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Risk Factors of Failed Conservative Treatment for Adjacent Vertebral Fractures Following Percutaneous Vertebroplasty. 经皮椎体成形术后邻近椎体骨折保守治疗失败的风险因素。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-06-28 DOI: 10.1097/BRS.0000000000005085
Po-Hao Huang, Chih-Wei Chen, Ming-Hsiao Hu, Shu-Hua Yang, Chuan-Ching Huang

Study design: A retrospective, single-center, observational study.

Objective: This study investigated the risk factors associated with the failure of conservative treatment for adjacent vertebral fractures (AVFs).

Summary of background data: Adjacent vertebral fractures following vertebroplasty for osteoporotic vertebral compression fractures are not uncommon. Presently, there is a lack of consensus regarding the management of adjacent vertebral fractures.

Methods: We included patients who developed adjacent vertebral fractures within 2 years post single-level vertebroplasty between January 2013 and December 2020. All patients initially underwent 6 weeks of conservative treatment, including pain medications, bracing, and physical therapy. Surgical intervention was offered to those with intractable back pain due to AVFs. Baseline demographics, AVF characteristics, and radiologic measurements were systematically collected, and sequential univariable and multivariable logistic regression analyses were conducted to explore the risk factors.

Results: Of the 114 patients with a mean age of 78.6 years, 2-thirds (76 patients) tolerated conservative treatment well, whereas 38 required surgical interventions for adjacent vertebral fractures. Both groups demonstrated similar baseline demographics and radiologic parameters regarding AVFs ( P >0.05). The multivariable logistic regression analyses revealed that the development of AVFs later than 6 months post-vertebroplasty and their caudal location to the index vertebroplasty were the independent risk factors of unsuccessful conservative treatment, with odds ratios of 3.57 (95% confidence interval [CI]: 1.14-11.1, P =0.029) and 2.50 (95% CI, 1.09-5.88, P =0.032), respectively.

Conclusion: Adjacent vertebral fractures following percutaneous vertebroplasty generally have favorable outcomes under conservative treatment. However, the timing and the relative anatomical location of adjacent vertebral fractures are associated with treatment efficacy. Adjacent vertebral fractures occurring later than 6 months following the initial vertebroplasty or situated in the caudal location to the index vertebroplasty may exhibit reduced responsiveness to conservative treatment. These patients might benefit from a more aggressive therapeutic approach.

Level of evidence: 3.

研究设计回顾性、单中心、观察性研究:本研究调查了与邻近椎体骨折(AVF)保守治疗失败相关的风险因素:椎体成形术治疗骨质疏松性椎体压缩骨折后发生邻近椎体骨折的情况并不少见。目前,对于邻近椎体骨折的处理还缺乏共识:我们纳入了 2013 年 1 月至 2020 年 12 月间单水平椎体成形术后两年内发生邻近椎体骨折的患者。所有患者最初都接受了为期六周的保守治疗,包括止痛药物、支具和理疗。手术治疗适用于因反向房颤导致的顽固性背痛患者。研究人员系统收集了基线人口统计学数据、动静脉畸形特征和放射学测量数据,并进行了连续的单变量和多变量逻辑回归分析,以探究风险因素:在平均年龄为78.6岁的114名患者中,三分之二(76名)的患者能很好地耐受保守治疗,38名患者因邻近椎体骨折而需要手术治疗。两组患者的基线人口统计学和有关 AVF 的放射学参数相似(P>0.05)。多变量逻辑回归分析显示,椎体成形术后6个月后出现AVFs以及AVFs位于椎体成形术的尾部是保守治疗失败的独立风险因素,其几率分别为3.57(95% 置信区间[CI]:1.14-11.1,P=0.029)和2.50(95% CI:1.09-5.88,P=0.032):结论:经皮椎体成形术后的相邻椎体骨折在保守治疗下一般都有良好的预后。结论:经皮椎体成形术后的相邻椎体骨折在保守治疗下一般会有良好的疗效,但相邻椎体骨折发生的时间和相对解剖位置与治疗效果有关。在初次椎体成形术后六个月以后发生的邻近椎体骨折,或位于初次椎体成形术后尾部位置的邻近椎体骨折,可能对保守治疗的反应性降低。这些患者可能会从更积极的治疗方法中获益:3.
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引用次数: 0
Enhancing the Clinical Applicability of the Novel Classification System for Proximal Junctional Degeneration. 提高近端交界变性新分类系统的临床适用性[字母]。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-15 DOI: 10.1097/BRS.0000000000005197
Hao Rao
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引用次数: 0
The Impact of the Preoperative Mental Health Component Summary (MCS) Score on Short-Term Outcomes After Lumbar Fusion. 腰椎融合术后术前心理健康成分总结 (MCS) 评分对短期疗效的影响。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-06-07 DOI: 10.1097/BRS.0000000000005064
Teeto Ezeonu, Rajkishen Narayanan, Jeremy C Heard, Yunsoo A Lee, Aditya Mazmudar, Jeffrey Zucker, Alexander Shaer, Yoni Dulitzki, Dylan Resnick, Jose A Canseco, Mark F Kurd, Ian D Kaye, Alan S Hilibrand, Alexander R Vaccaro, Christopher Kepler, Gregory D Schroeder

Study design: Retrospective cohort study.

