Global Spine Journal最新文献

Study DesignRetrospective Cohort Study.ObjectivesTo compare 1-year postoperative outcomes and complication rates between single-level lumbar laminectomy and hemilaminectomy using a large, multicenter, propensity-matched dataset.MethodsWe queried the TriNetX global health research network (≥160 million patients) for adults undergoing single-level lumbar decompression between January 2005 and July 2025. Cohorts were defined by CPT codes: laminectomy and hemilaminectomy, with qualifying diagnoses of lumbar disc herniation, spinal stenosis, spondylolisthesis, or radiculopathy. Patients with fusion, prior lumbar surgery, or non-degenerative pathology were excluded. Outcomes included new postoperative events within 1 year: mortality, weakness, pain, sensory loss, cauda equina syndrome, radiculopathy, foot drop, CSF leak, and surgical-site infection. Propensity-score matching balanced demographics and comorbidities. Cox proportional hazards models, Kaplan-Meier curves, and relative risks were calculated.ResultsOf 167,177 patients, 80,440 underwent laminectomy and 86,737 hemilaminectomy. After matching, 50,853 patients per cohort were analyzed. One-year mortality was similar (0.57% vs 0.49%, HR 1.20; 95% CI 1.01-1.42; P = 0.045). Laminectomy conferred significantly higher risks of CSF leak (1.41% vs 1.00%; RR 1.41), surgical-site infection (1.45% vs 1.00%; RR 1.45), cauda equina syndrome (0.36% vs 0.22%; RR 1.62), and persistent weakness (4.12% vs 3.67%; RR 1.12). Persistent radiculopathy was modestly less frequent after laminectomy (10.5% vs 12.0%; RR 0.87). Other outcomes, including pain and foot drop, were comparable.ConclusionsHemilaminectomy was associated with lower perioperative complication rates compared to laminectomy, while laminectomy provided a modest reduction in persistent radiculopathy. These findings highlight a tradeoff between safety and decompressive efficacy, emphasizing the importance of patient-specific surgical selection.

Study DesignBasic Science Study.ObjectivesTo determine the impact of rod composition and bending method on metal debris production during fatigue testing of posterolateral lumbar fusion constructs.MethodsPosterolateral lumbar fusion constructs were embedded into Ultra-High Molecular Weight Polyethylene (UHMW-PE) blocks and subject to fatigue testing, following a modified ASTM F1717-21 protocol including cycles of compression with novel axial rotation. Variations in constructs included rod bending methods of pre-bent (PB) and surgeon-bent (SB) and rod compositions of titanium alloy (Ti) or cobalt chromium alloy (CC). Constructs were wrapped in lactated ringer solution-soaked cotton, which was dissolved and analyzed for metal particulate using inductively coupled mass spectrometry (ICP-MS).ResultsMetal debris produced by surgeon-bent cobalt chromium and pre-bent cobalt chromium constructs did not have significant differences in quantity or quality. Pre-bent cobalt chromium alloy rods produced a larger amount of chromium and cobalt metal debris than pre-bent titanium alloy rods.ConclusionsWe find that cobalt chromium alloy rods produce more metal debris than titanium alloy rods. We find no evidence that rod bending method affects metal debris quality or quantity. In considering factors that impact susceptibility to corrosion and metallosis, our data supports that rod composition, but not bending method, contributes significantly to metal debris production.

