Spine Journal最新文献

Background: Lumbar decompression is a common intervention for spinal stenosis and disc herniation, yet many patients fail to achieve a minimal clinically important difference (MCID) in disability. Identifying predictors of MCID may optimize patient selection and improve surgical outcomes.

Purpose: To identify demographic, clinical, and radiographic predictors of MCID achievement one year after lumbar decompression, and to develop a preoperative risk stratification tool.

Study design/setting: Prospective cohort study using a single-center spine registry.

Patient sample: One hundred ninety patients undergoing 1 to 4 level lumbar decompression (laminectomy, microdiscectomy, or laminotomy) from 2020 to 2023.

Outcome measures: Oswestry disability index (ODI) improvement meeting MCID, defined as ≥12.8-point improvement or ≥50% improvement if baseline ODI ≤26, per validated thresholds.

Methods: Patients were grouped by MCID status (MCID+ vs. MCID-). Comparative statistics, ROC analysis, and stepwise logistic regression were used to identify independent preoperative predictors.

Results: Mean age was 60.2 years; 64% were male. At 1 year, mean ODI improved from 41.9 to 16.3 (p<.001). Predictors of successful outcomes (MCID+) included: Demographic (age <62.2yrs, CCI <1.5, Clinical (symptom duration <6 months, ODI >41) and Radiographic (sagittal lordosis at L1 <9.67°, pelvic tilt <20.9°, pelvic incidence <54°). Subgroup analyses showed that predictors differed by procedure type, with microdiscectomy outcomes primarily influenced by symptom duration and number of levels decompressed, whereas laminectomy/laminotomy outcomes were additionally associated with segmental lordosis. A 4-point risk score was developed using the four strongest independent predictors overall: symptom duration <6 months, ODI >41, and pelvic tilt <20.9°, and procedure type (microdiscectomy). MCID achievement ranged from 39% (0 predictors) to 100% (4 predictors).

Conclusion: Shorter symptom duration, greater baseline disability, favorable pelvic alignment, and procedure type were independently associated with MCID achievement. The overall 4-point, 3-point for laminectomy/laminotomy, and 2-point for microdiscectomy risk scores are a practical tool for individualized preoperative counseling and surgical planning.

Background context: Increasing number of patients are undergoing surgical treatment for adult spinal deformity (ASD). The main indications are pain, disability and loss of function. Multiple patient- reported health related quality of life (HRQOL) measures are utilized to assess functional status and disability before and after the surgery. Some components of these questionnaires may be more pertinent in the elderly population.

Purpose: Primary aim was to assess key functional outcomes were most relevant to elderly patients undergoing multilevel fusion surgery for ASD. Secondary aim was to assess if these functional improvements were maintained over the follow up period.

Study design/setting: Post hoc analysis of prospectively collected data from multicenter observational study, where primary outcome was the absolute changes in the SRS-22r total and subtotal scores between baseline and 2-years FU.

Patient sample: Two Hundred nineteen patients.

Outcome measures: Self-reported and functional measures were included. Function was assessed using the Scoliosis Research Society 22r (SRS-22r) function domain, and the personal care, walking, sitting and standing sections from the Oswestry disability index (ODI) and EuroQol- 5 Dimension (EQ-5D-3L scores).

Methods: Patients ≥60 years of age from 12 international centres undergoing spinal fusion of at least 5 levels were included. Follow up visits were performed at 10 weeks, 12 months, 24 months and 60 months.

Results: A total of 219 patients (80.4% females) were included with a mean age of 67.5 years. The mean SRS-22r function scores preoperative were 2.70 (CI: 2.60-2.80), which improved to 3.46 (CI: 3.36-3.56) by 2 years postsurgery and were maintained at 5 years (3.39, CI: 3.27-3.51). 44.9% patients were either bedbound or had primarily no activity before the surgery which reduced to 18.3 % at 2 years and 17.4% at 5 years follow up. Similarly, the percentage of patients that could stand >30 minutes improved from 24.5% to 68.6% at 2 years and 59.4% at 5 years. 26% of the patients could walk for a mile or more before surgery which improved to 63.1 % at 2 years and maintained in 58.7% patients at 5 years. 43.1 % had unlimited sitting preoperatively, that improved to 65.3% at 2 years and 64.7% at 5 years. Normal social life was seen in 19.2% of patients at baseline compared to 57.5% at 2 years and 52.7% at 5 years.