Objective: The purpose of this study is to characterize the relationship between preoperative MCS and surgical outcomes after lumbar spine surgery including inpatient complications, length of stay, readmissions, and reoperations.

Summary of background data: As the prevalence of mental health disorders in the United States increases, it is important to identify risks associated with poor mental health status in the surgical spine patient. The mental health component summary (MCS) of the Short Form-12 has been used extensively as an indication of a patient's mental health status and psychological well-being.

Patients and methods: Adult patients older than or equal to 18 years who underwent primary one to three level lumbar fusion surgery at our academic medical institution from 2017 to 2021 were retrospectively identified. Preoperative MCS score was used to analyze outcomes in patients based on a cutoff (<45.6). A score >45.6 indicated better preoperative mental health and a score ≤45.6 indicated worse preoperative mental health.

Results: Patients with lower preoperative MCS scores had longer hospital stays (3.86±2.16 vs. 3.55±1.42 d, P =0.010) and were more likely to have inpatient renal complications (3.09% vs. 7.19%, P =0.006). Patients with lower preoperative MCS scores also had lower activity measure for post-acute care (AM-PAC) scores (17.1±2.85 vs. 17.6±2.49, P =0.030). Ninety-day surgical readmissions, medical readmissions, and reoperations were not significantly different between groups ( P >0.05).

Conclusion: Our study suggests that patients with lower preoperative mental health scores (MCS ≤45.6) were independently more likely to experience more renal complications and longer length of stay after primary lumbar fusion. In addition, higher MCS scores may correlate with better postoperative mobility and daily activity scores. Nevertheless, long-term outcomes are not significantly different between patients of better or worse preoperative mental health.

Level of evidence: Level IV.

研究设计回顾性队列研究:本研究的目的是描述腰椎手术后术前 MCS 与手术结果之间的关系,包括住院并发症、住院时间、再入院和再手术:随着美国精神疾病患病率的增加,确定脊柱手术患者精神健康状况不良的相关风险非常重要。短表-12的精神健康部分摘要(MCS)已被广泛用于显示患者的精神健康状况和心理健康状况:回顾性地确定了 2017 年至 2021 年期间在本学术医疗机构接受一级至三级腰椎融合术的年龄大于或等于 18 岁的成人患者。根据分界线(45.6 表示术前心理健康较好,得分结果为 45.6),使用术前 MCS 评分分析患者的预后:术前 MCS 评分较低的患者住院时间较长(3.86 + 2.16 天 vs. 3.55 + 1.42 天,P=0.010),更有可能出现住院肾脏并发症(3.09% vs. 7.19%,P=0.006)。术前MCS评分较低的患者,其术后护理活动量(AM-PAC)评分也较低(17.1 + 2.85 vs. 17.6 + 2.49,P=0.030)。90天手术再入院率、内科再入院率和再次手术率在组间无明显差异(P>0.05):我们的研究表明,术前心理健康评分较低(MCS < 45.6)的患者在初次腰椎融合术后更有可能出现更多肾脏并发症,住院时间也更长。此外,较高的心理健康评分可能与较好的术后活动能力和日常活动评分相关。尽管如此,术前心理健康状况较好或较差的患者的长期预后并无明显差异。
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引用次数: 0
L5-S1 Transforaminal Lumbar Interbody Fusion is Associated With Increased Revisions Compared With L4-L5 Transforaminal Lumbar Interbody Fusion at Two Years. 与 L4-L5 TLIF 相比,L5-S1 经椎间孔腰椎椎体融合术 (L5-S1 Transforaminal Lumbar Interbody Fusion, TLIF) 两年后的复查次数增加。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-09-04 DOI: 10.1097/BRS.0000000000005149
Manjot Singh, Jack Casey, Jacob Glueck, Mariah Balmaceno-Criss, Alejandro Perez-Albela, John Hanna, Bassel G Diebo, Alan H Daniels, Bryce A Basques

Study design: Retrospective cohort study.

Objective: The aim of this study was to compare outcomes in patients undergoing 1-level transforaminal lumbar interbody fusion (TLIF) at L4-S1.

Background: TLIF is frequently performed at L4-S1 to treat degenerative lumbar pathologies. However, the native alignment and biomechanics differ across L4-L5 and L5-S1, and there is limited data regarding comparative radiographic outcomes.

Patients and methods: Patients who underwent 1-level TLIF at L4-L5 or L5-S1 at a single academic institution were identified. Baseline demographics, procedural characteristics, change in postoperative spinopelvic alignment patient-reported outcome measures, and 2-year postoperative surgical complications were compared. Multivariate regression analyses, accounting for age, sex, Charlson Comorbidity Index, and body mass index, were also performed.

