Spine Journal最新文献

{"title":"50. The association of venous thromboembolism chemoprophylaxis and complications following spinal trauma surgery","authors":"Sanket Mehta MD","doi":"10.1016/j.spinee.2025.08.232","DOIUrl":"10.1016/j.spinee.2025.08.232","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a serious complication following spine surgery. Spine procedures in the setting of trauma carry an increased risk of adverse bleeding events, such as epidural hematomas, making anticoagulation management particularly challenging. Despite this concern, the role of perioperative VTE prophylaxis in the setting of spine trauma is less understood and remains an issue of debate.</div></div><div><h3>PURPOSE</h3><div>To investigate chemical prophylaxis administration (low molecular weight heparin [LMWH], unfractionated heparin [UH], none) with the probability of in-hospital complications in patients undergoing surgical intervention for spinal trauma in Level I-IV trauma centers.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This was a retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 55,548 patients registered in National Trauma Data Bank (NTDB) from 2011 to 2019 and initially evaluated in the ED of Level I-IV trauma centers in the United States who underwent operatively treated spine fracture or dislocation were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome measure was inpatient mortality. Secondary outcomes were in-hospital complications including VTE and adverse bleeding event.</div></div><div><h3>METHODS</h3><div>We performed a retrospective cohort study involving spine trauma patients aged 18 to 64 years who were registered in the National Trauma Data Bank (NTDB) between 2011 and 2019. Patients who were missing insurance information, dead on arrival, or had an injury severity score (ISS) less than 9 were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate logistic analysis was employed to investigate the association of insurance status with mortality and probability of select diagnostic and therapeutic procedures, adjusting for age, sex, race, ethnicity, ISS, presence of shock, mechanism of injury, intent of injury, Glasgow Coma Scale (GCS) motor score, significantly different comorbidities, and year of admission.</div></div><div><h3>RESULTS</h3><div>Overall, 31,715 (57.09%) received LMWH, 12,252 (22.06%) received UH, and 11,581 (20.85%) received no chemical prophylaxis. Comorbidity analyses revealed significant differences in alcoholism, bleeding disorder, congestive heart failure, current smoker status, chronic renal failure, stroke, diabetes mellitus, functionally dependent health status, history of myocardial infarction, hypertension, respiratory disease, and dementia. No differences existed in terms of ISS (17 vs 17 vs 16; p=0.95), but patients receiving no chemical prophylaxis were less likely to have presented in shock (none 2.53% vs LMWH 6.15% vs UH 6.32%; p<0.001). Mortality rate was greater in patients receiving UH compared to patients receiving LMWH or no chemical prophylaxis (4.08% v","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S27"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236586","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":"97. The 5-year incidence of progression to lumbar disc degeneration in patients prescribed glucagon-like peptide 1 receptor agonists","authors":"Abdullah Ghali MD , Jad Lawand MS , Harris Hafeez BS , Muaaz Wajahath BS , Lorenzo Deveza MD, PhD","doi":"10.1016/j.spinee.2025.08.280","DOIUrl":"10.1016/j.spinee.2025.08.280","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar disc degeneration (LDD) is a leading cause of chronic low back pain worldwide, exacerbated by obesity and type 2 diabetes mellitus (T2DM) through metabolic and inflammatory pathways. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of T2DM and obesity, offering potent weight loss and glycemic benefits. Moreover, preclinical studies suggest anti-inflammatory and anti-oxidative properties of GLP-1 RAs could theoretically slow the progression of LDD. Despite these promising indications, long-term clinical data on whether GLP-1 RAs truly mitigate LDD risk and related interventions is lacking. This study harnesses a large national database to elucidate the complex interplay between GLP-1 RA use, metabolic disease, and LDD outcomes over five years.</div></div><div><h3>PURPOSE</h3><div>We aimed to clarify the impact of GLP-1 RA use on the 5-year incidence of LDD, rates of lumbar fusion, and need for spinal injections in patients with varying obesity and T2DM statuses. Given the therapeutic potential of GLP-1 RAs in treating metabolic risk factors for LDD, we hypothesized that patients prescribed GLP-1 RAs would exhibit lower progression to LDD. Our findings challenge this assumption and offer new insights on the interplay between metabolic management and spine health.