Spine Journal最新文献

{"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":"<p><strong>Background context: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Study design/setting: </strong>Retrospective single-center cohort study with minimum follow-up of 5 years.</p><p><strong>Patient sample: </strong>A total of 86 patients who underwent L4-S1 spinal fusion between 2003 and 2015, with a mean follow-up of 12±4 years.</p><p><strong>Outcome measures: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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}

{"title":"Multisociety response to The BMJ publications on interventional spine procedures for chronic back and neck pain.","authors":"Andrew J Schoenfeld","doi":"10.1016/j.spinee.2025.03.030","DOIUrl":"10.1016/j.spinee.2025.03.030","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789308","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":"Efficacy and safety of allogeneic mesenchymal precursor cells with and without hyaluronic acid for treatment of chronic low back pain: A prospective, randomized, double blind, concurrent-controlled 36-month study.","authors":"Douglas P Beall, Hyun W Bae, Michael J DePalma, Kasra Amirdelfan, Edward Tavel, Timothy T Davis, James Scott Bainbridge, Arnold Weil, William Beckworth, Kee Kim, Philip Yuan, Pragya B Gupta, Eugene Wang, Bradley S Goodman, Ryan Reeves, Michael B Furman, Nagy Mekhail, David Nunez, Michael DiMuro, Matthew C Shonnard, Eric Rose, Roger D Brown","doi":"10.1016/j.spinee.2025.03.015","DOIUrl":"10.1016/j.spinee.2025.03.015","url":null,"abstract":"<p><strong>Background context: </strong>Low back pain (LBP) associated with degenerative disc disease (DDD) is a serious condition resulting in significant morbidity, disability, and reduced quality of life for millions of people each year. Patients who fail to improve with conservative/noninvasive treatments including physical therapy and nonopioid analgesic medications have limited options, which include opioid analgesics with their associated significant risks; epidural steroid injections with limited supporting evidence; or surgical interventions such as spine fusion or artificial disc replacement. A safe, minimally invasive, nonopioid treatment that provides prolonged improvement in pain, function, and quality of life is needed for such patients.</p><p><strong>Purpose: </strong>Evaluate the efficacy and safety of a single injection of mesenchymal precursor cells (MPCs) with or without hyaluronic acid (HA) compared to an intradiscal saline injection through 36 months follow-up in subjects with chronic low back pain (CLBP) associated with moderate DDD (mDDD).</p><p><strong>Study design/setting: </strong>A prospective, multicenter, randomized, double-blind, concurrent-controlled study conducted at 49 clinical sites.</p><p><strong>Subject sample: </strong>A total of 404 subjects with CLBP associated with mDDD at one level from L1 to S1 received MPCs without HA (MPC), MPCs with HA (MPC+HA), or saline control (control) treatment.</p><p><strong>Outcome measures: </strong>Subjects were clinically and radiographically evaluated at 1, 3, 6, 12, 18, 24, and 36 months postinjection. Clinical evaluation included adverse events, neurologic evaluation, laboratory tests, LBP intensity measured by Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and EQ-5D-5L Index. Radiographic assessments used Magnetic Resonance (MR) imaging and X-ray imaging studies.</p><p><strong>Methods: </strong>The primary efficacy endpoint was a composite responder analysis for overall treatment success at both 12 and 24 months that was comprised of:[1] at least a 50% reduction from baseline in low back pain VAS score (average pain over 24 h);[2] at least a 15-point decrease from baseline in ODI score; and[3] no adjudicated posttreatment interventions at the treated level. To assess superiority, a Bayesian analysis used a probability threshold of 0.9875. Additional analyses were performed on a prespecified subpopulation of subjects with CLBP duration at baseline less than the median baseline duration of 68 months (CLBPLTM). Statistical assessments included least squares (LS) mean, LS mean change from baseline (CFB) using the mixed model for repeated measures (MMRM) and categorical responder analyses using stratified Cochran Mantel Haenszel row means score test with p<.05 defined as statistically significant. This study was conducted under a US Food and Drug Administration (FDA) Investigational New Drug (IND) application sponsored and funded by Mesoblast.