Results: Across the 175 included patients, 125 had L4-L5 TLIF and 50 had L5-S1 TLIF. The mean age was 57.8 years, 56.6% were females, the mean Charlson Comorbidity Index was 0.9, and the mean follow-up was 26.7 months. In the hospital, the 2 cohorts were not statistically different with regard to estimated blood loss and length of stay. Two years postoperatively, multivariate linear regression analyses revealed that L5-S1 TLIF achieved 6.0° higher correction in L4-S1 lordosis ( P = 0.012) than L4-L5 TLIF. At the same time, however, L5-S1 patients undergoing TLIF experienced significantly higher rates of pseudoarthrosis (8.0% vs. 1.6%, P = 0.036) and subsequent spine surgery (18.0% vs. 7.2%, P = 0.034), specifically for pseudoarthrosis (6.0% vs. 0.0%, P = 0.006), with this cohort having 8.7 times higher odds of subsequent spine surgery for pseudoarthrosis ( P = 0.015) than L4-L5 patients undergoing TLIF on multivariate logistic analyses. Patient-reported outcome measures, in contrast, were not different across the 2 cohorts.

Conclusions: Although L5-S1 TLIF yielded good radiographic correction, it was associated with higher rates of subsequent spine surgery for pseudoarthrosis compared with L4-L5 TLIF. These findings may be related to differences in native segmental alignment and biomechanics across the L4-L5 and L5-S1 motion segments and are important to consider during surgical planning.

Level of evidence: Level IV.

研究设计回顾性队列研究:比较在L4-S1接受一水平经椎间孔腰椎椎体间融合术(TLIF)患者的预后:背景:TLIF 经常在 L4-S1 处进行,以治疗腰椎退行性病变。背景:TLIF 常被用于治疗腰椎退行性病变。然而,L4-L5 和 L5-S1 的原生对位和生物力学存在差异,有关放射学结果比较的数据也很有限:方法:确定了在一家学术机构接受 L4-L5 或 L5-S1 单水平 TLIF 的患者。比较了基线人口统计学、手术特征、术后脊柱对位的变化、患者报告的结果测量(PROMs)以及术后两年的手术并发症。此外,还对年龄、性别、查尔森综合症指数(CCI)和体重指数(BMI)进行了多变量回归分析:在纳入的 175 名患者中,125 人接受了 L4-L5 TLIF,50 人接受了 L5-S1 TLIF。平均年龄为 57.8 岁,56.6% 为女性,平均 CCI 为 0.9,平均随访时间为 26.7 个月。在医院中,两组患者的 EBL 和 LOS 没有统计学差异。术后两年的多变量线性回归分析显示,L5-S1 TLIF 比 L4-L5 TLIF 的 L4-S1 前凸矫正率高 6.0°(P =0.012)。但与此同时,L5-S1 TLIF 患者的假关节发生率(8.0% vs. 1.6%,P =0.036)和后续脊柱手术发生率(18.0% vs. 7.2%,P =0.034)明显更高,尤其是假关节发生率(6.0% vs. 0.0%,P =0.006),在多变量逻辑分析中,该队列患者因假性关节炎(P =0.015)接受后续脊柱手术的几率是 L4-L5 TLIF 患者的 8.7 倍。另一方面,两组患者的PROM并无差异:结论:虽然L5-S1 TLIF能产生良好的放射学矫正效果,但与L4-L5 TLIF相比,它与更高的假关节后续脊柱手术率相关。这些发现可能与L4-L5和L5-S1运动节段的原生节段对位和生物力学差异有关,在手术计划中必须予以考虑:证据级别:IV。
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引用次数: 0
Immediate Postoperative Change in the Upper Instrumented Screw-Vertebra Angle is a Predictor for Proximal Junctional Kyphosis and Failure. 术后上部器械螺钉与椎体夹角的即时变化是近端交界性脊柱后凸和失败的预测因素。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-05-23 DOI: 10.1097/BRS.0000000000005048
Riza M Cetik, Steven D Glassman, John R Dimar, Charles H Crawford, Jeffrey L Gum, Jensen Smith, Nicole McGrath, Leah Y Carreon

Study design: Retrospective review.

Objectives: To determine if change in position of upper instrumented vertebral (UIV) screw between intraoperative prone and immediate postoperative standing radiographs is a predictor for proximal junctional kyphosis or failure (PJK/PJF).

Summary of background data: Cranially directed UIV screws on postoperative radiographs have been found to be associated with PJK. Change in the screw position between intraoperative and immediate postoperative radiographs has not been studied.

Materials and methods: Patients with posterior fusion greater than or equal to three levels and UIV at or distal to T8, and minimum two-year follow-up were identified from a single-center database. Primary outcomes were radiographic PJK/PJF or revision for PJK/PJF. Demographic, surgical, and radiographic variables, including intraoperative screw-vertebra (S-V) angle, change in S-V angle, direction of UIV screw (cranial-neutral-caudal), and rod-vertebra (R-V) angle were collected.