Study DesignRetrospective cohort study.ObjectivesTo update national estimates of in-hospital mortality after lumbar fusion, characterize when deaths occur during hospitalization, and identify independent predictors of mortality.MethodsAdult (≥18 years) lumbar fusion hospitalizations in the National Inpatient Sample (NIS) from 2016 to 2022 were analyzed. The primary outcome was in-hospital mortality. Secondary outcomes included hospital-day timing of death and survivor-decedent comparisons of comorbidity and perioperative complication profiles. Multivariable logistic regression identified independent predictors (P < 0.05).ResultsAmong 1,181,465 weighted admissions, mortality was 0.11% (1290 deaths) and occurred early (approximately 50% within 7 days; >90% by ∼ 30 days). Decedents more often underwent multilevel fusion (67.8% vs 38.8%, P < 0.001), were aged ≥75 years (41.5% vs 16.5%, P < 0.001), and had higher comorbidity burden (mean Elixhauser count 3.92 vs 2.15, P < 0.001). Independent predictors included age ≥75 years (OR 4.49, P = 0.003), multilevel fusion (OR 2.09, P < 0.001), congestive heart failure (OR 4.46, P < 0.001), coagulopathy (OR 3.44, P < 0.001), neurologic disorders (OR 9.27, P < 0.001), peripheral vascular disease (OR 1.61, P = 0.031), and higher comorbidity count (per-point OR 1.16, P = 0.010). Female sex (OR 0.72, P = 0.022) and highest income quartile (OR 0.58, P = 0.009) were protective.ConclusionsIn-hospital mortality after lumbar fusion is uncommon but concentrates early and disproportionately affects older, medically complex patients undergoing multilevel procedures, supporting preoperative counseling, front-loaded perioperative risk stratification, and heightened early postoperative vigilance.

Study DesignRetrospective cohort study.ObjectiveSpinal metastases are common in patients with breast cancer, and accurate estimation of postoperative survival is crucial for selecting appropriate candidates for metastasis surgery. This study investigated the association between breast cancer subtype, according to the St. Gallen classification, and survival after surgery for spinal metastases with the aim of improving prognostic assessment and supporting informed patient counselling.MethodsThis study included 110 patients with breast cancer who underwent surgery for spinal metastases identified from the Swedish Spine Register and the Swedish National Quality Register of Breast Cancer. Patients were categorized in terms of the breast cancer subtype according to the St. Gallen classification. Postoperative survival was analysed using Kaplan-Meier estimates and a Cox proportional hazards model.Results: The overall median survival following spinal surgery was 25 months (95% CI 19-31), while the median postoperative survival by subtype was 39 months (95% CI 28-50) for luminal A patients, 20 months (95% CI 9-31) for luminal B patients, and 48 months (95% CI 20-76) for luminal B/HER2+ patients. The median survival was not reached for the nonluminal HER2+ group, whereas patients with triple-negative breast cancer had a median survival of only 5 months (95% CI 4-6). The St. Gallen subtype was significantly associated with postoperative survival according to univariable (P<0.001) and multivariable analyses (P = 0.011).ConclusionsBreast cancer subtype according to the St. Gallen classification was significantly associated with survival after surgery for spinal metastases. These findings indicate that the St. Gallen classification may serve as a valuable prognostic tool in the metastatic spine setting. Incorporation of molecular subtype information may improve estimation of postoperative survival and support informed patient counselling, expectation management, and individualized surgical decision-making in patients with breast cancer spinal metastases.

Study DesignRetrospective multicenter cohort study.ObjectivesSpine surgery for multiple myeloma (MM) is associated with an increased intraoperative blood loss. Therefore, this study aims to examine prognostic factors for higher intraoperative blood loss in spine surgery for patients with MM.MethodsIn total, 158 adult patients with MM undergoing spine surgery between May 2001 and December 2021 were included. The main outcome for intraoperative blood loss was the Bleeding Index (BI), next to the visually estimated blood loss (EBL). Two separate multivariable generalized linear models (GLMs) were utilized to assess the associations between the predictors and these two outcomes.ResultsThe average BI was 4.4 and average EBL was 750 mL. Compared to corpectomy with stabilization, other types of surgery (decompression with stabilization, sole decompression, sole stabilization) were associated with a lower expected BI, ranging from a 26.5% to 39% decrease. A cervical location of surgery was associated with a 40.3% reduction of expected BI compared to a lumbar location (P = 0.006). Lower platelet count (P = 0.003) and longer duration of surgery (P < 0.001) were associated with a higher expected BI. For EBL, ECOG score, surgery type, and duration of surgery were found as independent predictors.ConclusionsThis study identified lower platelet count, type of surgery, location of operated spinal levels, and a longer duration of surgery as independent predictors of higher intraoperative BI in MBD-related spine surgery. These outcomes can be relevant for preoperative screening, shared decision making, and perioperative blood transfusion deliberation or planning.