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>We conducted a retrospective cohort study using the TriNetX US collaborative network—one of the largest real-world healthcare databases, capturing deidentified electronic medical records from diverse hospital systems. This robust platform enabled detailed analyses of longitudinal patient data (≥5 years of follow-up) for a comprehensive assessment of LDD progression and associated interventions.</div></div><div><h3>PATIENT SAMPLE</h3><div>From over 21 million patients seen between 2014 and 2017, we excluded those with preexisting LDD, yielding multiple key subcohorts based on T2DM and obesity status. Specifically, we compared GLP-1 RA users to nonusers in: Obese patients with T2DM, Obese patients without T2DM, Nonobese patients with T2M. To broaden the investigation, we also evaluated a random matched sample representing the general patient population without a history of LDD. This multipronged approach illuminates the differential effects of GLP-1 RAs across diverse metabolic profiles.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary Outcomes: 5-year incidence of new-onset LDD, identified through ICD-10-CM codes (eg, M51.x series), lumbar fusion procedures, and major spinal injections (eg, transforaminal epidurals, facet blocks). Secondary Outcomes: Changes in body mass index (BMI) and hemoglobin A1c (HbA1c) from baseline to 2 years postindex, providing key insights into the metabolic improvements attributable to GLP-1 RA therapy.</div></div><div><h3>METHODS</h3><div>This retrospective cohort study utilized a large deidentified database, isolating patients","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S51-S52"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236552","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":"42. Retrospective review of outcomes in patients with Bertolotti’s syndrome who underwent intra-articular pseudo-joint injection","authors":"Rachel Pooley BS ,&nbsp;Mingda Chen BA ,&nbsp;Muhammad T. Amjad DO ,&nbsp;Adam Delora MD, MS ,&nbsp;Kush K Goyal MD","doi":"10.1016/j.spinee.2025.08.224","DOIUrl":"10.1016/j.spinee.2025.08.224","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Bertolotti’s syndrome is a clinical diagnosis characterized by low back pain (LBP) associated with a lumbosacral transitional vertebra (LSTV). Limited research exists on the diagnostic utility and therapeutic efficacy of intra-articular pseudojoint injections.</div></div><div><h3>PURPOSE</h3><div>To evaluate the therapeutic efficacy of pseudo-articular injections for patients with Bertolotti’s syndrome.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective chart review at a large tertiary referral medical center.</div></div><div><h3>PATIENT SAMPLE</h3><div>Forty-five patients.</div></div><div><h3>OUTCOME MEASURES</h3><div>NRS pain scores.</div></div><div><h3>METHODS</h3><div>We included all consecutive patients at our institution who were diagnosed with Bertolotti’s syndrome and underwent an intra-articular pseudojoint injection (anesthetic and corticosteroid) from September 2013 to August 2024. We performed manual chart review to collect information about the patients’ demographics, comorbid conditions, clinical and patient-reported outcomes. We examined predictors of post-procedural relief, and the relationship between diagnostic injection outcomes and subsequent surgical resection results.</div></div><div><h3>RESULTS</h3><div>In this cohort, 31.1% (14/45) were male and 68.9% (31/45) were female. Notably 25.0% (11/45) of patients had lumbar spondylolisthesis. A considerable psychological dimension is contributory to pain with these patients, as 62.2% (28/45) of patients had an anxiety disorder, 48.9% (22/45) had depression, 11.1% (5/45) had other psychiatric conditions. Inflammatory component was highlighted as 26.7% (12/45) of patients had a history of a rheumatologic condition. 15.6% (7/45) of patient were taking prescription opioids at the time of the injection. Median pain relief was 80%, with median diagnostic relief of 8.50 days. Mean NRS pain scores prior to the procedure were 5.5 (95% CI [4.9, 6.2]), and at follow-up, the mean score was 4.2 (95% CI [3.4, 5.0]). The majority of Bertolotti’s syndrome patients were referred by spine surgery providers. Following their pseudojoint injection, 15.6% of patients (7/45) subsequently underwent a Bertolotti resection surgery. Among the patients who later underwent surgical resection after relief from pseudojoint injection, 71.4% experienced significant post-operative relief.</div></div><div><h3>CONCLUSIONS</h3><div>Our data suggests that fluoroscopicallyguided pseudojoint injections with corticosteroid may provide both efficacious pain relief for Bertolotti’s syndrome and prognostic value for post-resection outcomes. Additionally, the correlation between injection and surgical outcomes highlights the benefit of close collaboration between interventional spine providers and spine surgeons.