Results: Totally, 143 cases from 110 patients were included with a mean age of 62.9 years and a follow-up of 3.5 years. Fifty-four (38%) cases developed PJK/PJF, of whom 30 required a revision. Mean S-V angle was -0.9°±5.5° intraoperative and -2.8°±5.5° postoperative. The group with PJK/PJF had a mean S-V angle change of -2.5°±2.4 while the rest had a change of -1.0°±1.6 ( P =0.010). When the change in S-V angle was <5°, 33% developed PJK, this increased to 80% when it was ≥5° ( P =0.001). Revision for PJK/PJF increased from 16% to 60% when S-V angle changed ≥5° ( P =0.001). Regression analysis showed S-V angle change as a significant risk factor for PJK/PJF ( P =0.047, OR=1.58) and for revision due to PJK/PJF ( P =0.009, OR=2.21).

Conclusions: Change in the S-V angle from intraoperative prone to immediate postoperative standing radiograph is a strong predictor for PJK/PJF and for revision. For each degree of S-V angle change, odds of revision for PJK/PJF increases by x2.2. A change of 5° should alert the surgeon to the likely development of PJK/PJF requiring revision.

Level of evidence: Level II.

研究设计回顾性分析:目的:确定术中俯卧位和术后立即站立位X光片之间上部器械椎体(UIV)螺钉位置的变化是否是近端交界性后凸或失败(PJK/PJF)的预测因素:背景数据摘要:在术后X光片上发现颅向UIV螺钉与PJK有关。尚未对术中和术后即刻X光片上螺钉位置的变化进行研究:从一个中心的数据库中找出后路融合≥3级、UIV位于T8或其远端、随访至少2年的患者。主要结果为放射学上的PJK/PJF或因PJK/PJF而进行的翻修。收集了人口统计学、手术和放射学变量,包括术中螺钉-椎体(S-V)角度、S-V角度变化、UIV螺钉方向(头颅-中轴-尾椎)和杆-椎体(R-V)角度:结果:110 名患者的 143 个病例被纳入研究,平均年龄为 62.9 岁,随访时间为 3.5 年。54例(38%)出现了PJK/PJF,其中30例需要进行翻修。术中平均S-V角为-0.9°±5.5°,术后为-2.8°±5.5°。PJK/PJF组的平均S-V角变化为-2.5°±2.4,而其他组的变化为-1.0°±1.6(P=0.010)。当 S-V 角的变化为结论时:从术中俯卧位到术后立即站立位X光片上的S-V角变化是预测PJK/PJF和翻修的有力指标。S-V 角每变化一度,PJK/PJF 的翻修几率就会增加 2.2 倍。每变化 5°,外科医生就应警惕可能发展为需要翻修的 PJK/PJF。
{"title":"Immediate Postoperative Change in the Upper Instrumented Screw-Vertebra Angle is a Predictor for Proximal Junctional Kyphosis and Failure.","authors":"Riza M Cetik, Steven D Glassman, John R Dimar, Charles H Crawford, Jeffrey L Gum, Jensen Smith, Nicole McGrath, Leah Y Carreon","doi":"10.1097/BRS.0000000000005048","DOIUrl":"10.1097/BRS.0000000000005048","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objectives: </strong>To determine if change in position of upper instrumented vertebral (UIV) screw between intraoperative prone and immediate postoperative standing radiographs is a predictor for proximal junctional kyphosis or failure (PJK/PJF).</p><p><strong>Summary of background data: </strong>Cranially directed UIV screws on postoperative radiographs have been found to be associated with PJK. Change in the screw position between intraoperative and immediate postoperative radiographs has not been studied.</p><p><strong>Materials and methods: </strong>Patients with posterior fusion greater than or equal to three levels and UIV at or distal to T8, and minimum two-year follow-up were identified from a single-center database. Primary outcomes were radiographic PJK/PJF or revision for PJK/PJF. Demographic, surgical, and radiographic variables, including intraoperative screw-vertebra (S-V) angle, change in S-V angle, direction of UIV screw (cranial-neutral-caudal), and rod-vertebra (R-V) angle were collected.</p><p><strong>Results: </strong>Totally, 143 cases from 110 patients were included with a mean age of 62.9 years and a follow-up of 3.5 years. Fifty-four (38%) cases developed PJK/PJF, of whom 30 required a revision. Mean S-V angle was -0.9°±5.5° intraoperative and -2.8°±5.5° postoperative. The group with PJK/PJF had a mean S-V angle change of -2.5°±2.4 while the rest had a change of -1.0°±1.6 ( P =0.010). When the change in S-V angle was <5°, 33% developed PJK, this increased to 80% when it was ≥5° ( P =0.001). Revision for PJK/PJF increased from 16% to 60% when S-V angle changed ≥5° ( P =0.001). Regression analysis showed S-V angle change as a significant risk factor for PJK/PJF ( P =0.047, OR=1.58) and for revision due to PJK/PJF ( P =0.009, OR=2.21).</p><p><strong>Conclusions: </strong>Change in the S-V angle from intraoperative prone to immediate postoperative standing radiograph is a strong predictor for PJK/PJF and for revision. For each degree of S-V angle change, odds of revision for PJK/PJF increases by x2.2. A change of 5° should alert the surgeon to the likely development of PJK/PJF requiring revision.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"304-310"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Predictive Hemodynamic Monitoring on Intraoperative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery.
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-13 DOI: 10.1097/BRS.0000000000005121
Leah Y Carreon, Steven D Glassman, Desiree Chappell, Steven Garvin, Anna M Lavelle, Jeffrey L Gum, Mladen Djurasovic, Wael Saasouh

Study design: Prospective longitudinal comparative cohort.

