Clinical Spine Surgery最新文献

Study design: Descriptive study.

Summary of background data: Patients commonly use online patient education materials (PEM) to learn about anterior cervical discectomy and fusion (ACDF).

Objective: The purpose of this study is to evaluate the readability of patient education materials on anterior cervical discectomy and fusion.

Methods: The Google search engine was queried using the term "Anterior Cervical Discectomy and Fusion patient information." The first 25 websites meeting inclusion criteria for this term were evaluated. Readability scores were automatically calculated by transferring the texts to http://www.readabilityformulas.com . Descriptive statistics were calculated for each measure using SPSS version 28.0.0.

Results: The mean average reading level was 9.2±2.4. The mean readability score out of 100 for the FK Reading Ease Score was 55.2±8.6. The remaining scores were: Gunning Fog, 12.7±2.2; FK Grade Level, 8.9±2.0; The Coleman Liau Index, 11.0±1.7; SMOG Index, 48.1±197.0; Automated Readability Index, 8.1±3.11; Linsear Write Formula, 9.8±2.1. Only 2 of the PEMs were written at or below a sixth grade level and only 7 were written at or below an eighth grade reading level.

Conclusion: Patient readability is an important component of patient care and the current readability level of ACDF PEMs is insufficient. At their current state, PEMs may not allow a significant portion of the population to understand the nature of their condition and procedure properly.

Level of evidence: Level III.

Study design: Prospective survey study.

Objective: To address a gap that exists concerning ChatGPT's ability to respond to various types of questions regarding cervical surgery.

Summary of background data: Artificial Intelligence (AI) and machine learning have been creating great change in the landscape of scientific research. Chat Generative Pre-trained Transformer(ChatGPT), an online AI language model, has emerged as a powerful tool in clinical medicine and surgery. Previous studies have demonstrated appropriate and reliable responses from ChatGPT concerning patient questions regarding total joint arthroplasty, distal radius fractures, and lumbar laminectomy. However, there is a gap that exists in examining how accurate and reliable ChatGPT responses are to common questions related to cervical surgery.

Materials and methods: Twenty questions regarding cervical surgery were presented to the online ChatGPT-3.5 web application 3 separate times, creating 60 responses. Responses were then analyzed by 3 fellowship-trained spine surgeons across 2 institutions using a modified Global Quality Scale (1-5 rating) to evaluate accuracy and utility. Descriptive statistics were reported based on responses, and intraclass correlation coefficients were then calculated to assess the consistency of response quality.

Results: Out of all questions proposed to the AI platform, the average score was 3.17 (95% CI, 2.92, 3.42), with 66.7% of responses being recorded to be of at least "moderate" quality by 1 reviewer. Nine (45%) questions yielded responses that were graded at least "moderate" quality by all 3 reviewers. The test-retest reliability was poor with the intraclass correlation coefficient (ICC) calculated as 0.0941 (-0.222, 0.135).

Conclusion: This study demonstrated that ChatGPT can answer common patient questions concerning cervical surgery with moderate quality during the majority of responses. Further research within AI is necessary to increase response.

Study design: Retrospective cohort study.

Objectives: Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery.

Summary of background data: The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting.

Materials and methods: Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients.

Results: Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001.

Conclusions: Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting.

Level of evidence: Level 3.

Study design: Randomized control trial.

Objective: To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.

Summary of background data: Pain management is a key aspect of a patient's care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.

Methods: A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.

Results: Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P = 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days ( P < 0.0001).

Conclusions: The patient population that received the erector spinae block had significantly lower pain scores on days 1-3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.

Study design: Retrospective analysis.

Objective: The purpose of this study is to quantify the rate at which the atlantoaxial level is omitted from official cervical magnetic resonance imaging (MRI) radiologic reports and to identify potential missed pathology, emphasizing the need for improved standardization of evaluation.

Summary of background data: MRI is a readily utilized modality for evaluating the axial skeleton. In our experience, the atlantoaxial level of the cervical spine is often overlooked on MRI radiologic reports in the absence of trauma or obvious pathology.

Methods: The preoperative MRIs and associated radiologic reports of 219 patients undergoing cervical decompression and fusion in a single year were collected. The inclusion or omission of distinct evaluation at the atlantoaxial level within each radiologic report was recorded. All imaging was then reviewed. The atlantoaxial level was specifically evaluated, and any pathology was noted and compared with the official radiologic reports. The rates of atlantoaxial evaluation omission from the radiologic reports and missed pathology at this level were primarily and secondarily reported.

Results: MRI studies were performed at 101 different institutions, with reports issued by 126 individual radiologists. Specific documentation of atlantoaxial evaluation was noted in 32 (14.6%) radiology reports, with the remaining 187 cases (85.4%) including no mention of this level. Upon independent re-review of the imaging, pathology was noted at the atlantoaxial level in 18 patients (8.2%), totaling 19 abnormal findings. Such findings were absent from the official reports in 13 of these cases (5.9% of the total study population).

