Pub Date : 2025-01-20DOI: 10.1016/j.xnsj.2025.100587
Julius Gerstmeyer MD , Anna Gorbacheva , August Avantaggio , Clifford Pierre MD , Emre Yilmaz MD , Thomas A. Schildhauer MD , Amir Abdul-Jabbar MD , Rod J Oskouian MD , Jens R Chapman MD
Background
A corpectomy of the lumbar spine is a widely performed surgical procedure with numerous indications. Previous research predominantly focused on various surgical techniques and their outcomes, lacking a general and comprehensive analysis of factors affecting this procedure. With this study, we aimed to assess the all-cause 90-day readmission rate and identify risk factors for adverse events following a lumbar corpectomy.
Methods
Utilizing the 2020 Nationwide Readmissions Database adults (>18 years) were selected by ICD-10 procedure category codes for lumbar corpectomy. Patients with adult deformity or degenerative conditions were excluded due to coding inconsistencies. Demographic information and clinical data, including comorbidities, was extracted. Patients were categorized by their readmission status. The primary outcome was readmission, with multivariable logistic regression analysis used to identify independent risk factors.
Results
A total of 3,238 patients were included, with 20.8% readmitted. The readmission group was significantly older and had higher comorbidity burdens. Malignancy had the greatest odds of readmission (OR 3.172, p=.002), with spondylodiscitis also showing significant association (OR 2.177, p=.030). Fractures were significantly more frequent in the single admission group and not associated with readmission (OR 1.235, p=.551). Medical comorbidities differed significantly between the groups with a variety of them being identified as risk factors.
Conclusions
We established an all-cause 90-day readmission rate of 20.8%, which is in range of other procedures in spine surgery but underscores the severity of lumbar corpectomy. Underlying pathologies have a greater impact on the readmission rate compared to medical comorbidities. These findings highlight the importance of preoperative patient selection, especially when performing more invasive procedures. However, the study's limitations may limit the generalizability of the findings.
{"title":"Spine surgery and readmission: Risk factors in lumbar corpectomy patients","authors":"Julius Gerstmeyer MD , Anna Gorbacheva , August Avantaggio , Clifford Pierre MD , Emre Yilmaz MD , Thomas A. Schildhauer MD , Amir Abdul-Jabbar MD , Rod J Oskouian MD , Jens R Chapman MD","doi":"10.1016/j.xnsj.2025.100587","DOIUrl":"10.1016/j.xnsj.2025.100587","url":null,"abstract":"<div><h3>Background</h3><div>A corpectomy of the lumbar spine is a widely performed surgical procedure with numerous indications. Previous research predominantly focused on various surgical techniques and their outcomes, lacking a general and comprehensive analysis of factors affecting this procedure. With this study, we aimed to assess the all-cause 90-day readmission rate and identify risk factors for adverse events following a lumbar corpectomy.</div></div><div><h3>Methods</h3><div>Utilizing the 2020 Nationwide Readmissions Database adults (>18 years) were selected by ICD-10 procedure category codes for lumbar corpectomy. Patients with adult deformity or degenerative conditions were excluded due to coding inconsistencies. Demographic information and clinical data, including comorbidities, was extracted. Patients were categorized by their readmission status. The primary outcome was readmission, with multivariable logistic regression analysis used to identify independent risk factors.</div></div><div><h3>Results</h3><div>A total of 3,238 patients were included, with 20.8% readmitted. The readmission group was significantly older and had higher comorbidity burdens. Malignancy had the greatest odds of readmission (OR 3.172, p=.002), with spondylodiscitis also showing significant association (OR 2.177, p=.030). Fractures were significantly more frequent in the single admission group and not associated with readmission (OR 1.235, p=.551). Medical comorbidities differed significantly between the groups with a variety of them being identified as risk factors.</div></div><div><h3>Conclusions</h3><div>We established an all-cause 90-day readmission rate of 20.8%, which is in range of other procedures in spine surgery but underscores the severity of lumbar corpectomy. Underlying pathologies have a greater impact on the readmission rate compared to medical comorbidities. These findings highlight the importance of preoperative patient selection, especially when performing more invasive procedures. However, the study's limitations may limit the generalizability of the findings.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100587"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143285809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.xnsj.2025.100585
Adam P. Henderson BS , M. Lane Moore MD, MBA , Camryn S. Payne BA , Jack M. Haglin MD, MS , Joseph C. Brinkman MD , Paul R. Van Schuyver MD , Joshua S. Bingham MD , Michael S. Chang MD
Background
Medicare reimbursement for spine procedures has been decreasing, and it is well-established that Medicaid reimburses physicians even less than Medicare. This study seeks to provide an updated analysis of Medicaid reimbursement using 24 common spine procedure codes.