Objectives: To determine if the use of predictive hemodynamic monitoring (PHM) during elective multi-level posterior instrumented spine fusions decreases episodes of intraoperative hypotension (IOH) and complications.

Background: A recent study showed an association between complications and duration of IOH in patients undergoing multi-level spine fusions. Whether the use of PHM to maintain hemodynamic stability intraoperatively decreases postoperative complications has not been evaluated.

Methods: Adults undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring were identified and stratified into those in which predictive hemodynamic monitoring (PHM) was used and those in which it was not. Number of minutes of hypotension (MAP <65 mm Hg) and hypertension (MAP ≥100 mm Hg), volume of fluids, blood products and vasopressors administered intraoperatively and within the first 4 hours postoperatively as well as the number and type of postoperative complications were collected.

Results: The 47 cases in the PHM group and 70 in the non-PHM group had similar demographic and operative characteristics. A shorter duration of IOH was seen in the PHM group (8.13 min) compared with the non-PHM group (13.28 min, P=0.029); and a shorter duration of intraoperative hypertension seen in the PHM group (0.46 min) compared with the non-PHM group (1.38 min, P=0.032). There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs. 13%, P=0.027), postoperative nausea and vomiting (0 vs. 14%, P=0.004) and postoperative cognitive dysfunction (6% vs. 19%, P=0.049) compared with the non-PHM group. There was also a statistically significant shorter length of hospitalization in the PHM (4.62 d) compared with the non-PHM group (5.99 d, P=0.017).

Conclusion: Predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intraoperative hypotension, a lower prevalence of complications, and a decreased hospital stay in multi-level spinal fusion surgery.

{"title":"Impact of Predictive Hemodynamic Monitoring on Intraoperative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery.","authors":"Leah Y Carreon, Steven D Glassman, Desiree Chappell, Steven Garvin, Anna M Lavelle, Jeffrey L Gum, Mladen Djurasovic, Wael Saasouh","doi":"10.1097/BRS.0000000000005121","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005121","url":null,"abstract":"<p><strong>Study design: </strong>Prospective longitudinal comparative cohort.</p><p><strong>Objectives: </strong>To determine if the use of predictive hemodynamic monitoring (PHM) during elective multi-level posterior instrumented spine fusions decreases episodes of intraoperative hypotension (IOH) and complications.</p><p><strong>Background: </strong>A recent study showed an association between complications and duration of IOH in patients undergoing multi-level spine fusions. Whether the use of PHM to maintain hemodynamic stability intraoperatively decreases postoperative complications has not been evaluated.</p><p><strong>Methods: </strong>Adults undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring were identified and stratified into those in which predictive hemodynamic monitoring (PHM) was used and those in which it was not. Number of minutes of hypotension (MAP <65 mm Hg) and hypertension (MAP ≥100 mm Hg), volume of fluids, blood products and vasopressors administered intraoperatively and within the first 4 hours postoperatively as well as the number and type of postoperative complications were collected.</p><p><strong>Results: </strong>The 47 cases in the PHM group and 70 in the non-PHM group had similar demographic and operative characteristics. A shorter duration of IOH was seen in the PHM group (8.13 min) compared with the non-PHM group (13.28 min, P=0.029); and a shorter duration of intraoperative hypertension seen in the PHM group (0.46 min) compared with the non-PHM group (1.38 min, P=0.032). There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs. 13%, P=0.027), postoperative nausea and vomiting (0 vs. 14%, P=0.004) and postoperative cognitive dysfunction (6% vs. 19%, P=0.049) compared with the non-PHM group. There was also a statistically significant shorter length of hospitalization in the PHM (4.62 d) compared with the non-PHM group (5.99 d, P=0.017).</p><p><strong>Conclusion: </strong>Predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intraoperative hypotension, a lower prevalence of complications, and a decreased hospital stay in multi-level spinal fusion surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 5","pages":"333-338"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Disc Height on Outcomes Following Cervical Disc Replacement: A Systematic Review. 椎间盘高度对颈椎椎间盘置换术后疗效的影响:系统回顾
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-08 DOI: 10.1097/BRS.0000000000005211
Gregory S Kazarian, Robert Cecere, Michelle A Zabat, Mihir S Dekhne, Even Sheha, James Dowdell, Sravisht Iyer, Sheeraz Qureshi

Study design: Systematic review.