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S23"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236320","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":"31. Patient perceptions after elective outpatient lumbar spine surgery: do patients prefer same day discharge or an overnight stay?","authors":"HSS SpineTeam MD ,&nbsp;Tejas Subramanian BS ,&nbsp;Stephane Owusu-Sarpong MD ,&nbsp;Chad Simon BS ,&nbsp;Robert Uzzo MBA ,&nbsp;Tomoyuki Asada MD, PhD ,&nbsp;Eric Zhao BS ,&nbsp;Kasra Araghi BS ,&nbsp;Pratyush Shahi MBBS, MS ,&nbsp;Sereen Halayqeh MD ,&nbsp;Adin Ehrlich BA ,&nbsp;Andrea Pezzi MD ,&nbsp;Atahan Durbas MD ,&nbsp;Adrian Lui MBBS ,&nbsp;Olivia Tuma BS ,&nbsp;Rujvee P. Patel MBBS, MPH ,&nbsp;Tarek Harhash BS ,&nbsp;James Dowdell MD ,&nbsp;Sheeraz A Qureshi MD, MBA ,&nbsp;Sravisht Iyer MD","doi":"10.1016/j.spinee.2025.08.213","DOIUrl":"10.1016/j.spinee.2025.08.213","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;While the safety and efficacy of ambulatory spine surgery have been well established, patient perceptions and experiences with these accelerated recovery pathways remain underexplored.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aims to assess patient experiences in ambulatory lumbar spine surgery, with a focus on their expectations and preferences regarding discharge disposition, as well as the impact of discharge timing and alignment with patient preferences on satisfaction and early recovery outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Single-center, survey-based study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The survey was administered to adult patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) or laminectomy (MI-Lami) and were discharged either on the same day of surgery (SDD) or after an overnight hospital stay (OVN).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;A custom survey, designed by the authors, assessed patient experiences, preferences, and satisfaction related to discharge disposition. Respondents were asked to reflect on their surgical experience, focusing on their preferences for discharge timing and the reasons behind those preferences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patient preferences were qualitatively analyzed to identify recurring themes, while their postoperative night one experience was quantitatively scored across multiple domains, including sleep quality, comfort, hygiene management, and overall satisfaction. These data were then used to explore the relationship between discharge timing, and preference concordance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 227 responses were collected, with 64 (28.2%) undergoing MI-TLIF and 163 (71.8%) undergoing MI-Lami. Of these, 116 (51.1%) were discharged on the same day (SDD) and 111 (48.9%) had an overnight stay (OVN). While 36% preferred SDD and 49.8% preferred OVN, 56.9% reported feeling ready for same-day discharge. Qualitative analysis revealed that SDD preferences were driven by comfort at home, better sleep, and avoiding hospital inconveniences. Conversely, OVN preferences emphasized medical support, pain control, and logistical ease. Patients discharged the same day reported better care, sleep, hygiene, and comfort (p &lt; 0.05 for all). Those discharged in concordance with their preferences reported significantly lower rates of feeling discharged prematurely (3.4% vs 32.3%; p &lt; 0.001) and superior outcomes across multiple domains, including pain control, comfort, and reduced burden on families (p &lt; 0.05 for all).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;SDD patients reported improved postoperative experiences, including sleep and satisfaction. Aligning discharge timing with patient preferences further enhanced outcomes, emphasizing the importance of patient-centered discharge planning in spine surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;FDA Device/D","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S17"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236230","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":"68. Disease-modifying anti-rheumatic drugs and anterior cervical discectomy and fusion: influence on postoperative complications and reoperation rates","authors":"Muhammad Waheed MD ,&nbsp;Ashar Ahmed BS ,&nbsp;Rahul Vaidya FRCSC, MD ,&nbsp;Ilyas Aleem MD, MSc, FRCSC","doi":"10.1016/j.spinee.2025.08.250","DOIUrl":"10.1016/j.spinee.2025.08.250","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation, leading to progressive joint degeneration and the potential need for surgical intervention, including anterior cervical discectomy and fusion (ACDF). Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of RA management, modulating immune responses to reduce disease progression. However, concerns exist regarding their impact on postoperative outcomes, particularly in relation to medical complications and overall reoperation risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To investigate the impact of DMARD therapy on postoperative complication rates, reoperation rates, and long-term survival probabilities in RA patients undergoing ACDF, with specific emphasis on early (90-day) and longer-term (2-year) outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Retrospective propensity-matched cohort study utilizing a large patient database from US academic hospitals (TriNetX).