Methods
Medicaid rates were obtained from state online fee schedules, and Medicare rates from the Centers for Medicare and Medicaid online fee database. Rates were compared directly to each other by state and averaged to reflect national differences. The Medicare Wage Index was used to control for variability in wages between states and was used to adjust Medicaid data for comparison. Variability between states and codes was quantified using coefficient of variation values.
Results
Medicaid reimbursement was lower than Medicare for all 24 included Current Procedural Terminology codes. Nationally, Medicaid rates were 13% less than Medicare, and this difference increased to 25% when adjusting for wage differences. Average cost differences were −$118 per code. Substantial variability between states and codes was also found for Medicaid, while little variability in Medicare rates existed.
Conclusions
We found that Medicaid reimbursement to surgeons for 24 common spine surgeons was 13% less than Medicare on average. This difference increased to 25% when adjusting for wage differences. For Medicaid, wide variability existed between states and between different codes, indicating that some state payment systems may lack objective metrics when determining rates.
{"title":"Common spine codes are reimbursed 13% less by Medicaid compared to Medicare, ranging from 46% to 160% by state","authors":"Adam P. Henderson BS , M. Lane Moore MD, MBA , Camryn S. Payne BA , Jack M. Haglin MD, MS , Joseph C. Brinkman MD , Paul R. Van Schuyver MD , Joshua S. Bingham MD , Michael S. Chang MD","doi":"10.1016/j.xnsj.2025.100585","DOIUrl":"10.1016/j.xnsj.2025.100585","url":null,"abstract":"<div><h3>Background</h3><div>Medicare reimbursement for spine procedures has been decreasing, and it is well-established that Medicaid reimburses physicians even less than Medicare. This study seeks to provide an updated analysis of Medicaid reimbursement using 24 common spine procedure codes.</div></div><div><h3>Methods</h3><div>Medicaid rates were obtained from state online fee schedules, and Medicare rates from the Centers for Medicare and Medicaid online fee database. Rates were compared directly to each other by state and averaged to reflect national differences. The Medicare Wage Index was used to control for variability in wages between states and was used to adjust Medicaid data for comparison. Variability between states and codes was quantified using coefficient of variation values.</div></div><div><h3>Results</h3><div>Medicaid reimbursement was lower than Medicare for all 24 included Current Procedural Terminology codes. Nationally, Medicaid rates were 13% less than Medicare, and this difference increased to 25% when adjusting for wage differences. Average cost differences were −$118 per code. Substantial variability between states and codes was also found for Medicaid, while little variability in Medicare rates existed.</div></div><div><h3>Conclusions</h3><div>We found that Medicaid reimbursement to surgeons for 24 common spine surgeons was 13% less than Medicare on average. This difference increased to 25% when adjusting for wage differences. For Medicaid, wide variability existed between states and between different codes, indicating that some state payment systems may lack objective metrics when determining rates.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143285811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.xnsj.2024.100579
Anita Fitzgerald MPH , Rachael McCool BSc , Emma Carr BA , Paul Miller MSc , Katie Reddish BSc , Cynthia C Lohr DC , Elena Annoni MSc , Brandon Lawrence MD
Background
Degenerative disc disease (DDD) is associated with chronic lower back pain that may have impacts on individual's quality of life and functional ability. Lumbar interbody fusion can be carried out with a variety of bone grafting products, the choice depends on several factors including the patient, site, procedure, cost and indication. This systematic review (SR) intends to validate and consolidate the existing evidence base supporting bone graft materials related to lumbar interbody fusion procedures for DDD, specifically anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF).
Methods
An SR was conducted in February 2023. Clinical and economic studies of adults with DDD in regions L2 to S1 undergoing lumbar interbody fusion with Infuse™, allograft, synthetic bone grafts, demineralized bone matrices or cell-based matrices were eligible for inclusion.
Results
Twenty-one studies (reported in 25 publications) were included in the review. Eighteen studies (reported in 22 publications) reported clinical outcomes, while 4 studies reported economic outcomes. Nine studies (in 5 publications) investigated Infuse™, including 3 randomized controlled trials (RCTs), one cohort study and 4 case series. Ten studies investigated allograft bone, bone harvested from the vertebral spur combined with apacerum powder, or tricalcium phosphate soaked in autologous bone marrow aspirate, including one RCT, 2 cohort studies, and 7 case series.