Objective: To describe the impact of disc height (DH) on outcomes after cervical disc replacement (CDR).

Background: Implant sizing and positioning may impact outcomes after CDR.

Materials and methods: A systematic review was performed in accordance with the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative "DH" on clinical and radiologic outcomes after CDR.

Results: A total of 12 studies were included in the systematic review. In the literature, "DH" was assessed using multiple different measures: postoperative DH (n = 4), DH change (DHC; n = 4), degree of disc distraction (n = 2), prosthesis height (n = 2), functional spinal unit height (n = 2), and facet distraction (n = 1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2 mm as an important cutoff to optimize outcomes.

Conclusions: "DH," especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2 mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.

研究设计目的:描述椎间盘高度对颈椎间盘置换术(CDR)后疗效的影响:描述椎间盘高度对颈椎间盘置换术(CDR)后疗效的影响:植入物的大小和位置可能会影响颈椎间盘置换术后的疗效:根据《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,使用 EMBASE 和 PubMed 数据库进行了系统综述。综述的目的是评估术后 "椎间盘高度 "对 CDR 后临床和放射学结果的影响:结果:共有 12 项研究被纳入系统性综述。在文献中。"椎间盘高度 "采用多种不同的方法进行评估:术后椎间盘高度(DH;n=4)、椎间盘高度变化(DHC;n=4)、椎间盘牵张程度(DDD;n=2)、假体高度(PH;n=2)、功能性脊柱单位高度(FSUH;n=2)和面牵张(FD;n=1)。DH和DHC是最常见的研究指标。DHC 与几项患者报告结果指标 (PROM) 在统计学和临床上的显著差异有关。然而,DH 在 PROMs 方面没有任何统计学或临床显著差异。在颈椎活动范围(ROM)方面,DHC似乎在本综述所包含的一些研究中显示出统计学和临床相关性差异,而DH则与统计学差异相关,但无临床显著性差异。大多数研究确定了 DHC 结论:"椎间盘高度",尤其是通过 DHC 测量的高度,可能是 CDR 术中选择植入物大小的一个重要考虑因素。保持 DHC
{"title":"The Impact of Disc Height on Outcomes Following Cervical Disc Replacement: A Systematic Review.","authors":"Gregory S Kazarian, Robert Cecere, Michelle A Zabat, Mihir S Dekhne, Even Sheha, James Dowdell, Sravisht Iyer, Sheeraz Qureshi","doi":"10.1097/BRS.0000000000005211","DOIUrl":"10.1097/BRS.0000000000005211","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To describe the impact of disc height (DH) on outcomes after cervical disc replacement (CDR).</p><p><strong>Background: </strong>Implant sizing and positioning may impact outcomes after CDR.</p><p><strong>Materials and methods: </strong>A systematic review was performed in accordance with the \"Preferred Reporting Items for Systematic Reviews and Meta-Analyses\" guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative \"DH\" on clinical and radiologic outcomes after CDR.</p><p><strong>Results: </strong>A total of 12 studies were included in the systematic review. In the literature, \"DH\" was assessed using multiple different measures: postoperative DH (n = 4), DH change (DHC; n = 4), degree of disc distraction (n = 2), prosthesis height (n = 2), functional spinal unit height (n = 2), and facet distraction (n = 1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2 mm as an important cutoff to optimize outcomes.</p><p><strong>Conclusions: </strong>\"DH,\" especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2 mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"347-356"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morbidly Obese Patients Have Similar Clinical Outcomes and Recovery Kinetics After Minimally Invasive Decompression. 微创减压术后,病态肥胖患者的临床疗效和恢复动力学相似。
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-05-17 DOI: 10.1097/BRS.0000000000005045
Pratyush Shahi, Tejas Subramanian, Sumedha Singh, Kasra Araghi, Tomoyuki Asada, Maximilian Korsun, Nishtha Singh, Olivia Tuma, Chad Simon, Avani Vaishnav, Eric Mai, Joshua Zhang, Cole Kwas, Myles Allen, Eric Kim, Annika Heuer, Evan Sheha, James Dowdell, Sheeraz Qureshi, Sravisht Iyer

Study design: Retrospective cohort.

Objective: To study the impact of class 2/3 obesity (body mass index, BMI ≥35) on outcomes following minimally invasive decompression.

Summary of background data: No previous study has analyzed the impact of class 2/3 obesity on outcomes following minimally invasive decompression.

Materials and methods: Patients who underwent primary minimally invasive decompression were divided into four cohorts based on their BMI: normal (BMI: 18.5-<25), overweight (25-<30), class 1 obesity (30-<35), and class 2/3 obesity (BMI ≥35). Outcome measures were: 1) intraoperative variables: operative time, estimated blood loss (EBL); 2) patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; 4) return to activities; and 5) complication and reoperation rates.

