old) who underwent primary, elective single-level posterior lumbar decompression and fusion between January 2014 and December 2021 at a tertiary referral center or an orthopaedic specialty hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;PROMs: Oswestry Disability Index (ODI), Short-form 12 (SF12) Mental Component Summary (MCS); SF12 Physical Component Summary (PCS); Visual Analogue Back and Leg (VAS Back/Leg).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;PROMs were collected preoperatively, 6 months after surgery, and 1 year after surgery. Six-month and 1-year delta PROM values were calculated by subtracting the preoperative PROM score from the 6-month or 1-year score, respectively. Multivariable linear regression analyses were conducted to assess the independent effect of hospital location on postoperative PROM scores.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 288 patients were identified as part of the study cohort including 205 patients who underwent surgery at the tertiary hospital and 83 patients who underwent surgery at the OSH. OSH patients had shorter length of stay (1.57±0.72 vs 3.28±1.32, p&lt;.001), however there was no difference in discharge disposition or 90-day readmission rates between hospitals (p&gt;.05). At 6 months, having surgery at the specialty hospital was associated with higher PCS (estimate=2.96, confidence interval: 0.21–5.71, p=.035). At 1-year postoperatively, the location of surgery no longer demonstrated significant associations with PROM scores. Preoperative PROM scores demonstrated significant associations with 6-month and 1-year scores for each PROM (p&lt;.05) except VAS leg at 6 months postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;To our knowledge, this is one of the largest studies investigating PROMs at OSH versus TRCs for single-lev","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2297-2304"},"PeriodicalIF":4.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299502","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":"Long-term reoperation after decompression with versus without fusion among patients with degenerative lumbar spinal stenosis: a systematic review and meta-analysis.","authors":"Fon-Yih Tsuang, Yu-Lun Hsu, Tzu-Yi Chou, Chung Liang Chai","doi":"10.1016/j.spinee.2024.11.015","DOIUrl":"10.1016/j.spinee.2024.11.015","url":null,"abstract":"<p><strong>Background: </strong>The debate over adding fusion after decompression in lumbar spinal stenosis patients without spondylolisthesis is due to the \"absence of evidence\" in its benefits, particularly in reoperation. However, this \"absence of evidence\" does not indicate \"evidence of absence.\"</p><p><strong>Purpose: </strong>To investigate the reoperation rates following the addition of fusion after decompression in patients with lumbar spinal stenosis without spondylolisthesis.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched Medline, Embase, Web of Science, and Google Scholar databases on December 12, 2021, with an updated search conducted on April 06, 2023. Inclusion criteria were adult patients with lumbar spinal stenosis. Exclusions comprised cases of spondylolisthesis and instabilities. The occurrence of reoperation was summarized using odds ratios (OR), while other outcomes were presented as mean differences. We employed a Cox-based shared-frailty model with random effects for the time-to-event analysis of reoperation. Additionally, we used a 2-stage method to validate our estimates. Heterogeneity variance within the random-effects model was estimated using the Hartung-Knapp-Sidik-Jonkman method.</p><p><strong>Results: </strong>A total of 1973 studies were identified and screened, of which 48 met selection criteria, and 17 were included in the meta-analysis. Comparison between fusion and non-fusion groups in patients with lumbar stenosis and neurological claudication revealed no significant difference in reoperation rates (odds ratio: 1.13 [95% CI: 0.88 to 1.46]; 8016 participants; 14 studies; I² = 0%). Bayesian analysis indicated an 8.9-fold likelihood of similar reoperation rates. Time-to-reoperation analysis revealed a 16.46 months delay in the fusion group, though not statistically significant (mean difference: 16.46 [95% CI: -3.13-36.04]; 83 participants; 3 studies; I² = 46%). Consistently, ODI, back pain, and leg pain VAS showed no significant differences. The certainty of the evidence was low for odds of reoperation and leg pain VAS, and very low for the remaining outcomes.</p><p><strong>Conclusion: </strong>In lumbar spinal stenosis patients without spondylolisthesis, the addition of fusion after decompression showed limited benefits in terms of reoperation rates, ODI, and leg pain.