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Effect of Surgical Approach on Patient-reported Outcomes of Lumbar Fusion for Degenerative Spondylolisthesis: Should Grade Influence Approach? 手术入路对退行性椎体滑脱腰椎融合术疗效的影响:手术入路是否应受手术入路的分级影响?
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-03-01 Epub Date: 2025-06-11 DOI: 10.1097/BSD.0000000000001822
Alec Giakas, Teeto Ezeonu, Rajkishen Narayanan, Jonathan Dalton, Rachel Huang, Yunsoo Lee, Alex Christianson, Catherine Alvaro, Jose Pena, Nathan Thomas, Jose A Canseco, Mark F Kurd, Ian David Kaye, Barrett I Woods, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler

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.

研究设计:回顾性队列研究。目的:本研究旨在比较通过PLDF和TLIF进行脊柱融合的患者的结果,并确定基于CARDS和Meyerding分类的特定放射学特征是否可能影响最佳融合技术。背景资料摘要:尽管退行性椎体滑脱(DS)的发病率和疾病负担很高,但关于手术治疗的共识仍然缺乏。方法:回顾性分析退行性腰椎滑脱行原发性单节段腰椎融合术的成年患者(≥18岁)。我们回顾术前屈伸侧位片,使用Meyerding分级系统以及经过验证的临床和放射学退行性椎体滑脱(CARDS)分级系统对退行性椎体滑移进行分类。术前和术后1年采集PROM评分,包括Oswestry残疾指数(ODI)、视觉模拟量表背部和腿部(分别为VAS背部和VAS腿部)以及短表12调查的精神和身体部分(MCS和PCS)。结果:共发现594例患者。卡片型A型椎体滑脱患者行TLIF后ODI改善更大(-11.02 vs -3.06, P=0.005);然而,卡片B级患者在PLDF后ODI改善更大(-14.33 vs -5.45)。结论:虽然有几个因素需要考虑,但这些结果表明PLDF可能是轻度椎体滑移的退行性椎体滑脱患者的最佳方法。晚期椎间盘塌陷、终板移位和后凸的患者可能从TLIF中获益更多。
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引用次数: 0
Nonpharmacologic Interventions to Reduce Preoperative Anxiety and Optimize Related Outcomes in Spine Surgery: A Systematic Review. 非药物干预减少脊柱手术术前焦虑和优化相关结果:一项系统综述。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-23 DOI: 10.1097/BSD.0000000000002038
Charu Jain, Olgerta Mucollari, Luca M Valdivia, Jonathan J Huang, Brocha Z Stern, Nikan K Namiri, Junho Song, John Corvi, Andrew C Hecht

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.

研究设计:本系统综述评价了评估脊柱手术患者术前焦虑的非药物干预的前瞻性研究。目的:评价非药物干预与标准治疗在减轻脊柱手术患者术前焦虑方面的效果。背景资料总结:未解决的术前焦虑会对骨科脊柱手术后的恢复产生负面影响。除了减少焦虑外,非药物干预还可以最大限度地减少疼痛,减少对阿片类药物或抗焦虑药物的依赖,改善术后结果,提高患者满意度。方法:检索PubMed、Embase和Scopus数据库自建库至2024年12月。我们纳入了前瞻性研究,检查术前或手术当天提供的非药物干预措施与标准护理在减少脊柱手术患者术前焦虑方面的有效性。数据独立地从全文文章中提取。结果:纳入7项研究,548例患者。四项研究评估了教育技术:1项使用了传统的方法,如小册子和导览,3项使用了基于技术的方法,2项侧重于音乐疗法,1项调查了放松的引导图像。在纳入的研究中,与标准治疗相比,所有7项研究均显示接受非药物干预的患者术前焦虑有统计学意义的显著降低。大多数研究注意到患者满意度、疼痛管理、住院时间和睡眠质量等其他结果的改善。结论:非药物干预,如教育技术、音乐疗法和引导成像可以减少脊柱手术患者的术前焦虑。这些具有成本效益,微创的方法可以提供低风险的替代或补充药物。持续的研究和跨学科合作对于扩大证据基础和进一步验证这些战略至关重要。证据等级:一级。
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引用次数: 0
A Systematic Review of Pneumocephalus as a Complication of Spinal Procedures. 脊柱手术并发症中脑气的系统回顾。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-23 DOI: 10.1097/BSD.0000000000002035
Christian Rajkovic, Ankita Jain, Elizabeth Davis, Donald MacElroy, Shray Khanna, Steve Park, John V Wainwright, Merritt D Kinon

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.

