Spine Journal最新文献

Dexamethasone as an Adjuvant to Erector Spinae Plane Block Is Associated With Improved Neuromonitoring Parameters and Analgesia in Pediatric Spine Surgery. 地塞米松辅助竖脊肌平面阻滞与小儿脊柱手术中神经监测参数的改善和镇痛相关

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-05 DOI: 10.1016/j.spinee.2026.01.021

Malgorzata Reysner, Juliusz Huber, Tomasz Reysner, Piotr Janusz, Pawel Glowka, Wojciech Gola, Anna Perek, Justyna Marszałek-Buko, Przemyslaw Daroszewski, Tomasz Kotwicki

Background context: Posterior spinal fusion for idiopathic scoliosis in children and adolescents is associated with severe postoperative pain and high opioid requirements. The erector spinae plane block (ESPB) provides effective analgesia, but its duration is limited. Dexamethasone prolongs peripheral nerve blocks in adults; however, its effects on analgesia and neurophysiological parameters in pediatric spine surgery remain unclear.Purpose: To evaluate whether dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated with prolonged analgesia, reduced opioid consumption, and changes in motor neurophysiological parameters in pediatric scoliosis surgery.Study design/setting: Prospective, randomized, double-blind, controlled clinical trial conducted at a tertiary university hospital.Patient sample: Sixty children and adolescents aged 10-18 years with Lenke type 3 scoliosis undergoing posterior spinal fusion were randomized to receive ESPB with ropivacaine 0.2% plus dexamethasone (0.1 mg/kg; DEX group, n=30) or ropivacaine 0.2% alone (NO DEX group, n=30).Outcome measures: Primary outcome was time to first rescue opioid analgesia within 48 hours postoperatively. Secondary outcomes included total opioid consumption, postoperative pain scores (Numerical Rating Scale, NRS), perioperative blood glucose levels, neurological complications, intraoperative motor evoked potentials (MEPs), and postoperative electroneurography (ENG) parameters.Methods: Bilateral ultrasound-guided ESPBs were performed at T4 and T10 after anesthesia induction. Neuromonitoring included intraoperative transcranial electrical stimulation-elicited MEPs and postoperative transcranial magnetic stimulation-elicited MEPs, as well as postoperative motor ENG of the peroneal nerves. Pain scores and opioid consumption were recorded by blinded assessors. Appropriate parametric and non-parametric tests, including repeated-measures analyses, were applied.Results: Time to first opioid administration was longer in the DEX group than in the NO DEX group (13.0 ± 2.1 h vs. 5.2 ± 1.6 h; p<0.0001). Total opioid consumption during the first 48 hours was lower in the DEX group (18.1 ± 3.8 mg vs. 27.3 ± 4.4 mg morphine equivalents; p<0.0001). NRS pain scores were lower at 8, 12, and 24 hours postoperatively (p<0.05). Neurophysiological assessments showed higher postoperative MEP amplitudes and more favorable ENG parameters in the DEX group compared with the NO DEX group; overall postoperative improvement in neurophysiological measures was observed in both groups. No differences in perioperative blood glucose levels or neurological complications were detected.Conclusions: In pediatric scoliosis surgery, dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated

背景：儿童和青少年特发性脊柱侧凸的后路脊柱融合术与严重的术后疼痛和高阿片类药物需求相关。竖脊肌平面阻滞（ESPB）提供了有效的镇痛，但其持续时间有限。地塞米松延长成人周围神经阻滞；然而，其对小儿脊柱手术镇痛和神经生理参数的影响尚不清楚。目的：评估在小儿脊柱侧凸手术中，筋膜平面内给予地塞米松作为ESPB的辅助治疗是否与延长镇痛、减少阿片类药物消耗和运动神经生理参数的改变有关。研究设计/环境：在某三级大学附属医院进行的前瞻性、随机、双盲、对照临床试验。患者样本：60例10-18岁Lenke 3型脊柱侧凸行脊柱后路融合术的儿童和青少年，随机分为两组，分别接受ESPB联合罗哌卡因0.2% +地塞米松（0.1 mg/kg； DEX组，n=30）或单独罗哌卡因0.2% （NO DEX组，n=30）。观察指标：主要观察指标为术后48小时内阿片类药物首次镇痛时间。次要结局包括阿片类药物总消耗量、术后疼痛评分（数值评定量表，NRS）、围手术期血糖水平、神经系统并发症、术中运动诱发电位（MEPs）和术后神经电图（ENG）参数。方法：在麻醉诱导后的T4和T10进行双侧超声引导下的espb。神经监测包括术中经颅电刺激诱发的mep和术后经颅磁刺激诱发的mep，以及术后腓神经运动ENG。由盲法评估者记录疼痛评分和阿片类药物消耗。应用了适当的参数和非参数检验，包括重复测量分析。结果：DEX组首次给药时间比NO DEX组更长（13.0±2.1 h vs 5.2±1.6 h）。结论：在小儿脊柱侧凸手术中，筋膜平面内给药地塞米松作为ESPB的辅助剂，可以延长镇痛时间，减少阿片类药物的需求，而不会增加不良反应。各组间神经生理参数的差异应被解释为相关性，可能反映围手术期条件的调节，而不是直接的神经保护作用。术后整体神经生理改善可能与脊柱侧凸矫正手术有关。

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引用次数: 0

Translating Biomechanics to Clinic: Validating a Spine-Specific Wearable for Remote Functional Assessment. 将生物力学转化为临床：验证用于远程功能评估的脊柱特定可穿戴设备。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-04 DOI: 10.1016/j.spinee.2026.01.025

Ram Haddas, Kade Kaufmann, Prasanth Romiyo, Ye Shu, Gabriel Ramirez, Paul Rubery, Ashley Rogerson, Varun Puvanesarajah, Willian Lavelle, Addisu Mesfin, Yair Barzilay

Background context: Disability and impaired function are hallmarks of spine pathology. Current clinical tools fail to quantitatively capture these functional deficits. Laboratory-based motion analysis offers precision but is costly and impractical for routine care. Wearable IMUs are a promising alternative; however, rigorous validation of spine-specific wearables during functional tasks remains limited. The clinical adoption of single-sensor IMUs has been limited because their accuracy depends on subject-specific calibration, drift correction, and high-fidelity sensor fusion, technical considerations that have not been fully validated in spine-specific, functional tasks, highlighting the need for systematic evaluation to determine their clinical utility.Purpose: To validate a novel spine-specific wearable IMU device for accurate, clinically meaningful assessment of trunk kinematics and functional performance in patients with degenerative and structural spine disorders.Study design: Prospective, single-center validation of spine-specific wearable inertial measurement units (IMUs) compared with traditional motion capture technology.Methods: Fifty adults with spine pathology (mean age 63.2 ± 11.8 years; BMI 31.1 ± 6.6 kg/m²) performed gait, quiet standing, standardized lifting, and sit-to-stand tasks wearing a spine-specific IMU worn externally at the level of T1. The device was calibrated per participant to define a neutral trunk reference, and drift was minimized using sensor fusion algorithms. Data was recorded simultaneously with a ten-camera marker-based motion capture system. Trunk kinematics and balance metrics were compared using intraclass correlation coefficients (ICC), root mean square deviation (RMSD), and waveform correlations.Results: The IMU showed excellent agreement with traditional motion capture for sagittal plane peak flexion/extension across tasks (ICC 0.89-0.96), with RMSD <5°. Coronal and transverse plane peak angles showed good-to-excellent reliability (ICC 0.71-0.94) and moderate range-of-motion agreement. Pattern correlations ranged from moderate to near-perfect (r = 0.60-0.99), with the strongest reliability during lifting and sit-to-stand tasks. These tasks represent the majority of daily functional activities in spine patients, capturing spinal loading, postural control, and transitional movements, highlighting both clinical relevance and potential for perioperative and rehabilitation monitoring.Conclusions: Spine-specific wearable IMUs accurately and reliably quantify trunk motion and balance in spine patients with spine pathology. Through high-precision engineering and validated measurement algorithms, these devices provide objective, actionable insights that extend beyond laboratory settings, enabling remote, continuous functional assessment and supporting personalized rehabilitat

