Global Spine Journal最新文献

Study DesignRetrospective cohort study.ObjectivesPreoperative risk stratification using frailty is common for adults but difficult to apply to pediatric populations. We aimed to identify risk factors indicating physiologic vulnerability and predict perioperative complications in children with neuromuscular scoliosis (NMS) and to create a prediction model for physiological vulnerability (PV-5).MethodsPatients with NMS were identified from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. The 9442 patients identified were randomly divided into training and testing cohorts. Univariate and multivariable logistic regression were performed; variables significantly associated with complications were evaluated using the Akaike information criterion and area under the curve. Significant variables received weighted scores, and a patient-specific prediction model was generated and evaluated using the Brier score.ResultsPatients with central nervous system abnormality (OR 1.32 [95%CI 1.13-1.53]), hematologic disorder (OR 1.40 [1.06-1.85]), congenital malformation (OR 1.30 [1.1-1.54]), nutritional support (OR 2.21 [1.91-2.57]), and preoperative wound infection (OR 2.3 [1.4-3.76]) were more likely to develop complications after spinal fusion surgery. PV-5 scores were calculated from these risk factors to generate a prediction model. PV-5 scores of 1 (OR: 2.0 [1.27-3.43], P < 0.004), 2 (OR: 2.75 [1.63-4.64], P < 0.001), 3 (OR: 3.67 [2.18-6.19], P < 0.001), 4 (OR: 4.09 [2.39-6.99], P < 0.001), and 5+ (OR: 3.58 [1.35-9.47], P = 0.01) predicted greater complication risk than PV-5 of zero (accuracy = 89.65%, Brier score = 0.09).ConclusionsUsing factors associated with complications in children with NMS undergoing spinal fusion surgery, we created a prediction model to illustrate physiologic vulnerability and morbidity. Our model serves as a foundation for further body system-specific investigation.

Study DesignRetrospective cohort.ObjectivesTo assess the incidence, time to presentation, and independent risk factors for retropharyngeal hematoma causing airway obstruction following anterior cervical discectomy and fusion (ACDF).MethodsThe PearlDiver national database was queried for patients who underwent one- to four-level ACDF. Patients who underwent concomitant posterior fusion or had surgical indications related to malignancy, trauma, or infection were excluded. Patients were stratified based on the development of a retropharyngeal hematoma causing airway obstruction within 7 days. Descriptive statistics assessed differences in patient demographics and comorbidities. Univariable and multivariable regression analyses identified independent predictors.ResultsAmong 430,542 patients, 140 (0.03%) developed postoperative retropharyngeal hematoma leading to acute airway obstruction. A significant proportion of patients presented within 1 day of surgery (45 patients, 32.14%), with 23 (16.43%) on day zero and 22 (15.71%) on day 1. Notably, 40.71% of cases occurred after discharge. Independent predictors included ossified posterior longitudinal ligament (OPLL) (aOR: 8.07, P < 0.001), male gender (aOR: 2.30, P < 0.001), hypertension (aOR: 1.67, P < 0.05), viral hepatitis (aOR: 1.57, P < 0.05), and comorbidity index (aOR: 1.14, P < 0.001).ConclusionThis study identified a 0.03% incidence of retropharyngeal hematoma leading to acute airway obstruction and several independent predictors, including comorbidity index, male gender, hypertension, viral hepatitis, and OPLL. Surgeons should consider overnight admission for observation in patients with these risk factors, as a significant proportion of hematomas present within 1 day of surgery.

Study DesignCross-sectional study.ObjectiveTo examine the association between SIRI and spinal BMD and assess the influence of age, hypertension, and diabetes.MethodsWe analyzed data from 13,950 participants aged ≥20 years. SIRI was calculated using neutrophil, monocyte, and lymphocyte counts, and spinal BMD was measured by DXA. Linear regression, generalized additive models, and segmented regression were used, with subgroup analyses based on age, hypertension, and diabetes.ResultsA threshold effect was observed at SIRI = 0.68. Below this threshold, SIRI negatively correlated with spinal BMD (β = -0.0412, P = 0.0494), while above it, a positive correlation was found (β = 0.0079, P < 0.0001). Subgroup analyses showed stronger positive associations in older adults (≥65 years, β = 0.0136, P < 0.0001), and those with hypertension (β = 0.0089, P = 0.0004) and diabetes (β = 0.0187, P < 0.001).ConclusionA segmented nonlinear relationship exists between SIRI and spinal BMD, with age, hypertension, and diabetes as significant modifiers. SIRI may serve as a biomarker for osteoporosis risk.