Results: Totally, 838 patients were included (226 normal, 357 overweight, 179 class 1 obesity, and 76 class 2/3 obesity). Class 1 and 2/3 obesity groups had significantly greater operative times compared with the other groups. Class 2/3 obesity group had worse ODI, VAS back and SF-12 PCS preoperatively, worse ODI, VAS back, VAS leg and SF-12 PCS at below six months, and worse ODI and SF-12 PCS at above six months. However, they had significant improvement in all PROMs at both postoperative timepoints and the magnitude of improvement was similar to other groups. No significant differences were found in MCID and PASS achievement rates, likelihood of betterment on the GRC scale, return to activities, and complication/reoperation rates.

Conclusions: Class 2/3 obese patients have worse PROMs preoperatively and postoperatively. However, they show similar improvement in PROMs, MCID and PASS achievement rates, likelihood of betterment, recovery kinetics, and complication/reoperation rates as other BMI groups following minimally invasive decompression.

研究设计目的:研究2/3级肥胖(体重指数大于35)对微创减压术后疗效的影响:研究2/3级肥胖(体重指数大于35)对微创减压术后效果的影响:之前没有研究分析过2/3级肥胖对微创减压术后效果的影响:根据体重指数将接受初级微创减压术的患者分为 4 组:正常(体重指数 18.5 至 35)。结果测量包括1)术中变量:手术时间、估计失血量(EBL);2)患者报告结果测量指标(PROMs)(Oswestry残疾指数,ODI;视觉模拟量表,VAS背部和腿部;12项简表调查身体成分得分,SF-12 PCS);3)总体评分变化(GRC)、最小临床重要差异(MCID)和患者可接受症状状态(PASS)达标率;4)恢复活动;5)并发症和再手术率:共纳入 838 名患者(226 名正常、357 名超重、179 名 1 级肥胖、76 名 2/3 级肥胖)。与其他组别相比,1 级和 2/3 级肥胖组的手术时间明显更长。2/3 级肥胖组术前的 ODI、背部 VAS 和 SF-12 PCS 均较差,6 个月后的 ODI、背部 VAS、腿部 VAS 和 SF-12 PCS 均较差。不过,他们在术后两个时间点的所有 PROMs 均有明显改善,改善程度与其他组相似。在MCID和PASS达标率、GRC量表的改善可能性、恢复活动以及并发症/手术率方面,没有发现明显差异:结论:2/3 级肥胖患者术前和术后的 PROM 均较差。结论:2/3 级肥胖患者术前和术后的 PROM 较差,但在 PROM、MCID 和 PASS 达标率、好转可能性、恢复动力和并发症/手术率方面的改善情况与其他 BMI 组别患者在微创减压术后的情况相似。
{"title":"Morbidly Obese Patients Have Similar Clinical Outcomes and Recovery Kinetics After Minimally Invasive Decompression.","authors":"Pratyush Shahi, Tejas Subramanian, Sumedha Singh, Kasra Araghi, Tomoyuki Asada, Maximilian Korsun, Nishtha Singh, Olivia Tuma, Chad Simon, Avani Vaishnav, Eric Mai, Joshua Zhang, Cole Kwas, Myles Allen, Eric Kim, Annika Heuer, Evan Sheha, James Dowdell, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005045","DOIUrl":"10.1097/BRS.0000000000005045","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To study the impact of class 2/3 obesity (body mass index, BMI ≥35) on outcomes following minimally invasive decompression.</p><p><strong>Summary of background data: </strong>No previous study has analyzed the impact of class 2/3 obesity on outcomes following minimally invasive decompression.</p><p><strong>Materials and methods: </strong>Patients who underwent primary minimally invasive decompression were divided into four cohorts based on their BMI: normal (BMI: 18.5-<25), overweight (25-<30), class 1 obesity (30-<35), and class 2/3 obesity (BMI ≥35). Outcome measures were: 1) intraoperative variables: operative time, estimated blood loss (EBL); 2) patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; 4) return to activities; and 5) complication and reoperation rates.</p><p><strong>Results: </strong>Totally, 838 patients were included (226 normal, 357 overweight, 179 class 1 obesity, and 76 class 2/3 obesity). Class 1 and 2/3 obesity groups had significantly greater operative times compared with the other groups. Class 2/3 obesity group had worse ODI, VAS back and SF-12 PCS preoperatively, worse ODI, VAS back, VAS leg and SF-12 PCS at below six months, and worse ODI and SF-12 PCS at above six months. However, they had significant improvement in all PROMs at both postoperative timepoints and the magnitude of improvement was similar to other groups. No significant differences were found in MCID and PASS achievement rates, likelihood of betterment on the GRC scale, return to activities, and complication/reoperation rates.</p><p><strong>Conclusions: </strong>Class 2/3 obese patients have worse PROMs preoperatively and postoperatively. However, they show similar improvement in PROMs, MCID and PASS achievement rates, likelihood of betterment, recovery kinetics, and complication/reoperation rates as other BMI groups following minimally invasive decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"318-325"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of Thrombin-gelatin Matrix Compared With Absorbable Gelatin Sponge on Intraoperative Hemostasis in Unilateral Open-door Laminoplasty: A Randomized Controlled Trial. 凝血酶-明胶基质与可吸收明胶海绵相比对单侧开门板层成形术术中止血的影响:随机对照试验
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-07-29 DOI: 10.1097/BRS.0000000000005107
Chengyi Huang, Zhu Chen, Hao Liu, Junbo He, Yiwei Shen, Tingkui Wu, Beiyu Wang

Study design: Prospective, randomized, parallel-controlled trial.