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774079","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":"Potential causes of iatrogenic intraoperative bleeding during C1 surgeries: a CT 3D rendering study.","authors":"Ping Wang, Yuezhan Shan, Lifeng Yu, Rui Xin, Rui Yang, Jianfei Hou, Zhen Ye, Xuezhi Wei, Shaoyun Wang, Xiang Zhang, Jiangdong Wu, Gang Ma, Changjun Zheng, Xuedong Fang, Kailiang Cheng","doi":"10.1016/j.spinee.2024.11.012","DOIUrl":"10.1016/j.spinee.2024.11.012","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic intraoperative bleeding during C1 surgeries is difficult to manage.</p><p><strong>Purpose: </strong>To investigate the potential causes of iatrogenic intraoperative bleeding in atlas surgeries.</p><p><strong>Study design: </strong>This was a retrospective study, observational cohort of patients with DICOM.</p><p><strong>Patient sample: </strong>High-resolution head and neck computed tomography angiography (CTA) images from 551 subjects were included.</p><p><strong>Outcome measures: </strong>Ponticulus posticus (POPO), vertebral artery (VA), venous plexus communication.</p><p><strong>Methods: </strong>Three dimension rendering was utilized in the present study. Potential arterial bleeding was evaluated based on the variation in the VA and the polymorphism of the POPO over the groove for VA (GVA). The communication of the venous plexus in the occipitoatlantal region was investigated to assess the venous hemorrhage.</p><p><strong>Results: </strong>Among the 551 atlases examined, POPOs were identified on 155 sides, resulting in a prevalence of 14.07% (155/1102). These POPOs (n = 155) were reclassified into four types: tiny spur (54.84%), long spur (7.10%), ossified bridge (30.32%), and ossified canal (7.74%). In 42.92% (473/1102) of cases, the VA did not directly contact the sulci of the GVA, creating space for the passage of the rich venous plexus that drained intracranial venous blood outflow to various extracranial layers. Moreover, in 12.7% of the subjects, the study revealed the presence of additional foramens in the posterior lamina of C1, which served as a conduit for the communicating vein CONCLUSION: The potential underestimation of polymorphism in POPOs and VAs can lead to arterial bleeding, whereas a lack of understanding of the intricate condylar emissary venous plexus can result in venous hemorrhage. To mitigate iatrogenic hemorrhage during C1 surgeries, a preoperative HEAD AND NECK CTA is recommended, and heightened caution should be exercised during dissection in the lateral half of the C1 lamina. Furthermore, unknown causes of intraoperative bleeding may arise during the posterior C1 approach; modifications should be considered based on the specific circumstances encountered.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774083","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":"¹⁸F-Naf PET/CT in pseudarthrosis after anterior cervical discectomy and fusion.","authors":"Yacine El Yaagoubi, Eric Lioret, Clément Thomas, Jean-Edouard Loret, Adrien Simonneau, Aymeric Amelot, Anne-Victoire Michaud-Robert, Henri Pasquesoone, Laurent Philippe, Caroline Prunier-Aesch","doi":"10.1016/j.spinee.2024.11.013","DOIUrl":"10.1016/j.spinee.2024.11.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Pseudarthrosis is a well-known cause of persistent or recurrent pain after anterior cervical discectomy and fusion (ACDF). Numerous radiographic criteria to determine the fusion status has been described in the literature, but their accuracies in clinical practice vary considerably and no 1 single method has proved superior. Fluorine-18 sodium fluoride (&lt;sup&gt;18&lt;/sup&gt;F-NaF) positron emission tomography/computed tomography (PET/CT), depicting osteoblastic activity, might be useful to identify pseudarthrosis after ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the ability of &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT to identify pseudarthrosis after ACDF using surgical revision as the reference standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients sample: &lt;/strong&gt;A total of 30 patients consisting of 40 surgical levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;For each level, the presence or absence of intragraft uptake (InGU) and extragraft uptake (ExGU) were recorded, as well as adjacent segment uptake (ASU). CT part of the scan was rated as \"fused\" or \"nonfused.