背景背景：残疾和功能受损是脊柱病理学的标志。目前的临床工具无法定量捕捉这些功能缺陷。基于实验室的运动分析提供了精度，但对于常规护理来说成本高昂且不切实际。可穿戴imu是一个很有前途的选择；然而，在功能性任务中对脊柱特定可穿戴设备的严格验证仍然有限。单传感器imu的临床应用受到限制，因为其准确性依赖于受试者特定的校准、漂移校正和高保真传感器融合，这些技术考虑因素尚未在脊柱特定的功能任务中得到充分验证，因此需要系统评估以确定其临床实用性。目的：验证一种新的脊柱特异性可穿戴IMU设备，用于对退行性和结构性脊柱疾病患者的躯干运动学和功能表现进行准确、有临床意义的评估。研究设计：前瞻性、单中心验证脊柱专用可穿戴惯性测量单元（imu）与传统运动捕捉技术的比较。方法：50名患有脊柱病理的成年人（平均年龄63.2±11.8岁，BMI 31.1±6.6 kg/m²）穿戴T1水平的脊柱专用IMU进行步态、安静站立、标准化举起和坐立任务。每个参与者对设备进行校准，以定义中性主干参考，并使用传感器融合算法最小化漂移。数据同时记录与一个十摄像头标记为基础的运动捕捉系统。使用类内相关系数（ICC）、均方根偏差（RMSD）和波形相关性对躯干运动学和平衡指标进行比较。结果：IMU与传统的矢状面屈伸峰值运动捕捉非常吻合（ICC 0.89-0.96）， RMSD结论：脊柱特异性可穿戴IMU准确可靠地量化脊柱病变患者的躯干运动和平衡。通过高精度工程和经过验证的测量算法，这些设备提供了超越实验室设置的客观、可操作的见解，实现了远程、连续的功能评估，并支持个性化康复和纵向监测。临床意义：经过验证的脊柱特异性可穿戴imu允许临床医生在现实环境中客观地跟踪功能恢复，确定代偿运动策略，优化康复干预措施，加强术后和纵向结果监测，弥合工程精度和以患者为中心的脊柱护理之间的差距。

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引用次数: 0

Assessing the Variation and Drivers of Cost in One-Level Lumbar and Lumbosacral Discectomy: A Time-Driven Activity-Based Costing Analysis. 评估单节段腰椎间盘切除术成本的变化和驱动因素：时间驱动的基于活动的成本分析。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-04 DOI: 10.1016/j.spinee.2026.02.001

Bradley T Hammoor, David N Bernstein, Zenaida A Enchill, Daniel G Tobert, Harry M Lightsey, Stuart H Hershman, Christopher M Bono, Harold A Fogel

Background context: Optimizing the surgical episode cost of care represents a major opportunity for healthcare cost reduction. This requires determining an accurate estimate of these costs, which has historically been difficult to determine. Time-driven activity-based costing (TDABC) has emerged as a methodology for determining more accurate surgical cost drivers compared to traditional methods.Purpose: To examine cost variation and cost drivers in single-level lumbar discectomies using TDABC methodology, focusing on total hospital cost variation, differences between high- and non-high-cost patients and identification of main factors affecting total hospital cost.Study design/setting: Retrospective, multi-center, observational study conducted at an integrated healthcare system between November 2021 and December 2022.Patient sample: The cohort comprised 184 patients undergoing isolated, primary single-level lumbar or lumbosacral discectomy. Revision procedures, multi-level surgeries, concurrent procedures, and cases performed by surgeons with fewer than nine procedures were excluded.Outcome measures: Total hospital costs were calculated using TDABC methodology and normalized to an average of 1.00 per institutional requirements. Cost variation, cost drivers, and differences between high-cost (top decile) and non-high-cost patients were assessed.Methods: TDABC methodology was utilized to calculate total costs for all procedures. Statistical analyses included descriptive statistics, bivariate comparisons between high-cost and non-high-cost patients, and multivariable linear regression to identify individual cost drivers.Results: The most expensive surgery was 3.6 times more expensive than the least expensive, with intraoperative costs comprising 79% of total expenses. A strong correlation existed between surgical time and total cost (ρ = 0.78, p<0.001). High-cost patients were more likely to undergo surgery at academic medical centers (89% vs 42%, p<0.001), less likely to have outpatient surgery (33% vs 93%, p<0.001), had a higher comorbidity burden (Elixhauser comorbidity index 3.1 vs 1.7, p=0.005), and longer operative times (153 vs 59 minutes, p<0.001). Multivariable analysis identified surgical time, outpatient surgery, surgery location, and individual surgeon idiosyncrasies as significant cost determinants.Conclusions: Single-level lumbar discectomies demonstrate modest cost variation primarily driven by surgical time, patient complexity, and surgeon-specific factors. While efforts to reduce unwarranted cost variation without negatively impacting patient outcomes are warranted, orthopaedic or neurosurgical departments and hospital systems may wish to focus their initial efforts on higher cost spine procedures with greater cost variation first before tackling si

背景背景：优化手术期护理成本是降低医疗保健成本的主要机会。这就需要对这些费用作出准确的估计，这在过去是很难确定的。与传统方法相比，时间驱动的作业成本法（TDABC）已经成为一种确定更准确的手术成本驱动因素的方法。目的：采用TDABC方法研究单节段腰椎间盘切除术的成本变化和成本驱动因素，重点关注医院总成本变化、高成本患者和非高成本患者之间的差异以及确定影响医院总成本的主要因素。研究设计/设置：回顾性、多中心、观察性研究，于2021年11月至2022年12月在一个综合医疗保健系统中进行。患者样本：该队列包括184例接受孤立、原发性单节段腰椎或腰骶椎间盘切除术的患者。排除了翻修手术、多级手术、并发手术和少于9例手术的病例。结果测量：使用TDABC方法计算医院总费用，并将其归一化为每个机构需求的平均1.00。评估了成本变化、成本驱动因素以及高成本患者（前十分位数）和非高成本患者之间的差异。方法：采用TDABC方法计算各工序的总成本。统计分析包括描述性统计、高成本和非高成本患者之间的双变量比较，以及多变量线性回归来确定个体成本驱动因素。结果：最昂贵的手术费用是最便宜手术费用的3.6倍，术中费用占总费用的79%。手术时间与总成本之间存在很强的相关性（ρ = 0.78）。结论：单节段腰椎间盘切除术的成本变化不大，主要受手术时间、患者复杂性和外科医生特异性因素的影响。虽然在不影响患者预后的情况下减少不必要的成本变化是有必要的，但骨科或神经外科部门和医院系统可能希望在处理单节段腰椎间盘切除术之前，首先将精力集中在成本更高、成本变化更大的脊柱手术上。