研究设计:系统评价。目的:系统回顾脊柱手术后的脑气病例,评估这种病理的预后和有效的治疗方案。背景资料总结:脑气是脊柱手术中一种罕见的并发症,需要独特的症状管理和治疗策略。当颅内压迅速升高时,颅内空气可引起急性失代偿,因此,早期识别气头对恢复至关重要。方法:系统回顾PubMed/MEDLINE对脊柱手术后脑气病例的临床和放射学表现进行了询问。结果:共纳入105篇文章,其中133例为脊柱手术并发症。最常见的手术是硬膜外注射(38.7%)和减压手术(17.0%)。报告了17例紧张性脑气,没有增加死亡(P=0.59)、ICU住院(P=0.76)或持续症状(P=0.71)的风险。与内科治疗的患者相比,接受手术治疗的患者更有可能在住院期间住进ICU (P=0.005),但在症状改善(P=0.35)、放射学缓解(P=0.34)或死亡率(P=0.62)方面没有差异。伴有其他神经系统后遗症的患者也更有可能接受手术(结论:作为脊柱手术并发症的气脑的总体预后是有利的。关于症状表现的见解可以帮助脊柱外科医生改善对预期结果的沟通。证据等级:四级。
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引用次数: 0
Loss of Lordosis at C5-7 Following 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Subsequent Reoperations. 2节段前颈椎间盘切除术和融合术后C5-7椎体前凸消失与随后的再手术相关。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-23 DOI: 10.1097/BSD.0000000000002002
Manjot Singh, Alejandro Perez-Albela, Puru Sadh, Ishan Shah, Timothy Jeng, Charles Furlong, Alan H Daniels, Bryce A Basques

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.

研究设计:单中心、回顾性队列研究(水平 III)。目的:本研究评估C5-C7 ACDF后的对准改变和结果,并探讨节段矫正程度是否与再次手术相关。背景:C5-6和C6-7节段由于其可移动性和过渡性解剖结构,在颈椎退变性椎间盘疾病中经常受到影响。两节段前路颈椎椎间盘切除术和融合术(ACDF)通常在这些节段进行。尽管整体颈椎对准修复与改善功能结果和减少邻接节段疾病相关,但C5-C7颈椎术后前凸矫正对临床测量和翻修风险的具体影响仍不明确。方法:在单一机构进行回顾性队列研究。对接受2级C5-C7 ACDF的患者进行术后1年的人口统计学、矢状面对准参数和并发症评估。采用多变量logistic回归,控制年龄、性别、Charlson合并症指数(CCI)和基线颈椎畸形,评估节段矫正与再手术之间的关系。结果:92例患者行C5-C7 ACDF。平均年龄51.7岁,女性占57%,平均CCI为0.5。在C2-C7前凸(2.4-7.3度)、融合节段对齐(-4.3 - 2.1度)和T1-CL(23.8-20.9度)方面观察到显著改善(所有p结论:C5-C7 ACDF产生显著的矢状面矫正。然而,有限的节段改善可能增加再手术风险。获得足够的矫正对于优化结果和减少并发症非常重要。
{"title":"Loss of Lordosis at C5-7 Following 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Subsequent Reoperations.","authors":"Manjot Singh, Alejandro Perez-Albela, Puru Sadh, Ishan Shah, Timothy Jeng, Charles Furlong, Alan H Daniels, Bryce A Basques","doi":"10.1097/BSD.0000000000002002","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002002","url":null,"abstract":"<p><strong>Study design: </strong>Single-center, retrospective cohort study (level III).</p><p><strong>Objective: </strong>This study evaluates alignment changes and outcomes after C5-C7 ACDF and examines whether the degree of segmental correction is associated with reoperation.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of Dexamethasone in the Immediate Postoperative Period Is Associated With Increased Risk of Instrumentation and Surgical Site Complications in Diabetic Patients Undergoing Lumbar Spinal Fusion. 糖尿病腰椎融合术患者术后立即使用地塞米松会增加内固定和手术部位并发症的风险。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-20 DOI: 10.1097/BSD.0000000000002031
Douglass Johnson, Brian McCormick, Brian Kim, Austin H Carroll, Joseph Ferguson, Bryan W Cunningham, Paul C McAfee

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.