\" Results were correlated to the gold-standard of revision surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively included consecutive patients who underwent revision surgery for suspicion of symptomatic pseudarthrosis after ACDF following &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT performed between July 2019 and march 2023. &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT results were compared with the gold standard of surgical evaluation of the stability of the fusion material. All patients underwent a systematic CT scan to evaluate the success of revision surgery 1 year postoperatively. We also investigated whether some patients underwent a repeated &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT for persistent or recurrent pain after revision surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Revision surgery demonstrated pseudarthrosis in 37 levels (93%) and excluded pseudarthrosis in 3 levels (7%). In the pseudarthrosis group (n=37), InGU was observed in all levels (100%) while ExGU was present in only 10 levels (27%). Fifteen levels (41%) with confirmed pseudarthrosis were rated as \"fused\" on CT scan preoperatively. In the non-pseudarthrosis group (n=3), InGU was observed in 2 levels (67%) while ExGU was never present. Two levels (67%) were rated as \"fused\" on fusion CT scan. One year postoperatively, fusion was successfully achieved on CT scan in 39 levels (98%). Seven patients (consisting of 8 levels) had been subsequently re-explored by &lt;sup&gt;18&lt;/sup&gt;F-NaF PET/CT for persistent or recurrent pain following revision surgery. PET/CT did not reveal any uptake (InGU or ExGU) in 7 levels, rated as \"fused\" on follow-up CT scan. PET/CT showed InGU in the only level rated as \"nonfused\" on CT scan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;&lt;sup&gt;18&lt;/sup&gt;F NaF PET/CT may be a useful adjunctive diagnostic tool to detect pseudarthrosis after ACDF surgery, especially in case of high clini","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774076","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":"Higher socioeconomic status is associated with greater rates of surgical resource utilization prior to spine fusion surgery.","authors":"Teeto Ezeonu, Rajkishen Narayanan, Rachel Huang, Yunsoo Lee, Nathaniel Kern, John Bodnar, Perry Goodman, Anthony Labarbiera, Jose A Canseco, Mark F Kurd, Ian David Kaye, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1016/j.spinee.2024.11.005","DOIUrl":"10.1016/j.spinee.2024.11.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Previous research has demonstrated an association between socioeconomic status (SES) and patient health, specifically noting that patients of lower SES have poor health outcomes. Understanding how social factors, including socioeconomic status (SES), relate to disparities in health outcomes is critical to closing gaps in equitable care to patients. While several studies have examined the effect of SES on postoperative spine outcomes, there is limited spine literature evaluating SES in the context of barriers to spine care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The primary objective of this study was to determine if socioeconomic status is associated with resource utilization prior to spine surgery consultation. As part of a sub-analysis, this paper also explores the effect of other social factors on previsit resource utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Adult patients who underwent elective cervical or lumbar spinal fusion between 2020 and 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Previsit resource utilization including 1) epidural steroid injection, 2) opioid use, 3) physical therapy, 4) prior spine surgeon, and 5) prior spine surgery METHODS: Each patient was assigned a \"distressed score\" using the Distressed Communities Index (DCI) and a socioeconomic status (SES) score using the Social Vulnerability Index (SVI) based on their zip code. Patient charts were manually reviewed to collect data regarding previsit resource utilization. The cohort was analyzed based on DCI quintile and SVI quartile. Additional analyses were conducted based on marital status and race.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our study included 996 patients in the final analysis. Based on DCI, patients from prosperous communities were more likely to have previously visited a spine surgeon (13.2% (prosperous) vs. 7.58% vs. 6.92% vs. 9.09% vs. 3.70% (distressed), p=.015) and to have had prior spine surgery (11.1% (prosperous) vs. 9.57% vs. 9.09% vs. 2.52% vs. 6.36% (distressed), p=.015). Similarly, when evaluated based on SES SVI, patients who lived in a low-risk community were more likely to have previously visited a spine surgeon (13.0% low-risk vs. 7.26% low-medium risk vs. 16.9% medium-high risk vs. 10.6% high risk, p=.049) and to have had prior spine surgery (13.0% low-risk vs. 7.26% vs. 16.9% vs. 10.6% high risk, p=.030). When evaluated based on marital status, there was no difference in any resource utilization. Non-Black and non-White patients were more likely to have tried physical therapy compared to their black and white counterparts (76.9% (other) vs. 60.9% (Black) vs. 54.3% (White), p=.026).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study examined the relationship between socioeconomic status and resource utilization and found a positive correlation between higher social standing and access to spine surgery and spine surgeons. These findings demonstrat","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774078","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}