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引用次数: 0

The Mediating Role of Segmental Lordosis Changes in the Relationship Between Surgical Approach and the Incidence of Adjacent Segment Disease in Patients With Degenerative Spinal Disorders: A Retrospective Cohort Study. 在退行性脊柱疾病患者手术入路与相邻节段疾病发生率的关系中，节段前凸改变的中介作用：一项回顾性队列研究

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-04 DOI: 10.1016/j.spinee.2026.01.024

Hong Liu, DongHua Huang, ZhenZhong Chen, Zhan Wang, MiaoJie Fang, Ning Zhang

Background context: Minimally invasive lateral lumbar interbody fusion (MIS-LLIF) and transforaminal lumbar interbody fusion (TLIF) are widely used for lumbar degenerative disease. However, their comparative risk for adjacent segment disease (ASD) remains controversial. Changes in segmental lordosis (∆SL) may play a mediating role in ASD development, but this pathway has not been rigorously quantified.

Purpose: This study aimed to compare the risk of ASD following MIS-LLIF versus TLIF and to evaluate whether ∆SL mediates this relationship.

Study design/setting: An exploratory retrospective cohort study of patients who underwent single-level lumbar fusion at a single institution.

Patient sample: We reviewed 143 patients who underwent single-level MIS-LLIF or TLIF between January 2017 and December 2022.

Outcome measures: The primary outcome measure was the incidence of radiographically confirmed ASD with a minimum 2-year follow-up. The mediating variable was the change in segmental lordosis (∆SL).

Methods: Baseline demographics, surgical parameters, and radiographic outcomes were collected. The mediating effect of ∆SL was assessed using Baron and Kenny with Sobel testing, adjusting for covariates. A counterfactual-based mediation analysis with bootstrap confidence intervals (1,000 samples) was also performed to validate the findings.

Results: The overall incidence of ASD was 16.1% (23.2% in MIS-LLIF vs. 9.5% in TLIF; P=0.045). MIS-LLIF resulted in less segmental lordosis improvement (∆SL) than TLIF (1.50° vs. 2.60°; P<0.001). Initially, MIS-LLIF was associated with higher ASD odds (OR 2.78, 95% CI: 1.12-7.45; P =0.027). Mediation analysis (α = 0.10) identified ∆SL as a mediator, accounting for 64.6% of the total effect (indirect effect: 0.083, 95% CI: 0.01-0.20, P=0.028). After adjusting for ∆SL, the surgical approach was no longer significantly associated with ASD (OR 1.78, 95% CI: 0.56-5.95; P=0.300), whereas ∆SL remained an independent protective factor (OR 0.53 per degree, 95% CI: 0.31-0.87; P=0.010).

Conclusions: In this exploratory analysis, ∆SL statistically explained a substantial proportion of the association between surgical approach and ASD risk. Optimizing segmental lordosis restoration may be a critical and modifiable factor for mitigating ASD, warranting prospective validation.

背景背景：微创侧位腰椎椎间融合术（MIS-LLIF）和经椎间孔腰椎椎间融合术（TLIF）被广泛应用于腰椎退行性疾病。然而，它们对邻近节段疾病（ASD）的比较风险仍存在争议。节段性前凸（∆SL）的改变可能在ASD的发展中起中介作用，但这一途径尚未被严格量化。目的：本研究旨在比较MIS-LLIF与TLIF后ASD的风险，并评估∆SL是否介导了这种关系。研究设计/设置：一项探索性回顾性队列研究，研究对象为在单一机构接受单节段腰椎融合术的患者。患者样本：我们回顾了2017年1月至2022年12月期间接受单级MIS-LLIF或TLIF的143例患者。结局指标：主要结局指标是经过至少2年随访的影像学证实的ASD发病率。调节变量为节段性前凸变化（∆SL）。方法：收集基线人口统计学、手术参数和影像学结果。采用Baron和Kenny结合Sobel检验评估∆SL的中介作用，并对协变量进行调整。一个反事实为基础的中介分析与bootstrap置信区间（1000个样本）也进行了验证结果。结果：ASD的总发病率为16.1% （MIS-LLIF组为23.2%，TLIF组为9.5%，P=0.045）。misi - llif导致的节段性前凸改善（∆SL）低于TLIF（1.50°vs. 2.60°）；结论：在这一探索性分析中，∆SL在统计学上解释了手术入路与ASD风险之间的很大比例的关联。优化节段性前凸修复可能是减轻ASD的关键和可修改的因素，需要前瞻性验证。

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引用次数: 0

Revisiting Hemostasis Strategy: The Impact of Excessive Monopolar Electrocautery on Periosteal-Driven Spinal Fusion. 止血策略重述：过度单极电灼对骨膜驱动脊柱融合的影响。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-04 DOI: 10.1016/j.spinee.2026.01.019

Duby D Okonkwo, Atsuyuki Kawabata, Rachel M Mckee, Kurando Utagawa, J Court Reese, Taku Oyaizu, Stephanie N Moore-Lotridge, Byron F Stephens, Craig R Louer, Toshitaka Yoshii, Jonathan G Schoenecker

Background context: The common surgical approach in posterior spinal fusion (PSF) conflicts with basic principles of bone repair and may lead to high failure rates. In recent years, experimental data has shown that the periosteum plays an indispensable role in fracture bone repair both for skeletal stem/progenitor cells (SSPCs) and for angiogenesis promotion. However, the role of the periosteum in spinal fusion remains experimentally poorly defined. Furthermore, current surgical approach often involves electrocautery to achieve subperiosteal dissection. However, the impact of this electrocautery remains not fully defined. We hypothesize that the periosteum is a potent driver of spinal fusion, and that its excessive ablation through electrocautery can be a significant iatrogenic contributor to reduced bone formation.Purpose: This study investigates the periosteum's contribution to spinal fusion and how electrocautery, commonly used for subperiosteal dissection, impacts this contribution.Study design: A non-decorticated murine PSF model compared bone formation after sharp dissection with electrocautery (Caut) versus sharp dissection without electrocautery (Sharp). A non-decorticated model was utilized to isolate the contributions of the periosteum without decortication as a confounding variable.Methods: Bone formation and integration were evaluated using microCT and histology. Pulse-chase lineage tracing in Aggrecan CreERT2+/Ai9+ mice tracked SSPC source and differentiation pathway. This model identifies mostly cells committed to the chondrogenic lineage during regeneration. Angiogenesis was assessed with Microfil, including 2D and 3D reconstructions.Results: Bone formation was significantly lower on the cauterized side (p = 0.0002; p < 0.0001) 6 weeks after surgery. Sharp dissection without electrocautery triggered a periosteum-driven regenerative process similar to fracture repair, involving both endochondral and intramembranous ossification. Electrocautery abolished this response and significantly decreased periosteum-derived chondrogenesis (p = 0.0009). Angiogenesis was also reduced on the cauterized side (p = 0.0367). Without surgical decortication, new bone integrated into the native cortex through biological remodeling, indicating that surgical decortication may not be necessary.Conclusion: The periosteum is a potent driver of PSF bone formation through combined endochondral and intramembranous ossification, achieving integration without surgical decortication.Clinical significance: Monopolar electrocautery can destroy key regenerative contributions of the periosteum in PSF, cautioning the excessive use of monopolar electrocautery in surgical practices. More research is needed to determine the impact of alternate means of achieving hemostasis such as bipolar on bone formation, as