研究设计:回顾性数据库研究。目的:评价1节段或2节段后路腰椎融合术(PLSF)后立即使用地塞米松是否会导致糖尿病患者伤口和器械并发症的发生率增加。背景:地塞米松被广泛应用于PLSF患者的术后治疗,以控制疼痛和/或持续性神经根病。糖尿病患者更容易发生术后手术部位感染(ssi)和器械并发症,目前评估地塞米松对糖尿病患者的影响的文献较少。方法:采用PearlDiver数据库对诊断为2型糖尿病的1级或2级PLSF患者进行回顾性分析,这些患者术后3天内接受地塞米松治疗。接受地塞米松治疗的糖尿病患者与未接受地塞米松治疗的糖尿病患者的倾向性匹配比例为1:10。在30天、90天和1年时评估ssi、器械并发症和医疗并发症。结果:本研究共纳入7865例。试验组为715例接受地塞米松治疗的患者,对照组为7150例未接受地塞米松治疗的患者。试验组ssi在30天[OR=1.51 (1.01-2.13), P=0.019]、90天[OR=1.38 (1.00-1.91), P=0.047]、1年[OR=1.36 (1.01-1.84), P=0.046]时显著升高。试验组内固定并发症在所有时间点也显著升高:30天[OR=2.0 (1.16-3.43), P=0.012], 90天[OR=2.18(1.45-3.28)]。结论:1节段或2节段PLSF术后给予地塞米松可能与选择性1节段或2节段腰椎融合术的糖尿病患者在30天、90天和1年发生SSI和内固定并发症的风险较高相关。
{"title":"Use of Dexamethasone in the Immediate Postoperative Period Is Associated With Increased Risk of Instrumentation and Surgical Site Complications in Diabetic Patients Undergoing Lumbar Spinal Fusion.","authors":"Douglass Johnson, Brian McCormick, Brian Kim, Austin H Carroll, Joseph Ferguson, Bryan W Cunningham, Paul C McAfee","doi":"10.1097/BSD.0000000000002031","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002031","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective database study.</p><p><strong>Objective: </strong>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.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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].</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Smoking Increases the Risk of Reoperation and an Extended Hospital Stay Following Anterior Cervical Discectomy With Fusion Surgery. 吸烟增加颈椎前路椎间盘切除术融合手术后再手术和延长住院时间的风险。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-20 DOI: 10.1097/BSD.0000000000002001
Christopher G Hendrix, Haseeb E Goheer, Alexander R Garcia, Evan P Sandefur, Mark W Schmitt, W Garret Burks, Jonathan J Carmouche

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.