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 1,016 patients with RA who underwent primary one-level ACDF, including 508 patients receiving DMARD therapy and 508 matched controls without DMARD exposure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Primary outcomes included rates of postoperative medical and mechanical complications, readmission, and reoperation at 90 days and 2 years. Secondary outcomes included myocardial infarction (MI) incidence and reoperation-free survival.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patients were identified using ICD-10 and CPT codes from the TriNetX database. Inclusion criteria consisted of patients &gt;18 years of age who underwent a single-level, elective ACDF procedure at an academic institution. Postoperative complications, readmission rates, and reoperation rates were compared between DMARD users and nonusers at 90 days and 2 years. Kaplan-Meier survival analysis was performed to assess reoperation-free survival. Statistical significance was set at p&lt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;At 90 days, DMARD users had higher readmission (4.3% vs 2.0%, p=0.031) and reoperation rates (4.1% vs 2.0%, p=0.045) compared to nonusers. At 2 years, reoperation rates remained higher in the DMARD group (8.3% vs 4.1%, p=0.006). Interestingly, DMARD users had a lower incidence of myocardial infarction (MI) at 2 years (2.2% vs 4.7%, p=0.025). Kaplan-Meier analysis demonstrated significantly reduced reoperation-free survival in the DMARD group (p=0.0083).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Rheumatoid arthritis patients on DMARD therapy undergoing ACDF experience higher early and late reoperation rates compared to patients who are not on DMARD therapy. However, the lower MI incidence in DMARD users suggests a possible cardiovascular protective effect. Careful preoperative risk assessments and patient counseling regarding the risks and benefits of DMARD therapy may be warranted in this patie","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S36-S37"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236401","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":"57. A comparison of conventional and contemporary radiation techniques in the treatment of spinal metastases","authors":"Jordan O Gasho BS ,&nbsp;Daniel de Reus MD ,&nbsp;Joseph Schwab MD ,&nbsp;Daniel G Tobert MD","doi":"10.1016/j.spinee.2025.08.239","DOIUrl":"10.1016/j.spinee.2025.08.239","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;As cancer patients continue to live longer and the prevalence of spinal metastasis rises, effective palliative treatments become increasingly important for multidisciplinary clinical teams. For decades, conventional external beam radiotherapy (cEBRT) has been standard for palliation after spinal metastasis surgery. However, cEBRT is dose-limited due to its effects on the skin and flat dose gradient. Contemporary stereotactic body radiotherapy (SBRT) may circumvent these limitations by delivering higher doses in fewer fractions to smaller, well-defined targets, improving local control and reducing treatment-related toxicities. However, the efficacy of postoperative radiotherapy for local control of spinal metastases with SBRT in direct comparison to cEBRT has not yet been studied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To compare clinical outcomes in patients with spinal metastases treated with postoperative cEBRT versus SBRT after spinal metastasis surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&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;Eligible patients included those treated surgically for spinal metastasis at Massachusetts General Hospital between January 2017 and December 2022, followed by postoperative palliative radiotherapy using either cEBRT or SBRT. A matched cohort of 204 patients was created using propensity score matching.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary endpoint was reoperation. Secondary outcomes included overall survival (OS), tumor progression, and postoperative complications. Risk factors for reoperation were also considered.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patients were divided into two propensity score matched cohorts: cEBRT and SBRT. Patients were matched on revised Katagiri score, Charlson Comorbidity Index (CCI), Eastern Cooperative Oncology Group (ECOG) performance status, American Spinal Injury Association (ASIA) impairment scale, number of spinal metastases, smoking status, and time between surgery and the start of RT. Kaplan-Meier analysis was used to assess differences in overall survival and reoperation rates. Additionally, risk factors for reoperation were evaluated using univariate and multivariable logistic regression to adjust for residual bias, controlling for dose, time between surgery and the start of RT, revised Katagiri score, number of spinal metastases, visceral metastases, ECOG, and ASIA score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 204 patients (84 women and 120 men) with a mean age of 62 years (21-88, median 63 years) were included. 