Global Spine Journal最新文献

Study DesignSystematic Review and Meta-Analysis.ObjectivesDespite a surge in the use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in spine surgery candidates, evidence on their perioperative use remains unclear. This meta-analysis aimed to synthesize the evidence on the safety and efficacy of GLP-1 RA use in patients undergoing spine surgeries.MethodsA systematic search of PubMed (MEDLINE), Embase, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Studies that compared spine surgery outcomes in GLP-1 RA users and non-users were included. Two reviewers independently selected articles. (PROSPERO: CRD420251061447).ResultsEleven retrospective studies reporting on 27,143 patients were included. Three studies focused on the cervical spine, 6 on the lumbar spine, and 2 included all spinal fusions. Risk of bias was deemed to be low in all studies. There were no significant differences in the GLP-1 RA users and non-users in pooled estimates for pseudoarthrosis (odds ratio: 1.29 [95% CI: 0.09 - 19.23]), surgical site infections (0.97 [0.74 - 1.27]), pneumonia (1.19 [0.30 - 4.68]), deep vein thrombosis (1.34 [0.86 - 2.08]), acute kidney injury (1.27 [0.93 - 1.74]), readmission rate (1.06 [0.94 - 1.18]), and emergency department visits (0.95 [0.10 - 8.99]).ConclusionsCurrently available level 4 evidence suggests that perioperative GLP-1 RA use in spine surgery candidates does not affect the risk of postoperative complications. However, these studies are based on administrative databases and may be confounded by indication. Future studies should include glycemic control and weight loss to better elucidate the impact of GLP-1 RA.

Study DesignConducted in vivo and in vitro modeling investigations.ObjectiveThe present research aims to explore the regulatory role of microRNA (miR)-369-3p in spinal cord injury inflammatory response and its targeting mechanism.MethodsA female mouse model with T8-T10 spinal cord injury (SCI) was established. The motor function assessment (BMS) score was employed to evaluate motor function. BV2 microglial cells were treated with lipopolysaccharide (LPS) in vitro to construct an inflammatory cell model. Real-time fluorescence quantitative PCR was applied to assess miR-369-3p, M1 (CD86, iNOS), and M2 (Arg-1) polarization markers. Enzyme-linked immunosorbent assay (ELISA) determined the concentration of inflammatory factors (TNF-α, IL-6, and IL-1β). Additionally, RNA pull-down, RNA immunoprecipitation, and Dual-luciferase reporter experiments were performed to verify that miR-369-3p targets Pellino E3 ubiquitin protein ligase 1 (PELI1).ResultsmiR-369-3p was noticeably down-regulated in SCI mice spinal cord tissues and LPS-induced BV2 cells, while PELI1 expression was upregulated. Raising miR-369-3p improved BMS scores (for moto function) and reduced inflammatory cytokines in spinal cord tissues. Mechanistically, miR-369-3p targeted PELI1. LPS treatment increased inflammatory factor mRNA levels and concentrations, which were significantly reversed by raising miR-369-3p and restored by PELI1. Also, raising miR-369-3p suppressed CD86 and iNOS and induced Arg-1 expression in LPS-activated microglia, while PELI1 reversed this effect.ConclusionmiR-369-3p mitigates inflammation and suppresses microglia polarization by targeting PELI1, ultimately mitigating the progression of spinal cord injury. Our research suggests miR-369-3p as a potential therapeutic target for spinal cord injury.

