Clinical Spine Surgery最新文献

Study design: This was a retrospective single-center study.

Objectives: To investigate the relationship between intraoperative arterial blood pressure (MAP) changes and the occurrence of C5 palsy.

Summary of background data: C5 palsy is a disabling complication of cervical spine surgery, and its pathophysiology remains unknown. We hypothesized that intraoperative MAP changes might influence the occurrence of postoperative C5 palsy.

Methods: This retrospective study included patients who underwent continuous arterial blood pressure monitoring during elective cervical spine surgery. Patients were divided into 2 groups according to the presence or absence of C5 palsy (defined as a decrease of at least 1 grade in deltoid muscle strength). The demographics, diagnoses, surgical characteristics, and intraoperative MAP parameters were reviewed.

Results: A total of 74 patients were included in this analysis (mean age: 70.5 y; 22 women). Of these patients, 13 developed C5 palsy, which occurred after a mean of 2.2 days following surgery. There were no significant differences between the C5 palsy and control groups in terms of age, sex, diagnosis, preexisting hypertension, and blood pressure on the day before surgery. Patients with C5 palsy showed a greater change in intraoperative MAP than those in the control group (92​​​​​​ vs. 73 mm Hg, P=0.013). The number of episodes of intraoperative hypotension was similar in the C5 palsy and control groups (2.5 vs. 3.1 episodes). After adjustment by a multivariable logistic regression analysis, intraoperative MAP change remained an independent risk factor for C5 palsy (odds ratio 1.03 per 1 mm Hg increase, 95% CI: 1.01-1.05, P=0.03).

Conclusion: A larger change in the intraoperative MAP was associated with C5 palsy after cervical surgery. Our findings suggest a potential role for intraoperative hemodynamic changes in the development of C5 palsy.

Study design: This is a retrospective study.

Objective: To evaluate and compare the clinical efficacy and fusion outcomes of allograft versus hydroxyapatite (HA) as bone graft materials in anterior cervical discectomy and fusion (ACDF) surgery.

Summary of background data: ACDF is used for cervical disc herniation treatment; however, there is no consensus on the optimal bone graft material, particularly between allograft and hydroxyapatite.

Methods: This retrospective study included patients who underwent ACDF at the Third Affiliated Hospital of Southern Medical University between January 2015 and December 2019. A total of 63 patients met the inclusion criteria and were divided into 2 groups: the allograft group (n=39) and the HA group (n=24). Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Cervical spine radiographs were utilized to evaluate fusion status, intervertebral height, and sagittal alignment parameters.

Results: Both groups demonstrated significant postoperative improvement in VAS, JOA, and NDI scores compared with preoperative values. The magnitude of improvement was similar between the 2 groups, the allograft group exhibited superior final VAS, JOA, and NDI scores relative to the HA group. Radiographic analysis revealed a significantly lower fusion rate and score in the HA group. The incidence of cage subsidence was higher in the HA group, although no significant difference in intervertebral height was observed between groups. Notably, 6 patients (25.0%) in the HA group experienced fusion failure requiring revision surgery, of whom 3 underwent reoperation. No fusion failure or revision surgery was reported in the allograft group.

Conclusion: ACDF remains a widely accepted and effective treatment for cervical disc herniation. While both graft types provide symptomatic relief and functional recovery, the allograft demonstrates superior performance in terms of fusion rate, structural integrity, and lower revision risk.

Study design: Retrospective cohort study.

Objective: To determine independent risk factors for sacral fracture after lumbosacral fusion.

Summary of background data: Sacral fractures are an uncommon complication after lumbosacral fusion, with recent research suggesting that osteoporosis is an independent risk factor. However, there is a paucity of data regarding other potential risk factors.

