Spine Journal最新文献

Background: Congenital cervical stenosis (CCS) is a rare condition involving a narrowed spinal canal due to developmental anomalies. CCS heightens the risk of neurologic deficits and acute spinal cord injury posttrauma, influencing return-to-play decisions for contact athletes. Additionally, CCS patients are prone to cervical myelopathy as degenerative changes progress with age. Limited evidence-based literature exists addressing the epidemiology of CCS, including the effects of race.

Purpose: To investigate the anatomical differences and prevalence of CCS as it pertains to race and ethnicity.

Study design: Single center retrospective cross-sectional study.

Patient sample: A total of 343 patients with cervicalgia between the years of 1999 and 2023.

Outcome measures: Radiographic measurements of anatomical parameters were collected and CCS was defined as a sagittal canal diameter (SCD) of less than 10 mm at 2 or more vertebral levels (C3-7) at the pedicle.

Methods: We screened 5,395 cervical MRIs from a single institution. Exclusion criteria included patients under 18 and over 50 years, prior cervical spine surgery, congenital fusions, spinal malignancy, or active smoking history. For each patient, axial measurements were taken at each level, including coronal vertebral body length, anteroposterior vertebral body length, pedicle width, pedicle length, laminar length, anteroposterior lateral mass length, posterior canal distance, apex-to-vertebral body, lamina-disc angle (LDA), lamina-pedicle angle, and anteroposterior spinal cord diameter.

Results: CCS prevalence varied significantly among ethnic groups; Black (39.3%), Asian (33.6%), and Hispanic (22%) patients demonstrated significantly higher CCS rates than White patients (7.5%) (x² [3, N=343] = 30.04, p<.05). Blacks and Asians showed consistently smaller SCDs at all pedicle levels compared to Whites, who had the largest SCDs overall (p<.001). Average SCDs were 11.4 mm (White), 10.4 mm (Black), 10.5 mm (Asian), and 11 mm (Hispanic). Additionally, LDAs were larger in Asians, Blacks, and Hispanics compared to Whites, leading to a significantly decreased cross-sectional canal area (p<.001).

Conclusions: Our study indicates a statistically significant correlation between race/ethnicity and CCS prevalence. Black and Asian patients had the highest CCS rates, smallest SCDs, and largest LDAs. These anatomical differences may predispose these subjects to the development of cervical myelopathy compared to those with normal spinal canal diameters. Increased knowledge base of the epidemiology of this condition may lead to personalized clinical management and possibly early intervention to prevent spinal cord injuries in these patients.

Background: Widespread racial, gender-related, socioeconomic and insurance-related disparities have been widely implicated in the utilization of new and improved surgical techniques including various aspects spinal surgery. A comprehensive analysis of such disparities is lacking for motion-preserving techniques in cervical spine surgery.

Purpose: To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery.

Study design/ setting: Retrospective review of large database PATIENT SAMPLE: NSQIP® database from 2010 to 2021 and PearlDiver® database from 2010 to 2022 were queried. CPT codes for cervical disc arthroplasty (CDA), and anterior cervical discectomy and fusion (ACDF) were utilized to isolate the case records (Table 1 and 3).

Outcome measures: Preoperative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment.

Methods: Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively.

Results: A total of 5,912 and 32,625 CDA cases and 69,701 and 526,851 ACDF cases were isolated from NSQIP® and PearlDiver®, respectively. 'Younger' age, 'Asian Pacific Islander' race and elective surgery (p<.001), were associated with undergoing CDA in NSQIP® database. Presence of Type 1 diabetes, smoking and hypertension (HTN) (p<.001) were associated with undergoing ACDF in NSQIP®. PearlDiver® database showed 'Younger' age, higher area-level 'Family Income', and a higher mean percent of patients with 'private health insurance' (p<.001) were associated with undergoing CDA. Higher area level unemployment was associated with ACDF.

Conclusion: Wide spread racial, gender-related, and socioeconomic disparities have been observed. Identification of these disparities is sentinel for implication of change in health-care policy mitigating issues such as underinsurance leading to establishment of health equity.

