Spine Surgery and Related Research最新文献

Introduction: This study aims to determine whether Patient-Reported Outcomes Measurement Information System (PROMIS) domain scores can predict elective spine surgery within 1 year of initial clinic evaluation.

Methods: A retrospective query for all new patient spine clinic visits with diagnosis codes related to lower back pain was carried out at a single academic institution. A chart review was conducted to collect sociodemographic variables, clinic visit details, and PROMIS domain scores (PF [Physical Function], PI [Pain Interference], Depression, and Global Health-Physical and Global Health-Mental). Patients were divided into Surgery and No Surgery, and for time to surgery, a subanalysis was also carried out.

Results: Overall, 116 (8.4%) of 1,387 new patients underwent surgery within 1 year. Race, Surgeon vs. Advanced Practice Provider (APP), and whether advanced imaging (MRI or CT myelogram) was available for interpretation were statistically associated with undergoing surgery. Patients in the Surgery group had statistically significant worse PROMIS scores in all domains when compared with the No Surgery group, and PROMIS PI was additionally associated with Time to Surgery. Multivariate analysis identified PROMIS PI, race, presence of advanced imaging interpretation, and Surgeon vs. APP as independent predictors of Surgery vs. No Surgery; however, only race and PROMIS PI were independent predictors of Time to Surgery.

Conclusions: Worse new patient PROMIS PI scores were associated with undergoing surgery within one year of initial evaluation. To determine if PROMIS scores may help in a triage capacity to identify which patients are most appropriate for a surgeon visit versus a nonsurgical provider, further research is needed, thereby improving the efficiency of surgical care delivery.

Introduction: There is ongoing debate over whether to remove or retain posterior spinal implants following the successful union of thoracolumbar fractures. This study aimed to compare clinical and radiographic outcomes following removal versus retention of posterior spinal implants in patients with healed thoracolumbar fractures.

Methods: All patients who underwent posterior short segment fixation for thoracolumbar (T11-L2) fractures and presented to the outpatient clinic of our institution (level I trauma center) from October 2020 to October 2022 were enrolled in the study. The participants were randomly assigned to one of the two groups. The EQ-5D-5L was the primary outcome of the study. The secondary outcomes were the Oswestry Disability Index (ODI), loss of correction, and incidence of complications.

Results: A total of 52 patients were included in the final analysis with 26 patients in each group. During the 6-month and 1-year follow-up visits, the implant removal group had a statistically significant improvement in the EQ-Index, EQ-VAS, and ODI, while there were no significant differences in these parameters in the implant retention group. There was no significant difference between the two groups regarding loss of correction (P=0.109).

Conclusions: In patients who have undergone posterior instrumentation for thoracolumbar fractures, the removal of implants following fracture consolidation demonstrates enhanced clinical outcomes when compared to retaining the implants. Although loss of correction is marginally higher in the implant removal group than in the retention group, this disparity did not attain statistical significance, nor did it correlate with inferior clinical outcomes. Furthermore, the incidence of complications following implant removal remained minimal. These findings emphasize the favorable efficacy and safety profile of implant removal procedures within this patient population.

Introduction: During spinal surgery, management of intraoperative bleeding and effective hemostasis are required to clearly visualize the surgical field and to safely perform procedures and positive postoperative outcomes. However, it is challenging to stop bleeding from the venous plexus around the dural sac due to the potential risk of neural tissue damage. We aimed to develop hemostatic sheets with appropriate characteristics for spinal surgery, such as softness, appropriate thickness, biodegradability, thrombin bioactivity, and minimal water-induced expansion.

Methods: Hemostatic sheets were made by dissolving bovine bone-derived gelatin in water and aerating it to form foam, followed by freeze-drying, crosslinking, and thrombin-soaking. Sheets A to H were produced with different gelatin concentrations, foam densities, and crosslinking times by additional heat treatment. The sheets were then soaked in thrombin solution for enhanced hemostasis. Material properties, such as density, tensile strength, biodegradability, and hemostatic capacity, were evaluated. Sheet efficacy was further assessed with liver bleeding and spinal venous plexus bleeding models in a miniature pig.