背景背景：脊柱后路融合（PSF）常见的手术入路与骨修复的基本原则相冲突，可能导致高失败率。近年来的实验数据表明，骨膜在骨折骨修复中无论是对骨干/祖细胞（SSPCs）还是促进血管生成都起着不可或缺的作用。然而，骨膜在脊柱融合中的作用在实验上仍然没有明确的定义。此外，目前的手术方法通常包括电灼来实现骨膜下剥离。然而，这种电灼的影响仍然没有完全确定。我们假设骨膜是脊柱融合的一个强有力的驱动因素，并且通过电灼过度消融骨膜可能是导致骨形成减少的一个重要医源性因素。目的：本研究探讨骨膜对脊柱融合的贡献，以及通常用于骨膜下剥离的电灼术如何影响这一贡献。研究设计：一个未去皮的小鼠PSF模型比较了电灼尖锐解剖（Caut）和未电灼尖锐解剖（sharp）后的骨形成情况。一个未去皮的模型被用来分离没有去皮的骨膜作为一个混杂变量的贡献。方法：采用显微ct和组织学检查观察骨形成和骨整合情况。Aggrecan CreERT2+/Ai9+小鼠的脉冲追踪谱系追踪了SSPC来源和分化途径。该模型鉴定了在再生过程中大部分致力于软骨细胞谱系的细胞。用Microfil评估血管生成，包括2D和3D重建。结果：术后6周，灼烧侧骨形成明显降低（p = 0.0002;p < 0.0001）。无电灼的尖锐剥离触发骨膜驱动的再生过程，类似于骨折修复，涉及软骨内和膜内骨化。电灼消除了这种反应，并显著减少骨膜来源的软骨形成（p = 0.0009）。灼烧侧血管生成也减少（p = 0.0367）。如果不进行手术去皮，新生骨通过生物重塑与原皮质融合，表明手术去皮可能是不必要的。结论：骨膜是PSF骨形成的一个强有力的驱动力，通过软骨内和膜内联合骨化，在没有手术去皮的情况下实现整合。临床意义：单极电灼可破坏PSF骨膜的关键再生功能，手术中应谨慎过度使用单极电灼。需要更多的研究来确定其他止血方法如双极止血对骨形成的影响，因为这些方法可以更好地保护骨膜组织。

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引用次数: 0

Lumbar ossification of the posterior longitudinal ligament as a distinct phenotype of diffuse spinal ligament ossification¹. 腰椎后纵韧带骨化是弥漫性脊柱韧带骨化的一种独特表型。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-03 DOI: 10.1016/j.spinee.2026.01.023

Yoshinao Koike, Tsutomu Endo, Ryo Fujita, Katsuhisa Yamada, Masahiro Kanayama, Hideki Sudo, Ken Kadoya, Huohuo Xue, M Alaa Terkawi, Daisuke Ukeba, Takashi Ohnishi, Shotaro Fukada, Yohei Sodeyama, Ryota Suzuki, Misaki Ishii, Norimasa Iwasaki

Background context: Lumbar ossification of the posterior longitudinal ligament (L-OPLL) has been underrecognized and remains poorly characterized clinically. We hypothesized that L-OPLL constitutes a distinct phenotype within the broader OPLL spectrum, sharing features of obesity and diffuse spinal ligament ossification.Purpose: To evaluate the clinical and radiographic features of L-OPLL and assess their relationship with diffuse spinal ligament ossification and obesity-related factors.Study design: Cross-sectional study with a replication cohort.Patient sample: A total of 186 patients with OPLL were diagnosed using whole-spine computed tomography (CT) at a regional spine center in Japan (2007-2024). Additionally, 75 asymptomatic individuals with OPLL from a population-based health screening cohort comprised the replication cohort.Outcome measures: Patient background, including BMI, was assessed. Spinal ligament ossification was evaluated using whole-spine CT. The severity of ossification was scored for four ligaments-OPLL, OALL (ossification of the anterior longitudinal ligament), OLF (ossification of the ligamentum flavum), and ossification of the supra/interspinous ligament-and summed to define the ossification index (OS index). Regional scores from the cervical, thoracic, and lumbar spine were combined to calculate the total index.Methods: In the primary analysis, patients were classified into L-OPLL and non-L-OPLL groups, and their clinical and radiographic features were compared. Multiple linear regression analysis was used to assess the independent association between L-OPLL and OS index. In the secondary analysis, patients were classified into three groups: localized cervical OPLL (C-OPLL), thoracic OPLL (T-OPLL), and L-OPLL groups, and comparisons were made between the localized C-OPLL group and the T- and L-OPLL groups.Results: The L-OPLL group had a significantly higher BMI (median 27.5 vs. 26.0 kg/m², p=0.003) and greater prevalence of obesity than the non-L-OPLL group, along with significantly elevated thoracic OPLL and OLF indices. Multiple linear regression analysis confirmed that L-OPLL was independently associated with a higher OS index (regression coefficient: 0.448, 95% confidence interval: 0.162 to 0.735, p=0.002). The L-OPLL group also exhibited significantly higher BMI and OS index than the localized C-OPLL group, primarily driven by increased thoracic and lumbar OPLL and OLF. The replication cohort results were consistent with an association between L-OPLL, obesity, and diffuse ligament ossification.Conclusions: L-OPLL is rarely an isolated lumbar lesion; instead, it commonly coexists with extensive spinal ligament ossification and marked obesity. Its distinct clinical and radiographic features support classification as a separate entity

背景背景：腰椎后纵韧带骨化（L-OPLL）一直未被充分认识，临床特征仍然很差。我们假设L-OPLL在更广泛的OPLL谱系中是一种独特的表型，具有肥胖和弥漫性脊柱韧带骨化的特征。目的：评价L-OPLL的临床和影像学特征，并探讨其与弥漫性脊髓韧带骨化和肥胖相关因素的关系。研究设计：具有重复队列的横断面研究。患者样本：在日本的一个区域脊柱中心，共186例OPLL患者使用全脊柱计算机断层扫描（CT）进行诊断（2007-2024）。此外，来自基于人群的健康筛查队列的75名无症状OPLL患者组成了复制队列。结果测量：评估患者背景，包括BMI。采用全脊柱CT评估脊柱韧带骨化情况。对4个韧带骨化的严重程度进行评分——opll、OALL（前纵韧带骨化）、OLF（黄韧带骨化）和棘上/棘间韧带骨化，并将其相加确定骨化指数（OS指数）。结合颈椎、胸椎和腰椎的区域评分来计算总指数。方法：在初步分析中，将患者分为L-OPLL组和非L-OPLL组，比较其临床和影像学特征。采用多元线性回归分析评价L-OPLL与OS指数之间的独立相关性。在二次分析中，将患者分为颈椎局部OPLL （C-OPLL）、胸椎局部OPLL （T-OPLL）和L-OPLL三组，并将局部C-OPLL组与T-、L-OPLL组进行比较。结果：与非L-OPLL组相比，L-OPLL组的BMI（中位数为27.5 vs. 26.0 kg/m²，p=0.003）和肥胖患病率显著高于非L-OPLL组，同时胸部OPLL和OLF指数显著升高。多元线性回归分析证实L-OPLL与较高的OS指数独立相关（回归系数为0.448,95%置信区间为0.162 ~ 0.735,p=0.002）。L-OPLL组的BMI和OS指数也明显高于局部C-OPLL组，这主要是由于胸椎和腰椎OPLL和OLF增加所致。复制队列结果与L-OPLL、肥胖和弥漫性韧带骨化之间的关联一致。结论：L-OPLL很少是孤立的腰椎病变；相反，它通常与广泛的脊柱韧带骨化和明显的肥胖共存。其独特的临床和放射学特征支持将其分类为更广泛的OPLL谱中的独立实体。

