Clinical Spine Surgery最新文献

Study design: Retrospective cohort study.

Objective: The present study aims to compare outcomes for patients undergoing spinal fusion through PLDF and TLIF and determine whether specific radiographic characteristics, based upon both the CARDS and Meyerding classifications, might influence optimal fusion technique.

Summary of background data: Despite the significant prevalence and high disease burden of degenerative spondylolisthesis (DS), consensus regarding surgical management is still lacking.

Methods: Adult patients (≥18 years old) who underwent primary single-level lumbar fusion for degenerative spondylolisthesis were retrospectively identified. Preoperative flexion-and-extension lateral radiographs were reviewed to classify DS using the Meyerding grading system, as well as the validated Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system. PROM scores were collected preoperatively and 1 year postoperatively and included the Oswestry Disability Index (ODI), Visual Analog Scale back and leg (VAS back and VAS leg, respectively), and the mental and physical component of the short-form 12 survey (MCS and PCS).

Results: A total of 594 patients were identified. Patients with CARDS type A spondylolisthesis experienced greater improvement in ODI (-11.02 vs. -3.06, P =0.005) when they underwent TLIF; however, patients with CARDS class B experienced greater ODI improvement after a PLDF (-14.33 vs. -5.45, P <0.001). Patients with Meyerding grade 1 spondylolisthesis experienced greater improvement in ODI (-10.15 vs. -6.27, P =0.006) and MCS (5.68 vs. 2.87, P =0.011) when they underwent PLDF compared with TLIF. There were no other differences in PROM improvement between approaches for other grades and classes. After controlling for patient characteristics, these differences persisted on linear regression analysis.

Conclusion: Although there are several factors to consider, these results show that PLDF may be the optimal approach for degenerative spondylolisthesis patients with milder degrees of vertebral slippage. Patients with advanced disc collapse, endplate apposition, and kyphosis may benefit more from TLIF.

Study design: This systematic review evaluated prospective studies assessing nonpharmacologic interventions for preoperative anxiety in spine surgery patients.

Objective: To evaluate the effectiveness of nonpharmacologic interventions compared with standard care to reduce preoperative anxiety among spine surgery patients.

Summary of background data: Unaddressed preoperative anxiety negatively impacts recovery following orthopedic spine surgery. Beyond reducing anxiety, nonpharmacologic interventions can minimize pain, decrease reliance on opioids or anxiolytics, improve postoperative outcomes, and enhance patient satisfaction.

Methods: PubMed, Embase, and Scopus databases were searched from database inception to December 2024. We included prospective studies examining the effectiveness of nonpharmacologic interventions delivered the day before or on the day of surgery versus standard care in reducing preoperative anxiety in spinal surgery patients. Data were independently extracted from full-text articles.

Results: The review included 7 studies encompassing 548 patients. Four studies assessed educational techniques: 1 used traditional approaches such as booklets and tours, 3 used technology-based methods, 2 focused on music therapy, and 1 investigated relaxing guided imagery. Of the included studies, all 7 demonstrated statistically significant reductions in preoperative anxiety among patients receiving nonpharmacologic interventions compared with standard care. Most studies noted improvements in other outcomes of patient satisfaction, pain management, length of hospital stays, and sleep quality.

Conclusions: Nonpharmacologic interventions such as educational techniques, music therapy, and guided imagery reduce preoperative anxiety in spine surgery patients. These cost-effective, minimally invasive approaches may offer a low-risk alternative or complement to medication. Continued research and interdisciplinary collaboration are essential to expand the evidence base and further validate these strategies.

Level of evidence: Level I.

Study design: Systematic Review.

Objective: To systematically review cases of pneumocephalus following spinal procedures and evaluate prognosis and effective treatment options for this pathology.

Summary of background data: Pneumocephalus is a rare complication of spinal procedures requiring unique strategies for symptom management and treatment. Intracranial air may cause acute decompensation when intracranial pressure rises rapidly, and therefore, early identification of pneumocephalus is crucial for recovery.

