Spine open最新文献

{"title":"Sex Differences in Opioid Prescriptions Following Anterior Cervical Spine Surgery.","authors":"Matthew T Carr, Brocha Z Stern, Mert Karabacak, Saad B Chaudhary, Konstantinos Margetis","doi":"10.1097/bn9.0000000000000050","DOIUrl":"10.1097/bn9.0000000000000050","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Our objective was to compare postoperative opioid prescriptions between male and female patients following anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA).</p><p><strong>Summary of background data: </strong>Sex differences in pain are well-established in basic science and clinical medicine; however, sex differences in postoperative pain management following spine surgery are less well-studied.</p><p><strong>Methods: </strong>The Marketscan Commercial Claims and Encounters database was queried for adults without a history of chronic opioid use who underwent ACDF or CDA from January 2017 through June 2021. Binary logistic regression analyses of filling an opioid prescription and generalized linear model analyses of total oral morphine milligram equivalents (MMEs) prescribed were performed. \"Perioperative\" prescription were defined as 30 days before to 14 days after surgery; \"prolonged postoperative\" was defined as 91 to 180 days after surgery.</p><p><strong>Results: </strong>For single-level ACDF (n=9844; 51.7% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.36; 95% CI: 1.18, 1.56; p<0.001] and filled lower perioperative MMEs than males [adjusted mean difference (AMD): -15.32; 95% CI: -28.52, -2.13; p=0.02].For multi-level ACDF (n=12,871; 52.5% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.16; 95% CI: 1.03, 1.30; p=0.02] and filled lower MMEs than males in the perioperative period [AMD: -27.47; 95% CI: -39.78, -15.17; p<0.001].Following CDA (n=3283, 48.8% female), females were more likely to fill a prolonged postoperative opioid prescription [aOR: 1.53; 95% CI: 1.17, 2.00; p=0.002], but there was no association between sex and perioperative or prolonged postoperative MME.</p><p><strong>Conclusions: </strong>These findings can guide the expectations on postoperative opioid prescribing after ACDF/CDA and warrant further studies to confirm the results and optimize postoperative pain management.</p>","PeriodicalId":521215,"journal":{"name":"Spine open","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human molecular mechanisms of lumbar disc degeneration: A scoping review.","authors":"Abby P Chiu, Savera Khan, Joseph B Lesnak, Ava Ward, Katherin Gabriel, Theodore J Price, Lars Arendt-Nielsen, Michele Curatolo, Pavlos Bobos","doi":"10.1097/bn9.0000000000000021","DOIUrl":"10.1097/bn9.0000000000000021","url":null,"abstract":"<p><strong>Study design: </strong>Scoping review.</p><p><strong>Objective: </strong>To synthesize current knowledge of molecular mechanisms underlying human lumbar disc degeneration (LDD) and identify knowledge gaps to be addressed by future research.</p><p><strong>Summary of background data: </strong>Chronic low back pain (CLBP) is a leading cause of disability worldwide. Epidemiological studies based on radiologic findings suggest that patients with LDD are more likely to develop CLBP. Despite many reviews on disc degeneration, no systematic synthesis has focused on the molecular mechanisms of LDD using human tissue models.</p><p><strong>Methods: </strong>A systematic search of 12 databases identified 8310 studies. After applying screening criteria, 159 studies analyzing human lumbar degenerative disc tissues from adult patients with radiologically diagnosed LDD were eligible for data extraction. Studies with sample sizes < 20, tissues from organ donors or non-lumbar regions, or findings based solely on animal data or public repositories (<i>e.g.</i>, Gene Expression Omnibus) without clinical validation were excluded from the final synthesis.</p><p><strong>Results and conclusions: </strong>Twenty-nine studies were selected for the synthesis of findings. Current evidence converges on dysregulated lipid metabolism, including impaired phosphatidylcholine synthesis and oxidized low-density lipoprotein signaling via LOX-1; ferroptosis and pyroptosis driven by iron overload and mitochondrial DNA-mediated inflammasome activation; and interleukins (IL-21, IL-17A) that enhance TNF-α-mediated catabolic and inflammatory signaling. Epigenetic regulators (SIRT1 and BRD4), posttranscriptional/translational proteins (TRIM21, Piezo1, YAP1, CHSY3, FSTL1, and IGFBP5), and noncoding RNAs further modulate extracellular matrix homeostasis, cell cycle progression, apoptosis, and inflammation, often through NF-κB and MAPK pathways. Despite their clinical relevance, the included studies had several major limitations: small sample sizes, limited phenotypic profiling and stratification, demographically unbalanced cohorts, and reliance on in vitro or animal models for experimental data. Future studies should integrate multi-omics, imaging, and clinical data to enhance mechanistic insight and support the development of targeted therapies for LDD.</p>","PeriodicalId":521215,"journal":{"name":"Spine open","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12826677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}