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引用次数: 0

Radiographic Predictors of Lumbar Disc Re-Herniation Requiring Repeat Discectomy or Fusion - A Matched Retrospective Cohort Analysis. 需要重复椎间盘切除术或融合的腰椎间盘再次突出的影像学预测因素——一项匹配的回顾性队列分析。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-02 DOI: 10.1016/j.spinee.2026.01.018

Joshua L Golubovsky, Ben J Gu, Elie Massaad, Mert M Dagli, George A Crabill, Yohannes Ghenbot, John Arena, Michael Shost, William C Welch, Zarina Ali, Brendan Judy, Neil R Malhotra, John H Shin, Ali K Ozturk

Background context: Lumbar discectomy is the standard of care for symptomatic lumbar disc herniation (LDH). However, recurrent LDH (rLDH) necessitates reoperation in 3-18% of patients, posing a substantial challenge for both patient counseling and healthcare economics. While studies have focused on demographic and clinical risk factors, the contribution of preoperative radiographic parameters to recurrence risk remains poorly defined.Purpose: This study evaluated preoperative MRIs for patients undergoing one-level lumbar discectomy to determine combined clinical and radiographic factors associated with operative rLDH following a single-level discectomy.Study design: This retrospective cohort study included adult patients who underwent a primary, single-level lumbar microdiscectomy at a tertiary academic center.Patient sample: Adult patients undergoing index one-level lumbar discectomy were included. Patients were excluded for revision surgery, fusion, non-discal pathology, or unavailable preoperative MRI.Outcome measures: Patients were considered to have operative rLDH if they underwent repeat discectomy or discectomy and fusion at the index level within 3 years of their primary surgery. Potential variables included demographics, comorbidities, and radiographic parameters from preoperative MRI, including herniation morphology, disc degeneration (modified Pfirrmann grade), endplate changes (Modic), and facet arthropathy.Methods: A multivariable Cox proportional hazards model was used on a matched cohort to identify independent variables associated with time to reoperation. Receiver operating characteristics curves and were developed based on mixed clinical and radiographic models.Results: 2608 patients underwent single level lumbar discectomy between 2013 - 2024, of whom 129 (4.9%) required reoperation for rLDH. The matched cohort included 250 patients, of whom 129 (51.6%) required reoperation for rLDH within 3 years. After multivariable adjustment, several factors were independently associated with recurrence risk. Significant radiographic factors included the presence of Modic changes (HR, 1.86; 95% CI, 1.23-2.82; P = .003) and a higher facet degeneration index (HR, 1.43 per grade; 95% CI, 1.30-1.57; P < .001). Significant clinical variables included a higher Charlson Comorbidity Index (HR, 1.21 per point; 95% CI, 1.08-1.36; P = .002), younger age (HR, 0.98 per year; 95% CI, 0.96-1.00, P = .04), and male sex (HR, 1.58; 95% CI, 1.09-2.30; P = .02). Radiographic factors increased the AUC compared to clinical factors alone, particularly beyond 1 year.Conclusions: Higher systemic comorbidity burden, degenerative endplate changes, and worsened facet arthropathy are significantly associated with risk of operative rLDH and should be considered for patient counseling a

背景：腰椎间盘切除术是治疗症状性腰椎间盘突出症（LDH）的标准治疗方法。然而，复发性LDH （rLDH）在3-18%的患者中需要再次手术，这对患者咨询和医疗经济学都提出了重大挑战。虽然研究集中在人口统计学和临床危险因素上，但术前放射学参数对复发风险的贡献仍然不明确。目的：本研究评估单节段腰椎间盘切除术患者的术前mri，以确定与单节段腰椎间盘切除术后rLDH相关的临床和影像学综合因素。研究设计：这项回顾性队列研究纳入了在三级学术中心接受初级单节段腰椎微椎间盘切除术的成年患者。患者样本：纳入接受指数一级腰椎间盘切除术的成年患者。排除翻修手术、融合、非椎间盘病理或术前无法获得MRI的患者。结果测量：如果患者在首次手术后3年内再次进行椎间盘切除术或椎间盘切除术并在指数水平进行融合，则认为患者存在手术性rLDH。潜在的变量包括人口统计学、合并症和术前MRI影像学参数，包括突出形态、椎间盘退变（改良Pfirrmann分级）、终板改变（Modic）和小关节突。方法：对匹配队列采用多变量Cox比例风险模型，确定与再手术时间相关的自变量。在临床和放射学混合模型的基础上开发了受试者工作特征曲线。结果：2013 - 2024年间，2608例患者接受了单节段腰椎间盘切除术，其中129例（4.9%）因rLDH需要再次手术。匹配的队列包括250例患者，其中129例（51.6%）在3年内因rLDH需要再次手术。多变量调整后，多个因素与复发风险独立相关。重要的影像学因素包括Modic变化的存在（HR, 1.86; 95% CI, 1.23-2.82; P = ）。003)和更高的关节突退变指数（HR，每级1.43;95% CI, 1.30-1.57; P < .001）。显著的临床变量包括较高的Charlson合并症指数（HR， 1.21 /点；95% CI, 1.08-1.36; P = ）。002)，年龄更小(HR， 0.98 /年；95% CI, 0.96-1.00, P = 。04),雄性(HR 1.58; 95%可信区间,1.09 - -2.30;P = .02点)。与单独的临床因素相比，影像学因素增加了AUC，特别是超过1年。结论：更高的全身合并症负担、退行性终板改变和恶化的小关节突关节病与手术性rLDH的风险显著相关，应在患者咨询和手术计划中予以考虑。

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引用次数: 0

Widening Gaps in Episode of Care Markers between Medicare Managed Care and Medicare Fee-for-Service in Spinal Fusion. 在脊柱融合术中，医疗保险管理式医疗和医疗保险按服务收费之间的护理指标差距越来越大。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-02 DOI: 10.1016/j.spinee.2026.01.022

Alexa K Pius, Henry Wong, Jayme C B Koltsov, Serena S Hu, Andrew J Schoenfeld, Grace X Xiong

