Global Spine Journal最新文献

Study DesignRetrospective Cohort Study.ObjectivesThere are several approaches for lumbar fusion, which is often used to treat degenerative lumbar spondylolisthesis. This study aimed to compare perioperative complications, mortality, discharge disposition, and costs amongst patients undergoing anterior (ALIF) and posterior/transforaminal lumbar interbody fusion (P/TLIF).MethodsThe National Inpatient Sample was queried from 2016-2022 for admissions after ALIF, PLIF, or TLIF in the setting of degenerative lumbar spondylolisthesis. Perioperative complications, discharge disposition, and mortality rates were compared using survey-weighted regression models. Cost and length of stay (LOS) were compared using survey-weighted means and t-tests. Significance was set at P < 0.05.Results70,580 weighted elective inpatient admissions (ALIF - 12,410, P/TLIF - 58,170) were included. P/TLIF patients were older (63.6 vs 62.3 years, P < 0.001) and more frequently underwent single-level fusions (83.0% vs 78.1%, P < 0.001). P/TLIF had higher odds of CSF leak/dural tear (OR 2.34, 95% CI 1.43-3.83, P < 0.001), transfusion (OR 1.42, 95% CI 1.03-1.97, P = 0.032), adverse events (OR 1.18, 95% CI 1.02-1.37, P = 0.028), and non-routine discharge (OR 1.17, 95% CI 1.05-1.30, P = 0.005). P/TLIF had lower odds of vascular injury (OR 0.03, 95% CI 0.00-0.33, P = 0.003) and lower inpatient mortality (OR 0.13, 95% CI 0.04-0.45, P = 0.001). ALIF incurred higher costs ($43,003 vs $35,513, P < 0.001). LOS was shorter with ALIF (2.81 vs 3.03 days, P < 0.001).ConclusionThe P/TLIF and ALIF cohorts were associated with unique perioperative risk profiles. ALIF was associated with decreased LOS but increased costs. These findings can be used to guide operative management in patients with degenerative spondylolisthesis.Level of EvidenceIII.

Study DesignRetrospective analysis using national Medicare data.ObjectivesTo evaluate historical trends in single and multi-level ACDF utilization and project future procedure volumes among Medicare beneficiaries through 2060.MethodsPublicly available data from the Centers for Medicare and Medicaid Services (CMS) Medicare Part-B National Summary were analyzed for single-level and multi-level ACDF from 2011 through 2022. Analyses were limited to Part-B claims and therefore excluded inpatient-only procedure codes that are not reported in Part-B. Volumes were adjusted for Medicare Advantage enrollment. Four forecasting models were applied, with Poisson regression selected based on model performance. Point forecasts and 95% confidence intervals were generated through 2060.ResultsSingle-level ACDF volumes decreased by 0.32% from 2011 to 2022, with the largest annual increase from 2011 to 2012 (11.3%) and 5-year growth from 2011 to 2016 (25.7%). In contrast, multi-level ACDF volumes increased by 86.9%, with a 19.5% increase between 2011 and 2012 and 69.8% growth from 2011 to 2016. The Poisson model projected stable annual growth for single-level ACDF at 0.04%, reaching 8,789 procedures (95% CI: 8,606-8,973) by 2060. Multi-level ACDF is projected to grow by approximately 4.9% annually, reaching 377,826 procedures (95% CI: 376,622-379,031) by 2060.ConclusionsSingle-level ACDF utilization is projected to remain stable, while multi-level ACDF is expected to increase substantially through 2060. These trends highlight the growing reliance on ACDF for complex cervical pathology and carry implications for surgical workforce planning, hospital resource allocation, and policy in an aging population.

Study DesignPropensity-matched retrospective cohort study.ObjectiveThis study aimed to compare the incidence of venous thromboembolism (VTE) complications following posterior cervical decompression and fusion (PCDF) and anterior cervical discectomy and fusion (ACDF).MethodsThe TriNetX database was queried for patients >18 years old undergoing single- or multi-level ACDF or PCDF between 2004 and 2024. Patients with prior VTE, thrombophilia, or prior cervical spine surgery were excluded. Propensity score matching was performed using demographics, comorbidities, and anticoagulation use. Primary outcomes included 30- and 90-day incidence of VTE events and post-operative bleeding complications. Differences between PCDF and ACDF were reported as odds ratios with 95% confidence intervals (CI).ResultsThere were 4381 patients included in each single-level cohort and 15 577 patients in each multi-level cohort. Compared to single-level ACDF, single-level PCDF was associated with higher odds of VTE events at 30-days (OR: 1.96, 95% CI: 1.28-2.94; P = 0.001) and 90-days (OR: 2.05, 95% CI: 1.43-2.94; P < 0.001). Multi-level PCDF was also associated with higher odds of VTE events at 30-days (OR: 3.83, 95% CI: 3.13-4.76; P < 0.001) and 90-days (OR: 3.97, 95% CI: 3.33-4.76; P < 0.001) when compared to multi-level ACDF. There were no significant differences in post-operative bleeding complications (P > 0.05).ConclusionsPCDF was associated with increased VTE complications with no differences in postoperative bleeding events when compared to ACDF. Incorporating surgical approach may enhance VTE risk assessment following cervical spine surgery.

