International Journal of Spine Surgery最新文献

Background: In recent years, hybrid surgery (HS), which combines cervical disc replacement and anterior cervical discectomy and fusion (ACDF) in treating multilevel cervical degenerative disc disease (CDDD), has emerged; however, its advantages over ACDF remain uncertain. This study aims to evaluate the safety, effectiveness, and reliability of HS and to provide updated insights into its clinical application and support surgical decision-making.

Methodology: This study included 20 articles that compared ACDF and HS in multilevel CDDD from January 2017 to January 2025. The following outcomes were analyzed: operation time, blood loss, hospital stay, functional parameters (visual analog scale, Neck Disability Index, and Japanese Orthopedic Association scores), radiological parameters (range of motion [ROM], T1 slope, cervical lordosis, sagittal vertical axis), complications, reoperation, and adjacent segment disease (ASD). To enhance the reliability of results, Egger's and Begg's tests, sensitivity, and meta-regression analyses were performed.

Results: The pooled analysis showed that ACDF demonstrated greater loss of cervical spine motion (P < 0.0001) and increased superior adjacent segment ROM (P < 0.0001), suggesting increased burden on the adjacent segments. Whereas HS was associated with a lower incidence of ASD (P = 0.05). In addition, complication incidence (P = 0.02) and dysphagia (P = 0.02) were significantly lower in the HS group, suggesting a favorable safety profile. Heterotopic ossification was not observed in any of the ACDF cases (P = 0.02). No significant differences were noted in other functional or radiological outcomes.

Conclusion: This meta-analysis provided updated evidence on the clinical outcomes of HS and ACDF in multilevel CDDD. HS offers advantages when it comes to preserving ROM, with trends toward lower complication and reoperation rates, as well as reduced incidence of ASD. On the other hand, ACDF is a favorable option in terms of lower operative time and blood loss. Both treatments have comparable postoperative functional outcomes. This suggests that HS is an effective and reliable surgical alternative. By combining fusion and motion-preserving components, HS allows surgeons to decide based on specific pathology at each spinal level, resulting in a more individualized and biomechanically balanced approach.

Clinical relevance: Comparing outcomes of ACDF and HS can assist surgical decision-making in multilevel CDDD, supporting individualized treatment planning.

Level of evidence: 1:

Background: In recent years, bone health optimization, including vitamin D supplementation, has increasingly been advocated in spinal surgery to improve surgical outcomes. Nevertheless, few studies have explored the connection between blood vitamin D levels and surgical outcomes for lumbar spinal canal stenosis (LSS). The purpose of this study was to investigate the prevalence of vitamin D deficiency among patients with LSS and whether vitamin D levels were associated with surgical outcomes for LSS.

Methods: In this retrospective study, we investigated the association between recovery rate and factors including vitamin D levels using univariate and multivariate regression analyses.

Results: A total of 154 patients (83 men and 71 women) were included in this study. Among them, 71% were diagnosed with vitamin D deficiency. Multivariable linear regression analysis identified preoperative serum vitamin D levels as an independent factor associated with the recovery rate after surgery for LSS (P = 0.02). Patients with vitamin D deficiency exhibited lower recovery rates compared with those with sufficient vitamin D levels (P = 0.01).

Conclusions: Preoperative vitamin D levels were associated with surgical outcomes for LSS. Further studies are warranted to examine the optimal threshold of vitamin D levels associated with clinical outcomes in spine surgery and whether therapeutic interventions could improve postoperative outcomes.

Clinical relevance: This study highlights that vitamin D deficiency is highly prevalent in patients with LSS and is significantly associated with poorer postoperative recovery.

Level of evidence: 4:

Background: Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are 2 surgical approaches for achieving arthrodesis and restoring alignment. Novel expandable interbody technology may provide an advantage for TLIF procedures. Limited comparative data exist for LLIF with static interbody cages and TLIF with expandable interbody cages. This study aimed to examine the differences in radiographic and clinical outcomes between these procedures.

Methods: This is a retrospective analysis comparing single-level LLIF with static interbody cages and TLIFs with expandable interbody cages performed at our institution. Demographic, operative, radiographic, and patient-reported data were collected. Upright radiographic images were used to assess pre- and postoperative radiographic parameters. Patient-reported outcomes were assessed using the Oswestry Disability Index and minimal clinically important difference (MCID).