Background context: Failure to accurately predict length of stay (LOS) and discharge disposition in the setting of spine fusion episodes of care can have substantial impact on patient care and resource allocation. Mandatory upcoming bundled payment models for spinal fusion will focus solely on Traditional Medicare beneficiaries; however, less is known about episode of care metrics in this subgroup compared with patients in other insurance classes.Purpose: We sought to compare time-based trends among Traditional Medicare (TM) and Medicare Advantage (MA) in 1) LOS and home discharge, 2) readmission and emergency department visits, and 3) prevalence of medical comorbidities and social vulnerability.Study design/setting: The Epic Cosmos dataset (comprising longitudinal records for over 300 million patients from over 1,700 hospitals) was used for this retrospective cohort study.Patient sample: Episodes of care containing single-level lumbar fusions performed in adults between January 1st, 2016, to December 31st, 2024.Outcome measures: The primary outcome was length of stay in days. Secondary outcomes included rates of discharge home, 30-day readmission rates, and 30-day emergency department visits.Methods: Time-based trends and differences among primary insurance classes in LOS were assessed via a negative binomial regression model that included a two-way interaction between primary insurance class and time, with adjustment for sociodemographic, clinical, and institutional covariates. Primary insurance classes included Traditional Medicare, Medicare Advantage, Commercial, and Medicaid. Post-hoc tests were adjusted for multiple comparisons via the Holm-Bonferroni method.Results: Among 126,304 spinal fusion episodes, LOS for TM patients decreased at an adjusted rate of 1.1% [(95% CI 0.4,1.7), p<0.001] faster per year compared with MA (TM: 2016-2024 unadjusted LOS 3.37-2.54; MA 3.53-3.12 days). Between 2016-2024, TM and MA both saw increases in home discharge, however by 2024 MA had higher adjusted rates of home discharge (unadjusted 2016-2024 raw rates TM 77.2-86.8%; MA 76.0-87.9%; adjusted 2024 rate 33% higher than TM [95% CI 18,51%, p < 0.001]). Over the study period, the MA cohort changed to become the group with the greatest number of Hierarchical Conditional Categories (2016 to 2024, 0.45-0.77; 15% increase compared to TM [10%, 22%, p < 0.001]). At the end of the study period, TM and Commercial had similar SVI (unadjusted 50th vs 50th percentile, adjusted p > 0.05) and MA and Medicaid had similar SVI (unadjusted 56th and 63rd percentile, adjusted p > 0.05). There were no differences in time-based trends between groups for readmission rates and emergency department visits.Conclusions: We observed lon

背景背景：在脊柱融合的护理中，不能准确预测住院时间（LOS）和出院处置会对患者护理和资源分配产生重大影响。强制性即将推出的脊柱融合捆绑支付模式将只关注传统医疗保险受益人；然而，与其他保险类别的患者相比，对该亚组的护理指标了解较少。目的：我们试图比较传统医疗保险（TM）和医疗保险优势（MA）在以下方面的基于时间的趋势：1)LOS和家庭出院，2)再入院和急诊就诊，以及3)医疗合并症和社会脆弱性的患病率。研究设计/设置：这项回顾性队列研究使用了Epic Cosmos数据集（包括来自1700多家医院的3亿多名患者的纵向记录）。患者样本：2016年1月1日至2024年12月31日期间在成人中进行的包含单节段腰椎融合的护理事件。结局指标：主要结局指标为住院天数。次要结局包括出院率、30天再入院率和30天急诊科就诊率。方法：通过负二项回归模型评估LOS中基本保险类别基于时间的趋势和差异，该模型包括基本保险类别与时间之间的双向交互作用，并调整了社会人口统计学，临床和制度协变量。主要保险类别包括传统医疗保险、医疗保险优势、商业保险和医疗补助。通过Holm-Bonferroni方法调整事后检验以进行多重比较。结果：在126,304例脊柱融合术中，TM患者的LOS降低率为1.1% (95% CI 0.4,1.7)，第5百分位vs第50百分位，调整后的p > 0.05)， MA和Medicaid具有相似的SVI（未调整的第56和63百分位，调整后的p > 0.05）。两组再入院率和急诊就诊的时间基础趋势无差异。结论：我们观察到，随着时间的推移，与传统医疗保险相比，医疗保险优势延长了住院时间，增加了家庭出院率，但在再入院率或急诊就诊方面没有明显改善。传统的医疗保险现在有LOS和SVI接近商业保险。尽管即将到来的强制性捆绑支付模式将只针对传统医疗保险受益人，但本研究显示的变化突显了传统医疗保险和医疗保险优势受益人之间日益扩大的差距。随着医疗保险优势成为老年人口的主要保险类别，脊柱外科医生应该意识到医疗保险优势患者的特定模式，例如延长住院时间和增加急性后护理的拒绝。临床医生在护理点设定患者期望方面发挥关键作用，手术前出院计划对某些亚组可能很重要。

{"title":"Widening Gaps in Episode of Care Markers between Medicare Managed Care and Medicare Fee-for-Service in Spinal Fusion.","authors":"Alexa K Pius, Henry Wong, Jayme C B Koltsov, Serena S Hu, Andrew J Schoenfeld, Grace X Xiong","doi":"10.1016/j.spinee.2026.01.022","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.01.022","url":null,"abstract":"Background context: Failure to accurately predict length of stay (LOS) and discharge disposition in the setting of spine fusion episodes of care can have substantial impact on patient care and resource allocation. Mandatory upcoming bundled payment models for spinal fusion will focus solely on Traditional Medicare beneficiaries; however, less is known about episode of care metrics in this subgroup compared with patients in other insurance classes.Purpose: We sought to compare time-based trends among Traditional Medicare (TM) and Medicare Advantage (MA) in 1) LOS and home discharge, 2) readmission and emergency department visits, and 3) prevalence of medical comorbidities and social vulnerability.Study design/setting: The Epic Cosmos dataset (comprising longitudinal records for over 300 million patients from over 1,700 hospitals) was used for this retrospective cohort study.Patient sample: Episodes of care containing single-level lumbar fusions performed in adults between January 1st, 2016, to December 31st, 2024.Outcome measures: The primary outcome was length of stay in days. Secondary outcomes included rates of discharge home, 30-day readmission rates, and 30-day emergency department visits.Methods: Time-based trends and differences among primary insurance classes in LOS were assessed via a negative binomial regression model that included a two-way interaction between primary insurance class and time, with adjustment for sociodemographic, clinical, and institutional covariates. Primary insurance classes included Traditional Medicare, Medicare Advantage, Commercial, and Medicaid. Post-hoc tests were adjusted for multiple comparisons via the Holm-Bonferroni method.Results: Among 126,304 spinal fusion episodes, LOS for TM patients decreased at an adjusted rate of 1.1% [(95% CI 0.4,1.7), p<0.001] faster per year compared with MA (TM: 2016-2024 unadjusted LOS 3.37-2.54; MA 3.53-3.12 days). Between 2016-2024, TM and MA both saw increases in home discharge, however by 2024 MA had higher adjusted rates of home discharge (unadjusted 2016-2024 raw rates TM 77.2-86.8%; MA 76.0-87.9%; adjusted 2024 rate 33% higher than TM [95% CI 18,51%, p < 0.001]). Over the study period, the MA cohort changed to become the group with the greatest number of Hierarchical Conditional Categories (2016 to 2024, 0.45-0.77; 15% increase compared to TM [10%, 22%, p < 0.001]). At the end of the study period, TM and Commercial had similar SVI (unadjusted 50th vs 50th percentile, adjusted p > 0.05) and MA and Medicaid had similar SVI (unadjusted 56th and 63rd percentile, adjusted p > 0.05). There were no differences in time-based trends between groups for readmission rates and emergency department visits.Conclusions: We observed lon","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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