</p><p><strong>Result","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774616","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":"Association between obesity and pseuarthrosis risk following lumbar fusion surgery.","authors":"Yu Chang, Kuan-Yu Chi, Junmin Song, Hong-Min Lin, Chien-Min Chen","doi":"10.1016/j.spinee.2025.03.031","DOIUrl":"10.1016/j.spinee.2025.03.031","url":null,"abstract":"<p><strong>Background context: </strong>Obesity is a known risk factor for various adverse health conditions and surgical complications, including in spine surgery. While obesity is associated with increased perioperative risks in lumbar fusion surgery, its impact on long-term fusion success remains controversial.</p><p><strong>Purpose: </strong>To evaluate the effect of obesity on fusion outcomes following posterior lumbar fusion surgery, with a specific focus on the incidence of pseudarthrosis at multiple postoperative time points.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>Patients were identified through the TriNetX Global Collaborative Network using ICD-10-PCS and CPT codes specific to lumbar fusion procedures. After propensity score matching for demographic and comorbidity variables, 41,436 obese patients (BMI ≥ 30 kg/m²) were compared with 41,436 non-obese patients (BMI < 30 kg/m²).</p><p><strong>Outcome measures: </strong>The primary outcome was the incidence of pseudarthrosis, identified using ICD-10 code M96.0 at 6 months, 1 year, and 2 years postoperatively.</p><p><strong>Methods: </strong>Propensity score matching (PSM) was applied to minimize confounding. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the risk of pseudarthrosis between obese and non-obese groups.</p><p><strong>Results: </strong>The incidence of pseudarthrosis was consistently lower in the obese cohort across all postoperative time points. At 6 months postoperatively, the incidence was 9.2% in obese patients compared to 11.8% in non-obese patients (OR: 0.75, 95% CI: 0.72-0.79). At 1 year, pseudarthrosis occurred in 10.4% of obese patients versus 13.0% in non-obese patients (OR: 0.78, 95% CI: 0.74-0.81). At 2 years, rates were 11.6% in the obese group and 14.1% in the non-obese group (OR: 0.80, 95% CI: 0.76-0.83). These findings indicate a consistent and statistically significant association between obesity and lower odds of pseudarthrosis following lumbar spine fusion surgery.</p><p><strong>Conclusions: </strong>Despite higher perioperative complication rates typically associated with obesity, our study found that obese patients experienced significantly lower rates of pseudarthrosis following lumbar spine fusion surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774613","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":"Multimodal machine learning for predicting perioperative safety indicators in spinal surgery.","authors":"Kyle Mani, Thomas Scharfenberger, Samuel N Goldman, Emily Kleinbart, Evan Mostafa, Rafael De La Garza Ramos, Mitchell S Fourman, Ananth Eleswarapu","doi":"10.1016/j.spinee.2025.03.021","DOIUrl":"10.1016/j.spinee.2025.03.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Machine learning (ML) algorithms can utilize the large amount of tabular data in electronic health records (EHRs) to predict perioperative safety indicators. Integrating unstructured free-text inputs via natural language processing (NLP) may further enhance predictive accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To design and validate a preoperative multimodal ML architecture that integrates structured EHR data (patient demographics, comorbidities, and clinical covariates) with unstructured free-text inputs (past medical and surgical history, medications, and problem lists) via NLP. The multimodal models aim to improve the prediction of perioperative safety indicators compared to baseline ML models that only use structured tabular EHR data.