研究设计:回顾性队列研究。目的:探讨吸烟对颈前路椎间盘切除术融合术(ACDF)术后30天并发症的影响。背景资料总结:尽管吸烟对骨科手术中骨愈合有显著的负面影响,但目前关于吸烟对ACDF手术患者影响的文献存在矛盾。方法:2011年至2021年间接受ACDF手术的患者通过2011年至2021年的CPT代码22551在美国外科医师学会国家手术质量改进计划(ACS-NSQIP)数据库中被识别。研究人群分为两组:吸烟者和不吸烟者。分类变量采用卡方检验,连续变量采用t检验,确定两组围手术期变量的差异。在调整这些因素后,多变量logistic回归分析评估吸烟状况对术后预后的影响。结果:共有85,758例患者接受了ACDF手术,其中22,223例(25.9%)为吸烟者,63,535例(74.1%)为非吸烟者。吸烟者比非吸烟者年轻(51.84岁对56.74岁)。结论:过去一年内有吸烟史的患者在ACDF后再次手术的风险增加,住院时间延长。这些发现可以增强有吸烟史患者的知情同意。未来的研究应评估患者报告的结果和假关节发生率,以进一步阐明吸烟在颈椎手术中的作用。
{"title":"Smoking Increases the Risk of Reoperation and an Extended Hospital Stay Following Anterior Cervical Discectomy With Fusion Surgery.","authors":"Christopher G Hendrix, Haseeb E Goheer, Alexander R Garcia, Evan P Sandefur, Mark W Schmitt, W Garret Burks, Jonathan J Carmouche","doi":"10.1097/BSD.0000000000002001","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002001","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the influence of smoking on 30-day postoperative complications following anterior cervical discectomy with fusion (ACDF) surgery.</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is Anterior Cervical Decompression and Fusion Still Considered the Gold-Standard Treatment Option Relative to Anterior Cervical Disc Replacement for the Treatment of Symptomatic Disc Herniation in the Nonspondylotic Cervical Spine? 相对于前路颈椎椎间盘置换术,颈椎前路减压融合术是否仍被认为是治疗无脊柱性颈椎病症状性椎间盘突出的金标准治疗选择?
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-16 DOI: 10.1097/BSD.0000000000002040
Madelyn Anderson, Alec Thingvold, Thomas Kroymann, Blake Salfer, Lauren M Boden, William Sheppard, Taylor Paziuk
{"title":"Is Anterior Cervical Decompression and Fusion Still Considered the Gold-Standard Treatment Option Relative to Anterior Cervical Disc Replacement for the Treatment of Symptomatic Disc Herniation in the Nonspondylotic Cervical Spine?","authors":"Madelyn Anderson, Alec Thingvold, Thomas Kroymann, Blake Salfer, Lauren M Boden, William Sheppard, Taylor Paziuk","doi":"10.1097/BSD.0000000000002040","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002040","url":null,"abstract":"","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Paraspinal Muscle Functional Cross-Sectional Area Alterations in Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Correlational Analysis. 单节段开放和微创经椎间孔腰椎椎间融合术中棘旁肌功能横截面积的改变:相关分析。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-13 DOI: 10.1097/BSD.0000000000002044
Sujan Maharjan, Zhili Zeng, Yan Yu, Liming Cheng

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.

研究设计:回顾性队列研究。目的:比较单节段开放经椎间孔腰椎椎间融合术(open -TLIF)与微创腰椎椎间融合术(MIS-TLIF)患者椎旁肌肉的功能截面积(FCSA),并评估肌肉变化与临床结果(包括腰椎视觉模拟评分(VAS)、腿部VAS和Oswestry残疾指数(ODI))之间的相关性。背景资料总结:脊柱旁肌萎缩与腰椎手术后较差的预后有关。微创技术可以减少肌肉损伤。了解肌肉保留程度及其与恢复的关系可以指导手术决策。方法:本研究纳入了129例患者(Open-TLIF: 60例;MIS-TLIF: 69例),这些患者在2020年9月至2024年12月期间接受了单级别TLIF,随访至少1年。计算机断层扫描(CT)测量多裂肌、竖脊肌和腰肌在指数和邻近水平的FCSA。相关和回归分析评估了FCSA变化、手术方法和临床结果(腰椎VAS、腿部VAS、ODI)之间的关系。结果:开放tlif患者的指数和邻近的多裂肌和指数竖脊肌的FCSA明显降低。在最后随访时,MIS-TLIF患者的腰椎VAS和ODI评分较低。结论:与Open-TLIF相比,MIS-TLIF与椎管旁肌萎缩明显减少,腰椎VAS和ODI结果更好。多裂肌的保留与临床改善密切相关,腰大肌FCSA的增加有助于改善残疾预后。证据等级:二级。
{"title":"Paraspinal Muscle Functional Cross-Sectional Area Alterations in Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Correlational Analysis.","authors":"Sujan Maharjan, Zhili Zeng, Yan Yu, Liming Cheng","doi":"10.1097/BSD.0000000000002044","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002044","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>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).</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Study on Effectiveness of Unilateral Biportal Endoscopic Lumbar Interbody Fusion and Percutaneous Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Degenerative Diseases. 单侧双门静脉内镜腰椎椎间融合术与经皮后外侧经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的疗效比较研究。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-13 DOI: 10.1097/BSD.0000000000002041
Wensen Pi, Yuxiang Deng, Yang Liu, Haidan Chen, Hongwei Zhao

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.

