Clinical Spine Surgery最新文献

Study design: Retrospective study.

Objective: To assess the feasibility and outcome of rapid recovery protocol (RRP) in severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥90 degrees underwent single-staged posterior spinal fusion (PSF).

Summary of background data: Corrective surgeries in severe AIS patients entail a higher risk of prolonged operation, excessive bleeding, extended hospital stay, and higher complication rates compared with non-severe AIS patients. Implementation of RRP among severe AIS patients has not been reported.

Methods: Thirty-seven severe AIS patients who underwent single-staged PSF surgery from 2019 to 2022 were recruited. The RRP consisted of a preoperative regime and counselling, intraoperative strategies to reduce operation duration and blood loss and an accelerated postoperative rehabilitation pathway. Outcome measures were operative time, blood loss, postoperative pain scores, patient-controlled analgesia (PCA) morphine usage, length of hospital stay, and recovery milestones. Descriptive statistics were reported in mean (SD) for numerical data, whereas categorical data were presented in n (%).

Results: The mean operation duration was 173.5±39.4 minutes, and the mean blood loss was 1064.6±473.3 mL. The average postoperative hospital stay was 3.2±0.6 days. Twelve hours post-operation pain score was 4.0±2.0 and reduced to 3.9±1.6 at 48 hours. 78.4% of patients discontinued their PCA at 48 hours. First liquid intake was at 6.3±8.5 hours, whereas solid food consumption was initiated at 23.4±14.2 hours. The urinary catheter was removed at 17.8±7.6 hours. Patients started ambulation at 24±12.7 hours, first passed flatus at 37.7±20.4 hours and had their first bowel movement at 122.1±41.7 hours. Three complications (8.1%) were reported, which included superficial surgical site infection, proximal wound stitch abscess and superficial thermal injury due to forced air-warming blanket.

Conclusion: The implementation of the RRP after PSF in severe AIS patients was feasible and resulted in a short postoperative hospital stay of 3.2 days without increasing the risk of major complications, readmissions, and reoperations.

Study design: Multicenter retrospective cohort study.

Objective: To evaluate the efficacy and safety of using cement-augmented pedicle screw (CAPS) fixation only for the cephalad and caudal vertebral bodies.

Summary of background data: Pedicle screw fixation is less effective in patients with low-quality bone. Although CAPS fixation has shown promise in improving stability and reducing screw loosening in such cases, cement leakage can have serious consequences.

Methods: This study included 65 patients who underwent spinal surgery using CAPS and were followed up for >3 months. Four CAPSs were used in each patient, and 254 CAPSs were included in the analysis.

Results: Of the 65 patients, 36.9% showed intravenous cement leakage, and a low bone mineral density (BMD) was associated with a higher risk of cement leakage. The use of a CAPS on the right side was also potentially associated with a higher risk of leakage. However, the shape and location of the leaked cement remained stable over time. Screw loosening occurred in 3.5% of the CAPSs and was associated with a lower cement volume.

Conclusion: Cement leakage was related to lower BMD. Using CAPS exclusively at the lower or upper instrumentation levels might minimize the risk of cement leakage in osteoporotic patients.

Study design: Retrospective cohort.

Objective: To analyze the annual trends in the most prevalent topics, journals, and geographic regions of the top 100 spine surgery articles, as determined by altmetric attention scores (AASs). We also describe the relationship between AAS and traditional article metrics.

Background: The rapid growth of social media has transformed how medical literature is disseminated and perceived, including within the field of spine surgery. AAS is a metric that characterizes an article's reach and impact in various online sources.

Materials and methods: We reviewed the Altmetric database to identify the top 100 spine surgery articles by AAS from 2015 to 2020 across 8 leading spine journals. Article topics, geographic origins, and publishing journals were analyzed. Correlation analyses were performed between AAS and traditional metrics.

Results: Five hundred forty-one studies met the inclusion criteria. The majority were published in Spine (34.4%), TheSpine Journal (25.7%), European Spine Journal (15.0%), and Journal of Neurosurgery: Spine (14.2%). North America and Europe were the predominant regions of origin. The most common topics were injections (12.2%), diagnostics (11.8%), and complications (11.3%). A weak correlation was found between AAS and traditional metrics such as impact factor (Pearson coefficient = 0.041), total citations (0.051), and citations per year (0.048).

Conclusions: Although AAS provides insights into the public and online engagement of articles, it shows only a weak correlation with traditional metrics. Therefore, AAS should be considered a complementary metric for gauging the impact of research. In the era of social media, authors should continue to promote their research to broaden readership, however further investigation into characterizing article impact is warranted.

Study design: Retrospective review.

Objective: To validate using patient-reported outcome measurement information system-pain interference (PROMIS-PI) to assess outcomes in patients undergoing lumbar decompression surgery compared with well-established pain and disability measures.