Conclusions: Elderly patients undergoing multilevel spinal fusions for ASD experienced significant functional improvements, which were maintained at 5 years postoperatively. This practical information can be utilized during patient counselling preoperatively when considering functional outcomes after major ASD surgery in patients over 60 years of age.

Background context: Surgical treatment for adult spinal deformity (ASD) is associated with high rates of perioperative complications and mortality. To address these complexities, multidisciplinary approaches have emerged as a promising strategy to optimize patient care, enhance surgical outcomes, and mitigate complications.

Purpose: This study examines whether a multidisciplinary conference at a quaternary referral center discriminates based on socioeconomic disparities measured by the Area Deprivation Index (ADI).

Study design/ setting: Single-center retrospective review.

Patient sample: 698 patients evaluated in a multidisciplinary conference between August 2015 and March 2025.

Outcome measures: The primary outcome was the recommendation for surgery following multidisciplinary conference discussion. ADI scores were compared between patients who were recommended for surgery and those who were not. Secondly outcomes were demographic data, clinical outcomes, comorbidity index (CCI), and socioeconomic factors among these two groups.

Methods: Participants were categorized to surgery group (n = 398) and non-surgery group (n = 300).

Results: On univariate analysis, patients recommended for surgery were more likely to be White (80.7% vs. 65.3%, p < .001), non-Hispanic (88.4% vs. 73.3%, p < .001), and had greater distance to the hospital (146.7 vs. 91.7 miles, p = .01). In the multivariate model, non-Hispanic ethnicity (OR 2.58, 95% CI 1.69-3.99) and White race (OR 1.60, 95% CI 1.09-2.33) were independently associated with higher odds of surgical recommendation. Other factors, including insurance type, CCI, ADI, and distance to hospital, were not significant predictors in the multivariate model.

Conclusions: This study identified that surgical recommendations in a multidisciplinary spine clinic were not associated with socioeconomic factor. Our findings highlight the importance of future efforts on developing strategies to identify and mitigate these persistent individual-level biases.

Background context: Full-endoscopic lumbar discectomy for disc herniation has gained attention as a minimally invasive technique aimed at reducing approach-related morbidity while achieving similar outcomes to more conventional microscopic discectomy techniques.

Purpose: To assess the safety and efficacy of full-endoscopic versus microscopic lumbar discectomy for the treatment of lumbar disc herniation.

Study design: Systematic review and meta-analysis.

Methods: A systematic review of randomised and nonrandomised studies comparing full-endoscopic and microscopic lumbar discectomy was conducted in accordance with the PRISMA guidelines. Treatment effects were estimated using pairwise random-effects meta-analysis. Quality assessment was evaluated using the Joanna Briggs Institute Critical Appraisal Tool.

Results: A total of 28 primary references comprising 4,186 patients were included. Endoscopic decompression was associated with significantly shorter time to return to work (WMD=-22.61 days, 95% CI: -34.15 to -11.08, p<.01), shorter length of hospital stay (WMD=-2.20 days, 95% CI: -3.16 to -1.24, p<.01), lower risk of postoperative infections (RR=0.38, 95% CI: 0.18 to 0.80, p=.95), and lower risk of delayed wound healing, poor wound healing, and wound dehiscence (RR=0.20, 95% CI: 0.04 to 0.91, p=.93). However, endoscopic decompression was also associated with a higher risk of postoperative dysesthesia (RR=2.28, 95% CI: 1.12 to 4.61, p=.56).

Conclusion: Full-endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar disc herniation. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to substantiate findings from the present study.

Stem cell-based therapies for spinal cord injury (SCI) have generated substantial global interest; however, no regenerative treatment has yet demonstrated sufficient efficacy to achieve full regulatory approval in major jurisdictions. In Japan, an expedited regulatory framework enabled the conditional approval of Stemirac, an autologous mesenchymal stem cell therapy for SCI, based on limited and uncontrolled clinical evidence. This Perspective examines the scientific, methodological, and ethical implications of that decision. Focusing on trial design, outcome assessment, extensive public and media attention during the confirmatory trial period, and downstream societal consequences, we explore how premature commercialization under public reimbursement may compromise scientific rigor and erode public trust. The Stemirac case offers important lessons for regulators, clinicians, and researchers worldwide, underscoring the need to balance rapid patient access with robust evidentiary standards in the development of regenerative therapies for SCI.