&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;1,898 patients admitted for elective or emergency spine surgery at four separate large urban academic spine centers during a 5-year period from 2018 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Numerical outputs between 0 and 1 corresponding to the likelihood of (I) extended length of stay (LOS), (II) 90-day reoperation, and (III) perioperative intensive care unit (ICU) admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We predicted the following safety indicators (I) extended length of stay (LOS), (II) 90-day reoperation, and (III) perioperative intensive care unit (ICU) admission. The quanteda package for NLP within the R environment was utilized to preprocess free-text EHR inputs. The refined text was tokenized and transformed into numerical vectors using a bag-of-words approach and integrated with the tabular EHR data to create a document-feature matrix. Two extreme gradient boosted (XGBoost) ML models were trained: a base model utilizing only structured tabular EHR data and a combined multimodal model that leveraged both combined structured tabular EHR data with numerical vectors derived from free-text NLP inputs. Hyperparameter tuning was performed via grid search, and the models were validated using 10-fold cross validation with an 80:20 training/testing split. Word clouds were generated for the free-text data and explainable artificial intelligence (XAI) techniques were employed for feature importance. Metrics calculated for model performance included Area Under the Receiving-Operating Characteristic Curve (AUC-ROC), Brier score, Calibration slope, Calibration Intercept, Precision, Recall and F1-Score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;1,898 patients (60.7% female) were extracted from January 2018 to September 2023, with a median age of 60.0 (IQR: 52.0-68.0) and median body mass index (BMI) of 30.3 kgm&lt;sup&gt;2&lt;/sup&gt; (IQR: 26.3-34.6). Extended LOS was defined as ≥ 14.4 days, constituting 10.1% of all individuals. The median LOS for the entire cohort was 4.0 days (IQR: 2.0-7.0), while the 90-day reoperation rate was 10.54%, and the ICU admission rate was 7.74%. The preoper","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755375","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":"Performance comparison between Hounsfield units and DXA in predicting lumbar cage subsidence in the degenerative population.","authors":"Lindsay D Orosz, Kirsten A Schuler, Brandon J Allen, Wondwossen T Lerebo, Tarek Yamout, Rita T Roy, Thomas C Schuler, Christopher R Good, Colin M Haines, Ehsan Jazini","doi":"10.1016/j.spinee.2025.03.028","DOIUrl":"10.1016/j.spinee.2025.03.028","url":null,"abstract":"<p><strong>Background context: </strong>Bone mineral density assessment is essential for surgical planning for most spine surgeries, but gold standard dual-energy x-ray absorptiometry (DXA) is affected by degeneration often resulting in falsely elevated scores. Studies of the opportunistic measurement of computed tomography (CT) Hounsfield units (HU) suggest lower CTHU values predict interbody cage subsidence, yet cutoff values vary and lack standardization.</p><p><strong>Purpose: </strong>This study aimed to determine if value CTHU<135 was associated with lumbar interbody cage subsidence and to compare the predictive performance of subsidence between CTHU and DXA.</p><p><strong>Study design/setting: </strong>Single-center, multi-surgeon, retrospective cohort study PATIENT SAMPLE: Adult, circumferential lumbar fusions ≤5 interbody levels with DXA, CTs, radiographs, and at least 1 year of follow up.</p><p><strong>Outcome measures: </strong>CTHU at L1, lowest DXA T-score, and postoperative change in disc space height (cage migration) on radiographs METHODS: Lowest DXA T-scores overall and of the lumbar spine were recorded and categorized, and L1 CTHUs were measured. Interbody fusions were analyzed for subsidence ≥2 mm on radiographs by a validated, computer vision algorithmic approach. Analysis determined if an association existed between subsidence and CTHU<135 or DXA lowest T-score. Logistic regression analyzed the performance of predicting subsidence by each method.</p><p><strong>Results: </strong>The 127-patient cohort had 82.7% degenerative pathologies, 45.7% males, median age of 60 years, 2.4% osteoporosis on DXA, 44.1% CTHU<135, and 13.4% subsidence. CTHU<135 (p=.004) and age (p=.016) were significantly associated with subsidence, however DXA lowest T-score (p=.550) was not. The odds of subsidence were significant if CTHU<135 for crude and adjusted (OR=4.0, 95% CI 1.2-13.9, p=.029) comparisons. The odds of subsidence were not significant for DXA_any lowest T-score or DXA_spine lowest T-score (OR=1.8, 95% CI 0.6-4.9, p=.284 and OR=1.1, 95% CI 0.3-4.1, p=.920, respectively).