Conclusions
The SR shows that Infuse™ offers comparable results to iliac crest bone graft with the benefit of not requiring harvested bone and offers significant benefits in surgical time and blood loss. There is a lack of comparative evidence for any other bone grafts identified in this SR, highlighting the need for further well-designed studies to be conducted in this area.
{"title":"A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease","authors":"Anita Fitzgerald MPH , Rachael McCool BSc , Emma Carr BA , Paul Miller MSc , Katie Reddish BSc , Cynthia C Lohr DC , Elena Annoni MSc , Brandon Lawrence MD","doi":"10.1016/j.xnsj.2024.100579","DOIUrl":"10.1016/j.xnsj.2024.100579","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative disc disease (DDD) is associated with chronic lower back pain that may have impacts on individual's quality of life and functional ability. Lumbar interbody fusion can be carried out with a variety of bone grafting products, the choice depends on several factors including the patient, site, procedure, cost and indication. This systematic review (SR) intends to validate and consolidate the existing evidence base supporting bone graft materials related to lumbar interbody fusion procedures for DDD, specifically anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF).</div></div><div><h3>Methods</h3><div>An SR was conducted in February 2023. Clinical and economic studies of adults with DDD in regions L2 to S1 undergoing lumbar interbody fusion with Infuse™, allograft, synthetic bone grafts, demineralized bone matrices or cell-based matrices were eligible for inclusion.</div></div><div><h3>Results</h3><div>Twenty-one studies (reported in 25 publications) were included in the review. Eighteen studies (reported in 22 publications) reported clinical outcomes, while 4 studies reported economic outcomes. Nine studies (in 5 publications) investigated Infuse™, including 3 randomized controlled trials (RCTs), one cohort study and 4 case series. Ten studies investigated allograft bone, bone harvested from the vertebral spur combined with apacerum powder, or tricalcium phosphate soaked in autologous bone marrow aspirate, including one RCT, 2 cohort studies, and 7 case series.</div></div><div><h3>Conclusions</h3><div>The SR shows that Infuse™ offers comparable results to iliac crest bone graft with the benefit of not requiring harvested bone and offers significant benefits in surgical time and blood loss. There is a lack of comparative evidence for any other bone grafts identified in this SR, highlighting the need for further well-designed studies to be conducted in this area.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100579"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-08DOI: 10.1016/j.xnsj.2025.100581
Kevin Ermann PT, Benita Olivier PT PhD
Background
The hip joint's close association and coupling with the lumbar spine may influence its axes of rotation during closed-chain movement. Consequently, altered hip range of movement (ROM) may potentially foment the symptoms of non-specific lower back pain (NSLBP), warranting its investigation. A quantitative, cross-sectional, analytical design was employed to determine whether NSLBP has an association with altered hip ROM and dominance-aligned hip side-to-side asymmetries.
Methods
Ninety-three convenience sampled participants with and without NSLBP were enrolled. These were assigned to the Lumbar Pain Group (LPG), comprising 61 individuals, 32 males and 29 females or the Control Group (CG), consisting of 32 pain-free volunteers, 18 males and 14 females. Individuals with hip conditions were excluded from the study. Participants completed a Baecke questionnaire and their BMI, Beighton score and leg dominance was established. The following asymptomatic, dominance aligned hip ROM was measured with an Inertial Measurement Unit (IMU): hip flexion ROM in supine; hip extension ROM in prone; Modified Thomas Test (MTT) with knee extension; straight leg raise (SLR); abduction in supine; adduction in supine and hip internal (IR) and external rotation (ER) in prone, sitting and supine in 30° flexion using a framework.
Results
The LPG and CG showed similar hip ROM. However, significant hip side-to-side asymmetries presented in the LPG's sagittal, frontal and transverse planes but only presented in the CG's transverse plane hip ranges. The dominant side usually displayed the smaller range.
Conclusions
Without further evidence, it is unlikely that symmetrically atypical coupled hip ranges should be ignored in the treatment of NSLBP, but a stronger case exists for attention to the hip ROM side-to-side asymmetries. Compounded, multi-planar hip ROM side asymmetries may be one of the causes of NSLBP.