81 patients treated with cEBRT were matched with 123 patients treated with SBRT. Overall reoperation rate was 13.2%, with no significant difference between the cEBRT and SBRT groups (12.4% vs 13.8%, p=0.76). Median time to reoperation was 6 months (IQR 1.4-11.5 months). Median OS was 15.9 months (IQR, 6.7-40.6 months). Kaplan-Meier analysis revealed no significan","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S31"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236362","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":"48. Extension of fusion to cervical spine vs upper thoracic spine for the management of proximal junctional kyphosis","authors":"Ahmed Sulieman MD ,&nbsp;Yesha Parekh MD ,&nbsp;Virginie Lafage PhD ,&nbsp;Renaud Lafage MSc ,&nbsp;Breton Line BS ,&nbsp;Christopher P. Ames MD ,&nbsp;Shay Bess MD ,&nbsp;Thomas J Buell MD ,&nbsp;Robert K. Eastlack MD ,&nbsp;Jeffrey L. Gum MD ,&nbsp;Munish C Gupta MD, MBA ,&nbsp;Richard A. Hostin MD ,&nbsp;Han Jo Kim MD ,&nbsp;Darryl Lau MD ,&nbsp;Gregory M. Mundis MD ,&nbsp;Peter Gust Passias MD ,&nbsp;Themistocles Stavros Protopsaltis MD ,&nbsp;Christopher I. Shaffrey MD ,&nbsp;Justin S. Smith MD, PhD ,&nbsp;Khaled M. Kebaish MD ,&nbsp;Sang-Hun Lee MD, PhD","doi":"10.1016/j.spinee.2025.08.230","DOIUrl":"10.1016/j.spinee.2025.08.230","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Revision surgery for PJK requires extending fusion to cranial spinal segments. Unlike extensions to the lower thoracic segments, which are less mobile, crossing the cervicothoracic junction involves highly mobile cervical segments, which may increase complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study sought to compare outcomes and complications of extension of fusion to the cervical vs upper thoracic spine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;Prospective multicenter study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Patients undergoing revision surgery for thoracic PJK.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Surgical complications, revision surgeries, HRQoLs radiographic measurements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Data were collected from multicenter prospective cervical deformity database, focusing on surgical patients with thoracic PJK who underwent extension of fusion to either cervical spine or the upper thoracic spine (UT: T1 or T2). Extension of fusion to T3 and below were excluded. Cervical UIV patients were subdivided into 2 categories: lower cervical (LC; C4-7), and upper cervical (UC; Occiput-C3). Baseline demographics, intraoperative metrics, radiographic measurements, 2-year HRQLs, complications and reoperation/revision rate were analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 51 patients were included, with a mean age of 60.4 ± 12.9 years, and 91% were female, all with at least 2 years of follow-up. Of those, 12 patients were in the UT group (Preoperative UIV n: 8 at T1-4, 2 at T5-8, 2 at T9-12), 20 in the LC group (Preoperative UIV n: 18 at T1-4, 2 at T9-12), and 19 in the UC group (Preoperative UIV n: 14 at T1-4, 1 at T5-8, 4 at T9-12). The demographic data and Charlson Comorbidity Index were similar across groups. EBL, operative time were similar while levels fused were more in the UC, followed by LC and the UT group. All groups had similar radiographic measurements, including change in proximal junctional angle. For complications, instrumentation failure was higher in LC group (25%, vs 0% in group 1 and 8% in group 3 p=0.033). Other complications; medical, surgical, neurological and infectious were not significantly different. Reoperation rate was 0% in UT, 30% in LC and 10.5% in UC (p=0.071) and recurrent PJK was 0% in UT, 15% in LC and 10.5% in UC but did not show statistical significance (p=0.427). Postoperative radiographic and HRQols were similar across the groups at 2 years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Stopping fusion at the upper thoracic spine (T1 or T2) did not increase complications or reoperation rates compared to the group with a fusion to the cervical spine. The lower cervical spine UIV (C4-7) shows higher instrumentation related complications, recurrent PJK and revision rates compared to the upper cervical (C2-3) and the upper thoracic UIV. Crossing cervicothoracic junction may not be beneficial to avoid junctional le","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S26"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236328","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":"9. Changes in sagittal alignment following lumbar total disc replacement: analysis based on full-body EOS imaging","authors":"Scott L Blumenthal MD ,&nbsp;Emily Courtois MS ,&nbsp;Richard D. Guyer MD ,&nbsp;Jessica Shellock MD ,&nbsp;Jack E. Zigler MD ,&nbsp;Donna D. Ohnmeiss PhD","doi":"10.1016/j.spinee.2025.08.191","DOIUrl":"10.1016/j.spinee.2025.08.191","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>One important factor associated with spinal surgery is restoration of spinal sagittal alignment. Lordotic lumbar interbody fusion cages may aid in this restoration through the use of lumbar total disc replacement (TDR) implants, which come in a variety of heights and endplate angles. There is very little information available on the impact of TDR on sagittal alignment.