Summary of background data: PROMIS outcomes provide valuable information, but the PROMIS-PI measure has not been validated in lumbar decompression.

Methods: Patient data from a single-surgeon registry were queried to identify patients undergoing elective, primary lumbar decompression for disc herniation. Exclusion criteria included records missing patient-reported outcome measures (PROMs). PROMs included: PROMIS-PI, visual analog scale (VAS)-back, VAS-leg, and Oswestry disability index (ODI). The association between PROMIS-PI and the other PROMs was determined at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year time points using the Pearson paired correlation tests. MCID achievement rates were determined for all PROMs and correlations were calculated between PROMIS-PI MCID achievement rates and achievement rates for VAS-B, VAS-L, and ODI.

Results: A total of 102 patients were included. PROMIS-PI demonstrated a significant correlation to VAS-B at all periods (P<0.0048, all) with a magnitude of correlation (|r|) ranging from 0.535 to 0.907. PROMIS-PI demonstrated a significant correlation to VAS-L at all periods (P<0.0048, all) with a magnitude of correlation (|r|) ranging from 0.393 to 0.907. PROMIS-PI demonstrated a significant correlation to ODI (P<0.0010, all) with a magnitude of correlation (|r|) ranging from 0.664 to 0.925. There were moderate correlations between MCID achievement rates between PROMIS-PI and all other PROMs studied (P<0.0019, all) with correlation coefficients ranging from 0.367 to 0.406.

Conclusion: PROMIS-PI demonstrated a significant correlation to VAS-back, VAS-L, and ODI metrics at preoperative and all postoperative follow-up periods. PROMIS-PI as a valid tool for the evaluation of patient-reported pain provides an additional metric that can guide pain management in patients undergoing spine surgery.

Study design: Retrospective review.

Objective: This study aims to compare postoperative patient-reported outcome measures (PROMs) in predominant back pain (PBP) versus predominant leg pain (PLP) patients following lumbar fusion for degenerative spondylolisthesis (DS).

Summary of background data: Prior studies comparing PROMs in patients undergoing lumbar fusion with PBP versus PLP symptoms have included heterogeneous spinal pathology and restricted analysis to posterior fusion techniques.

Methods: Demographics, perioperative characteristics, complications, and PROMs from a retrospective single-surgeon database were collected for primary, elective, and single-level lumbar fusion for DS. Preoperative/postoperative PROMs included visual analog scale (VAS)-back/leg pain (VAS-BP/VAS-LP), Oswestry disability index (ODI), 12-Item Short Form Physical and Mental Composite Score (SF-12 PCS/MCS), and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF). Preoperative VAS-BP>VAS-LP established the PBP cohort and VAS-LP>VAS-BP established the PLP cohort. The average follow-up was 23.4±2.8 months. Improvement in PROMs (ΔPROM) at 6 weeks (ΔPROM-6W) and final follow-up (ΔPROM-FF) were calculated. χ2 and the Student t test analyzed categorical and continuous variables, respectively. Postoperative PROMs, ΔPROMs, and MCID achievement rates were compared between groups with multivariate linear or logistic regression.

Results: In total, 166 patients were selected with 108 in the PBP cohort. Both cohorts saw improvements in all PROM scores over time. The PBP cohort reported significantly greater ΔPROM-6W and ΔPROM-FF for VAS-BP (P<0.003). The PLP cohort reported greater ΔPROM-6W and ΔPROM-FF for VAS-LP and ΔPROM-FF for SF-12 PCS (P<0.014). MCID achievement rates for VAS-BP were higher in the PBP cohort, and VAS-LP MCID achievement rates were higher in the PLP cohort (P<0.015).

Conclusion: Regardless of predominant pain location, patients-reported improvements in all PROs at the final follow-up. Patients with PLP-reported greater improvement in leg pain and physical function and patients with PBP-reported greater back pain improvement.

Study design: Retrospective study.

Objective: The purpose of this study was to determine whether IBD in patients with degenerative lumbar changes undergoing primary 1-2LF is associated with higher rates of (1) in-hospital length of stay, (2) medical complications, (3) readmissions, and (4) costs of care.

Summary of background data: In the United States, the prevalence of inflammatory bowel disease (IBD) has increased concurrently with an aging population with degenerative disk changes. In these patients, primary 1- to 2-lumbar fusion (1-2LF) is a common procedure to resolve serious complications of the spine. Studies comparing these patient demographics to hospital lengths of stay, postoperative complications, readmission rates, and costs of care are limited in the literature.

Methods: The inclusion criteria consisted of patients with IBD who underwent 1-2LF, using a 90-day surveillance period, postoperatively. This 90-day surveillance period was used to measure the length of hospital stay, rates of medical complications, rates of readmissions, and overall costs of care. The IBD cohort was matched against a case-matched cohort group.