BackgroundDegenerative lumbar disc disease (DLDD) can contribute to substantial low back pain and radicular leg pain. Emerging evidence suggests that racial and ethnic disparities in DLDD care could impact clinical outcomes, yet these trends remain largely unexplored. This study investigates differences in health literacy, access to care, and healthcare utilization among patients with DLDD using the All of Us (AoU) Research Program.MethodsAdults diagnosed with DLDD were identified from the AoU database using ICD-9 and ICD-10 diagnostic codes. Participants were stratified by race and ethnicity into White, Black, Hispanic, and Other. Demographics, socioeconomic status, health literacy (BRIEF score), healthcare access, and treatment utilization across racial and ethnic groups were compared across cohorts using chi-square analyses. Multivariate logistic regressions evaluated these outcomes while adjusting for demographic and socioeconomic status.ResultsIn total, 30,775 participants with DLDD were identified. Most participants were 65+ years (62.8%) and female (65.3%), with 74.0% self-identifying as White, 10.7% as Black, 8.1% as Hispanic, and 7.2% as Other. Compared to Whites, Black and Hispanic participants were significantly more likely to report limited health literacy (White = 15.3%, Black = 22.2%, Hispanic = 28.1%, Other = 21.3%, P < 0.001). In addition, they were more likely to be denied insurance coverage (9.7%, 10.5%, 14.5%, 13.8%) and report difficulty affording care, including prescription medications (11.5%, 20.9%, 19.0%, 18.9%) and follow-up visits (6.2%, 10.0%, 10.7%, 9.3%) (all P < 0.001). Finally, Black participants, in particular, were more likely to receive nonoperative treatments such as physical therapy (25.7%, 28.2%, 23.1%, 25.9%), steroid injections (14.4%, 16.7%, 12.8%, 12.4%), and opioids (49.1%, 53.4%, 42.5%, 48.3%) compared to White participants (all P < 0.001). Many of these disparities persisted in multivariate models after adjusting for demographic and socioeconomic covariates.ConclusionDisparities in DLDD are multifactorial, reflecting the intersection of age, sex, race/ethnicity, comorbidities, and social determinants of health. Despite most participants being Medicare-eligible, minority groups continued to report access and affordability barriers, suggesting the role of underinsurance and coverage gaps. These findings underscore the need for targeted interventions to improve access, promote education, and ensure equitable treatment of DLDD across minority populations.

Study DesignRandomized controlled trial (RCT).ObjectivesTo compare the clinical performance of anterior cervical X-shape-corpectomy and fusion (ACXF) and anterior cervical corpectomy and fusion (ACCF) in treating cervical spondylotic myelopathy (CSM).MethodsIn this single-center, prospective RCT, patients with CSM were enrolled between January 2023 and June 2024 and randomly assigned to undergo either ACXF or ACCF. Blinded coordinators collected clinical and imaging data at baseline, 3 months, 6 months, and 1 year postoperatively. The primary outcome was the composite success rate at 1 year postoperatively. Secondary outcomes included perioperative outcomes, patient-reported outcome measures (PROMs), and radiological outcomes.ResultsEighty-six patients were randomized equally to the ACXF or ACCF group, among whom 82 (95.3%) were eligible for the primary analysis. At 1 year postoperatively, the composite success rate was significantly higher in the ACXF group than in the ACCF group (57.5% vs 21.4%, P < 0.001), with lower incidences of general medical adverse events (15.0% vs 41.5%, P = 0.008), dysphagia (10.0% vs 27.5%, P = 0.045), and implant subsidence (25.0% vs 75.6%, P < 0.001). ACXF also resulted in lower drainage volume (P < 0.001) and shorter drainage duration (P < 0.001). Both groups showed improvements in PROMs and sagittal alignment, with no between-group differences. Fusion rates remained comparable between the ACXF and ACCF group throughout follow-up, while ΔFSU height and subsidence rate in the ACXF group was significantly lower than that in the ACCF group.ConclusionACXF achieved a higher composite success rate than conventional ACCF. It may represent a valuable surgical alternative for appropriately selected patients with CSM.