{"title":"The association of hip range of movement, and its side-to-side asymmetries, and non-specific lower back pain in adults aged 40 years and older","authors":"Kevin Ermann PT, Benita Olivier PT PhD","doi":"10.1016/j.xnsj.2025.100581","DOIUrl":"10.1016/j.xnsj.2025.100581","url":null,"abstract":"<div><h3>Background</h3><div>The hip joint's close association and coupling with the lumbar spine may influence its axes of rotation during closed-chain movement. Consequently, altered hip range of movement (ROM) may potentially foment the symptoms of non-specific lower back pain (NSLBP), warranting its investigation. A quantitative, cross-sectional, analytical design was employed to determine whether NSLBP has an association with altered hip ROM and dominance-aligned hip side-to-side asymmetries.</div></div><div><h3>Methods</h3><div>Ninety-three convenience sampled participants with and without NSLBP were enrolled. These were assigned to the Lumbar Pain Group (LPG), comprising 61 individuals, 32 males and 29 females or the Control Group (CG), consisting of 32 pain-free volunteers, 18 males and 14 females. Individuals with hip conditions were excluded from the study. Participants completed a Baecke questionnaire and their BMI, Beighton score and leg dominance was established. The following asymptomatic, dominance aligned hip ROM was measured with an Inertial Measurement Unit (IMU): hip flexion ROM in supine; hip extension ROM in prone; Modified Thomas Test (MTT) with knee extension; straight leg raise (SLR); abduction in supine; adduction in supine and hip internal (IR) and external rotation (ER) in prone, sitting and supine in 30° flexion using a framework.</div></div><div><h3>Results</h3><div>The LPG and CG showed similar hip ROM. However, significant hip side-to-side asymmetries presented in the LPG's sagittal, frontal and transverse planes but only presented in the CG's transverse plane hip ranges. The dominant side usually displayed the smaller range.</div></div><div><h3>Conclusions</h3><div>Without further evidence, it is unlikely that symmetrically atypical coupled hip ranges should be ignored in the treatment of NSLBP, but a stronger case exists for attention to the hip ROM side-to-side asymmetries. Compounded, multi-planar hip ROM side asymmetries may be one of the causes of NSLBP.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100581"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143161397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tethered cord syndrome is commonly caused by thick filum terminale and split cord malformation (SCM), which can coexist. If surgery is necessary, it should address both conditions for complete untethering. Some authors also suggest that resection of the septum should precede filum sectioning. Otherwise, cranial migration of the spinal cord after filum cut may cause further damage at the septum level. However, we found no example in the literature demonstrating any adverse effect if that order was not followed. A 34-year-old woman presented with worsening symptoms, including urinary retention, low back and leg pain after surgery at another center, where the thick filum terminale was cut without addressing a midline fibrous septum splitting the cord. We achieved complete untethering with a second surgery by septum resection. The patient's pain improved, but sphincteric disfunction persisted. Our case supports the opinion that in cases of coexisting SCM and thick filum terminale, complete untethering should be achieved by first septum resection, then filum sectioning, in that particular order.
{"title":"Neurological deterioration in an adult patient with split cord malformation following untethering via filum sectioning: Case report","authors":"Orkhan Mammadkhanli MD, PhD, Cumhur Kilinçer MD, PhD","doi":"10.1016/j.xnsj.2024.100578","DOIUrl":"10.1016/j.xnsj.2024.100578","url":null,"abstract":"<div><div>Tethered cord syndrome is commonly caused by thick filum terminale and split cord malformation (SCM), which can coexist. If surgery is necessary, it should address both conditions for complete untethering. Some authors also suggest that resection of the septum should precede filum sectioning. Otherwise, cranial migration of the spinal cord after filum cut may cause further damage at the septum level. However, we found no example in the literature demonstrating any adverse effect if that order was not followed. A 34-year-old woman presented with worsening symptoms, including urinary retention, low back and leg pain after surgery at another center, where the thick filum terminale was cut without addressing a midline fibrous septum splitting the cord. We achieved complete untethering with a second surgery by septum resection. The patient's pain improved, but sphincteric disfunction persisted. Our case supports the opinion that in cases of coexisting SCM and thick filum terminale, complete untethering should be achieved by first septum resection, then filum sectioning, in that particular order.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-27DOI: 10.1016/j.xnsj.2024.100580
Ara Khoylyan BS , Jason Salvato BS , Frank Vazquez BSAT , Mina Girgis MD , Alex Tang MD , Tan Chen MD FRCSC FACS
Background
Concordance with evidence-based medicine (EBM) guidelines is associated with improved clinical outcomes in spine surgery. The North American Spine Society (NASS) has published coverage guidelines on indications for lumbar fusion surgery, with a recent survey demonstrating a 60% concordance rate across its members. GPT-4 is a popular deep learning model that receives knowledge training across public databases including those containing EBM guidelines. There is prior research exploring the potential utility of artificial intelligence (AI) software in adherence with spine surgery practices and guidelines, inviting opportunity to further investigate application in the setting of lumbar fusion surgery with current AI models.