Objective: The primary aim of this study was to determine whether thrombin-gelatin matrix (TGM) combined with an absorbable gelatin sponge (AGS) could more greatly reduce intraoperative blood loss (IBL) in unilateral open-door laminoplasty than the sole use of an AGS could. The secondary aims were to evaluate the hemostatic efficiency, amount of postoperative bleeding, and safety of the application of TGM combined with an AGS.

Summary of background data: IBL during cervical laminoplasty is substantial and is a proper indication for the application of hemostatic agents. However, we are unaware of any clinical trials on the application of TGM and an AGS in posterior cervical spine surgery.

Methods: A total of 80 consecutive patients who underwent unilateral open-door laminoplasty were enrolled from September 2020 to March 2022. Patients were randomized into 2 groups, the TGM-AGS group and the AGS group, with 40 patients in each group. The primary outcome was IBL. Other outcomes included the duration of operation, duration of hemostasis, duration of drainage, maximum decrease in hemoglobin (Hb), length of hospital stay, volume of drainage, number of drainage days, occurrence of adverse events, coagulation indicators, and patient-reported outcome measures (PROMs).

Results: The mean IBL for patients in the TGM-AGS group (75.22 ± 21.83 mL) was significantly lower than that in the AGS group (252.43 ± 57.39 mL) (mean difference = 177.21 mL, 95% confidence interval [CI], 157.88-196.53 mL, t=18.25, P <0.001); the duration of hemostasis, volume of drainage, days of drainage in the TGM group, and maximum decrease in Hb were also significantly less than those in the AGS group ( P <0.01).

Conclusion: The hemostatic efficacy of TGM-AGS is better than that of an AGS alone in IBL. TGM-AGS is also superior to an AGS alone in the evaluation of hemostatic efficiency and postoperative bleeding.

研究设计前瞻性、随机、平行对照试验:本研究的主要目的是确定与单纯使用可吸收明胶海绵(AGS)相比,凝血酶原明胶基质(TGM)结合可吸收明胶海绵(AGS)是否能更大程度地减少单侧开门板层成形术的术中失血量(IBL)。次要目的是评估 TGM 与 AGS 结合使用的止血效率、术后出血量和安全性:颈椎板成形术中的 IBL 量很大,是应用止血剂的适当适应症。然而,我们还没有听说过在颈椎后路手术中应用 TGM 和 AGS 的临床试验:方法:2020 年 9 月至 2022 年 3 月期间,共招募了 80 名连续接受单侧开门椎板成形术的患者。患者被随机分为两组,即 TGM-AGS 组和 AGS 组,每组 40 人。主要结果为 IBL。其他结果包括手术时间、止血时间、引流时间、血红蛋白(Hb)最大降幅、住院时间、引流量、引流天数、不良事件发生率、凝血指标和患者报告结果指标(PROMs):结果:TGM-AGS 组患者的平均 IBL(75.22 mL ±21.83 mL)显著低于 AGS 组(252.43 mL ±57.39 mL)(平均差异=177.21 mL,95% 置信区间[CI],157.88 mL -196.53 mL,t=18.25,PConclusion):在 IBL 中,TGM-AGS 的止血效果优于单用 AGS。在止血效率和术后出血评估方面,TGM-AGS 也优于单独使用 AGS。
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引用次数: 0
Impact of Low-density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion.
IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-18 DOI: 10.1097/BRS.0000000000005217
Ankit Hirpara, Cheryl L Ackert-Bicknell, Vikas V Patel

Study design: Retrospective cohort study.

Objective: To understand how preoperative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multilevel ACDF.

Summary of background data: Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF.

Materials and methods: Patients undergoing ACDF were identified using TriNetX, a health care database with over 100 million patients. Pseudarthrosis rates following single-level and multilevel ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and comorbidities.

Results: Patients with an LDL above 142 mg/dL, compared with below 66 mg/dL, had significantly higher rates of pseudarthrosis at six months, one year, and two years after single-level and multilevel ACDF. Patients not taking a statin or fish oil, compared with those taking a statin or fish oil, respectively, also had significantly higher rates of pseudarthrosis at all time points after multilevel ACDF, but not single-level ACDF.

Conclusion: Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multilevel ACDF. Statin and fish oil intake before surgery are also associated with reduced rates of pseudarthrosis after multilevel, but not single-level ACDF. These associations may be used for preoperative planning, patient optimization, and risk stratification.

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