</div></div><div><h3>PURPOSE</h3><div>The purpose of this study was to compare pre- to post-TDR sagittal alignment based on full-body imaging.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study included a series of 132 patients (mean age 41.1 years; mean BMI 27.7 kg/m2, 69.7% male) who had a full body EOS scan before TDR and at their first post-operative office visit. All patients were treated for symptomatic disc degeneration unresponsive to at least 6 months of nonoperative care.</div></div><div><h3>OUTCOME MEASURES</h3><div>Multiple radiographic measurements were made related to spinal alignment including pelvic incidence, sacral slope, pelvic obliquity, coronal balance, spino-sacral angle, thoracic kyphosis, and lumbar lordosis. The disc height and angulation were also measure for each lumbar level.</div></div><div><h3>METHODS</h3><div>Data were collected by chart review which included general descriptors and surgery data. Radiographic measurements were completed on SterEOS for both pelvic and postural parameters. Additionally, L1-S1 segmental disc angles and disc heights were measured using PACS applied to the EOS images.</div></div><div><h3>RESULTS</h3><div>There were 178 TDR devices implanted, with most operations at 1-level (n=89). There were statistically significant changes in 3 sagittal alignment measurements after TDR surgery: sacral slope, sagittal pelvic tilt, and spino-sacral angle. Both sacral slope and spino-sacral demonstrated an increase while sagittal pelvic tilt decreased. There was a statistically significant increase and decrease in disc angulation of operated levels and nonoperated levels, respectively. There was a statistically significant increase in disc height at the operated level(s) as well as the nonoperated levels, though this was not clinically relevant.</div></div><div><h3>CONCLUSIONS</h3><div>The findings demonstrate a significant rotation of the pelvis backwards, increased spino-sacral angulation, and disc space angulation, supporting lumbar TDR’s ability to successfully improve the upright standing position in the sagittal plane. Long-term follow-up will be necessary to determine if these early changes are maintained.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S6-S7"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236522","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":"13. Impact of oncological biomarkers and clinical factors on survival outcomes in renal cell carcinoma with spinal metastases: a retrospective analysis","authors":"Abdul Karim Ghaith MD, PhD ,&nbsp;Xinlan Yang MS ,&nbsp;Abdel-Hameed Al-Mistarehi MD ,&nbsp;A. Daniel Davidar ,&nbsp;Nicholas Theodore MD ,&nbsp;Daniel Lubelski MD","doi":"10.1016/j.spinee.2025.08.195","DOIUrl":"10.1016/j.spinee.2025.08.195","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Renal cell carcinoma (RCC) is a common malignancy with a high propensity to metastasize to the spine, leading to complex treatment challenges and reduced survival. In this study, we evaluated the prevalence of oncological biomarkers in patients with RCC spinal metastases and analyzed how these biomarkers, along with clinical factors, impact survival outcomes.</div></div><div><h3>PURPOSE</h3><div>N/A</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>N/A</div></div><div><h3>PATIENT SAMPLE</h3><div>N/A</div></div><div><h3>OUTCOME MEASURES</h3><div>N/A</div></div><div><h3>METHODS</h3><div>We conducted a retrospective analysis of patients with RCC who underwent surgical resection of spinal metastases at Johns Hopkins Hospital between 2013 and 2022. Two survival metrics—overall survival and survival following spinal metastasis—were the primary outcomes for this study. Demographic, clinical, and immunohistochemical biomarker expression data were collected. Log-rank tests were used to identify significant survival differences based on clinical and biomarker factors. Cox regression analyses were used to determine independent predictors of survival.