Methods: This retrospective study (TriNetX) included adults (18 y or above) who underwent first-time lumbosacral fusion between 2005 and 2023, divided into 2 cohorts: the osteoporosis cohort and the no osteoporosis cohort. The primary outcome was the incidence of sacral fracture after lumbosacral fusion over 2 years, estimated using Kaplan-Meier analysis, with hazard ratios (HRs) estimated for each covariate using a multivariable Cox proportional hazards model (P<0.05).

Results: There were 592 sacral fractures (2.3%) among 25,598 adults who underwent lumbosacral fusion, with 470 cases (2.8%) in the osteoporosis cohort and 122 cases (1.3%) in the no osteoporosis cohort. Independent risk factors (P<0.05) for sacral fracture after lumbosacral fusion included previous pelvic radiation [95% CI] (HR: 3.04 [1.26, 7.36]), history of falls (HR: 2.65 [2.21, 3.18]), osteoporosis (HR: 2.02 [1.64, 2.49]), long-term systemic corticosteroid use (HR: 1.47 [1.10, 1.98]), age at index lumbosacral fusion (HR: 1.01 [1.00, 1.02] per year), while protective factors included overweight and/or obesity status (HR: 0.79 [0.65, 0.97]), and male sex (HR: 0.64 [0.48, 0.85]). Variables determined not to be independent risk factors (P>0.05) included nicotine dependence, history of total hip arthroplasty, anterior surgical approach, posterior surgical approach, long lumbosacral spinal fusion with instrumentation (7-12 vertebral levels), diabetes mellitus, bone density medications, inflammatory polyarthropathies, pelvic fixation, vitamin D prescription, chronic kidney disease, and glucagon-like peptide-1 analogues.

Conclusions: Clinically meaningful independent risk factors for sacral fractures after lumbosacral fractures include pelvic radiation, history of falls, osteoporosis, long-term systemic corticosteroid use, and potentially increasing age, whereas being male and overweight or obese are independent protective factors.

Level of evidence: Level III-retrospective case-control study.

Study design: This study was a case-control study examining the relationship between changes in Facet Joint Orientation and degenerative lumbar spondylolisthesis.

Objective: The causal relationship between sagittal changes in the direction of the head-caudal facet joint and degenerative lumbar spondylolisthesis (DS) was investigated in this study.

Summary of background info: Several radiologic studies have indicated a correlation between DS and an increased sagittal orientation of the facet joints. However, the orientation of the facet joints has only been measured on 1 axial cut of computed tomography scans and magnetic resonance imaging.

Patients and methods: Fifty-six patients with DS only at the L4/L5 level were assigned to the DS group, and 58 patients without DS were assigned to the control group. Two computed tomography scans were performed for the cephalad and caudad portions of the facet joint at L3/L4, L4/L5, and L5/S1 levels, respectively. Delta facet angle was defined as facet angle (cephalad)-facet angle (caudad).

Results: Significant differences were observed in the joint angle of the L4/L5 head and tail processes between the DS group and the control group (P<0.05). The direction of the L4/L5 slipped segment in the DS group was significantly inclined toward the sagittal position. Moreover, significant differences (P<0.05) in the degree of joint degeneration in the L4/L5 head and tail processes were observed between the DS group and the control group, indicating more severe degeneration in the L4/L5 slip segment processes of the DS group.

Conclusions: In the present study, we found that the changes in the sagittal direction of facet joints occur most probably due to lumbar degeneration remodeling rather than their underlying cause.

Study design: Systematic review conducted under PRISMA guidelines.

Objective: To evaluate the impact of preoperative psychological interventions on spine surgery postoperative outcomes.

Summary of background data: Approximately one-third of individuals with chronic back pain report symptoms of preoperative anxiety and depression, which may worsen with surgery. Despite the increased risk for mental health comorbidity, preoperative psychological interventions are not well utilized in spine surgery preoperative care.

Methods: Literature search was conducted using the PubMed, EMBASE, Web of Science, and APA PsycINFO databases until August 22, 2025. The inclusion criteria consisted of adult spine surgery patients, preoperative psychological interventions, and the presence of postoperative outcomes. Primary data extraction factors included study type, patient population and demographics, diagnosis, and the specific psychological intervention used.