Results: High-density gelatin sheets showed stable shape retention in wet conditions and robust tensile strength. Sheets with higher density and more crosslinking had prolonged persistence in the pepsin test and lower biodegradability in vivo. Sheet B, produced from a 4% gelatin solution with heating at 155°C for 4 h, showed the best balance of properties, such as no deformation cracks, rapid water absorption, minimal expansion, and faster degradation within 10 weeks, compared with TachoSil and other sheets. In hemostasis models, Sheet B outperformed Avitene and TachoSil, achieving higher success rates in spinal (four out of six sites) and liver bleeding (five out of five sites) models.

Conclusions: A thrombin-loaded hemostatic sheet produced from 4% gelatin solution with a short heating time for crosslinking demonstrated well-balanced material properties, such as shape retention, biodegradability, and wet expansion rate, which resulted in effective hemostasis in in vivo models. These advances may contribute to surgical hemostatic applications.

Introduction: This study aimed to compare the biomechanical stress at the proximal junctional aspect between the conventional pedicle screw (PS) fixation (PSF) and the low PS density fixation (LPF) method.

Methods: This study involved 10 patients, half of whom have non-osteoporosis and the other half have osteoporosis. We made two types of intact models (one is from the upper thoracic-to-pelvis model, and the other is from the lower thoracic-to-pelvis model). From the intact models, we constructed two kinds of fusion models: (1) PSF and (2) LPF. The LPF method was as follows: The claw hooks (the combination of the down-going transverse process hooks and facet hooks) were set at the upper instrumented vertebra (UIV) and sublaminar wires at the thoracic spine and PSs at the lumbo-pelvis.

Results: Upper thoracic to pelvis fixation model In non-osteoporosis, no significant difference between the PSF and LPF is found. In osteoporosis, the von Mises stresses of the vertebra body at UIV, UIV+1, and disc were significantly lower in LPF than in PSF. Lower thoracic-to-pelvis fixation model In non-osteoporosis, the average von Mises stress of the vertebral body at UIV+1 and the maximum stress at UIV were lower in LPF than in PSF; however, no significant difference was found in the others. In osteoporosis, the von Mises stress was significantly lower in LPF than in PSF.

Conclusions: The claw hooks stabilized the vertebra body at UIV firmly, and sublaminar wires reduced load translation from the fixed spine.

Introduction: Iron deficiency anemia (IDA) is a common hematological disorder and cause of low hemoglobin. Preoperative anemia has been demonstrated to increase the risk of adverse outcomes after posterior cervical fusion and other spinal surgeries. The need for a transfusion during lumbar fusion has been shown to increase length of stay. This study aimed to assess the impact of IDA on outcomes after spinal fusion for adult spinal deformity (ASD).

Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) database was searched from 2009 to 2013 to identify all patients undergoing ≥2-level thoracolumbar spinal fusion (primary and revision) for ASD with a 2-year follow-up. The patients were then stratified by the presence or absence of IDA. Patients with IDA and patients without IDA were subjected to 1:1 propensity score matching based on age, sex, and obesity. Univariate analysis was employed to compare demographics, hospital parameters, and rates of adverse outcomes. Multivariate binary logistic regression with odds ratio (OR) was employed to identify independent risk factors for adverse postoperative outcomes.

Results: A total of 524 patients (262 with IDA and 262 without IDA) were identified. Patients with IDA experienced higher rates of overall surgical complications (50.4% vs 23.7%, P<0.001), wound complications (3.4% vs 0.4%, P=0.011), and blood transfusion (10.3% vs 6.5%, P<0.001). No difference was observed in the rate of overall medical complications. Patients with and without IDA had comparable rates of readmission (8.0% vs 13.0%, P=0.064), although patients with IDA had lower rates of reoperation (7.6% vs 13.0%, P=0.044). There was no mortality in either cohort. IDA was independently associated with wound complications (OR=10.6, P=0.028), blood transfusion (OR=3.9, P<0.001), and surgical complications (OR=3.5, P<0.001).