Study DesignRetrospective cohort study.ObjectivesThis study aimed to examine national trends in utilization, charges, and patient characteristics associated with endoscopic spine surgery (ESS) in ambulatory surgery centers (ASCs) from 2018 to 2022.MethodsThe Nationwide Ambulatory Surgery Sample (NASS) was queried for adult encounters identified by Current Procedural Terminology code 62380. Cases with valid weights and complete charge, payer, region (defined as HCUP U.S. Census regions), and month data were retained. Facility charges were inflation-adjusted to 2022 USD and winsorized at the 1st and 99th percentiles. Survey-weighted models estimated differences in charges and temporal trends, with pairwise comparisons from estimated marginal means. Significance was set at the P < 0.05 level.ResultsA total of 3097 ESS procedures were analyzed. Most were performed in urban settings (93.5%) and among patients in the highest income quartile (34.6%). Private insurance was the most common payer (47.8%), though self-pay utilization rose from 0.8% in 2018 to 9.7% in 2022 (P < 0.001). Costs varied significantly by payer and region, with self-pay patients incurring the highest charges ($70,000; P < 0.001) and the West recording the highest regional costs ($68,700; P < 0.001). Procedure volume increased in the West - from 4.3% of national volume in 2018 to 31.0% in 2022 (P < 0.001).ConclusionsESS in ASCs exhibited rapid procedural growth, particularly in the Western U.S., alongside substantial payer and region-specific variation in cost. These findings highlight the need for continued evaluation of access and reimbursement equity as ESS expands nationally.

Study DesignA retrospective cohort study.ObjectiveIntraoperative neurophysiological monitoring (IONM) is crucial for detecting impending iatrogenic neurological injury during high-risk scoliosis surgery. However, the implication of significant IONM alarms on long-term neurological function remains unknown for complex deformity correction. This study aims to report the longitudinal neurological outcomes and identify predictors of long-term neurological survivorship for patients with severe spinal deformities.MethodsA total of 115 patients who encountered significant intraoperative neuromonitoring alarms (excluding systematic and non-operative confounders) during high-risk surgical maneuvers were analyzed. A longitudinal clinical dataset containing baseline information, surgical details, multimodal IONM data, and follow-up neurological function was collected. Cox regression analysis was performed to identify prognostic factors that could predict long-term neurological survivorship. Kaplan-Meier curves were plotted for these predictors, and a nomogram facilitated the clinical prediction of 2-year neurological function.ResultsImmediately after surgery, 57 patients (49.6%) showed neurological deficits, which decreased to only 5 cases (4.3%) at the 2-year follow-up. Multivariate Cox regression analysis for long-term neurological survivorship identified decreased hazard ratios (HRs) for grade six osteotomy (HR, 0.311; P = 0.028), a positive wake-up test (HR, 0.216; P < 0.001), and no recovery of descending neurogenic evoked potentials (DNEPs) (HR, 0.162; P < 0.001). A nomogram based on osteotomy grade, wake-up test, and DNEP recovery status was established to predict 2-year neurological function.ConclusionsOverall, patients with severe spinal deformities who experienced significant IONM alarms demonstrated gradual neurological improvement over the 2-year follow-up. Osteotomy grade, wake-up test results, and DNEP recovery status were identified as valuable predictors that could facilitate surgical decision-making, prognostication, and counseling.

ObjectiveThis study aimed to evaluate the clinical applicability of pB-C2 in assessing reduction and ventral decompression, and to examine its association with postoperative neurological outcomes in patients with type A basilar invagination (BI).MethodsA retrospective analysis was conducted on 56 surgically treated patients with type A BI and 43 controls. Neurological recovery was assessed using the Japanese Orthopedic Association (JOA) score and its improvement rate. Radiological parameters were measured, and correlation, linear regression, and receiver operating characteristic (ROC) analyses were performed.ResultsThe preoperative pB-C2 value in the BI group was significantly higher than that in controls (P < 0.001). Following surgery, 44 of 56 patients showed satisfactory improvement in the JOA score, while 12 demonstrated limited recovery. The mean postoperative pB-C2 decreased from 12.5 ± 2.0 mm to 8.1 ± 1.8 mm (P < 0.01). Significant correlations were identified between cosα·pB-C2 and the modified atlantoodontoid interval (mADI), as well as between cosβ·pB-C2 and Chamberlain's line (CL), McRae's line (ML), and Wackenheim's line (WL) (P < 0.05). Moreover, postoperative pB-C2 and its improvement rate were strongly associated with the cervicomedullary angle (CMA) and the JOA improvement rate. ROC analysis revealed that a postoperative pB-C2 of 8.4 mm or an improvement rate of 80.0% yielded the optimal Youden index.ConclusionThe pB-C2 provides a practical metric for assessing surgical reduction and ventral decompression in type A BI. Its correlation with the CMA and neurological recovery supports further exploration of pB-C2 as an intraoperative tool in patients with type A BI.