Results: Thirteen studies representing 9316 patients were included. Pharmacotherapy showed a significant positive association with pain reduction in 4/6 analyses. No analyses studying pharmacotherapy and disability or mental well-being showed a significant positive association with disability reduction or with mental well-being improvement. All studies of cognitive behavioral therapy (CBT) measuring disability (2/2) showed a positive significant association with disability reduction. The study of CBT measuring mental well-being (1/1) showed a positive significant association with mental well-being improvement. CBT did not have a positively significant association in studies measuring reduction in pain. Stress-relief methods had positive significant associations with better mental well-being in half of studies, and pain reduction in 3 out of 4 studies. No studies measured stress-relief methods' effect on disability.

Conclusions: This systematic review highlights that a range of preoperative psychological interventions have a significant positive association with improved postoperative outcomes. It also describes the current state of literature in an understudied field. Further research is needed to identify optimal timing of interventions and prospective studies are needed to evaluate clinical applicability for implementation.

Level of evidence: Level I.

The applications of new and emerging technologies in spine surgery are constantly expanding. Specifically, machine learning algorithms have seen a rise in utilization in clinical research, allowing for interpretation of large datasets that have the capability of experiential learning. The goal of this work is to present a guide for surgeons to better understand model design, key takeaways, and common pitfalls related to machine learning to ensure accurate and appropriate interpretation of analytical findings in their practice.

Study design: Retrospective case-control study.

Objective: To evaluate whether patients from highly deprived neighborhoods, as defined by the Area Deprivation Index (ADI), undergoing one-level cervical disc arthroplasty (CDA) experience differences in (1) postoperative medical complications, (2) lengths of stay (LOS), emergency department (ED) visits, and readmissions compared with less disadvantaged patients.

Summary of background data: The ADI measures neighborhood-level deprivation at the national level. Little is known about the role of neighborhood deprivation on outcomes after CDA.

Methods: A national insurance claims database was used to identify patients who underwent single-level CDA between 2010 and 2022. Patients from less disadvantaged neighborhoods (ADI <90th percentile) were matched in a 1:5 ratio with patients from more deprived areas (ADI >90th percentile) using propensity score matching on age, sex, and Elixhauser Comorbidity Index (ECI), yielding a final cohort of 25,975 patients: 4331 in the low ADI group and 21,644 in the high ADI group. Multivariable logistic regression models were used to assess odds of 90-day complications, readmissions, and ED visits. t tests compared LOS. P-values<0.05 were significant.

Results: High ADI patients experienced significantly higher odds of total 90-day medical complications compared with less disadvantaged patients (3.54% vs. 2.67%; OR: 1.37; 95% CI: 1.12-1.70; P=0.003). High ADI patients had longer mean hospital stays (1.75 vs. 1.66 d; P<0.01). Ninety-day readmission (1.54% vs. 1.36%; OR: 1.13; P=0.379) and ED visits (1.64% vs. 1.43%; OR: 1.14; P=0.330) were similar between groups.

Conclusions: Neighborhood deprivation is associated with increased lengths of stay and a higher overall rate of medical complications after CDA, despite similar readmission and ED visit rates. These findings emphasize the importance of incorporating socioeconomic context into perioperative care and resource planning.

Level of evidence: Level III.

Study design: A retrospective cohort study.

Objective: To describe the incidence, timing, and reason for ED visits following primary versus revision lumbar fusion.

Summary of background data: Emergency department (ED) presentation and misutilization place a substantial financial strain on patients and the health care system. ED visits following lumbar fusion are common and may be an overlooked target for reducing cost.