Results: A total of 163 patients, 75 in the TLIF group and 88 in the LLIF group, were included in this study (mean age: 63.3 ± 12.0 years; 54.8% women). Mean follow-up was 306.2 ± 161.4 days for the TLIF group and 502.3 ± 308.0 days for the LLIF group (P = 0.021). Both groups demonstrated significant improvements in lumbar lordosis, neuroforaminal height, and disc angle (P < 0.01). LLIF patients demonstrated a significant correction of segmental lordosis (P < 0.01), whereas TLIF patients did not (P > 0.05). Patients in the LLIF group demonstrated a greater increase in segmental lordosis (P = 0.005) and neuroforaminal height (P < 0.001) in comparison to those in the TLIF group. In addition, a modest but significant advantage was observed in overall lumbar lordosis in LLIF (P = 0.049). A significantly greater proportion of patients who underwent LLIF achieved an MCID (80.6% vs 66.7%, P = 0.041). The LLIF group had significantly fewer cases of radiographic subsidence than TLIF (10.2% vs 44%, P < 0.001). TLIF was the only significant predictor of subsidence (OR = 4.630 [1.493-14.364], P < 0.001).

Conclusions: LLIF resulted in greater restoration of neuroforaminal height and segmental lordosis, as well as a modest advantage in lumbar lordosis. In addition, a significantly greater proportion of patients who underwent LLIF achieved MCID. TLIF was a significant predictor of subsidence when controlling for confounding factors.

Clinical relevance: With the advent of expandable interbodies in TLIF, our findings demonstrate suboptimal radiographic and patient-reported outcomes in comparison to LLIF with static interbody cages. Surgeons should exercise caution regarding utilizing expandable interbody technology during TLIF.

Level of evidence: 3:

Background: A lumbar disc herniation is the primary cause of sciatica, affecting 1% to 5% of the population annually. Epidural corticosteroid injections, whether via the transforaminal or interlaminar route, are an option for patients with refractory sciatica pain. The transforaminal route has the advantage of directly addressing the site of pathology in the anterior epidural space, between the disc herniation and the nerve root.

Purpose: To evaluate the efficacy of transforaminal infraneural epidural injections using corticosteroids in the treatment of radiculopathy secondary to acute lumbar disc herniation.

Study design: Descriptive, nonrandomized, retrospective, and uncontrolled single-center study.

Patient sample: Patients with radiculopathy secondary to acute lumbar disc herniation who underwent transforaminal epidural infiltrations between 2022 and 2024 were included.

Main outcome measures: Efficacy of transforaminal infraneural epidural injections using corticosteroids in the treatment of radiculopathy secondary to acute lumbar disc herniation.

Methods: The inclusion criteria were (1) patients with onset of radiculopathy symptoms in the lower limbs less than 12 weeks prior; (2) patients with persistent radiculopathy symptoms in the lower limbs for more than 8 weeks; (3) clinical signs and symptoms of radiculopathy; (4) lumbar spine magnetic resonance imaging showing discopathy compatible with the clinical examination; and (5) minimum age of 18 years. From a technical standpoint, the entire procedure was performed in the operating room with sedation and local anesthesia.

Conclusions: Radicular blocks are minimally invasive forms of treatment for radiculopathy refractory to medication-based analgesia due to an acute lumbar disc herniation. Transforaminal blocks offer the advantage of providing analgesia with a smaller amount of corticosteroid and represent a nonsurgical alternative that appears to be effective in treating radiculopathy secondary to acute lumbar disc herniation.

Clinical relevance: This study highlights that infraneural transforaminal epidural steroid injection provides effective analgesia for acute lumbar radiculopathy secondary to disc herniation while using a smaller corticosteroid dose. This approach may help reduce systemic exposure and procedural risks, offering a safer alternative for patients requiring minimally invasive pain management.

Level of evidence: 3:

Background: Travel distance can serve as an objective, behavioral measure of patient preference in health care. Endoscopic spine surgery is the least invasive surgical option for treating spinal pathology, yet access is limited due to the relatively small number of trained surgeons. This study evaluates travel patterns of patients seeking care at the Endoscopic Spine Institute of New York, a specialized center staffed by 3 fellowship-trained endoscopic spine surgeons.

Methods: We conducted a retrospective analysis of the first 100 consecutive patients undergoing endoscopic spine surgery at Endoscopic Spine Institute of New York. The primary objective was to quantify patient travel distance as a behavioral proxy for preference for specialized, minimally invasive care. Secondary objectives were to characterize spinal pathology, determine revision surgery frequency, and compare travel distances by pathology type and revision status. Travel distances were calculated as straight-line distances from the patient's city of residence to the institute. Descriptive and comparative statistics were performed.

Results: The mean travel distance was 308.4 miles (SD: 494.1), with patients traveling from multiple states and internationally. Surgical interventions included cervical (20%), thoracic (18%), and lumbar (62%) pathologies. Revision surgeries accounted for 29% of cases. Travel distance was significantly greater for revision cases compared with primary cases (P < 0.05). Lumbar pathology cases were associated with slightly longer travel distances compared with cervical and thoracic cases, though differences were not statistically significant.

Conclusions: Patients are willing to travel substantial distances to access specialized, minimally invasive spine surgery. Travel distance serves as a behavioral measure of patient preference, distinct from conventional quality metrics, providing insight into patient priorities in health care utilization and informing the centralization of specialized surgical services.