</div></div><div><h3>RESULTS</h3><div>A total of 33 patients were included in this study, with a median age of 61 years. Primary tumor resection and preoperative ambulatory status were significantly associated with higher overall survival (99.6 vs 22.8 months, p=0.017; and 61.2 vs 15.6 months, p=0.012, respectively). CAM5.2 expression was associated with lower overall survival (14.4 vs 61.2 months, p=0.001). Survival following spinal metastasis was significantly lower in patients with lung metastases (8.4 vs 19.2 months, p=0.032) and those expressing CAM5.2 or EMA (6.0 vs 15.6 months for both, p=0.016 and p=0.039, respectively), while primary tumor resection was associated with improved survival post-spinal metastasis (37.2 vs 8.4 months, p=0.012). Cox regression identified postoperative non-ambulatory status (HR 7.98;95%CI .932-32.922; p=0.004) and CAM5.2 expression (HR 11.00; 95%CI 2.393-50.584; p=0.002) as independent risk factors for mortality. Lung metastasis (HR 2.45; 95%CI 1.037-5.769; p=0.041) and primary tumor resection (HR 0.35; 95%CI 0.136-0.899; p=0.029) were significant predictors of survival following spinal metastasis.</div></div><div><h3>CONCLUSIONS</h3><div>The oncological profile of RCC spinal metastases plays a critical role in survival outcomes, particularly with biomarkers like CAM5.2 and clinical factors such as ambulatory status and primary tumor resection. CAM5.2 and nonambulatory status were associated with decreased survival, while primary tumor resection correlated with improved survival.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S8"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236505","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":"77. Nontobacco nicotine dependence and incidence of pseudarthrosis and other postoperative complications in lumbar fusion surgery: a retrospective analysis","authors":"Abdullah Ghali MD ,&nbsp;Jad Lawand MS ,&nbsp;Lorenzo Deveza MD, PhD ,&nbsp;Harris Hafeez BS","doi":"10.1016/j.spinee.2025.08.259","DOIUrl":"10.1016/j.spinee.2025.08.259","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Lumbar fusion surgery is widely performed for various spinal pathologies, including trauma, tumors, infections, and degenerative conditions, yet carries notable risks of postoperative complications. Nicotine has been closely linked to adverse surgical outcomes, particularly pseudarthrosis, due to its vascular and bone-healing impacts. While tobacco nicotine dependence is well-studied, nontobacco nicotine products (eg, e-cigarettes, vaping devices) are increasingly popular and perceived by many as safer alternatives. However, their physiological impact—encompassing vasoconstriction, immune modulation, and potential toxicity from added chemicals—may similarly predispose patients to surgical complications. This study examines whether nontobacco nicotine dependence (NTND) increases the risk of short- and long-term complications following lumbar fusion surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To evaluate the relationship between preoperative non-tobacco nicotine dependence and postoperative complications in lumbar fusion patients within 90 days and up to 2 years post-surgery. A secondary comparison analyzed differences in 2-year implant-related outcomes between patients with NTND and those with tobacco nicotine dependence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A retrospective cohort study was performed using the TriNetX database, a global federated research network that provides deidentified electronic medical records from 89 healthcare organizations. This resource allows for large-scale analyses of surgical outcomes while maintaining patient confidentiality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Patients undergoing lumbar fusion were identified by relevant ICD-10 and CPT codes. Three cohorts were formed based on preoperative nicotine dependence status: NTND cohort – patients with nontobacco nicotine dependence (n=3,012) Tobacco nicotine dependence – patients using tobacco-based nicotine Control group – patients without any nicotine dependence (n=62,099 before matching) Propensity score matching (1:1) was conducted to control for demographics (age, gender, race), clinical comorbidities (eg, diabetes, hypertension, chronic kidney disease), and relevant medications (metformin).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Ninety-Day Complications: pulmonary embolism, deep vein thrombosis, myocardial infarction, stroke, pneumonia, renal failure, infections, wound complications, readmissions, emergency department visits, and sepsis. Two-Year Implant-Related Outcomes: pseudarthrosis, adjacent segment disease, foot drop, postlaminectomy syndrome, and repeat lumbar fusion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;A retrospective cohort study was conducted using the TriNetX database, which aggregates de-identified medical records from 89 healthcare organizations. Patients undergoing lumbar fusion surgery were identified and categorized into three cohorts based on preoperative nicotine dependence status:","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S40-S41"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236455","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}