</p><p><strong>Conclusion: </strong>CTHU<135 was associated with subsidence while DXA lowest T-score was not in this study of patients with degenerative pathologies. The odds of subsidence were 4.0 times higher for CTHU<135 after controlling for known risks, supporting this cutoff value. This study suggests that CTHU is a more reliable predictor of subsidence than DXA in this primarily degenerative population and is a useful tool for assessing bone quality at the region of interest when planning lumbar surgery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of quantitative instrumentation for cone of economy analysis: bridging radiographic and clinical measures.","authors":"Hsu Ming Chang, Soong Christina, Yeh Ting Jen, Chen Hsuan Yu","doi":"10.1016/j.spinee.2025.03.005","DOIUrl":"10.1016/j.spinee.2025.03.005","url":null,"abstract":"<p><strong>Background context: </strong>Postural misalignment and compromised balance are major contributors to fall risk in the elderly, leading to significant physical injuries, reduced quality of life (QOL), and increased healthcare burdens. Evaluating postural stability is critical for fall prevention. The cone of economy (CoE) concept explores the range of motion of the center of mass and head required to maintain a stable upright posture, yet its measurement remains challenging due to the limitations of existing methods.</p><p><strong>Purpose: </strong>This study introduces a novel apparatus for real-time measurement of both external and internal CoEs, offering a cost-effective alternative to expensive and complex traditional methods that require extensive data processing.</p><p><strong>Study design/setting: </strong>The study employed a controlled experimental design to develop and validate the proposed CoE measurement apparatus in a laboratory setting using a sample of healthy young adults.</p><p><strong>Methods: </strong>The proposed apparatus used 2 spherical measuring units to independently track pelvic and T1 vertebra motion, employing dual rotational magnetic encoders and a linear displacement sensor for precise 3D motion contour capture.</p><p><strong>Results: </strong>Validation experiments confirmed the system's reliability, achieving an average measurement error below 1.5 mm. The CoE is not an idealized cone but has an irregular conical shape, influenced by physiological factors (height and weight). The average range of sway (RoS) for external CoE at T1 was 42.7 (coronal), 47.6 (sagittal), and 12.5 cm (vertical), whereas that at the pelvic position was 14.3, 13.4, and 8 cm, respectively. The average RoS for internal CoE were smaller: 10.4 (coronal), 6.9 (sagittal), and 2 cm (vertical) at T1 and 8.2, 5.8, and 2.2 cm, respectively, at the pelvic position. The external CoE exhibited a larger RoS at the body's front, reflecting the foot's role in balancing forward shifts of gravity.</p><p><strong>Conclusions: </strong>Preliminary findings highlight a stronger correlation between external CoE and height than internal CoE, establishing a foundation for CoE research with implications for fall prevention and balance assessment.</p><p><strong>Clinical significance: </strong>This study introduces a reliable, cost-effective apparatus for real-time cone of economy (CoE) measurement, offering dynamic insights into postural stability, fall risk, and personalized balance assessment in clinical settings.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755373","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":"International external validation of the SORG machine learning algorithm for predicting sustained postoperative opioid prescription after anterior cervical discectomy and fusion using a Taiwanese cohort of 1,037 patients.","authors":"Yu-Yung Chen, Hung-Kuan Yen, Jui-Yo Hsu, Ta-Chun Lin, Hao-Chen Lin, Chih-Wei Chen, Ming-Hsiao Hu, Olivier Q Groot, Joseph H Schwab","doi":"10.1016/j.spinee.2025.03.022","DOIUrl":"10.1016/j.spinee.2025.03.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Anterior cervical discectomy and fusion (ACDF) is widely performed for cervical spine disorders, with opioids commonly prescribed postoperatively for pain management. However, prolonged opioid use carries significant risks such as dependency and adverse health effects. Predictive models like the SORG machine learning algorithm (SORG-MLA) have been developed to forecast prolonged opioid use post-ACDF. External validation is essential to ensure their effectiveness across different healthcare settings and populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The study aimed to assess the generalizability of the SORG-MLA to a Taiwanese patient cohort for predicting prolonged opioid use after ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study utilizing data from a tertiary care center in Taiwan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;1,037 patients who underwent ACDF between 2010 and 2018 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was