Methods
Seventeen well-validated clinical vignettes with specific indications for or against lumbar fusion based on NASS criteria were obtained from a prior published research study. Each case was transcribed into a standardized prompt and entered into GPT-4 to obtain a decision whether fusion is indicated. Interquery reliability was assessed with serial identical queries utilizing the Fleiss’ Kappa statistic. Majority response among serial queries was considered as the final GPT-4 decision. Queries were all entered in separate strings. The investigator entering the prompts was blinded to the NASS-concordant decisions for the cases prior to complete data collection. Decisions by GPT-4 and NASS guidelines were compared with Chi-square analysis.
Results
GPT-4 responses for 15/17 (88.2%) of the clinical vignettes were in concordance with NASS EBM lumbar fusion guidelines. There was a significant association in clinical decision-making when determining indication for spine fusion surgery between GPT-4 and NASS guidelines (χ² = 9.75; p<.01). There was substantial agreement among the sets of responses generated by GPT-4 for each clinical case (K = 0.71; p<.001).
Conclusions
There is significant concordance between GPT-4 responses and NASS EBM indications for lumbar fusion surgery. AI and deep learning models may prove to be an effective adjunct tool for clinical decision-making within modern spine surgery practices.
{"title":"Evaluation of GPT-4 concordance with north American spine society guidelines for lumbar fusion surgery","authors":"Ara Khoylyan BS , Jason Salvato BS , Frank Vazquez BSAT , Mina Girgis MD , Alex Tang MD , Tan Chen MD FRCSC FACS","doi":"10.1016/j.xnsj.2024.100580","DOIUrl":"10.1016/j.xnsj.2024.100580","url":null,"abstract":"<div><h3>Background</h3><div>Concordance with evidence-based medicine (EBM) guidelines is associated with improved clinical outcomes in spine surgery. The North American Spine Society (NASS) has published coverage guidelines on indications for lumbar fusion surgery, with a recent survey demonstrating a 60% concordance rate across its members. GPT-4 is a popular deep learning model that receives knowledge training across public databases including those containing EBM guidelines. There is prior research exploring the potential utility of artificial intelligence (AI) software in adherence with spine surgery practices and guidelines, inviting opportunity to further investigate application in the setting of lumbar fusion surgery with current AI models.</div></div><div><h3>Methods</h3><div>Seventeen well-validated clinical vignettes with specific indications for or against lumbar fusion based on NASS criteria were obtained from a prior published research study. Each case was transcribed into a standardized prompt and entered into GPT-4 to obtain a decision whether fusion is indicated. Interquery reliability was assessed with serial identical queries utilizing the Fleiss’ Kappa statistic. Majority response among serial queries was considered as the final GPT-4 decision. Queries were all entered in separate strings. The investigator entering the prompts was blinded to the NASS-concordant decisions for the cases prior to complete data collection. Decisions by GPT-4 and NASS guidelines were compared with Chi-square analysis.</div></div><div><h3>Results</h3><div>GPT-4 responses for 15/17 (88.2%) of the clinical vignettes were in concordance with NASS EBM lumbar fusion guidelines. There was a significant association in clinical decision-making when determining indication for spine fusion surgery between GPT-4 and NASS guidelines (χ² = 9.75; p<.01). There was substantial agreement among the sets of responses generated by GPT-4 for each clinical case (K = 0.71; p<.001).</div></div><div><h3>Conclusions</h3><div>There is significant concordance between GPT-4 responses and NASS EBM indications for lumbar fusion surgery. AI and deep learning models may prove to be an effective adjunct tool for clinical decision-making within modern spine surgery practices.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100580"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-15DOI: 10.1016/j.xnsj.2024.100576
Monis A. Khan MD , Haroon Kisana MD , Conner Clay MD , Ali A. Baaj MD , Jason Silvestre MD , Ben Watzig , James P. Lawrence MD, MBA , Charles Reitman MD , John Glaser MD , John H. Shin MD, MBA , Brandon Hirsch MD , Robert A. Ravinsky MDCM, MPH, FRCSC
Background
Vertebral compression fractures (VCFs) cause significant morbidity in the elderly population. This study aimed to determine the difference in pain-related outcomes in the elderly population who suffered vertebral body fractures, treated with balloon kyphoplasty at "early" (<4 weeks) and "late" (>4 weeks) stages. To the best of our knowledge, this has not been previously evaluated in a meta-analysis.