Conclusions: Baseline IDA was predictive of increased wound complications, postoperative blood transfusion, and overall surgical complications after thoracolumbar fusion surgery for ASD. Our findings could inform potential medical interventions to mitigate the risks of adverse outcomes in patients with IDA. Level of Evidence: III, retrospective cohort.

Introduction: Pre- and postoperative optimization remains a complex process impacted by various demographic factors. Our study aims to identify and describe those demographic factors associated with poor outcomes after spinal fusion with instrumentation in neuromuscular scoliosis to reduce health disparities and improve postoperative outcomes.

Methods: A retrospective analysis was conducted using Healthcare Cost and Utilization Project data from 2016 to 2020, encompassing a random sample of 20% of procedures in the United States. Data included demographic and hospital variables, including days from admission to the procedure, length of stay, recovery time, total charge, discharge disposition, and mortality rates. In addition to ANOVA, Chi-Squares, and t-tests, multiple-linear and multiple-logistic regression models were designed and run to generate adjusted odds ratios.

Results: Compared to non-Hispanic patients (N=1829), Hispanic patients (N=431) had spinal fusion with instrumentation at younger ages (12.9 vs. 14.1 years old, p=0.011) and had significantly different household incomes with less representation in the 75th to 100th percentile (16.8% vs. 26.5%, p<0.001). Additionally, Hispanic patients were more likely to be Medicaid users (67.2% vs. 46.0%, p<0.001). Hispanic patients undergoing spinal fusion with instrumentation had longer lengths of stay (LOS) (10.0 vs. 7.6 days, p<0.001), longer periods from admission to surgery (wait time) (1.6 vs. 1.0 days, p=0.046), and longer recovery times (8.5 vs. 6.7 days, p<0.001).

Conclusions: Hispanic patients with NMS often have longer lengths of stay, longer periods between admission and surgery, and longer recovery times than non-Hispanic patients. This difference in hospital courses and surgical timing could be an effect of disparities in healthcare access and socioeconomic standing. Further efforts are required to both understand and reduce barriers to healthcare access in the Hispanic patient population undergoing spinal fusion with instrumentation.

Lumbar spine microscopic decompression (LSMD) is a common surgical procedure for decompressing neural elements. Although the optimal extent of decompression remains a critical consideration, limited evidence-based guidelines define the threshold for instrumented fusion to maintain biomechanical stability. Existing studies suggest that unilateral LSMD generally does not result in iatrogenic instability. However, the potential instability associated with bilateral segmental decompression (BLSMD) is less well-defined, particularly in patients with pre-existing degenerative lumbar scoliosis (SC) or spondylolisthesis (SL). This retrospective study included patients undergoing BLSMD without instrumented fusion. Pre-existing SC was defined as Cobb's angle ≥10° and SL as any anterior-posterior slip of operated level adjacent vertebral bodies. The primary outcome was new or progressive SC/SL measured on pre and postoperative radiographs. Secondary outcomes were revision rates, changes in Visual Analog Scores (bVAS/lVAS), and Oswestry Disability Index (ODI) scores, collected preoperatively and 1-2 years postoperatively. Baseline characteristics such as age, BMI, sex, and number of levels operated were also collected. A total of 31 patients were reviewed comprising 15 female and 16 male patients with a mean age of 61.4 years (21-78) and BMI of 26.5 (18-41). There were 14 one-level, 12 two-level, and 4 three-level BLSMD performed. Patients with pre-existing SC and SL had a 66% and 23% incidence of radiological progression, respectively, compared to 0% in patients without pre-existing deformity. Progression cases were associated with high reoperation rates (up to 75%) and seemed to have inferior clinical outcomes than those without progression. In patients undergoing BLSMD, pre-existing SC/SL is linked to a higher incidence of radiological progression and higher reoperation rates. For patients with SC/SL, careful consideration should be given to limiting decompression, potentially exploring fusion options, and implementing close postoperative radiographic monitoring.