Outcomes of en bloc surgery versus separation surgery for spinal solitary bone plasmacytomas: a multicenter cohort study with long-term follow-up durations. 脊柱孤立性骨浆细胞瘤的整体手术与分离手术的结果：一项长期随访的多中心队列研究

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-01 DOI: 10.1016/j.spinee.2026.01.020

Minglei Yang, Xiao Liu, Nanzhe Zhong, Xinru Du, Zhaoming Ye, Juan Du, Weiwei Zou, Yangyang Zhou, Qi Jia, Fei Dong, Yan Liu, Hongqing Zhuang, Xinghai Yang, Jian Jiao, Feng Wei, Jianru Xiao

Background context: Surgical intervention is often required in cases of spinal solitary bone plasmacytoma (SBP) with nerve compression. There is no sufficient evidence to ascertain the advantages of short- and long-term prognosis in such patients receiving en bloc surgery (ES) versus separation surgery (SS).Purpose: To evaluate both short- and long-term outcomes of ES versus SS in patients with spinal SBP.Study design: Multicenter mixed cohort study.Patient sample: From January 2000 and December 2021, 130 patients with spinal SBP were enrolled.Outcome measures: The primary outcomes were overall survival (OS) and multiple myeloma progression-free survival (MPFS), and the secondary outcomes were postoperative neurological functions, visual analogue scale (VAS) and Karnofsky Performance Status (KPS) of the patients and short- or long-term complications.Methods: Of the 130 included patients, 43 received ES, and the other 87 patients received SS plus radiotherapy. Operative data, relief of preoperative symptoms, survival prognosis, disease progression, and local control were compared between the two groups. Bias was minimized via 1:1 propensity score matching (PSM) for age, tumor location and clonal plasma cells in bone marrow. Cox regression models were performed to investigate the association between surgical strategies and primary outcomes, adjusting for confounding factors. In addition, subgroup analysis was carried out based on sex, age, tumor location, clonal plasma cells in bone marrow, and serum M-protein. Finally, a sensitivity analysis that excluded patients with cervical SBP was performed to investigate the robustness and potential sources of bias in our findings.Results: Improvement of neurological symptoms, performance status and pain relief were achieved in both ES and SS groups at 3 months after surgery (both p<0.05). Risk of pleural effusion was significantly higher in ES group (p=0.003). The 5- and 10-year OS rate was 82.6% and 67.4% in the entire cohort, respectively. No significant difference was observed in OS between ES and SS groups (p=0.190). The 5- and 10-year MPFS rate was 71.2% and 55.7% in the entire cohort, respectively, showing no significant difference between the two groups (p=0.402). Also, Cox regression models showed no significant association of the surgical type with OS and MPFS. One of 43 patients (2.33%) in ES group and six of 87 patients (6.90%) in SS group developed local recurrence during the follow up periods (p=0.223). Subgroup analysis showed that ES offered potentially better prognosis in terms of OS and MPFS (both p<0.05) for spinal SBP with no marrow involvement, and these findings were consistent after PSM. The results of this sensitivity analysis were similar to those from the primary analysis.Conclusion: OS and MPFS we

背景：脊柱孤立性骨浆细胞瘤（SBP）合并神经压迫的病例通常需要手术干预。目前还没有足够的证据来确定这些患者接受整体手术（ES）与分离手术（SS）的短期和长期预后的优势。目的：评估ES与SS在脊柱收缩压患者中的短期和长期预后。研究设计：多中心混合队列研究。患者样本：从2000年1月至2021年12月，纳入了130例脊柱收缩压患者。结局指标：主要结局是总生存期（OS）和多发性骨髓瘤无进展生存期（MPFS），次要结局是患者术后神经功能、视觉模拟评分（VAS）和Karnofsky性能状态（KPS）以及短期或长期并发症。方法：纳入的130例患者中，43例接受ES治疗，87例接受SS +放疗。比较两组患者的手术资料、术前症状缓解、生存预后、疾病进展及局部控制情况。通过1:1的倾向评分匹配（PSM）将年龄、肿瘤位置和骨髓中克隆浆细胞的偏差降到最低。采用Cox回归模型来研究手术策略与主要结局之间的关系，并对混杂因素进行校正。此外，根据性别、年龄、肿瘤部位、骨髓克隆浆细胞、血清m蛋白进行亚组分析。最后，我们进行了敏感性分析，排除了颈椎收缩压患者，以调查我们研究结果的稳健性和潜在的偏倚来源。结果：术后3个月，ES组和SS组患者的神经症状、运动状态和疼痛均得到改善（结论：SS +放疗组与ES组患者的OS和MPFS同样令人满意）。对于没有骨髓受累的脊髓性收缩压，ES可能是实现长期疾病控制的更好选择。

{"title":"Outcomes of en bloc surgery versus separation surgery for spinal solitary bone plasmacytomas: a multicenter cohort study with long-term follow-up durations.","authors":"Minglei Yang, Xiao Liu, Nanzhe Zhong, Xinru Du, Zhaoming Ye, Juan Du, Weiwei Zou, Yangyang Zhou, Qi Jia, Fei Dong, Yan Liu, Hongqing Zhuang, Xinghai Yang, Jian Jiao, Feng Wei, Jianru Xiao","doi":"10.1016/j.spinee.2026.01.020","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.01.020","url":null,"abstract":"Background context: Surgical intervention is often required in cases of spinal solitary bone plasmacytoma (SBP) with nerve compression. There is no sufficient evidence to ascertain the advantages of short- and long-term prognosis in such patients receiving en bloc surgery (ES) versus separation surgery (SS).Purpose: To evaluate both short- and long-term outcomes of ES versus SS in patients with spinal SBP.Study design: Multicenter mixed cohort study.Patient sample: From January 2000 and December 2021, 130 patients with spinal SBP were enrolled.Outcome measures: The primary outcomes were overall survival (OS) and multiple myeloma progression-free survival (MPFS), and the secondary outcomes were postoperative neurological functions, visual analogue scale (VAS) and Karnofsky Performance Status (KPS) of the patients and short- or long-term complications.Methods: Of the 130 included patients, 43 received ES, and the other 87 patients received SS plus radiotherapy. Operative data, relief of preoperative symptoms, survival prognosis, disease progression, and local control were compared between the two groups. Bias was minimized via 1:1 propensity score matching (PSM) for age, tumor location and clonal plasma cells in bone marrow. Cox regression models were performed to investigate the association between surgical strategies and primary outcomes, adjusting for confounding factors. In addition, subgroup analysis was carried out based on sex, age, tumor location, clonal plasma cells in bone marrow, and serum M-protein. Finally, a sensitivity analysis that excluded patients with cervical SBP was performed to investigate the robustness and potential sources of bias in our findings.Results: Improvement of neurological symptoms, performance status and pain relief were achieved in both ES and SS groups at 3 months after surgery (both p<0.05). Risk of pleural effusion was significantly higher in ES group (p=0.003). The 5- and 10-year OS rate was 82.6% and 67.4% in the entire cohort, respectively. No significant difference was observed in OS between ES and SS groups (p=0.190). The 5- and 10-year MPFS rate was 71.2% and 55.7% in the entire cohort, respectively, showing no significant difference between the two groups (p=0.402). Also, Cox regression models showed no significant association of the surgical type with OS and MPFS. One of 43 patients (2.33%) in ES group and six of 87 patients (6.90%) in SS group developed local recurrence during the follow up periods (p=0.223). Subgroup analysis showed that ES offered potentially better prognosis in terms of OS and MPFS (both p<0.05) for spinal SBP with no marrow involvement, and these findings were consistent after PSM. The results of this sensitivity analysis were similar to those from the primary analysis.Conclusion: OS and MPFS we","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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