Study DesignRetrospective study.ObjectiveTo determine the fusion rate in patients undergoing anterior lumbar interbody fusion (ALIF) and/or lateral lumbar interbody fusion (LLIF) with titanium cages.MethodsFusion at 1-year was assessed by computed tomography (CT) using Lenke-Bridwell classification. Flexion-extension lateral radiographs confirmed fusion if motion was <5° through the fused segment. Perioperative metrics including bone graft type, operative time, estimated blood loss, revisions within the first postoperative year, clinical outcome assessed by the Oswestry Disability Index (ODI).ResultsOne hundred patients with a total of 137 fusion levels with 3DPTi cages were identified. In this cohort, 75% underwent primary surgery and 25% had a previous surgery. At 1-year post-op, 97.1% of interbody levels were fused (Grade I) on CT, and all levels appeared fused on flexion-extension radiographs. Four patients (4%) required additional surgery within the first two years. No revisions were required for cage subsidence/migration, or pseudoarthrosis. Median ODI significantly improved from 39 at baseline to 10 at 1-year (P = .001).Conclusion3D-printed titanium cages for ALIF and LLIF result in excellent fusion rates at one year postoperatively without the use of rhBMP-2.

Study DesignSystematic Review and Meta-analysis.ObjectivesLumbar degenerative disease (LDD) is prevalent among aging adults. While tubular retraction is a widely used minimally invasive approach, biportal endoscopic spine surgery has emerged as a potential alternative. This systematic review and meta-analysis compares the clinical outcomes of tubular retraction and biportal endoscopy for decompression procedures (discectomy, laminectomy, laminotomy) and transforaminal lumbar interbody fusion (TLIF) in LDD patients.MethodsA systematic review and meta-analysis of comparative studies was conducted per PRISMA guidelines. A comprehensive search of PubMed, Embase, and Scopus identified relevant studies published before October 7, 2024. Data were analyzed using a random-effects model to assess Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, complication rates, operative time, and length of stay at preoperative, ≤2-weeks postoperative, and ≥1-year postoperative time points.ResultsA total of 772 patients were included (400 tubular, 372 biportal). Biportal endoscopic surgery was associated with a lower complication rate (10.73% vs 15.94%; P < .001) and lower ≤2-week postoperative VAS back pain (2.70 ± 0.27 vs 3.55 ± 0.49; P < .001) relative to tubular spine surgery. Biportal decompression had a lower complication rate (15.13% vs 22.34%; P = .006) but similar patient-reported outcomes. Biportal TLIF had longer operative times (189.93 ± 25.90 vs 145.1 ± 14.90 min; P = .026) but lower complication rates (6.33% vs 9.55%; P = .026) and ≥1-year VAS leg pain (1.88 ± 0.29 vs 2.02 ± 0.26; P < .001).ConclusionsBiportal endoscopy for LDD had lower complication rates and similar patient-reported outcomes relative to tubular retraction, though longer operative times in TLIF subanalysis. Future studies are necessary to validate findings and guide patient-specific decision-making.

Study DesignA retrospective database analysis.ObjectiveTo determine the incidence of lower extremity deep vein thrombosis (DVT) and identify risk factors associated with DVT development in patients with spinal cord injury (SCI), stratified by level of injury.MethodsThe National Inpatient Sample from 2016 to 2021 was used to identify adult inpatients with SCI who developed DVT within the same admission and to categorize them by anatomical injury level. Multivariable logistic regression was used to assess independent risk factors by SCI level.ResultsAmong 59,498 SCI patients, the overall DVT incidence was 2.8%. The DVT rate was lowest in cervical SCI (2.6%) and highest in thoracic SCI (3.2%). Pulmonary embolism was a strong independent risk factor for DVT across all SCI levels ([Cervical] OR: 12.82, CI: 10.46-15.63, [Thoracic] OR: 11.82, CI: 9.13-15.20, [Lumbar] OR: 11.38, CI: 6.74-18.74). For cervical SCI, risk factors included coagulopathies (OR: 1.90, CI: 1.54-2.32), older age (OR: 1.01, CI: 1.01-1.02), complete (OR: 1.84, CI: 1.43-2.35) or incomplete cervical lesion (OR: 1.38, CI: 1.17-1.63), cervical (OR: 1.34, CI: 1.16-1.54) or lumbar fracture (OR: 1.58, CI: 1.17-2.11), and upper extremity DVT (OR: 3.58, CI: 2.53-4.97). For thoracic SCI, risk factors included thoracic fracture (OR: 1.46, CI: 1.20-1.77), upper extremity DVT (OR: 3.82, CI: 2.18-6.36), and fluid/electrolyte disorder (OR: 1.35, CI: 1.13-1.62). For lumbar SCI, fluid/electrolyte disorder (OR: 1.92, CI: 1.38-2.66) was an independent predictor.ConclusionDVT incidence and risk factors vary by SCI level. Identifying these factors is critical for stratifying care and developing tailored prophylactic strategies that prevent adverse events and optimize patient outcomes.

Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established. Given the significant morbidity associated with spine surgery in this frail population, efforts are ongoing to decrease the surgical footprint. The objective of this study is to provide the readers with a concise curation of the latest spine literature on reducing the surgical footprint for spine metastases and clinical recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsThe latest spine literature in the topic of reducing the surgical footprint for spine metastases was reviewed and clinical recommendations were formulated. The recommendations are dichotomously graded into strong and conditional based on the integration of scientific methodology and content expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high impact studies were selected for review. The findings suggest that surgery plays a key role in improving patients' quality of life, but incidence of adverse events remains high and hence methods to decrease surgical morbidity are necessary. The integration of radiation into the treatment algorithm allows for less extensive surgical procedures and SBRT should be strongly considered after surgery for spine metastases in appropriate patient populations. Implementation of enhanced recovery after surgery (ERAS) protocols reduce perioperative morbidity for both open and minimally invasive surgeries and should be considered on an institutional level. Utilization of minimally invasive surgical stabilization should be considered as it results in fewer post operative complications, lower infection rates, less blood loss during surgery, and a shorter hospital stay compared to open stabilization of unstable pathology thoracolumbar fractures.ConclusionsThe role and benefits of surgery for metastatic spine disease are well established, yet surgery carries significant risk for adverse events which may negatively affect overall cancer care. Methods for reducing the surgical footprint include incorporation of stereotactic radiation allowing less extensive surgery, implementation of ERAS protocols and utilization of minimally invasive surgical strategies.

Study DesignProspective, randomized controlled study.ObjectiveAssess early radiological outcomes in transforaminal lumbar interbody fusion (TLIF) with 3D-printed porous titanium (3DPPT) compared to PEEK.MethodsSingle-blinded prospective, randomized controlled trial comparing 1-2 level TLIF with micro- & nano-textured, 3DPPT vs PEEK cages from 11/2021 to 5/2023. Interbody fusion was assessed on CT at 6 months according to Brantigan and Steffee method, modified to describe the Fraser definition of locked pseudoarthrosis [(BSF) scale]. Primary outcome was radiographic fusion at 6 months. ResultsInitial study protocol included 70 total patients but was ended early given the significance on interim analysis. Amongst 17 patients with 25 interbody levels implanted, 10 3DPPT and 15 PEEK cages were implanted. 3DPPT levels had a significantly higher rate of successful fusion (BSF-3) at 6 months compared with PEEK (100% vs 0.0%, P < 0.001). The posterior probability that 3DPPT increased the odds of fusion versus PEEK was > 99.9%, indicating a near-certain beneficial effect. Using a Bayesian mixed-effects model, the predicted probability of 6-month BSF-3 fusion was 9.0% for PEEK and 91.2% for 3DPPT. There were no significant differences in lumbar pathologies, level of fusion, number of fused levels, cage height, length of hospital stay, surgery duration, postoperative complications, subsidence, or reoperations.ConclusionsThe rate of successful lumbar interbody fusion at 6 months was significantly higher in 3DPPT levels compared to PEEK. 3DPPT may accelerate the rate and quality of bony fusion. Additional studies are needed to further delineate the impact of these radiographical findings on long-term clinical outcomes.

Study DesignModified Delphi study.ObjectivesTelementoring, the practice of providing remote guidance and teaching from a distance using telecommunication technology, has demonstrated feasibility and value in assisting surgeons in remote locations. However, limited evidence exists regarding its effectiveness in improving surgeon performance. This study aimed to develop metrics to assess spine surgeon performance in scoliosis surgery, potentially within the context of a telementoring training program.MethodsTen expert spine surgeons participated in a four-round modified Delphi process including both online and in-person meetings. The resulting metrics were validated for objective assessment by eleven surgeons, who reviewed and rated a video recording using the established rubric.ResultsThe final set of metrics, comprising 50 procedural steps and 28 error categories, was unanimously approved by the panel. Additionally, the panel agreed that utilizing cameras, smart lenses, and output from intraoperative imaging monitors would provide sufficient visibility for assessing both steps and errors.ConclusionsA set of assessment metrics for adolescent idiopathic scoliosis surgery was successfully defined and validated by reviewing example videos. The longer-term research objective is to employ this rubric to assess surgeon's performance throughout a telementoring program, thus assessing its educational impact. The rubric could also be used in other contexts, such as live surgical observation.