Methods: A systematic review was performed to interrogate PubMed/MEDLINE for clinical and radiologic presentation of cases of pneumocephalus following spinal procedures.

Results: A total of 105 articles were included, with 133 cases of pneumocephalus presenting as a complication of spinal procedures. The most common procedures investigated were epidural injections (38.7%) and decompression surgeries (17.0%). Tension pneumocephalus was reported in 17 cases and conveyed no increased risk of mortality (P=0.59), ICU admission (P=0.76), or persistent symptoms (P=0.71). Patients receiving surgical treatment were significantly more likely to have an ICU stay during their hospital course (P=0.005) but had no difference in symptom improvement (P=0.35), radiologic resolution (P=0.34), or mortality (P=0.62) compared with medically managed patients. Patients with additional neurological sequelae were also more likely to receive surgery (P<0.001). Patients with headache were significantly less likely to experience persistent symptoms (P=0.008), persistent imaging findings (P=0.01), ICU care (P<0.001), and mortality (P=0.04), while altered mental status was associated with significantly greater risk of symptom persistence (P=0.04), ICU stay (P<0.001), and mortality (P=0.049). The overall symptom improvement rate was 86%, and the mortality rate was 5%.

Conclusions: Overall prognosis for pneumocephalus as a complication of spinal procedures is favorable. Insights concerning symptom presentation can help spine surgeons improve communication regarding expected outcomes.

Level of evidence: Level IV.

Study design: Single-center, retrospective cohort study (level III).

Objective: This study evaluates alignment changes and outcomes after C5-C7 ACDF and examines whether the degree of segmental correction is associated with reoperation.

Background: The C5-6 and C6-7 segments are frequently affected in cervical degenerative disc disease due to their mobility and transitional anatomy. Two-level anterior cervical discectomy and fusion (ACDF) is commonly performed at these levels. Although global cervical alignment restoration has been associated with improved functional outcomes and reduced adjacent-segment disease, the specific impact of postoperative lordotic correction at C5-C7 on clinical measures and revision risk remains poorly defined.

Methods: A retrospective cohort study was conducted at a single institution. Patients undergoing 2-level C5-C7 ACDF were evaluated for demographics, sagittal alignment parameters, and complications through 1 year postoperatively. Multivariate logistic regression, controlling for age, sex, Charlson comorbidity index (CCI), and baseline cervical deformity, was used to assess the association between segmental correction and reoperation.

Results: A total of 92 patients underwent C5-C7 ACDF. Mean age was 51.7 years, 57% were female, and mean CCI was 0.5. Significant improvements were observed in C2-C7 lordosis (2.4-7.3 deg.), fused segment alignment (-4.3 to 2.1 deg.), and T1-CL (23.8-20.9 deg.) (all P<0.01). Average correction at fused levels was 6.5 degrees (SD 7.4 deg.). Overall, 12% (11/92) underwent reoperation. Inadequate correction increased reoperation odds 7.2-fold (P=0.028).

Conclusions: C5-C7 ACDF yields significant sagittal correction. However, limited segmental improvement may increase reoperation risk. Achieving sufficient correction is important to optimize outcomes and reduce complications.

Study design: Retrospective database study.

Objective: To evaluate whether dexamethasone utilized in the immediate postoperative setting after 1- or 2-level posterior lumbar spinal fusion (PLSF) leads to an increased rate of wound and instrumentation complications in the diabetic population.

Background: Dexamethasone is widely utilized in the postoperative setting in patients undergoing PLSF for pain control and/or persistent radiculopathy. There is a paucity of literature evaluating the effects of dexamethasone in the diabetic population, who are more prone to postoperative surgical site infections (SSIs) and instrumentation complications.

Methods: Patients undergoing 1- or 2-level PLSF with a diagnosis of type II diabetes mellitus who received dexamethasone within 3 days postoperatively were retrospectively identified using the PearlDiver database. Diabetic patients receiving dexamethasone were propensity-matched in a 1:10 ratio to diabetic patients undergoing the same procedure who did not receive dexamethasone. SSIs, instrumentation complications, and medical complications were assessed at 30 days, 90 days, and 1 year.

Results: A total of 7865 were included in this study. The test group consisted of 715 patients who received dexamethasone, and the control group included 7150 patients who did not receive dexamethasone. SSIs were significantly elevated in the test group at 30 days [OR=1.51 (1.01-2.13), P=0.019], 90 days [OR=1.38 (1.00-1.91), P=0.047], and 1 year [OR=1.36 (1.01-1.84), P=0.046]. Instrumentation complications were also significantly elevated in the test group at all time points: 30 days [OR=2.0 (1.16-3.43), P=0.012], 90 days [OR=2.18 (1.45-3.28), P<0.001], and 1 year [OR=1.63 (1.22-2.19), P=0.001].

Conclusion: Administration of dexamethasone in the postoperative period after 1- or 2-level PLSF may be associated with a higher risk of SSI and instrumentation complications at 30 days, 90 days, and 1 year in diabetic patients undergoing elective 1- or 2-level lumbar fusion.

Study design: Retrospective cohort study.

Objective: To evaluate the influence of smoking on 30-day postoperative complications following anterior cervical discectomy with fusion (ACDF) surgery.

Summary of background data: Although smoking can have significant negative effects on bone healing in orthopaedic surgery, there is currently conflicting literature regarding the effect of smoking on patients undergoing ACDF surgery.

Methods: Patients who underwent an ACDF procedure between 2011 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database by CPT code 22551 from 2011 to 2021. The study population was divided into 2 groups: smokers and nonsmokers. Chi-square tests for categorical variables and t-tests for continuous variables were used to identify differences in perioperative variables between groups. Multivariable logistic regression analysis assessed smoking status effect on postoperative outcomes after adjusting for these factors.

Results: A total of 85,758 patients who underwent ACDF surgery were identified, of whom 22,223 (25.9%) were smokers and 63,535 (74.1%) were non-smokers. Smokers were younger than the non-smoker cohort (51.84 vs. 56.74 years, p<0.001). Smokers had a significant odds ratio (OR) for extended length of hospital stay (OR: 1.240, 95% CI: 1.114-1.380, p<0.001) and reoperation (OR: 1.144, 95% CI: 1.007-1.298, p=0.038), following a multivariate logistic regression analysis.

Conclusions: Patients with a history of smoking within the past year were at an increased risk for reoperation and extended length of stay after ACDF. These findings can enhance informed consent for patients with a smoking history. Future studies should evaluate patient-reported outcomes and pseudoarthrosis rates to further elucidate the role of smoking in cervical spine surgery.

Study design: Retrospective cohort study.

Objective: To compare the functional cross-sectional area (FCSA) of paraspinal muscles in patients undergoing single-level open transforaminal lumbar interbody fusion (Open-TLIF) versus minimally invasive TLIF (MIS-TLIF) and to assess correlations between muscle changes and clinical outcomes, including lumbar Visual Analogue Scale (VAS), leg VAS, and Oswestry Disability Index (ODI).

Summary of background data: Paraspinal muscle atrophy is linked to poorer outcomes after lumbar spine surgery. Minimally invasive techniques may reduce muscle damage. Understanding the degree of muscle preservation and its relationship to recovery can guide surgical decision-making.

Methods: This study included 129 patients (Open-TLIF: 60; MIS-TLIF: 69) who underwent single-level TLIF between September 2020 and December 2024, with at least 1 year of follow-up. Computed tomography (CT) measured FCSA of the multifidus, erector spinae, and psoas muscles at index and adjacent levels. Correlation and regression analyses evaluated relationships between FCSA changes, surgical method, and clinical outcomes (lumbar VAS, leg VAS, ODI).

Results: Open-TLIF patients had significantly greater reductions in FCSA of the index and adjacent multifidus and index erector spinae muscles. MIS-TLIF patients showed lower lumbar VAS and ODI scores at final follow-up. Index multifidus FCSA loss correlated with worse lumbar VAS (r = -0.253, P = 0.004) and ODI (r = -0.477, P<0.001). MIS-TLIF was significantly associated with multifidus preservation (r = 0.837, P<0.001). Increased psoas FCSA correlated positively with ODI improvement (r = 0.229, P = 0.009) but negatively with erector spinae FCSA (r = -0.221, P = 0.033).