Methods
We conducted a systematic literature review as per PRISMA guidelines using databases that included PubMed, EMBASE, Cochrane and Scopus.
The search included adults (age 19+) who sustained osteoporotic vertebral compression fractures that were treated with BKP, grouped by time to intervention as compared to conservative treatment to determine impact on radiographic and clinical outcomes.
Results
A total of 9 studies were included from a total of 139 screened records eligible for title and abstract screening after deduplication (39 PubMed, 85 EMBASE, 6 Cochrane, 50 Scopus). The total study sample size was 595. Of these, 6 studies defined their “Early” group as < 4 weeks and were included in our sub-analyses. In regard to pain scores we found a significant improvement in pain score in the early vs. late group. However, we did not find a significant correction in kyphotic correction.
Conclusions
Our study suggests that early treatment of vertebral compression fractures with Balloon Kyphoplasty (BKP), defined as < 4 weeks, provides a statistically significant improvement in pain scores and kyphotic angle correction compared to late treatment (>4 weeks). However, no statistically significant differences were observed in terms of height restoration or the risk of adjacent level fractures. These findings support the benefits of early intervention for pain relief and alignment, though further research is needed to standardize methodologies and assess long-term outcomes.
{"title":"The effect of time to balloon kyphoplasty on osteoporotic vertebral compression fractures: a systematic review with meta-analysis","authors":"Monis A. Khan MD , Haroon Kisana MD , Conner Clay MD , Ali A. Baaj MD , Jason Silvestre MD , Ben Watzig , James P. Lawrence MD, MBA , Charles Reitman MD , John Glaser MD , John H. Shin MD, MBA , Brandon Hirsch MD , Robert A. Ravinsky MDCM, MPH, FRCSC","doi":"10.1016/j.xnsj.2024.100576","DOIUrl":"10.1016/j.xnsj.2024.100576","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral compression fractures (VCFs) cause significant morbidity in the elderly population. This study aimed to determine the difference in pain-related outcomes in the elderly population who suffered vertebral body fractures, treated with balloon kyphoplasty at \"early\" (<4 weeks) and \"late\" (>4 weeks) stages. To the best of our knowledge, this has not been previously evaluated in a meta-analysis.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review as per PRISMA guidelines using databases that included PubMed, EMBASE, Cochrane and Scopus.</div><div>The search included adults (age 19+) who sustained osteoporotic vertebral compression fractures that were treated with BKP, grouped by time to intervention as compared to conservative treatment to determine impact on radiographic and clinical outcomes.</div></div><div><h3>Results</h3><div>A total of 9 studies were included from a total of 139 screened records eligible for title and abstract screening after deduplication (39 PubMed, 85 EMBASE, 6 Cochrane, 50 Scopus). The total study sample size was 595. Of these, 6 studies defined their “Early” group as < 4 weeks and were included in our sub-analyses. In regard to pain scores we found a significant improvement in pain score in the early vs. late group. However, we did not find a significant correction in kyphotic correction.</div></div><div><h3>Conclusions</h3><div>Our study suggests that early treatment of vertebral compression fractures with Balloon Kyphoplasty (BKP), defined as < 4 weeks, provides a statistically significant improvement in pain scores and kyphotic angle correction compared to late treatment (>4 weeks). However, no statistically significant differences were observed in terms of height restoration or the risk of adjacent level fractures. These findings support the benefits of early intervention for pain relief and alignment, though further research is needed to standardize methodologies and assess long-term outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100576"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143161398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the editor regarding: “The utility of vertebral Hounsfield units as a prognostic indicator of adverse events following treatment of spinal epidural abscess”","authors":"Borislav Kitov MD, PhD , Denis Milkov MD , Atanas N. Davarski MD, PhD","doi":"10.1016/j.xnsj.2024.100568","DOIUrl":"10.1016/j.xnsj.2024.100568","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100568"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.xnsj.2024.100570