Study DesignRetrospective cohort study.ObjectivesObesity and metabolic syndrome have become a common comorbidity among patients undergoing spine surgery. This study aimed to evaluate 30-day postoperative outcomes following cervical laminoplasty, stratified by BMI categories and the presence of metabolic syndrome.MethodsThis study utilized the 2007-2022 ACS-NSQIP database. Patients who underwent cervical laminoplasty were identified and categorized into six BMI groups, according to the World Health Organization guidelines, and based on the presence of metabolic syndrome. The primary outcome was the 30-day occurrence of at least one complication (excluding blood transfusions). Secondary outcomes included rates of complications, hospital length of stay, and total operative time.ResultsA total of 2261 patients were analyzed, including 21 underweight, 510 normal-weight, 782 pre-obese, 565 class I obese, 249 class II obese, and 134 class III obese individuals. The cohort consisted of only 244 individuals with metabolic syndrome. Class II obesity (coefficient 23.585, 95% CI 10.815-36.355; P < 0.001) and class III obesity (coefficient 20.096, 95% CI 4.712-35.479; P = 0.011) were independently associated with longer operative times. Metabolic syndrome was an independent risk factor for deep incisional SSI (OR 3.25, 95% CI 1.07-9.80, P = 0.037), postoperative pneumonia (OR 4.17, 95% CI 1.63-10.63, P = 0.003), and prolonged hospitalization (OR 1.68, 95% CI 1.17-2.41, P = 0.005).ConclusionsPatients with metabolic syndrome face an increased risk of adverse outcomes after cervical laminoplasty. Implementing preoperative preventive interventions may help mitigate complications and associated costs in these patients. Furthermore, preoperative weight loss in class II-III obese patients may help decrease operative time and associated costs.

Study DesignCross-sectional ecological analysis.ObjectivesThis study aims to assess the availability of robotic spine surgery across the United States and identify disparities in access.MethodsWe utilized provider-finding functions from major medical equipment manufacturers to identify robotic spine surgeons and categorized affiliated hospitals. Geospatial analyses combined with socioeconomic indicators, Rural-Urban Continuum Codes, and the Area Deprivation Index (ADI) provided insights into access disparities. Multivariate logistic regression and Student's t-tests were used to identify county-level variables associated with hotspots and coldspots. Statistical significance was set at the P < .05 level.ResultsNinety-one robotic spine surgeons were identified. Robotic spine surgeons were predominantly affiliated with nonteaching hospitals (50.55%), followed by minor teaching (38.46%) and major teaching (10.99%) hospitals. Access hotspots are in the Northeast and Southeast, with rural areas showing 22% lower odds of being hotspots (OR = 0.78, P < .001). Factors increasing the odds of being a hotspot include higher disability prevalence (OR = 1.19, P < .001), lack of insurance (OR = 1.18, P < .001), and older median age (OR = 1.17, P < .001). Educational attainment and ADI, despite being significant, had lower predictive values for access.ConclusionsDisparities in access to robotic spine surgery are associated with socioeconomic, demographic, and geographic factors. The concentration of surgeons in nonteaching hospitals and higher-income areas may reflect market dynamics. Efforts to improve access should consider regional resources, hospital type, and community disadvantage.

Study DesignBibliometric analysis.ObjectivesThis study used bibliometric analyses to characterize the effect of AO Spine Knowledge Forum (KF) participation on publication trends among members. We examined associations of membership in KF organizations with academic productivity, collaboration, and scientific impact.MethodsWe queried the Web of Science database for publications by members of KF Tumor (N = 58), KF Trauma and Infection (N = 45), KF Spinal Cord Injury (N = 38), KF Degenerative (N = 54), and KF Deformity (N = 55). Resulting metadata were exported; statistical and bibliometric analyses were performed using Python packages.ResultsOur query returned 24,267 articles by KF members, of which 18,804 were identified as relevant to respective organizational themes through an algorithmic analysis of titles and abstracts. These works, published between 1980 and 2025, included contributions from 67,895 authors. Research productivity, co-authorship among members (P < 0.001), unique institutional affiliations per article (P < 0.001), and international collaboration increased contemporaneously with the first KF formation (2010). A positive association was found between the number of KF authors per publication and source journal impact factor (P < 0.001). Term analysis highlighted research foci within each KF and influential publications were identified.ConclusionsThese findings suggest that formalization of researcher relationships and the research infrastructure and support provided by the KF model was associated with increased and more impactful research output and collaboration. The KF model could be applied in other organizations whose mission includes collaborative research. Methods used in this study are easily replicable and may be applied to investigate the impact of other professional organizations across various fields.

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.