Conclusions: In our study, formal documentation was omitted from 85% of reports resulting in missed pathology in nearly 6% of cases. This study underscores the importance of thorough imaging interpretation and clinical correlation with patient symptoms. In addition, it highlights the need for standardized reporting of these studies to prevent potential morbidity associated with a missed diagnosis.

Study design: Retrospective study.

Objective: To correlate the changes in the dural area on MRI and clinical outcome after unilateral biportal endoscopic (UBE) decompression.

Summary of background data: Clinical outcomes after UBE decompression have been published for up to 2 years for patients with isolated spinal stenosis at 1 level. Serial dural expansion after UBE decompression has not been published as well as correlation to clinical outcomes.

Method: We retrospectively reviewed the clinical and radiologic outcomes of 86 patients who underwent UBE decompression for spinal stenosis. Preoperative and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were analyzed, and MRI was used for radiologic evaluation before surgery, 3 days after surgery, and 2 years after surgery. The correlation of dural spinal area CSA (preoperative-final) and difference of clinical outcome (preoperative-final) were analyzed.

Result: None of the 86 patients had permanent neurological complications. Back VAS, leg VAS, and ODI showed improvement in symptoms postoperatively and 2 years postoperatively. The postoperative CSA of the dural sac on MRI was statistically significantly increased after surgery at all time points. VAS leg was moderately correlated with change in CSA, while ODI and VAS back were weakly correlated. Correlations were all statistically significant.

Conclusion: UBE decompression showed good clinical outcomes similar to previous studies, and the CSA of ​​the dural sac on MRI significantly increased in the late postoperative phase compared with the early postoperative phase. This technique is viable option to achieve radiographic dural expansion and improvement in clinical outcomes in degenerative lumbar spinal stenosis. However, there is at best only a moderate correlation with change in CSA and clinical outcomes.

Study design: Retrospective cohort study.

Objective: To assess the efficacy of tranexamic acid (TXA) on reducing perioperative blood loss and blood transfusion requirements in nonidiopathic scoliosis patients undergoing primary posterior spinal fusion.

Summary of background data: Posterior spinal fusion for correcting scoliosis in pediatric patients is associated with substantial volumes of perioperative blood loss and high transfusion requirements. Patients with nonidiopathic scoliosis typically experience greater blood loss than those with idiopathic scoliosis.

Methods: We retrospectively reviewed patients who underwent primary posterior fusion for nonidiopathic scoliosis between November 2014 and December 2020. Patients were assigned to the TXA or no-TXA group depending on intraoperative administration of TXA.

Results: Despite longer surgical duration ( P =0.009) and more spinal levels fused ( P =0.014), perioperative blood loss [2602 (810-9262) mL in the TXA group vs. 2058 (1019-4170) mL in the no-TXA group, P =0.554] and allogenic red blood cell transfusion rates (63% in the TXA group vs. 55% in the no-TXA group, P =0.508) were similar in the TXA and the no-TXA groups. After adjustments, TXA administration was found to have a significant negative effect on estimated blood loss (Est=-513.73, 95% CI=-925.41 to 125.3, P =0.045).

Conclusions: Significant perioperative blood loss and high transfusion rates remain a challenge in the surgical treatment of nonidiopathic scoliosis patients. Given the demonstrated negative effect of TXA on estimated blood loss, its routine application may be considered in the perioperative blood management of pediatric nonidiopathic scoliosis patients.

Level of evidence: Level III.

Study design: Retrospective analysis of retrospectively collected data.

Objective: To determine the effects of preoperative nonsteroidal anti-inflammatory drug (NSAID) use on estimated blood loss (EBL) and postoperative drain output in TLIF procedures.

Summary of background data: Current standards of care recommend patients prescribed NSAIDs for chronic lower back pain discontinue NSAIDs at least 1 week before spine fusion surgery. The literature surrounding the effects of preoperative NSAID use is unclear, however, with dissonant findings regarding postoperative blood loss and complications.

Methods: A retrospective case review was performed on 429 cases of 1-level or 2-level TLIF, with patient NSAID use recorded within 3 days of surgery, at a single institution. Linear and logistic regressions were used to assess associations between NSAID use, patient and surgical characteristics, EBL, and drain output.

Results: NSAID use was significantly positively associated with drain output ( P =0.03), with an approximate increase of 21±9.7 mL/day but no significant association with any postoperative complications ( P =0.77). Drain output also had significant, independent positive associations with patient age ( P =0.007), male sex ( P <0.001), and a number of levels fused ( P <0.001), and significant negative associations with robot-assisted ( P <0.001) and minimally invasive ( P =0.04) procedures. No significant association was detected between NSAID use and EBL ( P =0.21), though EBL had significant positive associations with operative time ( P <0.001) and levels fused ( P <0.001), and multiple NSAIDs had a significant positive association with EBL ( P <0.001).