sustained postoperative opioid prescription defined as continuous opioid use for at least 90 days following ACDF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The performance of the SORG-MLA in the validation cohort was assessed using discrimination measures (area under the receiver operating characteristic curve [AUROC] and the area under the precision-recall curve [AUPRC]), calibration, overall performance (Brier Score), and decision curve analysis. Comparing the validation cohort to the developmental revealed significant differences in demographic profiles, medicolegal frameworks, ethnic cultural contexts and key predictors of postoperative opioid use identified by the SORG-MLA. The Taiwanese cohort was characterized by an older age demographic, a lower proportion of female participants, higher smoking prevalence, higher incidence of preoperative myelopathy and radiculopathy, and more frequent use of antidepressants prior to surgery. Conversely, these patients were less likely to have extended preoperative opioid prescriptions beyond 180 days, undergo multilevel ACDF procedures, or be treated with concurrent medications such as Beta-2 agonists, Gabapentin, and ACE inhibitors. This study had no funding source or conflict of interests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The model demonstrated good discriminative ability, with an AUROC of 0.78 and an AUPRC of 0.35. Calibration curves indicated that the model overestimated the risk of prolonged opioid use. This discrepancy may be attributed to the significantly higher incidence of sustained opioid consumption in the American development cohort, spanning from 2000 to 2018, which was threefold higher than that in the Taiwanese validation cohort between 2010 and 2018 (9.9% [270/2737] vs. 3.3% [34/1037]; p &lt; .01). The Brier score was 0.033, which improved upon the null model's score of 0.040, indicating robust overall performance. Decision curve analysis confirmed the model's clinical utility, demonstrating ne","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755374","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 application value of intraoperative neurophysiological monitoring in cervical spinal canal stenosis decompression surgery.","authors":"Yongjie Zhang, Jialiang Li, Yang Yuan, Yuchen Wang, Dageng Huang, Huaguang Qi","doi":"10.1016/j.spinee.2025.03.029","DOIUrl":"10.1016/j.spinee.2025.03.029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Although intraoperative neurophysiological monitoring (IONM) has been widely recognized and used in spine surgery, its characteristics vary for different types of spinal disorders, necessitating the development of tailored monitoring strategies. Cervical spinal stenosis presents complex clinical symptoms and carries significant surgical risks, creating a critical need to clarify the monitoring features, alert patterns, and their relationship with outcomes in such surgeries. A comprehensive assessment and the development of a refined IONM monitoring plan throughout the perioperative period is an important direction for future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to investigate the influencing factors of intraoperative neurophysiological monitoring (IONM) alarm events in patients with cervical spinal canal stenosis and to evaluate the predictive value of different IONM alarm patterns on neurological recovery following decompression surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient samples: &lt;/strong&gt;This analysis included 1,622 patients who underwent cervical spinal canal decompression surgery and had complete IONM monitoring data between February 2017 and December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The preoperative and postoperative neurological status of the patients was assessed using the modified Japanese Orthopaedic Association (mJOA) score. The primary IONM alarm indicators included somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (MEP), compared to the preoperative baseline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Logistic regression was employed to analyze the correlation between preoperative diagnostic risk factors and intraoperative alarm events. Additionally, a multifactorial interaction analysis was performed to determine the relationship between IONM changes and the reversibility of alarms with the six-month mJOA recovery rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preoperative diagnoses of the ligamentum flavum hypertrophy and/or ossification of the