研究设计:回顾性临床研究。目的:探讨单侧双门静脉内镜下腰椎体间融合术(ULIF)与经皮后外侧经椎间孔腰椎体间融合术(PE-PTLIF)治疗腰椎退行性疾病(LDD)的疗效差异。背景:虽然微创脊柱手术越来越受欢迎,但关于ULIF和PE-PTLIF比较效果的研究仍然有限。材料和方法:从2021年1月至2022年1月,回顾性招募52例LDD患者进入PE-PTLIF组和ULIF组。手术时间、真总出血量、住院时间、术后切口及引流、术后并发症、住院费用、围手术期血液生化指标、视觉模拟量表(VAS)评分、Oswestry残疾指数(ODI)、改良MacNab标准、椎间盘高度(DH)、节段性前仰(SL)、腰椎前仰(LL)、硬膜囊横截面积(DSCA)、以多裂肌脂肪浸润评分(MAIS)和多裂肌萎缩率(MAR)为评价指标。结果:PE-PTLIF组手术时间、出血量、术后引流量均少于ULIF组。术后第1天和第3天,PE-PTLIF组的平均血清肌酸激酶(CK)、c反应蛋白(CRP)和血红蛋白(Hb)差异低于ULIF组。PE-PTLIF组术后3天及1个月腰痛VAS评分及ODI(%)均明显低于ULIF组。在最后一次随访时,ULIF组的MAR和MAIS高于PE-PTLIF组。结论:PE-PTLIF对肌肉等软组织损伤小,恢复快,但手术时间较长。两种内镜下腰椎融合术并发症发生率较低,均为安全有效的手术方法。
{"title":"Comparative Study on Effectiveness of Unilateral Biportal Endoscopic Lumbar Interbody Fusion and Percutaneous Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Degenerative Diseases.","authors":"Wensen Pi, Yuxiang Deng, Yang Liu, Haidan Chen, Hongwei Zhao","doi":"10.1097/BSD.0000000000002041","DOIUrl":"10.1097/BSD.0000000000002041","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical study.</p><p><strong>Objectives: </strong>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).</p><p><strong>Background: </strong>While minimally invasive spine surgeries are gaining popularity, research on the comparative effectiveness of ULIF and PE-PTLIF remains limited.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative Opioid Use is a Robust Predictor of Increased Health Care Utilization Following Lumbar Spine Surgery. 术前阿片类药物使用是腰椎手术后医疗保健利用增加的一个强有力的预测因子。
IF 1.7 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2026-02-13 DOI: 10.1097/BSD.0000000000002043
Mehul Mittal, Rishi Jain, Rahul K Chaliparambil, Tyler Compton, Shyam Chandrasekar, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi

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.

研究设计:回顾性队列研究。目的:本研究的目的是评估择期腰椎手术术前阿片类药物使用与术后医疗保健利用之间的关系,并表征阿片类药物新手(ON)和阿片类药物经验(OE)患者的手术指征和手术程序的差异。背景数据摘要:美国阿片类药物危机每年继续导致数千人死亡。尽管全国范围内阿片类药物的处方较少,但在脊柱手术中,阿片类药物仍然是控制疼痛的常用药物,超过一半的患者在术前使用阿片类药物。方法:回顾性分析2013年至2018年在单一学术中心接受择期腰椎减压伴或不伴融合术的成年人。如果患者在术前60天内至少有一次阿片类药物处方,则将其归类为OE。比较OE组和ON组的人口统计学、手术细节和术后1年内的医疗保健利用情况,包括影像学、紧急护理就诊、物理治疗、疼痛转诊和神经调节剂处方。进行未调整和调整的多变量回归和敏感性分析来评估独立关联。结果:433例患者中OE占70.5%,ON占29.5%。在未经调整的分析中,OE患者在180天的神经调节剂处方率明显更高(pp结论:术前阿片类药物使用与术后神经调节剂使用增加和腰椎手术后长期阿片类药物持续存在的风险更高)。这些发现强调了有针对性的围手术期干预以改善手术结果的必要性。
{"title":"Preoperative Opioid Use is a Robust Predictor of Increased Health Care Utilization Following Lumbar Spine Surgery.","authors":"Mehul Mittal, Rishi Jain, Rahul K Chaliparambil, Tyler Compton, Shyam Chandrasekar, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.1097/BSD.0000000000002043","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002043","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>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.</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Clinical Spine Surgery
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