Outpatient Anterior Cervical Discectomy and Fusion on the Rise: Changing Economics and Utilization Patterns in U.S. Hospital-Owned Ambulatory Surgical Centers. 门诊前路颈椎椎间盘切除术和融合术的增加：美国医院拥有的门诊外科中心不断变化的经济和使用模式。

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2026-02-01 DOI: 10.1016/j.spinee.2026.01.017

Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Ilan Podolski, Gregorio Baek, Morgan Hitchner, Afshin E Razi, Barrett Woods, Zachary Wilt, Andrew Alvarez, Jonathan Dalton, Thomas Cha, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler

Background context: The migration of spine surgery to ambulatory surgical centers (ASCs) continues to expand, but national trends in the utilization and cost of anterior cervical discectomy and fusion (ACDF) in these settings remain understudied. This study evaluates trends in volume, payer mix, and inflation-adjusted charges for single-level ACDF procedures performed in hospital-owned ASCs across the United States.

Purpose: To characterize national trends in the utilization and inflation-adjusted cost of single-level ACDF procedures performed in hospital-owned ASCs from 2016 to 2022.

Design: Retrospective cross-sectional study PATIENT SAMPLE: Adult patients undergoing single-level ACDF procedures at ASCs from the National Ambulatory Surgery Sample (NASS) database OUTCOME MEASURES: Our outcomes included outpatient procedure volumes, patient and facility demographics, and payer composition stratified by region and season.

Methods: We conducted a retrospective cross-sectional analysis of the NASS database from 2016 to 2022, identifying single-level ACDF procedures using CPT code 22551. Adult patients undergoing outpatient surgery were included. Survey-weighted methods were used to generate national estimates. Generalized linear models assessed differences in inflation-adjusted per-procedure charges by payer, geographic region, and season. Volume and market share trends were evaluated using linear regression.

Results: A total of 399,939 weighted single-level ACDF procedures were identified. Case volume increased from 33,687 in 2016 to 73,024 in 2021, with a slight decline in 2022. Median patient age increased from 52 to 57 years. The share of Medicare patients grew from 8.6% to 29%, while private insurance declined from 74% to 53%. The overall geometric mean cost was $57,600. Charges varied significantly by payer (P < 0.001), region (P < 0.001), and season (P < 0.001). Procedures in the West were 41% more expensive than in the Northeast. Medicare exhibited the fastest growth in both volume and cost.

Conclusion: ASC-based ACDF procedures have increased substantially, with increasing median patient age, Medicare relative to private patients, and regional cost variation. These findings have important implications for surgical planning, reimbursement, and policy development.

Level of evidence: III.

背景背景：脊柱外科向门诊外科中心（ASCs）的迁移继续扩大，但在这些机构中，前路颈椎椎间盘切除术和融合（ACDF）的使用和成本的全国趋势仍未得到充分研究。本研究评估了在美国医院所有的ASCs中进行的单级ACDF程序的数量、付款人组合和通货膨胀调整后的收费趋势。目的：描述2016年至2022年全国医院所属ASCs单级ACDF手术的使用率和通货膨胀调整后的成本趋势。设计：回顾性横断面研究患者样本：来自国家门诊手术样本（NASS）数据库的在ASCs接受单级ACDF手术的成年患者。结果测量：我们的结果包括门诊手术数量、患者和机构人口统计数据以及按地区和季节分层的付款人组成。方法：我们对2016年至2022年NASS数据库进行了回顾性横断面分析，使用CPT代码22551识别单级ACDF程序。接受门诊手术的成年患者也包括在内。使用调查加权方法来产生国家估计数。广义线性模型评估了付款人、地理区域和季节在通货膨胀调整后的每次收费方面的差异。使用线性回归评估销量和市场份额趋势。结果：共确定了399,939个加权单级ACDF手术。病例数从2016年的33687例增加到2021年的73024例，2022年略有下降。患者中位年龄从52岁增加到57岁。医疗保险患者的比例从8.6%上升到29%，而私人保险则从74%下降到53%。总几何平均费用为$57 600。不同付款人（P < 0.001）、地区（P < 0.001）和季节（P < 0.001）的收费差异显著。西部地区的手术费用比东北部高出41%。医疗保险在数量和成本上都表现出最快的增长。结论：基于asc的ACDF手术已大幅增加，随着患者年龄中位数的增加，相对于私人患者的医疗保险，以及区域成本变化。这些发现对手术计划、报销和政策制定具有重要意义。证据水平：III。

{"title":"Outpatient Anterior Cervical Discectomy and Fusion on the Rise: Changing Economics and Utilization Patterns in U.S. Hospital-Owned Ambulatory Surgical Centers.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, Ilan Podolski, Gregorio Baek, Morgan Hitchner, Afshin E Razi, Barrett Woods, Zachary Wilt, Andrew Alvarez, Jonathan Dalton, Thomas Cha, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1016/j.spinee.2026.01.017","DOIUrl":"https://doi.org/10.1016/j.spinee.2026.01.017","url":null,"abstract":"Background context: The migration of spine surgery to ambulatory surgical centers (ASCs) continues to expand, but national trends in the utilization and cost of anterior cervical discectomy and fusion (ACDF) in these settings remain understudied. This study evaluates trends in volume, payer mix, and inflation-adjusted charges for single-level ACDF procedures performed in hospital-owned ASCs across the United States.Purpose: To characterize national trends in the utilization and inflation-adjusted cost of single-level ACDF procedures performed in hospital-owned ASCs from 2016 to 2022.Design: Retrospective cross-sectional study PATIENT SAMPLE: Adult patients undergoing single-level ACDF procedures at ASCs from the National Ambulatory Surgery Sample (NASS) database OUTCOME MEASURES: Our outcomes included outpatient procedure volumes, patient and facility demographics, and payer composition stratified by region and season.Methods: We conducted a retrospective cross-sectional analysis of the NASS database from 2016 to 2022, identifying single-level ACDF procedures using CPT code 22551. Adult patients undergoing outpatient surgery were included. Survey-weighted methods were used to generate national estimates. Generalized linear models assessed differences in inflation-adjusted per-procedure charges by payer, geographic region, and season. Volume and market share trends were evaluated using linear regression.Results: A total of 399,939 weighted single-level ACDF procedures were identified. Case volume increased from 33,687 in 2016 to 73,024 in 2021, with a slight decline in 2022. Median patient age increased from 52 to 57 years. The share of Medicare patients grew from 8.6% to 29%, while private insurance declined from 74% to 53%. The overall geometric mean cost was $57,600. Charges varied significantly by payer (P < 0.001), region (P < 0.001), and season (P < 0.001). Procedures in the West were 41% more expensive than in the Northeast. Medicare exhibited the fastest growth in both volume and cost.Conclusion: ASC-based ACDF procedures have increased substantially, with increasing median patient age, Medicare relative to private patients, and regional cost variation. These findings have important implications for surgical planning, reimbursement, and policy development.Level of evidence: III.","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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