Conclusions: NSAID use had a statistically significant, but small, effect on drain output and no detectable effect on postoperative complications within 3 days of TLIF procedures, suggesting most patients can safely continue NSAID use up until their date of surgery. Future studies should further delineate the effects of preoperative NSAID use, such that a more refined risk profile could be developed from patient and surgical characteristics and NSAID use information.

Study design: Single-center retrospective analysis.

Objective: To establish an empirically derived threshold to define both coronal and sagittal malalignment (CM & SM) based on preoperative patient-reported outcomes (PROs).

Summary of background data: Currently, no radiographic alignment threshold defines preoperative CM in adult spinal deformity (ASD) patients based on disability. In a cohort of ASD patients undergoing corrective surgery, we sought to establish a threshold to define both CM and SM based on PRO and assess the clinical impact of CM and combined with SM.

Methods: ASD patients with ≥6 level fusions were included. CVA and SVA were measured. PROs included preoperative ODI and SRS-22r scores. CVA and SVA thresholds were derived to accurately differentiate patients with ODI >40 and SRS-pain+function <5. Patients were then separated into 4 groups: (1) neutral alignment (NA); (2) CM; (3) SM; and (4) combined coronal and sagittal malalignment (CCSM).

Results: Totally, 368 patients were included. Thresholds to distinguish patients with ODI ≥40 and SRS-pain/function <5 were: (1) CVA=3.96 cm (ODI) and 3.17 cm (SRS); (2) SVA=4.97 cm (ODI) and 7.52 cm (SRS). The lower numbers were chosen to define each threshold: CVA=3 cm and SVA=5 cm. Alignment breakdown was: NA=179 (48.6%), CM=66 (17.9%), SM=65 (17.7%), and CCSM=58 (15.8%). Both SM=( P =0.006) and CCSM ( P <0.001) patients had significantly worse ODI scores than NA patients, and CCSM patients were significantly worse than SM alone ( P =0.010). On the basis of preoperative total SRS-22r scores, only CCSM ( P =0.003) patients were significantly worse than the NA group. CVA significantly correlated with 4/7 (57.1%) preoperative PROs (ODI/SRS-total/function/image), while SVA correlated with 5/7 (71.4%) preoperative PROs (ODI/SRS-total/function/image/pain). A linear relationship was seen between increasing CVA and worsening ODI (β=0.92, 95% CI: 0.37-1.48, P =0.001). A significant and slightly stronger relationship was seen between increasing SVA and worsening ODI (β=1.28, 95% CI: 1.00-1.56, P <0.001).

Conclusions: CM and SM thresholds that accurately distinguished ASD patients with severe pain and disability preoperatively were 3 cm for CVA and 5 cm for SVA, respectively. Preoperative CM was significantly associated with worse ODI, SRS-22r total/function/image scores. CCSM led to more disability than SM alone.

Study design: A pilot randomized controlled trial.

Objective: To investigate the effects of a prehabilitation program on early postoperative outcomes in Japanese patients undergoing lumbar spinal stenosis (LSS) surgery.

Summary of background data: Prehabilitation has shown promise for improving postoperative outcomes in various surgical populations. However, its effectiveness in Japanese patients undergoing LSS surgery has not been previously studied.

Methods: Thirty-two of 34 patients scheduled for LSS surgery (mean age: 69.3 y, 17 female) were randomly assigned to the prehabilitation group (15 patients) or control group (17 patients). The primary outcomes were the Oswestry Disability Index (ODI) and 6-minute walk distance (6MWD). The secondary endpoints were the visual analog scale (VAS) scores for back pain, leg pain, and numbness. The intervention group received a 20-30-minute educational session from a physical or occupational therapist using a pamphlet 1 month before surgery, while the control group received a pamphlet handout. Assessments were conducted 1 month before surgery (baseline); 1 day before surgery; and 1, 3, and 6 months postoperatively.

Results: All patients underwent preoperative educational sessions. The prehabilitation group showed significant improvements in 6MWD at 3 months postoperatively compared with the control group (446.8±48.9 m vs. 384.3±58.3 m, P =0.01, Hedges' g=1.11). ODI scores at 1 month postoperatively were lower in the prehabilitation group (10.2±10.9 vs. 19.0±10.7, P =0.04, Hedges' g=-0.77). Low back pain VAS at 3 months postoperatively was also lower in the prehabilitation group (12.5±14.8 vs. 27.5±20.8, P =0.04, Hedges' g=0.75). No adverse events were reported in either of the groups.

Conclusions: Prehabilitation may enhance postoperative recovery and outcomes in patients undergoing surgery for LSS. Further research with a larger sample size is needed to establish the effectiveness of prehabilitation in this population.