John Fallon BBA , Jonathan Sgaglione BS , Matthew Rohde BS , Junho Song MD , Austen D. Katz MD , Alex Ngan MD , Sarah Trent MD , Bongseok Jung BS , Adam Strigenz BA , Mitchell Seitz BS , Joshua Zhang BS , Jeff Silber MD , David Essig MD , Sheeraz Qureshi MD, MBA , Sohrab Virk MD, MBA
<div><h3>Background</h3><div>Prior studies have linked sarcopenia and fat infiltration in paraspinal muscles with lumbar pain, spinal pathology, and adverse postoperative outcomes in lumbar spine surgery. A recent magnetic resonance imaging (MRI)-based method for assessing muscle health, incorporating parameters such as Goutallier Classification (GC) and the Paralumbar Muscle Cross-Sectional Area to Body Mass Index ratio (PL-CSA/BMI), has shown that higher muscle grades correlate with significant improvements in patient-reported outcomes. Despite these advancements, there is limited research on the associations between paralumbar muscle health and factors such as age, BMI, walking tolerability, and spondylolisthesis. Our study aimed to evaluate such associations.</div></div><div><h3>Methods</h3><div>This Institutional Review Board-approved retrospective cohort study included patients aged 18 or older presenting with back pain symptoms who underwent lumbar spine MRI within 12 months of presentation to a single orthopedic surgeon. Patients with incomplete imaging, cancer pathology, or trauma-induced injuries were excluded. MRI-based measurements of Lumbar Indentation Value (LIV), Goutallier Classification (GC), and PL-CSA/BMI were used as outcome measures. Paralumbar muscles on axial T2-weighted lumbar MRIs were outlined using ImageJ to determine the PL-CS and LIV through the L1–L5 disc spaces, with GC classified by the primary author. Quantile regression analysis was used for continuous variables, and negative binomial regression with an estimated ancillary parameter was applied for ordinal variables, with statistical significance set at <em>p</em><.05.</div></div><div><h3>Results</h3><div>Our analysis found that increasing age was associated with increased GC, decreased PL-CSA, and CSA/BMI at all lumbar levels. Age was associated with increased LIV at L1/L2. We found that increasing BMI was associated with increased LIV and PL-CSA and decreased CSA/BMI at all lumbar levels while it was only associated with increased GC at L1/L2, L2/L3 and L3/L4. Higher grade spondylolisthesis was associated with worse GC at all lumbar spinal levels except L3/L4 and with decreased LIV at L1/L2. An inability to walk > 1 block predicted LIV and GC at L2/L3 while predicting CSA/BMI at L4/L5. Increasing age was associated with decreased CSA at L1/L2, L2/L3 and L4/L5 while it was associated with decreased CSA/BMI and increased GC at all lumbar levels. Age was only associated with decreased LIV at L1/L2, L2/L3. Lastly, increasing BMI was associated with increased CSA, LIV, and decreased CSA/BMI at all lumbar levels and associated with increased GC at all lumbar levels except L4/L5. All statistically significant associations had <em>p</em>-values<.05.</div></div><div><h3>Conclusions</h3><div>Our analysis determined that increasing age, increased BMI, spondylolisthesis, and walking intolerability are significantly associated with poor paralumbar muscle health. Al
{"title":"Association between modifiable and nonmodifiable risk factors with paralumbar muscle health in patients with lower back pain","authors":"John Fallon BBA , Jonathan Sgaglione BS , Matthew Rohde BS , Junho Song MD , Austen D. Katz MD , Alex Ngan MD , Sarah Trent MD , Bongseok Jung BS , Adam Strigenz BA , Mitchell Seitz BS , Joshua Zhang BS , Jeff Silber MD , David Essig MD , Sheeraz Qureshi MD, MBA , Sohrab Virk MD, MBA","doi":"10.1016/j.xnsj.2024.100570","DOIUrl":"10.1016/j.xnsj.2024.100570","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies have linked sarcopenia and fat infiltration in paraspinal muscles with lumbar pain, spinal pathology, and adverse postoperative outcomes in lumbar spine surgery. A recent magnetic resonance imaging (MRI)-based method for assessing muscle health, incorporating parameters such as Goutallier Classification (GC) and the Paralumbar Muscle Cross-Sectional Area to Body Mass Index ratio (PL-CSA/BMI), has shown that higher muscle grades correlate with significant improvements in patient-reported outcomes. Despite these advancements, there is limited research on the associations between paralumbar muscle health and factors such as age, BMI, walking tolerability, and spondylolisthesis. Our study aimed to evaluate such associations.