Clinical relevance: Understanding how far patients will travel for endoscopic spine surgery provides insight into the growing demand for minimally invasive approaches and the regionalization of specialized spine care. This information can help guide resource allocation, referral patterns, and the develpment of centers of excellence.

Level of evidience: 4.

Background: To evaluate the clinical and radiological outcomes of biportal endoscopic lumbar interbody fusion (BE-LIF) using the 30-degree endoscope in patients with lumbar spondylolisthesis and severe disc height loss and to highlight its technical advantages in endplate preparation and contralateral decompression.

Methods: This retrospective study included 21 patients with single-level Meyerding grade II spondylolisthesis and preoperative disc height <5 mm who underwent BE-LIF combined with percutaneous pedicle screw fixation between February 2023 and February 2025. Clinical outcomes were assessed using the visual analog scale for back and leg pain and the Oswestry Disability Index. Radiographic parameters, including vertebral slip, disc height, and foraminal height, were evaluated on standing lateral x-ray images, while fusion status was assessed using Bridwell grading on 6-month postoperative computed tomography scans.

Results: At a mean follow-up of 11.7 ± 2.6 months, all patients demonstrated statistically significant clinical improvement, visual analog scale scores decreased from 7.2 ± 0.6 to 1.5 ± 0.5 for low back pain, from 7.5 ± 0.5 to 1.7 ± 0.6 for leg pain, and the Oswestry Disability Index improved from 42.6 ± 5.7 to 15.7 ± 2.5 (P < 0.001). Radiologically, vertebral slip was reduced from 11.3 ± 1.5 mm to 2.1 ± 0.4 mm. Anterior and posterior disc heights increased from 5.6 ± 0.6 mm and 4.9 ± 0.5 mm to 8.5 ± 1.2 mm and 8.3 ± 1.4 mm, respectively. Foraminal height improved from 9.8 ± 1.7 mm to 14.7 ± 2.8 mm. Fusion was confirmed in all cases (Bridwell grade I: 28.6%, grade II: 71.4%), with no cage subsidence or major complications reported.

Conclusion: The use of the 30-degree endoscope in BE-LIF for spondylolisthesis with severe disc collapse provides enhanced visualization, facilitates safe and effective decompression, and results in favorable clinical and radiological outcomes.

Level of evidence: 3:

A previously healthy 46-year-old man presented to a level 1 trauma center with polytraumatic injuries, including a unilateral right L5 pedicle fracture with a contralateral L5 lamina fracture. He was taken to the operating room for fixation of the L5 pedicle fracture using a 6.5 mm partially threaded screw. He tolerated the procedure well, and at 12 months postoperatively he reported no back pain, had returned to work and resumed all activities. The authors conclude that fixation of a unilateral pedicle fracture with a partially threaded screw is safe, effective, and minimally invasive. It should be considered a viable treatment option after a thorough workup and when properly indicated.

Background: Spine disorders are among the most common causes of disability, with utilization of spine procedures nearly doubling over the past 2 decades. As costs have continued to escalate, the Centers for Medicare & Medicaid Services have implemented bundled care initiatives and reimbursement reductions, leading to declining physician payment. This study provides a comprehensive summary of utilization and reimbursement for the most common spine procedures using a large national insurance database.

Methods: Patient data from 2010 to 2021 were accessed by querying the national insurance claims database using Current Procedural Terminology codes. After identifying the 10 most used spine procedures, the Physician Fee-Schedule Lookup Tool from the Centers for Medicare & Medicaid Services was queried to obtain Medicare physician reimbursement for the procedures (2012-2024). Dollar values were adjusted using the Consumer Price Index and are reported in 2024 US dollars. Yearly reimbursement was separated by procedure type and location. Utilization trends and demographic data were also obtained.

Results: From 2012 to 2021, 347,053 Medicare patients underwent 1 of the top 10 spine procedures, with fusion, laminectomy, and laminotomy being the most utilized. The average patient was 69 ± 8 years; 52.9% were women, with an average Elixhauser Comorbidity Index of 4.9 ± 3.7. Overall utilization increased by 19% (P = 0.04), with cervical and lumbar procedures rising by 30.61% (P = 0.01) and 19.97% (P = 0.04), respectively. Despite increased utilization, inflation-adjusted Medicare reimbursement significantly declined across all procedure types, with lumbar procedures experiencing the greatest reduction (-28.56%, P < 0.001). The largest annual decline occurred from 2021 to 2022 (-7.67% fusion and -7.52% decompression).

Conclusion: Despite the growing utilization of all included procedures, the present data have demonstrated a decrease in Medicare reimbursement across all subgroups.

Clinical relevance: These reimbursement trends shape the field of spine surgery, impacting the sustainability of spine practices, affecting patient access to care, and influencing the adoption of new technologies.

Level of evidence: 3: