Pub Date : 2025-10-10DOI: 10.1016/j.spinee.2025.10.007
W Evan Rivers, Eva Thomas, Jessica Chen, Steven Zeliadt, Pradeep Suri
Background context: Previous studies have described utilization trends for lumbar facet pain procedures (LFP) over the past 2 decades in Medicare and commercially-insured populations. No studies have examined LFP utilization in the United States Veterans Health Administration (VHA) healthcare system.
Purpose: To describe trends in utilization of LFP provided through VHA benefits from 2007-2020, including differences in utilization between VHA care and VHA-purchased care.
Study design/setting: Retrospective cohort study.
Patient sample: All Veterans in the VHA healthcare system.
Outcome measures: Annual rates of utilization of lumbar facet injections (LFI) and lumbar medial branch radiofrequency ablation (LMBRFA) procedures.
Methods: We used the VHA Corporate Data Warehouse to identify procedures to treat lumbar zygapophyseal joint pain performed in or purchased by VHA from 2007 to 2020. Descriptive analyses were performed to describe differences in utilization of LFI and LMBRFA procedures over time.
Results: During the 14-year study period, the number of LFP performed in or purchased by VHA per 100,000 enrollees increased by 298% for LFI and 767% for LMBRFA. The enrollee-adjusted growth in utilization for purchased care (1,586% [average annual growth of 122%] for LFI and 3,443% [average annual growth of 265%] for LMBRFA) outpaced observed growth in VHA care (70% [average annual growth of 5%] for LFI and 244% [average annual growth of 19%] for LMBRFA). Purchased care billed for more spinal levels during LFI than VHA care (5.32 vs. 3.71) and performed more procedures than VHA facilities at the end of the study period (2020).
Conclusion: There was substantial growth in the use of LFP among VHA enrollees from 2007-2020. Between 2007 and 2016, growth was greater than that in the Medicare and commercially-insured populations over the same time period. Growth was considerably greater among enrollees receiving LFP purchased by VHA from non-VHA facilities compared to VHA facilities. The steepest increase in utilization occurred after 2014, coinciding with policy changes to increase access to care provided by non-VHA providers.
{"title":"Trends in utilization of lumbar facet injection and radiofrequency ablation through veterans health administration: 2007-2020.","authors":"W Evan Rivers, Eva Thomas, Jessica Chen, Steven Zeliadt, Pradeep Suri","doi":"10.1016/j.spinee.2025.10.007","DOIUrl":"10.1016/j.spinee.2025.10.007","url":null,"abstract":"<p><strong>Background context: </strong>Previous studies have described utilization trends for lumbar facet pain procedures (LFP) over the past 2 decades in Medicare and commercially-insured populations. No studies have examined LFP utilization in the United States Veterans Health Administration (VHA) healthcare system.</p><p><strong>Purpose: </strong>To describe trends in utilization of LFP provided through VHA benefits from 2007-2020, including differences in utilization between VHA care and VHA-purchased care.</p><p><strong>Study design/setting: </strong>Retrospective cohort study.</p><p><strong>Patient sample: </strong>All Veterans in the VHA healthcare system.</p><p><strong>Outcome measures: </strong>Annual rates of utilization of lumbar facet injections (LFI) and lumbar medial branch radiofrequency ablation (LMBRFA) procedures.</p><p><strong>Methods: </strong>We used the VHA Corporate Data Warehouse to identify procedures to treat lumbar zygapophyseal joint pain performed in or purchased by VHA from 2007 to 2020. Descriptive analyses were performed to describe differences in utilization of LFI and LMBRFA procedures over time.</p><p><strong>Results: </strong>During the 14-year study period, the number of LFP performed in or purchased by VHA per 100,000 enrollees increased by 298% for LFI and 767% for LMBRFA. The enrollee-adjusted growth in utilization for purchased care (1,586% [average annual growth of 122%] for LFI and 3,443% [average annual growth of 265%] for LMBRFA) outpaced observed growth in VHA care (70% [average annual growth of 5%] for LFI and 244% [average annual growth of 19%] for LMBRFA). Purchased care billed for more spinal levels during LFI than VHA care (5.32 vs. 3.71) and performed more procedures than VHA facilities at the end of the study period (2020).</p><p><strong>Conclusion: </strong>There was substantial growth in the use of LFP among VHA enrollees from 2007-2020. Between 2007 and 2016, growth was greater than that in the Medicare and commercially-insured populations over the same time period. Growth was considerably greater among enrollees receiving LFP purchased by VHA from non-VHA facilities compared to VHA facilities. The steepest increase in utilization occurred after 2014, coinciding with policy changes to increase access to care provided by non-VHA providers.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281554","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}
Background context: Intervertebral disc degeneration (IVDD) may be age-related, and is often seen in evaluating patients with low back pain (LBP). However, the specific molecular mechanisms underlying IVDD remain incompletely understood.
Purpose: This study aims to collect nucleus pulposus (NP) tissue samples from human intervertebral discs (IVDs) at varying degeneration stages. Utilizing high-throughput proteomics and bioinformatics analysis, we seek to identify hub genes associated with IVDD, elucidate their functional mechanisms, and provide potential molecular targets and theoretical foundations for the precise treatment of IVDD.
Study design: An in vivo and in vitro study.
Methods: We performed mass spectrometry on human nucleus pulposus (NP) tissue samples and applied bioinformatics techniques to screen and identify Hub genes associated with IVDD, followed by enrichment analysis to infer their functional mechanisms. Subsequently, we employed comprehensive molecular biology and genetic approaches to validate the regulatory role of the key hub gene S100A6 in ferroptosis and extracellular matrix (ECM) metabolism. These investigations were systematically conducted across three experimental models: human NP tissue specimens, nucleus pulposus cell (NPC) cultures, and conditional S100A6 knockout mice.
Results: Our data demonstrate that during IVDD, the expression of S100A6 is enhanced through transcriptional regulation by STAT3. In NPCs, the interaction between S100A6 and P53 not only promotes the expression of P53 but also enhances its phosphorylation and nuclear accumulation. Once in the nucleus, P53 suppresses the transcription of SLC7A11, thereby promoting ferroptosis in NPCs and the degradation of the ECM. Knockout of S100A6 in mice alleviates the progression of IVDD.
Conclusions: The STAT3/S100A6/P53/SLC7A11 axis plays a critical role in regulating ferroptosis and ECM metabolism in NPCs, providing promising therapeutic targets for the treatment of IVDD.
Clinical significance: The present investigation provides compelling evidence from human tissues, in vitro cell systems, and knockout mouse models supporting the critical involvement of the STAT3/S100A6/p53/SLC7A11 axis in IVDD progression. These discoveries suggest that pharmacological modulation of this pathway could represent a viable therapeutic approach for managing.
{"title":"The STAT3/S100A6/P53/SLC7A11 axis mediates intervertebral disc degeneration by regulating ferroptosis in nucleus pulposus cells and the metabolism of the extracellular matrix.","authors":"Fengguang Yang, Xuening Liu, Yizhi Zhang, Xiaoming Qiu, Shuanhu Lei, Cangyu Zhang, Haijun Zhang, Yanni Duan, Xuchang Hu, Xuewen Kang","doi":"10.1016/j.spinee.2025.10.009","DOIUrl":"10.1016/j.spinee.2025.10.009","url":null,"abstract":"<p><strong>Background context: </strong>Intervertebral disc degeneration (IVDD) may be age-related, and is often seen in evaluating patients with low back pain (LBP). However, the specific molecular mechanisms underlying IVDD remain incompletely understood.</p><p><strong>Purpose: </strong>This study aims to collect nucleus pulposus (NP) tissue samples from human intervertebral discs (IVDs) at varying degeneration stages. Utilizing high-throughput proteomics and bioinformatics analysis, we seek to identify hub genes associated with IVDD, elucidate their functional mechanisms, and provide potential molecular targets and theoretical foundations for the precise treatment of IVDD.</p><p><strong>Study design: </strong>An in vivo and in vitro study.</p><p><strong>Methods: </strong>We performed mass spectrometry on human nucleus pulposus (NP) tissue samples and applied bioinformatics techniques to screen and identify Hub genes associated with IVDD, followed by enrichment analysis to infer their functional mechanisms. Subsequently, we employed comprehensive molecular biology and genetic approaches to validate the regulatory role of the key hub gene S100A6 in ferroptosis and extracellular matrix (ECM) metabolism. These investigations were systematically conducted across three experimental models: human NP tissue specimens, nucleus pulposus cell (NPC) cultures, and conditional S100A6 knockout mice.</p><p><strong>Results: </strong>Our data demonstrate that during IVDD, the expression of S100A6 is enhanced through transcriptional regulation by STAT3. In NPCs, the interaction between S100A6 and P53 not only promotes the expression of P53 but also enhances its phosphorylation and nuclear accumulation. Once in the nucleus, P53 suppresses the transcription of SLC7A11, thereby promoting ferroptosis in NPCs and the degradation of the ECM. Knockout of S100A6 in mice alleviates the progression of IVDD.</p><p><strong>Conclusions: </strong>The STAT3/S100A6/P53/SLC7A11 axis plays a critical role in regulating ferroptosis and ECM metabolism in NPCs, providing promising therapeutic targets for the treatment of IVDD.</p><p><strong>Clinical significance: </strong>The present investigation provides compelling evidence from human tissues, in vitro cell systems, and knockout mouse models supporting the critical involvement of the STAT3/S100A6/p53/SLC7A11 axis in IVDD progression. These discoveries suggest that pharmacological modulation of this pathway could represent a viable therapeutic approach for managing.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281496","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}
Pub Date : 2025-10-10DOI: 10.1016/j.spinee.2025.10.010
Niklas H Koehne, Junho Song, Auston R Locke, Justin Tiao, Omri Maayan, Eric Mai, Tariq Issa, John J Corvi, Nikan K Namiri, Andrew C Hecht, Sravisht Iyer, Sheeraz A Qureshi
Background context: Patient reported outcome measures (PROMs) have been increasingly utilized to evaluate outcomes of spinal surgery procedures such as lumbar microdiscectomy. To interpret PROMs in a clinically meaningful way, threshold values such as the minimum clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS), and others are used to describe PROM score changes that have clinical relevance. However, there are no standard threshold values for these metrics, which leads to potential variability in results and their clinical interpretation.
Purpose: The purpose of this study was to evaluate the variability of common threshold values reported in lumbar microdiscectomy literature.
Study design/setting: Systematic review METHODS: Pubmed and Embase were searched for studies from January 1, 2000 - May 1, 2024 that reported threshold values for PROMs following lumbar microdiscectomy. Patient demographics, study characteristics, threshold values, and threshold calculation methods were extracted for all PROM outcomes.
Results: A total of 45 relevant studies were identified, collectively studying 85,954 patients undergoing lumbar microdiscectomy. The average age of included patients was 46.7±5.9 years with an average BMI of 26.9±1.9. There were 121 MCID threshold values reported, 8 PASS thresholds, 3 SCB, 3 MIC, and 2 MCRC. A total of 20 unique PROMs were reported, which most commonly included ODI, VAS-leg, VAS-back, and SF-12 PCS. Forty-five of the included studies referenced previous threshold values, while 3 studies (all MCID) calculated novel threshold recommendations. Among these three studies, there were 10 novel MCID thresholds reported for 4 different PROMs. The range of MCID thresholds for the most common PROMs were 20 (2.0-22.0) for ODI, 4.7 (1.1-5.8) for VAS-leg, 1.8 (1.2-3.0) for VAS-back, and 2.8 (2.9-5.7) for SF-12 PCS. PASS, SCB, MIC, and MCRC thresholds did not demonstrate variability in the literature.
Conclusion: The MCID threshold values used in the lumbar microdiscectomy literature display considerable variability, especially for ODI PROMs. This variability is likely due to variations in calculation methods, the generalization of these values from other spine pathologies to microdiscectomy, and certain inherent limitations of MCID thresholds. This study highlights the importance of standardizing PROM threshold values for more accurate assessments of lumbar microdiscectomy outcomes.
{"title":"Variability of minimum clinically important difference threshold values in lumbar microdiscectomy literature: a systematic review.","authors":"Niklas H Koehne, Junho Song, Auston R Locke, Justin Tiao, Omri Maayan, Eric Mai, Tariq Issa, John J Corvi, Nikan K Namiri, Andrew C Hecht, Sravisht Iyer, Sheeraz A Qureshi","doi":"10.1016/j.spinee.2025.10.010","DOIUrl":"10.1016/j.spinee.2025.10.010","url":null,"abstract":"<p><strong>Background context: </strong>Patient reported outcome measures (PROMs) have been increasingly utilized to evaluate outcomes of spinal surgery procedures such as lumbar microdiscectomy. To interpret PROMs in a clinically meaningful way, threshold values such as the minimum clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS), and others are used to describe PROM score changes that have clinical relevance. However, there are no standard threshold values for these metrics, which leads to potential variability in results and their clinical interpretation.</p><p><strong>Purpose: </strong>The purpose of this study was to evaluate the variability of common threshold values reported in lumbar microdiscectomy literature.</p><p><strong>Study design/setting: </strong>Systematic review METHODS: Pubmed and Embase were searched for studies from January 1, 2000 - May 1, 2024 that reported threshold values for PROMs following lumbar microdiscectomy. Patient demographics, study characteristics, threshold values, and threshold calculation methods were extracted for all PROM outcomes.</p><p><strong>Results: </strong>A total of 45 relevant studies were identified, collectively studying 85,954 patients undergoing lumbar microdiscectomy. The average age of included patients was 46.7±5.9 years with an average BMI of 26.9±1.9. There were 121 MCID threshold values reported, 8 PASS thresholds, 3 SCB, 3 MIC, and 2 MCRC. A total of 20 unique PROMs were reported, which most commonly included ODI, VAS-leg, VAS-back, and SF-12 PCS. Forty-five of the included studies referenced previous threshold values, while 3 studies (all MCID) calculated novel threshold recommendations. Among these three studies, there were 10 novel MCID thresholds reported for 4 different PROMs. The range of MCID thresholds for the most common PROMs were 20 (2.0-22.0) for ODI, 4.7 (1.1-5.8) for VAS-leg, 1.8 (1.2-3.0) for VAS-back, and 2.8 (2.9-5.7) for SF-12 PCS. PASS, SCB, MIC, and MCRC thresholds did not demonstrate variability in the literature.</p><p><strong>Conclusion: </strong>The MCID threshold values used in the lumbar microdiscectomy literature display considerable variability, especially for ODI PROMs. This variability is likely due to variations in calculation methods, the generalization of these values from other spine pathologies to microdiscectomy, and certain inherent limitations of MCID thresholds. This study highlights the importance of standardizing PROM threshold values for more accurate assessments of lumbar microdiscectomy outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276452","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}
Background context: Lumbar facet joint osteoarthritis (FJOA) is a major cause of low back pain, yet its molecular mechanisms remain poorly understood. Casein Kinase 1 epsilon (CK1ε) has been implicated in OA, but its role in FJOA is unclear.
Purpose: To investigate the relationship between CK1ε expression and FJOA severity, and validate its functional role using CK1ε conditional knockout (CKO) mice.
Study design: An experimental study.
Methods: Human facet joint cartilage specimens were obtained from FJOA patients (Pathria grade 2-3) and controls (scoliosis patients, Pathria grade 0-1). CK1ε, matrix metallopeptidase 13 (MMP13), and collagen (Col) I, II, X expression were evaluated via immunofluorescence, immunohistochemistry, and Western blot. For in vivo validation, wild-type and CK1ε CKO mice underwent unilateral facet joint osteotomy to induce FJOA. Cartilage degeneration was assessed histologically (OARSI score) and molecularly (CK1ε, JNK/p-JNK, MMP13 expression).
Results: In human FJOA cartilage, CK1ε and MMP13 were significantly upregulated, while Col II decreased and Col I and Col X increased. CK1ε expression strongly correlated with Pathria grade (r=0.973, p<.001) and inversely with Col II (r=-0.992, p<.001). In mice, osteotomy-induced FJOA increased CK1ε, MMP13, and p-JNK expression, and severe cartilage degeneration was observed. CKO mice showed protection against cartilage damage, with near-normal OARSI scores and reduced expression of degenerative markers.
Conclusions: CK1ε is upregulated in FJOA and strongly correlates with degeneration severity. It promotes cartilage breakdown via JNK pathway activation. Genetic inhibition of CK1ε attenuates FJOA progression in mice.
Clinical significance: CK1ε is a key promoter of cartilage degeneration in FJOA and a potential therapeutic target for mitigating disease progression.
{"title":"Effect of casein kinase 1 epsilon on promoting cartilage degeneration in lumbar facet joint osteoarthritis.","authors":"Lixian Tan, Tianwei He, Runmin Tang, Wenwei Xie, Limin Rong, Liangming Zhang","doi":"10.1016/j.spinee.2025.10.013","DOIUrl":"10.1016/j.spinee.2025.10.013","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar facet joint osteoarthritis (FJOA) is a major cause of low back pain, yet its molecular mechanisms remain poorly understood. Casein Kinase 1 epsilon (CK1ε) has been implicated in OA, but its role in FJOA is unclear.</p><p><strong>Purpose: </strong>To investigate the relationship between CK1ε expression and FJOA severity, and validate its functional role using CK1ε conditional knockout (CKO) mice.</p><p><strong>Study design: </strong>An experimental study.</p><p><strong>Methods: </strong>Human facet joint cartilage specimens were obtained from FJOA patients (Pathria grade 2-3) and controls (scoliosis patients, Pathria grade 0-1). CK1ε, matrix metallopeptidase 13 (MMP13), and collagen (Col) I, II, X expression were evaluated via immunofluorescence, immunohistochemistry, and Western blot. For in vivo validation, wild-type and CK1ε CKO mice underwent unilateral facet joint osteotomy to induce FJOA. Cartilage degeneration was assessed histologically (OARSI score) and molecularly (CK1ε, JNK/p-JNK, MMP13 expression).</p><p><strong>Results: </strong>In human FJOA cartilage, CK1ε and MMP13 were significantly upregulated, while Col II decreased and Col I and Col X increased. CK1ε expression strongly correlated with Pathria grade (r=0.973, p<.001) and inversely with Col II (r=-0.992, p<.001). In mice, osteotomy-induced FJOA increased CK1ε, MMP13, and p-JNK expression, and severe cartilage degeneration was observed. CKO mice showed protection against cartilage damage, with near-normal OARSI scores and reduced expression of degenerative markers.</p><p><strong>Conclusions: </strong>CK1ε is upregulated in FJOA and strongly correlates with degeneration severity. It promotes cartilage breakdown via JNK pathway activation. Genetic inhibition of CK1ε attenuates FJOA progression in mice.</p><p><strong>Clinical significance: </strong>CK1ε is a key promoter of cartilage degeneration in FJOA and a potential therapeutic target for mitigating disease progression.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281465","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}
Pub Date : 2025-10-09DOI: 10.1016/j.spinee.2025.10.002
Luke Channer, Olivia Krol, Travis Philipp, Christina Wright, Jonathan Kark, Spencer Smith, Jung Yoo
<p><strong>Background context: </strong>Native vertebral osteomyelitis (NVO) presents a serious clinical challenge because of its nonspecific presentation, diagnostic delays, and associated morbidity and mortality. Existing literature on vertebral osteomyelitis (VO) emphasizes its general clinical features and mortality factors, yet critical gaps remain regarding the specific risk factors that drive NVO.</p><p><strong>Purpose: </strong>To quantify the incidence and identify risk factors for NVO in the United States using a longitudinal national claims database.</p><p><strong>Study design/setting: </strong>This was a retrospective study of patient healthcare records sourced from a national claims database.</p><p><strong>Patient sample: </strong>Patient records were obtained from the PearlDiver database, a comprehensive U.S. dataset encompassing patient records from governmental and commercial insurance providers, as well as the National Inpatient Sample. From this database, a random sample of 1 million patients was selected in 2010 and monitored over a 10-year period to identify new cases of VO. Patients who underwent spinal surgery within 6 months prior to infection were excluded to focus on risks of NVO.</p><p><strong>Outcome measures: </strong>Diagnosis of NVO using International Classification of Diseases, 10th revision (ICD-10) and International Classification of Diseases, 9th revision (ICD-9) codes from claims data, with subsequent risk factor analysis.</p><p><strong>Methods: </strong>Demographic and clinical variables included age, sex, alcohol abuse, chronic steroid use, osteoporosis, diabetes, tobacco use, cannabis use, stimulant use, rheumatoid arthritis, chronic liver disease, and the Charlson Comorbidity Index (CCI) score. Logistic regression was performed to identify independent risk factors for NVO. Cox proportional hazards modeling was applied to estimate the impact of covariates on infection over time.</p><p><strong>Results: </strong>The study analyzed 1 million patients in the PearlDiver database, identifying 1615 cases of VO over a 10-year period. After excluding 146 cases due to recent spinal surgery, 1469 patients were considered to have NVO. The incidence over the 10-year study period was 14.69 per 100,000 patients for 2010 to 2020. Patients with NVO were older than patients without NVO (61.8 years vs 50.8 years, p<.0001) with a slight male predominance (55.75%, n=819). Common comorbidities for patients in the NVO group included tobacco use (53.44%), diabetes (53.10%), obesity (48.47%) and chronic liver disease (24.78%). Multivariable logistic regression and Cox proportional hazards modeling were conducted. Stimulant use was strongly associated with increased odds of NVO (OR: 4.03, 95% CI: 3.09 to 5.21, p<.0001). Additional significant risk factors included rheumatoid arthritis (OR: 2.05, 95% CI 1.74-2.41, p < 0.0001), diabetes (OR 1.88, 95% CI: 1.69 to 2.11, p<.0001), cannabis use (OR: 1.72, CI: 1.35 to 2.18, p<.0001), obesit
{"title":"Incidence and risk factors for native vertebral osteomyelitis: a retrospective cohort study using a National Claims Database.","authors":"Luke Channer, Olivia Krol, Travis Philipp, Christina Wright, Jonathan Kark, Spencer Smith, Jung Yoo","doi":"10.1016/j.spinee.2025.10.002","DOIUrl":"10.1016/j.spinee.2025.10.002","url":null,"abstract":"<p><strong>Background context: </strong>Native vertebral osteomyelitis (NVO) presents a serious clinical challenge because of its nonspecific presentation, diagnostic delays, and associated morbidity and mortality. Existing literature on vertebral osteomyelitis (VO) emphasizes its general clinical features and mortality factors, yet critical gaps remain regarding the specific risk factors that drive NVO.</p><p><strong>Purpose: </strong>To quantify the incidence and identify risk factors for NVO in the United States using a longitudinal national claims database.</p><p><strong>Study design/setting: </strong>This was a retrospective study of patient healthcare records sourced from a national claims database.</p><p><strong>Patient sample: </strong>Patient records were obtained from the PearlDiver database, a comprehensive U.S. dataset encompassing patient records from governmental and commercial insurance providers, as well as the National Inpatient Sample. From this database, a random sample of 1 million patients was selected in 2010 and monitored over a 10-year period to identify new cases of VO. Patients who underwent spinal surgery within 6 months prior to infection were excluded to focus on risks of NVO.</p><p><strong>Outcome measures: </strong>Diagnosis of NVO using International Classification of Diseases, 10th revision (ICD-10) and International Classification of Diseases, 9th revision (ICD-9) codes from claims data, with subsequent risk factor analysis.</p><p><strong>Methods: </strong>Demographic and clinical variables included age, sex, alcohol abuse, chronic steroid use, osteoporosis, diabetes, tobacco use, cannabis use, stimulant use, rheumatoid arthritis, chronic liver disease, and the Charlson Comorbidity Index (CCI) score. Logistic regression was performed to identify independent risk factors for NVO. Cox proportional hazards modeling was applied to estimate the impact of covariates on infection over time.</p><p><strong>Results: </strong>The study analyzed 1 million patients in the PearlDiver database, identifying 1615 cases of VO over a 10-year period. After excluding 146 cases due to recent spinal surgery, 1469 patients were considered to have NVO. The incidence over the 10-year study period was 14.69 per 100,000 patients for 2010 to 2020. Patients with NVO were older than patients without NVO (61.8 years vs 50.8 years, p<.0001) with a slight male predominance (55.75%, n=819). Common comorbidities for patients in the NVO group included tobacco use (53.44%), diabetes (53.10%), obesity (48.47%) and chronic liver disease (24.78%). Multivariable logistic regression and Cox proportional hazards modeling were conducted. Stimulant use was strongly associated with increased odds of NVO (OR: 4.03, 95% CI: 3.09 to 5.21, p<.0001). Additional significant risk factors included rheumatoid arthritis (OR: 2.05, 95% CI 1.74-2.41, p < 0.0001), diabetes (OR 1.88, 95% CI: 1.69 to 2.11, p<.0001), cannabis use (OR: 1.72, CI: 1.35 to 2.18, p<.0001), obesit","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259804","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}
Pub Date : 2025-10-08DOI: 10.1016/j.spinee.2025.08.188
Anthony Yung MSc , Oluwatobi Onafowokan MBBS, MSc , Max Fisher MD , Ethan Cottrill MD, PhD , Iryna Ivasyk MD, PhD , Isabel Prado MS , Caroline M. Wu MD , Alexander Parsons MSc , Khoi Duc Than MD , Kristen Jones MD , Virginie Lafage PhD , Brett Rocos MD, MBChB, FRCS (Tr, Orth) , Renaud Lafage MSc , Christopher I. Shaffrey MD , Peter Gust Passias MD
<div><h3>BACKGROUND CONTEXT</h3><div>Adult spinal deformity (ASD) is a debilitating disorder of the lumbar and thoracic spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Preoperative rehabilitation programs have recently been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on surgical ASD patient outcomes.</div></div><div><h3>PURPOSE</h3><div>Identify if preoperative rehabilitation influences patient outcomes following ASD-corrective surgery</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study of a prospective adult thoracolumbar deformity database.</div></div><div><h3>PATIENT SAMPLE</h3><div>Consecutive series of 899 ASD patients.</div></div><div><h3>OUTCOME MEASURES</h3><div>Preoperative rehabilitation, cognitive behavioral therapy, length of stay, readmission, ODI.</div></div><div><h3>METHODS</h3><div>ASD patients with baseline (BL) and 2-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into 2 groups: those who had preoperative rehabilitation (Prehab+) and those who did not (Prehab-). Prehab consisted of physical and mental components. Patients were excluded if they presented with any of the following at BL: severe neurological deficit (< 3/5), minimal ambulation, or current depression/anxiety. Normalized HRQL scores at BL and follow-up intervals (6W, 1Y, 2Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost was calculated using the PearlDiver database. Cost per Quality-Adjusted Life Year (QALY) at 2Y was calculated. Means comparison tests and Multivariable regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.</div></div><div><h3>RESULTS</h3><div>The study included 464 patients, with 186 in the preoperative rehabilitation group (Prehab+) and 278 in the nonrehabilitation group (Prehab-). Prehab+ patients were older (65.5 ± 11.8 vs 57.2 ± 14.9 years; p < 0.001), had a higher Charlson Comorbidity Index (CCI) (2.2 ± 1.7 vs 1.5 ± 1.6; p < 0.001), and a higher BMI (28.4 ± 6.0 vs 26.2 ± 5.0; p < 0.001). They also exhibited higher rates of comorbidities such as hypertension, arthritis, and diabetes compared to the Prehab- group. Despite these differences, Prehab+ patients achieved significantly better outcomes. Prehab+ patients had shorter lengths of stay (LOS) (7.0 ± 4.3 vs 7.8 ± 4.1 days; p = 0.045) and lower estimated blood loss (1177.0 ± 1325.3 ml vs 1532.8 ± 1410.7 ml; p = 0.006). Transfusion rates were also lower in the Prehab+ group (54% vs 67%; p = 0.003). Early discharge was more common in the Prehab+ group, with significantly more patients discharged w
成人脊柱畸形（ASD）是一种腰椎和胸椎衰弱性疾病，严重影响患者的生活质量。手术矫正是一种行之有效的治疗选择，可提供功能恢复和疼痛缓解。最近实施了术前康复计划，为患者做好手术准备并促进患者健康。本研究的目的是确定术前康复对手术ASD患者预后的影响。目的：确定术前康复是否会影响asd矫正手术后患者的预后。研究设计/背景：前瞻性成人胸腰椎畸形数据库的回顾性队列研究。患者样本：899名ASD患者的连续系列。再手术康复，认知行为治疗，住院时间，再入院，ODI。方法纳入基线（BL）和2年（2Y）随访的ssd患者，如果他们有术前康复资料。患者分为术前康复组（Prehab+）和未术前康复组（Prehab-）。Prehab由身体和精神两部分组成。如果患者在BL中出现以下任何一种情况，则将其排除在外：严重的神经功能障碍（< 3/5），极少的活动，或当前的抑郁/焦虑。在BL和随访间隔（6W, 1Y, 2Y）生成归一化HRQL评分。绘制归一化hrql并计算曲线下的面积，生成一个描述总体恢复的数字（综合健康状态[IHS]）。使用PearlDiver数据库计算成本。计算2Y时每个质量调整生命年（QALY）的成本。方法比较试验和多变量回归分析评估了患者报告的结果以及基线和手术特征的成本调整。结果共纳入464例患者，术前康复组（Prehab+） 186例，非康复组（Prehab-） 278例。Prehab+患者年龄较大（65.5±11.8 vs 57.2±14.9;p < 0.001）， Charlson合并症指数（CCI）较高（2.2±1.7 vs 1.5±1.6;p < 0.001）， BMI较高（28.4±6.0 vs 26.2±5.0;p < 0.001）。与Prehab组相比，他们也表现出更高的合并症，如高血压、关节炎和糖尿病。尽管存在这些差异，Prehab+患者取得了明显更好的结果。Prehab+患者的住院时间（LOS）较短（7.0±4.3 vs 7.8±4.1天；p = 0.045），估计失血量较低（1177.0±1325.3 ml vs 1532.8±1410.7 ml; p = 0.006）。Prehab+组输血率也较低（54% vs 67%; p = 0.003）。提前出院在Prehab+组中更为常见，3天内出院的患者明显更多（13.0% vs 3.2%; p < 0.001）。Prehab+组SICU住院率较低（51.6% vs 65.4%; p = 0.003）。Prehab+组患者总并发症发生率（69.9% vs 78.4%, p = 0.038）和医学并发症发生率（16.7% vs 24.8%, p = 0.036）较低。Prehab+组的再手术率显著降低（18.3% vs 33.5%; p < 0.001）。多因素分析证实，Prehab+患者的并发症风险（OR: 0.6; 95% CI: 0.42-0.87; p = 0.035）和再手术风险（OR: 0.38; 95% CI: 0.24-0.61; p < 0.001）较低。Prehab+患者在2年时也表现出优越的健康相关生活质量（HRQL）结果，包括在6周时SF-36 PCS达到最小临床重要差异（MCID）的比例更高（42.9% vs 15.1%; p = 0.003）和1年时SRS-22r总分（OR: 3.11; 95% CI: 1.16-8.4; p = 0.024）。成本-效果分析显示，Prehab+患者在2年的每个QALY成本较低（14,463美元vs 45,515美元；p < 0.05）。结论：在成人脊柱畸形手术后2年随访中，术后康复与更短的住院时间、更好的临床结果报告、更大的效用、手术成本和成本效益显著相关。fda器械/药物状态本摘要未讨论或包括任何适用的器械或药物。
{"title":"6. The effect of preoperative rehabilitation on adult spinal deformity patient outcomes, patient recovery, kinetics, and cost-effectiveness","authors":"Anthony Yung MSc , Oluwatobi Onafowokan MBBS, MSc , Max Fisher MD , Ethan Cottrill MD, PhD , Iryna Ivasyk MD, PhD , Isabel Prado MS , Caroline M. Wu MD , Alexander Parsons MSc , Khoi Duc Than MD , Kristen Jones MD , Virginie Lafage PhD , Brett Rocos MD, MBChB, FRCS (Tr, Orth) , Renaud Lafage MSc , Christopher I. Shaffrey MD , Peter Gust Passias MD","doi":"10.1016/j.spinee.2025.08.188","DOIUrl":"10.1016/j.spinee.2025.08.188","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Adult spinal deformity (ASD) is a debilitating disorder of the lumbar and thoracic spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Preoperative rehabilitation programs have recently been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on surgical ASD patient outcomes.</div></div><div><h3>PURPOSE</h3><div>Identify if preoperative rehabilitation influences patient outcomes following ASD-corrective surgery</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study of a prospective adult thoracolumbar deformity database.</div></div><div><h3>PATIENT SAMPLE</h3><div>Consecutive series of 899 ASD patients.</div></div><div><h3>OUTCOME MEASURES</h3><div>Preoperative rehabilitation, cognitive behavioral therapy, length of stay, readmission, ODI.</div></div><div><h3>METHODS</h3><div>ASD patients with baseline (BL) and 2-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into 2 groups: those who had preoperative rehabilitation (Prehab+) and those who did not (Prehab-). Prehab consisted of physical and mental components. Patients were excluded if they presented with any of the following at BL: severe neurological deficit (< 3/5), minimal ambulation, or current depression/anxiety. Normalized HRQL scores at BL and follow-up intervals (6W, 1Y, 2Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost was calculated using the PearlDiver database. Cost per Quality-Adjusted Life Year (QALY) at 2Y was calculated. Means comparison tests and Multivariable regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.</div></div><div><h3>RESULTS</h3><div>The study included 464 patients, with 186 in the preoperative rehabilitation group (Prehab+) and 278 in the nonrehabilitation group (Prehab-). Prehab+ patients were older (65.5 ± 11.8 vs 57.2 ± 14.9 years; p < 0.001), had a higher Charlson Comorbidity Index (CCI) (2.2 ± 1.7 vs 1.5 ± 1.6; p < 0.001), and a higher BMI (28.4 ± 6.0 vs 26.2 ± 5.0; p < 0.001). They also exhibited higher rates of comorbidities such as hypertension, arthritis, and diabetes compared to the Prehab- group. Despite these differences, Prehab+ patients achieved significantly better outcomes. Prehab+ patients had shorter lengths of stay (LOS) (7.0 ± 4.3 vs 7.8 ± 4.1 days; p = 0.045) and lower estimated blood loss (1177.0 ± 1325.3 ml vs 1532.8 ± 1410.7 ml; p = 0.006). Transfusion rates were also lower in the Prehab+ group (54% vs 67%; p = 0.003). Early discharge was more common in the Prehab+ group, with significantly more patients discharged w","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Pages S4-S5"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236103","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}
<div><h3>BACKGROUND CONTEXT</h3><div>When chronic low back pain (CLBP) persists after conservative management, there are limited treatment options. Increasingly, researchers and clinicians are defining distinct phenotypes within the chronic low back pain population in order to develop and provide more targeted and effective interventions. One such phenotype involves people with mechanical low back pain and impaired motor control, identified with a positive prone instability test. Implantable restorative neurostimulation (ReActiv8, Mainstay Medical, San Diego CA) was developed to deliver an electrical stimulation to the L2 medial branch in two 30-minute intervals per day to restore multifidus function and improve chronic low back pain. Preliminary results were encouraging from a feasibility study, leading to a pivotal trial called “ReActive8-B” (https://clinicaltrials.gov/study/NCT02577354). While the pivotal trial demonstrated statistically significant benefits over the sham in all secondary outcomes, the primary outcome was inconclusive. More recently, results from a 1-year RCT comparing restorative neurostimulation to optimal medical management sheds new light on the timing of recovery from this therapy.</div></div><div><h3>PURPOSE</h3><div>This study was designed to re-evaluate the ReActive8 B outcomes in light of the newly published comparative-effectiveness trial and under parameters commonly employed in interventional pain trails.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Prospective, randomized, double-blind, multicenter sham-controlled clinical trial.</div></div><div><h3>PATIENT SAMPLE</h3><div>From 26 centers, 204 participants between ages 22-75 were recruited with mechanical low back pain on at least half of the days in the prior year, despite physical therapy and 90 days of medical management, and a positive prone instability test on physical exam.</div></div><div><h3>OUTCOME MEASURES</h3><div>Participants completed several patient-reported-outcomes at baseline and at the primary endpoint of 120 days following implantation of the active stimulator or sham stimulator, including: VAS, ODI, EQ-5D, and subject global impression of change (SGIC).</div></div><div><h3>METHODS</h3><div>Using an intention to treat analysis, we compared differences between the active stimulator group and the sham group. Demographics were expressed using descriptive statistics. Patient reported outcomes were compared between groups with a categorical analysis, setting responder thresholds at commonly used benchmarks and established minimum clinically important change (MCIC) thresholds. Statistical significance was determined by a 2-sided p-value from the Fisher's exact test with significance set at p<0.05.</div></div><div><h3>RESULTS</h3><div>A total of 200 participants (100 active, 100 sham) were included in the ITT analysis with an average age of 46.47 ± 9.42 years and 54.5% (109/200) female. From baseline to the 120-day primary endpoint, statistical
背景：当慢性腰痛（CLBP）在保守治疗后仍然存在时，治疗选择有限。越来越多的研究人员和临床医生在慢性腰痛人群中定义不同的表型，以便开发和提供更有针对性和有效的干预措施。其中一种表型涉及机械性腰痛和运动控制受损的人，通过俯卧不稳定性测试呈阳性。植入式修复性神经刺激（ReActiv8，中流砥柱医疗公司，San Diego CA）被开发用于每天两次30分钟的间隔向L2内侧分支提供电刺激，以恢复多裂肌功能并改善慢性腰痛。一项可行性研究的初步结果令人鼓舞，导致了一项名为“ReActive8-B”的关键试验（https://clinicaltrials.gov/study/NCT02577354）。虽然关键试验在所有次要结果中显示统计学上显著优于假试验，但主要结果尚无定论。最近，一项为期1年的RCT比较恢复性神经刺激和最佳医疗管理的结果揭示了这种治疗的恢复时间。目的：本研究旨在根据新发表的比较有效性试验和介入性疼痛试验常用的参数，重新评估reactive8b的结果。研究设计/设置：前瞻性、随机、双盲、多中心假对照临床试验。患者样本：从26个中心招募了204名年龄在22-75岁之间的参与者，尽管进行了物理治疗和90天的医疗管理，并且在体检中倾向不稳定测试呈阳性，但在前一年至少有一半的时间出现机械性腰痛。受试者在植入主动刺激器或假刺激器后120天的基线和主要终点完成了几项患者报告的结果，包括：VAS、ODI、EQ-5D和受试者总体变化印象（SGIC）。方法采用意向治疗分析，比较主动刺激器组与假手术组的差异。人口统计数据用描述性统计表示。通过分类分析比较两组患者报告的结果，在常用基准上设置应答者阈值，并建立最小临床重要变化（MCIC）阈值。统计学显著性由Fisher精确检验的双侧p值确定，显著性设置为p<；0.05。结果ITT分析共纳入受试者200例（阳性100例，假100例），平均年龄46.47±9.42岁，女性占54.5%（109/200）。从基线到120天的主要终点，在ODI的MCIC阈值上观察到积极治疗的统计学显著差异：≥15点改善（64.3% vs 47.5%, p=0.022）和≥30%改善（58.2% vs 40.4%, p=0.016）；EQ-5D的MCIC：改善0.15 (56.1% vs 34.7%; p=0.004)；SGIC为“更好”或更高（54.1% vs 33.3%; p=0.004）。疼痛结果产生了一个混合的结果，在积极治疗和假治疗之间，报告VAS改善50%的患者比例（43.9% vs 36.4%; p=0.311）或报告VAS改善2点的患者比例（60.2% vs 49.5%; p=0.153）无显著差异，而疼痛的平均减少在统计学上有利于积极治疗（-3.3 vs -2.4; p=0.032）。以120天为主要终点，采用常见的临床相关成功阈值，对reactive8b临床试验的再分析显示，积极治疗在残疾、生活质量和患者满意度方面具有统计学显著的益处，而在疼痛方面的改善则有不同的结果。在120天内，残疾、生活质量和患者满意度的持续改善以及不一致的疼痛结果可能反映了恢复性神经刺激的作用机制，或者可能是由于该疗法提供的疼痛改善的时间-正如最近的1年比较有效性RCT和reactive8b临床试验治疗组的5年结果所证明的那样。FDA器械/药物状态（StatusReActiv8）（批准用于该适应症）。
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Pub Date : 2025-10-08DOI: 10.1016/j.spinee.2025.08.225
Michelle Zhang BSN, RN , Rahul Ramanathan MD , Alexander Kaufmann BS(c) , Christopher Como MDBS , Yunting Tang MD , Anthony Oyekan MD , Christopher Gonzalez BA , Michael J Spitnale MD , Richard Wawrose MD , Joon Yung Lee MD , Jeremy D. Shaw MD
<div><h3>BACKGROUND CONTEXT</h3><div>Spine-related transfers to higher-level trauma centers have become common practice, often due to the complexity of spine care and the uncertainty referring providers face in managing spine pathology. Many cases result in nonoperative management, leading to unnecessary resource utilization, delayed care, and increased financial burden. Investigations into unnecessary spine transfers remain sparse, yet the impact remains a burden on patients, healthcare systems, and providers. Our study aims to analyze trends and impacts of spine transfers in a large multicenter hospital system and develop validated criteria to guide referring providers in determining transfer appropriateness.</div></div><div><h3>PURPOSE</h3><div>This study aims to evaluate trends and impacts of spine-related transfers within a large multicenter hospital system and develop validated criteria to guide referring providers in determining transfer appropriateness.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a retrospective cohort study conducted at our institution’s primary and tertiary referral centers.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 117 spine transfer cases were analyzed, including patients transferred for trauma, degenerative conditions, tumors, and infections.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary outcome measures include classification of transfer urgency, rates of surgical intervention, discrepancies between referring and spine provider evaluations, and the proportion of patients who could have been managed without transfer.</div></div><div><h3>METHODS</h3><div>A retrospective cohort of spine transfers to our institution’s primary and tertiary referral centers was collected. Variables included patient demographics, transfer category (trauma, degenerative, tumor, infection), referring vs spine provider physical examinations, and operative vs nonoperative management. A custom classification was developed based on spinal pathology criteria and categorized as Urgent Transfer, Nonurgent Transfer, No Transfer with Outpatient Follow-up, and No Transfer without Outpatient Follow-up. Each patient was assigned a classification based on transfer indication.</div></div><div><h3>RESULTS</h3><div>Preliminary analysis of 117 transfers showed trauma (47%) and degenerative (35.9%) indications comprised most transfers, followed by infection (11.1%) and finally tumor (6%). Most patients were classified as Nonurgent Transfer (44.4%), followed by No Transfer with Outpatient Follow-up (30.8%). Surgery was performed in 34.5% of transferred patients, with Urgent Transfers undergoing surgery more frequently. Neurological deficits documented by spine providers were 2.3 times more likely to lead to surgery than those documented by referring providers (p<.05). Significantly fewer patients received surgery in the No Transfer with Outpatient Follow-up group (4 vs 32, p<.05). No patients in the No Transfer without
背景背景脊柱相关转移到更高级别的创伤中心已经成为一种常见的做法，通常是由于脊柱护理的复杂性和转诊提供者在处理脊柱病理时面临的不确定性。许多病例导致非手术治疗，导致不必要的资源利用，延误护理，并增加经济负担。对不必要的脊柱转移的调查仍然很少，但对患者、医疗保健系统和提供者的影响仍然是一个负担。我们的研究旨在分析大型多中心医院系统中脊柱转移的趋势和影响，并制定有效的标准来指导转诊提供者确定转移的适当性。目的：本研究旨在评估大型多中心医院系统中脊柱相关转移的趋势和影响，并制定有效的标准来指导转诊提供者确定转移的适宜性。研究设计/设置：这是一项在我院初级和三级转诊中心进行的回顾性队列研究。患者SAMPLEA共分析了117例脊柱转移病例，包括因创伤、退行性疾病、肿瘤和感染而转移的患者。主要结局指标包括转院紧急程度的分类、手术干预率、转诊和脊柱提供者评估之间的差异，以及本可以不转院的患者比例。方法对我院一级和三级转诊中心的脊柱转移患者进行回顾性分析。变量包括患者人口统计学、转移类别（创伤、退行性、肿瘤、感染）、转诊与脊柱提供者体格检查、手术与非手术处理。根据脊柱病理标准制定了自定义分类，分为紧急转院、非紧急转院、无门诊随访的转院和无门诊随访的转院。根据转移指征对每位患者进行分类。结果117例转移的初步分析显示，外伤（47%）和退行性变（35.9%）是转移的主要指征，其次是感染（11.1%），最后是肿瘤（6%）。大多数患者为非紧急转院（44.4%），其次为无转院门诊随访（30.8%）。34.5%的转院患者接受手术，紧急转院患者接受手术的频率更高。脊柱提供者记录的神经功能缺陷导致手术的可能性是转诊提供者记录的神经功能缺陷的2.3倍（p< 0.05）。无转院门诊随访组接受手术的患者明显减少（4 vs 32, p < 0.05）。无门诊随访无转院组无手术。结论：我们的研究结果表明，相当一部分脊柱相关转移到更高级别的创伤中心是非紧急的，许多患者最终不需要手术干预。创伤和退行性疾病是转移的常见原因；然而，相当大比例的患者（29%）可以在转诊机构或通过门诊随访进行管理，因为他们不需要手术。被确定为紧急转院的患者最有可能接受手术，这支持了我们的定制分类系统在确定转院必要性方面的准确性和临床相关性。脊柱提供者记录的神经功能缺陷往往导致手术，突出了转诊提供者对脊柱患者的初步评估可能不准确或不一致。这些发现强调需要标准化的分诊标准和改善转诊提供者和脊柱专家之间的沟通，以尽量减少不必要的转移和优化患者护理。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。
{"title":"43. Optimizing spine transfer decisions: assessing appropriateness and reducing unnecessary transfers","authors":"Michelle Zhang BSN, RN , Rahul Ramanathan MD , Alexander Kaufmann BS(c) , Christopher Como MDBS , Yunting Tang MD , Anthony Oyekan MD , Christopher Gonzalez BA , Michael J Spitnale MD , Richard Wawrose MD , Joon Yung Lee MD , Jeremy D. Shaw MD","doi":"10.1016/j.spinee.2025.08.225","DOIUrl":"10.1016/j.spinee.2025.08.225","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Spine-related transfers to higher-level trauma centers have become common practice, often due to the complexity of spine care and the uncertainty referring providers face in managing spine pathology. Many cases result in nonoperative management, leading to unnecessary resource utilization, delayed care, and increased financial burden. Investigations into unnecessary spine transfers remain sparse, yet the impact remains a burden on patients, healthcare systems, and providers. Our study aims to analyze trends and impacts of spine transfers in a large multicenter hospital system and develop validated criteria to guide referring providers in determining transfer appropriateness.</div></div><div><h3>PURPOSE</h3><div>This study aims to evaluate trends and impacts of spine-related transfers within a large multicenter hospital system and develop validated criteria to guide referring providers in determining transfer appropriateness.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a retrospective cohort study conducted at our institution’s primary and tertiary referral centers.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 117 spine transfer cases were analyzed, including patients transferred for trauma, degenerative conditions, tumors, and infections.</div></div><div><h3>OUTCOME MEASURES</h3><div>Primary outcome measures include classification of transfer urgency, rates of surgical intervention, discrepancies between referring and spine provider evaluations, and the proportion of patients who could have been managed without transfer.</div></div><div><h3>METHODS</h3><div>A retrospective cohort of spine transfers to our institution’s primary and tertiary referral centers was collected. Variables included patient demographics, transfer category (trauma, degenerative, tumor, infection), referring vs spine provider physical examinations, and operative vs nonoperative management. A custom classification was developed based on spinal pathology criteria and categorized as Urgent Transfer, Nonurgent Transfer, No Transfer with Outpatient Follow-up, and No Transfer without Outpatient Follow-up. Each patient was assigned a classification based on transfer indication.</div></div><div><h3>RESULTS</h3><div>Preliminary analysis of 117 transfers showed trauma (47%) and degenerative (35.9%) indications comprised most transfers, followed by infection (11.1%) and finally tumor (6%). Most patients were classified as Nonurgent Transfer (44.4%), followed by No Transfer with Outpatient Follow-up (30.8%). Surgery was performed in 34.5% of transferred patients, with Urgent Transfers undergoing surgery more frequently. Neurological deficits documented by spine providers were 2.3 times more likely to lead to surgery than those documented by referring providers (p<.05). Significantly fewer patients received surgery in the No Transfer with Outpatient Follow-up group (4 vs 32, p<.05). No patients in the No Transfer without ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S23"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236321","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}
Pub Date : 2025-10-08DOI: 10.1016/j.spinee.2025.08.211
Thierry P Marnay MD , Guilhaume Geneste MD , Gregory Edgard-Rosa MD , Martin Grau-Ortiz MD
<div><h3>BACKGROUND CONTEXT</h3><div>Multiple studies have shown that lumbar total disc arthroplasty (TDA) is not only safe and effective in treating chronic lumbar degenerative disc disease (DDD), but also provides a better surgical alternative to fusion with respect to patient-reported results, restoring motion, and reducing reoperation rates and severity of adjacent level degeneration. Published evidence is limited regarding motion restoration analysis.</div></div><div><h3>PURPOSE</h3><div>Beyond index level measurements, we also extended our analysis to the influence of pelvic participation in flexion extension and global lumbar lumbo-pelvic motion after 1-level TDA.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective clinical study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 772 chronic lumbar DDD patients (391 male, 381 females, mean age 43±9.81 years).</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinically, patients were evaluated preoperatively, then postoperatively at 3, 6, 12, and 24 months, then yearly. Patient follow-up ranged between 7 and 21 years (mean 11 years, 8 months). Collected data included Oswestry Disability Index (ODI), Visual Analog back and leg pain Scores (VAS), neurological/physical assessment. Complication, reoperation/revision rates, and perioperative data points were also assessed. From a radiologic viewpoint we measured, pre- and postoperatively, pelvic parameters, index level flexion/extension motion, pelvic Range of Motion (ROM) (sacral slope, flexion/extension angle), and L1 RACE (L1 in extension and flexion angle). We also compared patients with prior surgeries versus those without previous surgeries.</div></div><div><h3>METHODS</h3><div>Patients who underwent lumbar TDA at one level from 1999 to 2013. A total of 222 out of 772 patients (28.7%) had prior index-level surgery. The level distribution was: 1 at L2-L3, 14 at L3-L4, 234 at L4-L5 and 523 at L5-S1.</div></div><div><h3>RESULTS</h3><div>All patients showed dramatic and statistically significant ODI reduction by 3 months postsurgery (p<0.001) and then maintained scores over time. ODI improvement ranged from 26 to 30 points. Although patients with prior surgery took longer to reach final VAS pain levels (back and leg) (6 versus 3 months), there was no statistical difference between groups in pain reduction at 24 months. Radiographically, we compared the gain in ROM for the L5-S1, L4-L5 and L3-L4 TDA groups. The index level ROM improved 8.3° at L5-S1 TDA group, 9.4° at L4-L5 TDA, 11.5° at L3-L4 group. The lumbar extension-flexion gain was 19.7° for L5-S1 TDA group, 14.1° for L4-L5, and 32.° for L3-L4. The pelvic range of motion gain was 13.83° at L5-S1 TDA group, 20.6° at L4-L5, and 21.2° for the patients operated on at L3-L4. The global motion gain measured by L1 Race was 31.34° in L5-S1 TDA group, 26.1° in L4-L5, and 50.0° in L3-L4.</div></div><div><h3>CONCLUSIONS</h3><div>In one of the largest groups of TDA patients evaluated
{"title":"29. Functional radiographic assessment of 772 patients treated with 1-level lumbar TDR: an analysis of pelvic ROM and LI race as motion parameters","authors":"Thierry P Marnay MD , Guilhaume Geneste MD , Gregory Edgard-Rosa MD , Martin Grau-Ortiz MD","doi":"10.1016/j.spinee.2025.08.211","DOIUrl":"10.1016/j.spinee.2025.08.211","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Multiple studies have shown that lumbar total disc arthroplasty (TDA) is not only safe and effective in treating chronic lumbar degenerative disc disease (DDD), but also provides a better surgical alternative to fusion with respect to patient-reported results, restoring motion, and reducing reoperation rates and severity of adjacent level degeneration. Published evidence is limited regarding motion restoration analysis.</div></div><div><h3>PURPOSE</h3><div>Beyond index level measurements, we also extended our analysis to the influence of pelvic participation in flexion extension and global lumbar lumbo-pelvic motion after 1-level TDA.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective clinical study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 772 chronic lumbar DDD patients (391 male, 381 females, mean age 43±9.81 years).</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinically, patients were evaluated preoperatively, then postoperatively at 3, 6, 12, and 24 months, then yearly. Patient follow-up ranged between 7 and 21 years (mean 11 years, 8 months). Collected data included Oswestry Disability Index (ODI), Visual Analog back and leg pain Scores (VAS), neurological/physical assessment. Complication, reoperation/revision rates, and perioperative data points were also assessed. From a radiologic viewpoint we measured, pre- and postoperatively, pelvic parameters, index level flexion/extension motion, pelvic Range of Motion (ROM) (sacral slope, flexion/extension angle), and L1 RACE (L1 in extension and flexion angle). We also compared patients with prior surgeries versus those without previous surgeries.</div></div><div><h3>METHODS</h3><div>Patients who underwent lumbar TDA at one level from 1999 to 2013. A total of 222 out of 772 patients (28.7%) had prior index-level surgery. The level distribution was: 1 at L2-L3, 14 at L3-L4, 234 at L4-L5 and 523 at L5-S1.</div></div><div><h3>RESULTS</h3><div>All patients showed dramatic and statistically significant ODI reduction by 3 months postsurgery (p<0.001) and then maintained scores over time. ODI improvement ranged from 26 to 30 points. Although patients with prior surgery took longer to reach final VAS pain levels (back and leg) (6 versus 3 months), there was no statistical difference between groups in pain reduction at 24 months. Radiographically, we compared the gain in ROM for the L5-S1, L4-L5 and L3-L4 TDA groups. The index level ROM improved 8.3° at L5-S1 TDA group, 9.4° at L4-L5 TDA, 11.5° at L3-L4 group. The lumbar extension-flexion gain was 19.7° for L5-S1 TDA group, 14.1° for L4-L5, and 32.° for L3-L4. The pelvic range of motion gain was 13.83° at L5-S1 TDA group, 20.6° at L4-L5, and 21.2° for the patients operated on at L3-L4. The global motion gain measured by L1 Race was 31.34° in L5-S1 TDA group, 26.1° in L4-L5, and 50.0° in L3-L4.</div></div><div><h3>CONCLUSIONS</h3><div>In one of the largest groups of TDA patients evaluated","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S16"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236325","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}
Pub Date : 2025-10-08DOI: 10.1016/j.spinee.2025.08.217
Daniella Ogilvie MD , Brandon Ogilvie MD , Tej Joshi MD , Michael J. Vives MD
<div><h3>BACKGROUND CONTEXT</h3><div>Adequate pain control after lumbar spinal surgery is essential for achieving optimal outcomes. While opioid analgesics have shown to be an effective tool in controlling pain, they come with the risk of patients becoming opioid dependent. Previous studies have demonstrated that administration of glucocorticoids after spinal surgery is associated with decreased postoperative pain scores. There is some hesitancy by surgeons to use glucocorticoids in lumbar fusion due to the risk of wound complications and pseudoarthrosis. To date, no large-scale studies have investigated the effects of postoperative methylprednisolone on opioid utilization following lumbar spinal fusions.</div></div><div><h3>PURPOSE</h3><div>The purpose of this study was to utilize a large, international database with a propensity-matched cohort to analyze the primary outcome of opioid utilization after lumbar fusion for patients who received postoperative methylprednisolone compared to those who did not.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This was a large, retrospective international database analysis utilizing the TriNetX platform.</div></div><div><h3>PATIENT SAMPLE</h3><div>All patients in the TriNetX platform who underwent lumbar fusion with a minimum follow-up of 30 days were included for analysis. Patients were excluded if they had received methylprednisolone at any point in the year preceding the index surgery.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome measure was opioid utilization at 7, 14, and 30 days postoperatively. Secondary outcome measures included bowel regimen use, postoperative ileus, deep venous thrombosis (DVT), pulmonary embolism (PE), surgical site infection, wound disruption, hospital readmission, and emergency department visits at the same time points. At 1- and 2-years postoperatively, additional outcomes included in our analysis were mechanical/hardware complications and pseudoarthrosis.</div></div><div><h3>METHODS</h3><div>Patients in the TriNetX platform who underwent lumbar fusion with a minimum follow-up of 30 days were identified. Patients were then split into two groups: those who received postoperative methylprednisolone and those who did not. These patients were then propensity-matched 1:1 based on sex, age, ethnicity, and additional comorbidities. Analysis was performed for the above outcome measures.</div></div><div><h3>RESULTS</h3><div>After propensity-matched analysis, 13,209 patients were included in each group. At all short-term time points of 7, 14, and 30 days, patients who received methylprednisolone had a 0.771 (HR 0.751 – 0.792, p < 0.001) times lower risk, 0.788 times lower risk (0.768 – 0.809, p < 0.001), and 0.792 (0.772 – 0.812, p < 0.001) times lower risk of opioid utilization, respectively. Similarly, at 7 (2.1 ± 1.9 versus 2.8 ± 2.0, p < 0.001), 14 (2.7 ± 2.8 versus 3.6 ± 3.2, p < 0.001), and 30 days (3.4 ± 4.2 versus 4.5 ± 4.7, p < 0.001)
{"title":"35. Postoperative methylprednisolone is associated with reduced opioid use following lumbar spinal fusion: a matched cohort analysis","authors":"Daniella Ogilvie MD , Brandon Ogilvie MD , Tej Joshi MD , Michael J. Vives MD","doi":"10.1016/j.spinee.2025.08.217","DOIUrl":"10.1016/j.spinee.2025.08.217","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Adequate pain control after lumbar spinal surgery is essential for achieving optimal outcomes. While opioid analgesics have shown to be an effective tool in controlling pain, they come with the risk of patients becoming opioid dependent. Previous studies have demonstrated that administration of glucocorticoids after spinal surgery is associated with decreased postoperative pain scores. There is some hesitancy by surgeons to use glucocorticoids in lumbar fusion due to the risk of wound complications and pseudoarthrosis. To date, no large-scale studies have investigated the effects of postoperative methylprednisolone on opioid utilization following lumbar spinal fusions.</div></div><div><h3>PURPOSE</h3><div>The purpose of this study was to utilize a large, international database with a propensity-matched cohort to analyze the primary outcome of opioid utilization after lumbar fusion for patients who received postoperative methylprednisolone compared to those who did not.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This was a large, retrospective international database analysis utilizing the TriNetX platform.</div></div><div><h3>PATIENT SAMPLE</h3><div>All patients in the TriNetX platform who underwent lumbar fusion with a minimum follow-up of 30 days were included for analysis. Patients were excluded if they had received methylprednisolone at any point in the year preceding the index surgery.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome measure was opioid utilization at 7, 14, and 30 days postoperatively. Secondary outcome measures included bowel regimen use, postoperative ileus, deep venous thrombosis (DVT), pulmonary embolism (PE), surgical site infection, wound disruption, hospital readmission, and emergency department visits at the same time points. At 1- and 2-years postoperatively, additional outcomes included in our analysis were mechanical/hardware complications and pseudoarthrosis.</div></div><div><h3>METHODS</h3><div>Patients in the TriNetX platform who underwent lumbar fusion with a minimum follow-up of 30 days were identified. Patients were then split into two groups: those who received postoperative methylprednisolone and those who did not. These patients were then propensity-matched 1:1 based on sex, age, ethnicity, and additional comorbidities. Analysis was performed for the above outcome measures.</div></div><div><h3>RESULTS</h3><div>After propensity-matched analysis, 13,209 patients were included in each group. At all short-term time points of 7, 14, and 30 days, patients who received methylprednisolone had a 0.771 (HR 0.751 – 0.792, p < 0.001) times lower risk, 0.788 times lower risk (0.768 – 0.809, p < 0.001), and 0.792 (0.772 – 0.812, p < 0.001) times lower risk of opioid utilization, respectively. Similarly, at 7 (2.1 ± 1.9 versus 2.8 ± 2.0, p < 0.001), 14 (2.7 ± 2.8 versus 3.6 ± 3.2, p < 0.001), and 30 days (3.4 ± 4.2 versus 4.5 ± 4.7, p < 0.001)","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 11","pages":"Page S19"},"PeriodicalIF":4.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236233","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}
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