</div></div><div><h3>Methods</h3><div>This Institutional Review Board-approved retrospective cohort study included patients aged 18 or older presenting with back pain symptoms who underwent lumbar spine MRI within 12 months of presentation to a single orthopedic surgeon. Patients with incomplete imaging, cancer pathology, or trauma-induced injuries were excluded. MRI-based measurements of Lumbar Indentation Value (LIV), Goutallier Classification (GC), and PL-CSA/BMI were used as outcome measures. Paralumbar muscles on axial T2-weighted lumbar MRIs were outlined using ImageJ to determine the PL-CS and LIV through the L1–L5 disc spaces, with GC classified by the primary author. Quantile regression analysis was used for continuous variables, and negative binomial regression with an estimated ancillary parameter was applied for ordinal variables, with statistical significance set at <em>p</em><.05.</div></div><div><h3>Results</h3><div>Our analysis found that increasing age was associated with increased GC, decreased PL-CSA, and CSA/BMI at all lumbar levels. Age was associated with increased LIV at L1/L2. We found that increasing BMI was associated with increased LIV and PL-CSA and decreased CSA/BMI at all lumbar levels while it was only associated with increased GC at L1/L2, L2/L3 and L3/L4. Higher grade spondylolisthesis was associated with worse GC at all lumbar spinal levels except L3/L4 and with decreased LIV at L1/L2. An inability to walk > 1 block predicted LIV and GC at L2/L3 while predicting CSA/BMI at L4/L5. Increasing age was associated with decreased CSA at L1/L2, L2/L3 and L4/L5 while it was associated with decreased CSA/BMI and increased GC at all lumbar levels. Age was only associated with decreased LIV at L1/L2, L2/L3. Lastly, increasing BMI was associated with increased CSA, LIV, and decreased CSA/BMI at all lumbar levels and associated with increased GC at all lumbar levels except L4/L5. All statistically significant associations had <em>p</em>-values<.05.</div></div><div><h3>Conclusions</h3><div>Our analysis determined that increasing age, increased BMI, spondylolisthesis, and walking intolerability are significantly associated with poor paralumbar muscle health. Al","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.xnsj.2024.100565
Maria Isabel Barros Guinle BA , Thomas Johnstone BS , Gabriela D. Ruiz Colón MD , Yingjie Weng MHS , Ella A. Nettnin BS , John K. Ratliff MD
Background
Low back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries.
Methods
This retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type.
Results
About 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001).
Conclusions
Nonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.
背景：腰痛（LBP）是65岁及以上成年人致残最常见的医学原因。以前没有研究表征医疗保险受益人的LBP的医疗保健费用和治疗模式。方法本回顾性队列研究量化了新诊断的LBP医疗保险受益人的医疗保健利用成本，比较了手术和非手术治疗患者的成本，确定了与治疗指南不遵守相关的成本，并描述了阿片类药物的处方模式。通过ICD代码从20%的医疗保险索赔记录随机抽样中查询患者。排除伴有或既往“危险信号”诊断、神经功能缺陷或诊断可能导致非退行性腰痛的患者。计算诊断当年的总护理费用，并按手术与非手术管理进行分层。为了评估指南的依从性，不同服务的利用率和成本被制成表格。阿片类药物处方模式以数量、成本、持续时间和药物类型为特征。结果共发现1269896例患者；23919例（1.8%）接受了手术。这些费用占该队列总费用的7%（总计5.14亿美元，每人21,496美元）。非手术治疗患者的费用超过70亿美元(每人5880美元；术;措施)。在非手术队列中，626,896例（50.3%）患者不遵守当前的保守治疗LBP指南。不遵守指南使每人每年的总费用增加了4,012美元（不遵守指南的患者为7,873美元，遵守指南的患者为3,861美元，p < 0.001）。303,796例独特患者（23.9%）在LBP诊断后30天内填写了约460,867张阿片类药物处方。在非手术队列中，未遵循影像学指南的患者比遵循指南的患者更有可能在此窗口内获得阿片类药物处方(26.5% vs. 21.2%；术;措施)。结论非手术治疗腰痛可显著降低患者人均费用。早期成像和阿片类药物处方是造成成本过高的重要因素。遵守拟议的治疗指南可节省超过28亿美元的医疗保健费用总额。
{"title":"Health care utilization among Medicare beneficiaries with newly diagnosed back pain","authors":"Maria Isabel Barros Guinle BA , Thomas Johnstone BS , Gabriela D. Ruiz Colón MD , Yingjie Weng MHS , Ella A. Nettnin BS , John K. Ratliff MD","doi":"10.1016/j.xnsj.2024.100565","DOIUrl":"10.1016/j.xnsj.2024.100565","url":null,"abstract":"<div><h3>Background</h3><div>Low back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries.</div></div><div><h3>Methods</h3><div>This retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type.</div></div><div><h3>Results</h3><div>About 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001).</div></div><div><h3>Conclusions</h3><div>Nonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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