Conclusions: MIS-TLIF is associated with significantly less paraspinal muscle atrophy and better lumbar VAS and ODI outcomes compared with Open-TLIF. Preservation of the multifidus muscle is strongly linked to clinical improvement, and increased psoas FCSA contributes to better disability outcomes.

Level of evidence: Level II.

Study design: Retrospective clinical study.

Objectives: To study the differences in effectiveness of unilateral biportal endoscopic lumbar interbody fusion (ULIF) and percutaneous endoscopic posterolateral transforaminal lumbar interbody fusion (PE-PTLIF) in the treatment of lumbar degenerative diseases (LDD).

Background: While minimally invasive spine surgeries are gaining popularity, research on the comparative effectiveness of ULIF and PE-PTLIF remains limited.

Materials and methods: From January 2021 to January 2022, 52 patients with LDD were retrospectively recruited into the PE-PTLIF and ULIF groups. The operation time, true total blood loss, length of hospital stay, postoperative incision and drainage, postoperative complications, hospitalization cost, perioperative blood biochemical indexes, visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab criteria, intervertebral disc height (DH), segmental lordosis (SL), lumbar lordosis (LL), dural sac cross-sectional area (DSCA), multifidus muscle fat infiltration score (MAIS) and multifidus muscle atrophy rate (MAR) were used as the evaluation indices.

Results: The surgical time, bleeding, and postoperative drainage volume in the PE-PTLIF group were less than those in the ULIF group. The average serum creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb) differences in the PE-PTLIF group were lower than those in the ULIF group on the first and third day after surgery. The VAS score of lower back pain and ODI (%) at 3 days and 1 month after surgery in the PE-PTLIF group were much lower than those in the ULIF group. At the last follow-up, the MAR and MAIS in the ULIF group were higher than in the PE-PTLIF group.

Conclusion: PE-PTLIF has less damage to muscle and other soft tissues, faster recovery, but longer operation time. The incidence of complications of the 2 endoscopic-assisted lumbar fusions is less, and both are safe and effective surgical methods.

Study design: Retrospective cohort study.

Objective: The aim of this study was to evaluate the association between preoperative opioid use and postoperative health care utilization following elective lumbar spine surgery, and to characterize differences in surgical indications and procedures between opioid-naive (ON) and opioid-experienced (OE) patients.

Summary of background data: The U.S. opioid crisis continues to cause thousands of deaths yearly. Despite fewer prescriptions nationally, opioids remain common for pain control in spine surgery, where over half of the patients use them preoperatively.

Methods: Adults who underwent elective lumbar decompression with or without fusion between 2013 and 2018 at a single academic center were retrospectively reviewed. Patients were classified as OE if they had at least one opioid prescription within 60 days preoperatively. Demographics, surgical details, and postoperative health care utilization within 1 year, which included imaging, urgent care visits, physical therapy, pain referrals, and neuromodulator prescriptions, were compared between the OE and ON groups. Unadjusted and adjusted multivariable regression and sensitivity analyses were conducted to assess independent associations.

Results: Among 433 patients, 70.5% were OE and 29.5% were ON. On unadjusted analysis, OE patients had significantly higher rates of neuromodulator prescriptions at 180 days (P<.0001) and total imaging studies at 1 year (P=.0014). After multivariable adjustment, preoperative opioid use remained independently associated with increased neuromodulator prescriptions at 180 days (β=0.23, P=.0069) and higher odds of persistent opioid use at 1 year (OR: 2.35, 95% CI: 1.15-4.83, P=.0196). No significant differences were observed in total imaging, lumbar x-ray imaging, or urgent care utilization after adjustment.

Conclusions: Preoperative opioid use is associated with increased postoperative neuromodulator use and a higher risk of long-term opioid persistence following lumbar spine surgery. These findings highlight the need for targeted perioperative interventions to improve surgical outcomes.