Results: Patients in the study group had significantly longer in-hospital lengths of stay. In addition, patients in the study group had significantly higher incidence and odds of developing postoperative medical complications within 90 days. Also, study group patients had significantly higher readmission rates. Finally, patients in the study group had significantly higher costs of care than their case-matched cohort.

Conclusions: This study demonstrated that patients with IBD and degenerative lumbar disease are burdened with longer in-hospital lengths of stay, rates of postoperative medical complications, rates of readmission, and costs of care after undergoing primary 1-2LF.

Study design: Retrospective cohort study.

Summary of background data: The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication.

Objective: To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches.

Results: We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9 d; P<0.001).

Conclusions: Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.

Study design: Retrospective Cohort study.

Objective: Our objective was to compare 3 socioeconomic status (SES) indexes and evaluate associations with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion.

Background data: Socioeconomic disparities affect patients' baseline health and clinical outcomes following spine surgery. It is still unclear whether community-level indexes are accurate surrogates for patients' socioeconomic status (SES) and whether they are predictive of postoperative outcomes.

Methods: Adult patients undergoing ACDF (N=1189) or lumbar fusion (N=1136) from 2014 to 2020 at an urban tertiary medical center were retrospectively identified. Patient characteristics, patient-reported outcomes (PROMs), and surgical outcomes (90-day readmissions, complications, and nonhome discharge) were collected from the electronic medical record. SES was extracted from 3 indexes (Area Deprivation Index, Social Vulnerability Index, and Distressed Communities Index). Patients were classified into SES quartiles for bivariate and multivariate regression analysis. We utilized Youden's index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables.

Results: Preoperatively, lumbar fusion patients in the poorest ADI community exhibited the greatest ODI (P=0.001) and in the poorest DCI and SVI communities exhibited worse VAS back (P<0.001 and 0.002, respectively). Preoperatively, ACDF patients in the lowest DCI community had significantly worse MCS-12, VAS neck, and NDI, and in the poorest ADI community had worse MCS-12 and NDI. There were no differences in the magnitude of improvement for any PROM. All indexes performed poorly at predicting surgical outcomes (AUC: 0.467-0.636, all P>0.05).

Conclusions: Community-wide SES indexes are not accurate proxies for individual SES. While patients from poorer communities present with worse symptoms, community-level SES is not associated with overall outcomes following spine fusion. Patient-specific factors should be employed when attempting to stratify patients based on SES given the inherent limitations present with these indexes.

Level of evidence: Level III.

Study design: A prospective randomized clinical trial.

Objective: In this study, we compared local anesthesia with 1% lidocaine (LA) and general anesthesia (GA) utilized in PEID at L5/S1 disc herniation.

Summary of background data: Given the anatomic characteristics of L5/S1 segment, interlaminar approach was preferred to perform endoscopic discectomy for L5/S1 disc herniation. Typically, general anesthesia was used for interlaminar approach. However, with general anesthesia, nerve damage during surgery due to being unable to monitor patient status is a main concerned for surgeons. As an alternative option, local anesthesia has been developed recently. But, the optimal type of anesthesia for PEID remains controversial.

Methods: From March 2021 to March 2023, 103 consecutive patients with L5/S1 disc herniation who planned to undergo PEID in our unit were randomized to the LA group (n=53) or GA group (n=50). Both groups were followed up for at least 24 months. Surgical-related parameters, clinical outcomes, and complications were compared between the 2 groups.

Results: The mean operative time and bed rest time were shorter in the LA group than in the GA group (both P<0.001). The estimated blood loss in the LA group was greater than that in the GA group (P<0.001). The cost of hospitalization in the LA group was significantly lower than that in the GA group (P<0.001). At every time point of follow-up, there was no significant difference between the 2 groups in terms of VAS, ODI, and modified MacNab criteria. The satisfaction surveys showed that more patients in the LA group would choose contrary anesthesia, including 6 patients who were administered extravenously injected sufentanil intraoperatively due to intensive pain. Postoperative neuropathic abnormalities were rarer in the LA group.

Conclusions: Both local anesthesia using 1% lidocaine and general anesthesia are effective and safe for PEID at the L5/S1 segment. The use of local anesthesia is preferable due to its associated reductions in operative time, bed rest duration, and economic costs.

One recent innovation in the health care landscape is the integration of Digital Twin (DT) in the field of spine surgery. DT, first used in 2002 is defined as the replication of physical entities in a virtual environment. It has emerged as a transformative tool for optimizing complex systems. In this review, we delve into the intersection of DT and spine surgery, exploring how this symbiotic relationship is reshaping precision medicine. By creating virtual replicas of the spine and its intricate neural networks, surgeons gain insights into personalized patient care, preoperative planning, and postoperative analysis. This exploration tackles the potential impact of DT on neurosurgical procedures, emphasizing its role in enhancing surgical precision, improving patient outcomes, and pushing the boundaries of innovation in modern health care.