posterior longitudinal ligament, combined with an mJOA score &lt;12, were identified as high-risk factors for intraoperative alarms. The sensitivity of alarms in the high-risk group was 100%, with a positive predictive value of 90.6%; in the low-risk group, the sensitivity was 91.7%, with a positive predictive value of 40.74%. Variance analysis indicated that the mJOA improvement rate at six months was significantly lower in patients with irreversible IONM alarms compared to those with reversible alarms. Interaction analysis suggested that the reversibility of intraoperative alarm events was a principal predictor of postoperative outcomes, while risk factors for alarms had predictive value only in patients with irreversible alarms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients with cervical spinal canal stenosis caused by disc degeneration, the presence of ligamentum fla","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744325","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":"Adverse respiratory events during treatment with gabapentin and opioids among older adults with spine-related conditions: a propensity-matched cohort study in the US Medicare population.","authors":"Laura S Gold, Patrick J Heagerty, Ryan N Hansen, Janna L Friedly, Richard A Deyo, Michele Curatolo, Judith A Turner, Sean D Rundell, Jeffrey G Jarvik, Pradeep Suri","doi":"10.1016/j.spinee.2025.03.014","DOIUrl":"10.1016/j.spinee.2025.03.014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Recent work indicates no increased mortality risk with concurrent gabapentin and opioid use when using an active comparator control design. However, concurrent gabapentin and opioid prescriptions have been associated with greater risk of respiratory depression in some studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the risk of respiratory events among Medicare enrollees with histories of spine-related diagnoses treated with gabapentin+opioids versus those treated with tricyclic antidepressants (TCA) or duloxetine+opioids. We hypothesized that enrollees treated with gabapentin+opioids would have increased risk of adverse respiratory events compared to those treated with an active control+opioids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Propensity score-matched cohort study with an incident user, active comparator (TCA/duloxetine) control design. The primary analysis included those who concurrently (within 30 days) filled ≥1 incident gabapentin+≥1 opioid or ≥1 incident TCA/duloxetine+≥1 opioid prescription.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;U.S. Medicare beneficiaries with histories of spine-related diagnoses 2017 to 2019. People treated with gabapentin+opioids (n=66,860) were matched on demographic and clinical factors to people treated with TCAs/duloxetine+opioids (n=66,860).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Time to a composite respiratory outcome consisting of mechanical ventilation, intubation, respiratory failure, pneumonia, or acute respiratory distress syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Cox proportional hazard regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 133,720 Medicare enrollees (median age 73.3 years; 66.9% female), 6277 (4.7%) experienced respiratory events before the end of follow-up. A total of 3,469 (5.2%) of people who were treated with gabapentin+opioids (median initial dose/day of gabapentin was 300 mg) had respiratory events compared to 2808 (4.2%) of those treated with an active control+opioids. The increased risk in those treated with gabapentin+opioids was statistically significant after adjustment (HR 1.19; 95% CI 1.13, 1.25; p&lt;.0001). The most common respiratory events were pneumonia (3.7% of people in the gabapentin+opioids group versus 3.0% of people in the TCA/duloxetine+opioids group) and respiratory failure (2.3% in the gabapentin+opioids group versus 1.8% in the TCA/duloxetine+opioids group). Results were similar in analyses (a) restricted to ≤30-day follow-up and (b) that required ≥2 fills of each prescription.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;While recent work indicates no increased mortality risk with concurrent gabapentin and opioid use in this population, the current findings suggest clinicians should exercise caution in prescribing gabapentin to older adults with spine conditions who are using opioids, due to possible impacts on respiratory events. H","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744259","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}