Methods: A retrospective cohort study of patients undergoing 1-3 level primary versus revision lumbar fusion was performed. Outcomes included the incidence and characteristics (inpatient admission, discharge home, or reoperation) of ED visits at 2 weeks, 30 days, and 90 days postoperatively. Logistic regression analysis was performed to identify independent predictors of postoperative ED visits.

Results: A total of 2360 patients were included (1852 primary and 508 revision). Rate of 90-day ED visits was higher in the revision group (10.2%) compared with the primary group (6.86%, P=0.014). However, breakdown by 15-day intervals revealed this was only significant between 14 and 30 days postoperatively (1.30% vs. 3.35% for revisions, P=0.004). Reasons for ED visits were similar, with both groups presenting most commonly for pain complaints. Primary patients presenting to the ED were more likely to require admission (48.0% vs. 26.9%; P=0.015). Logistic regression demonstrated that revision surgery (OR: 2.67, P<0.001), Cut-to-close time (OR: 1.003, P=0.028) and LOS (OR: 1.11, P=0.023) independently predicted postoperative ED visits.

Conclusion: Revision lumbar fusion was an independent predictor of visiting the ED, especially from 14 to 30 days postoperatively, but the absolute increase in risk was mild at 3.4%. Cut-to-close time was also statistically predictive, although with an effect size that is not clinically significant. However, visits to the ED after revision surgery were less likely to require readmission compared with visits after primary lumbar surgery. These findings may suggest that patients undergoing lumbar fusion should be appropriately counseled regarding postoperative pain expectations and appropriate acute care utilization, especially in the revision setting.

Malpractice litigation is a persistent challenge in spinal surgery, with a significant number of claims involving procedural errors, inadequate informed consent, and wrong-level surgeries. These cases often have serious implications for both patient care and the careers of surgeons. This study combines a review of the literature with the analysis of 4 real-world cases to identify patterns and offer practical recommendations to reduce legal risks. The author (S.R.) served as an expert witness in all 4 cases, providing a unique perspective on the legal, clinical, and professional elements involved in each situation. The key findings highlight the importance of thorough preoperative planning, the use of advanced imaging techniques during surgery, and consistent postoperative follow-up to detect and address complications early. Transparent communication with patients, especially when complications occur, is critical for maintaining trust and avoiding legal disputes. In addition, avoiding blame-shifting among surgeons is essential to uphold professional integrity and patient safety. By addressing these factors and fostering a culture of transparency and accountability, surgeons can improve patient outcomes and minimize exposure to litigation. This study provides practical strategies to help spinal surgeons navigate legal challenges effectively and maintain a focus on high-quality patient care.

Study design: A case-series study.

Objectives: To acquire diagnostic insights to distinguish between intradural extramedullary spinal metastases (IESM) and benign spinal tumors by comparing patients with IESM and those with schwannoma or spinal meningioma.

Summary of background data: IESM constitute a rare category of spinal metastases. As the outcome of IESM is usually poor without intervention, early diagnosis and treatment are particularly important for better prognosis. As few studies have clearly addressed the features of IESM, it is necessary to gain comprehensive diagnostic insights into the characteristics of the disease.

Methods: Included in this study were 14 IESM patients who underwent gross total tumor resection. IESM and schwannoma or meningioma were compared in a ratio of 1:2. Differences in clinical and imaging presentations between them were analyzed statistically, and survival curves were plotted using the Kaplan-Meier method.

Results: IESM presented an unclear boundary (P=0.005), an irregular shape (P=0.035), and A low probability of cystic degeneration (P=0.028) as compared with schwannoma. Compared with IESM, meningioma tended to have a clear boundary (P=0.001), a wide base (P=0.047), high calcification possibility (P=0.040), and homogeneous enhancement on MRI (P=0.016). The estimated mean overall survival of IESM patients was 16.80±3.94 months.

Conclusion: This study demonstrated the characteristics of IESM and clarified the distinguishing points between IESM and intradural extramedullary benign tumors. Early warning features drawn from this study may be able to help clinicians to identify patients with IESM.