Background context: Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques.

Purpose: To compare complications and radiographic alignment in osteoporotic versus nonosteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF).

Design: Retrospective cohort study.

Patient sample: A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study.

Outcome measures: The following data were observed for all cases: patient demographics, radiographic alignment, and complications.

Methods: Adult patients with 2-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to 2-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF.

Results: In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At 2 years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from preoperation (6.55° vs. -0.02°, p=.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment disease (p=.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=.008) than patients without osteoporosis, most commonly for adjacent segment disease.

Conclusion: In this single-center multisurgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.

Background context: Menarche is widely recognized as one of the prognostic factors for curve progression in patients with adolescent idiopathic scoliosis (AIS). However, few studies focus on the relationship between small AIS curves without brace treatment and menarche, presenting a challenge to building further evidence.

Purpose: This study aims to investigate the chronological changes in curve progression and risk of final brace initiation around menarche in small AIS curves under 25°.

Study design: This was a retrospective cohort study.

Patient sample: We longitudinally examined 1,090 AIS patients with a curve of less than 25° at the initial visit.

Outcome measures: Patients were followed up until they achieved skeletal maturity or initiated brace treatment.

Methods: Curve progression based on time from menarche was analyzed using a t-test. Receiver operating characteristic curve analysis was performed based on the time from menarche, with curve magnitude as the independent variable and the final initiation of brace treatment as the dependent variable.

Results: Overall, 1,090 female patients were included, with a mean initial visit age of 12.9 years (standard deviation [SD]: 1.5) and a mean coronal Cobb angle of 17.5° (SD: 4.3). Curve progression was significantly decreased between 0-1 and 1-2 years post-menarche (0-1 year post-menarche: 2.9°/year vs. 1-2 years post-menarche: 1.3°/year; p=.03). After 2 years from menarche, the mean curve progression was less than 0.4°/year. The cut-off value of the curve magnitude for the final initiation of brace treatment at the timing of menarche was 20.5° (area under the curve: 0.89, p<.001, 95% confidence interval: 0.86-0.91).

Conclusions: This study highlights that in small AIS curves under 25°, minimal curve progression was observed after 2 years post-menarche, aiding follow-up strategies for AIS conservative treatment.

Background context: Survival prediction models for patients with spinal metastases may inform patients and clinicians in shared decision-making.

Purpose: To externally validate all existing survival prediction models for patients with spinal metastases.

Design: Prospective cohort study using retrospective data.

Patient sample: 953 patients.

Outcome measures: Survival in months, area under the curve (AUC), and calibration intercept and slope.

Method: This study included patients with spinal metastases referred to a single tertiary referral center between 2016 and 2021. Twelve models for predicting 3, 6, and 12-month survival were externally validated Bollen, Mizumoto, Modified Bauer, New England Spinal Metastasis Score, Original Bauer, Oswestry Spinal Risk Index (OSRI), PathFx, Revised Katagiri, Revised Tokuhashi, Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA), Tomita, and Van der Linden. Discrimination was assessed using (AUC) and calibration using the intercept and slope. Calibration was considered appropriate if calibration measures were close to their ideal values with narrow confidence intervals.

Results: In total, 953 patients were included. Survival was 76.4% at 3 months (728/953), 62.2% at 6 months (593/953), and 50.3% at 12 months (479/953). Revised Katagiri yielded AUCs of 0.79 (95% CI, 0.76-0.82) to 0.81 (95% CI, 0.79-0.84), Bollen yielded AUCs of 0.76 (95% CI, 0.73-0.80) to 0.77 (95% CI, 0.75-0.80), and OSRI yielded AUCs of 0.75 (95% CI, 0.72-0.78) to 0.77 (95% CI, 0.74-0.79). The other 9 prediction models yielded AUCs ranging from 0.59 (95% CI, 0.55-0.63) to 0.76 (95% CI, 0.74-0.79). None of the twelve models yielded appropriate calibration.

Conclusions: Twelve survival prediction models for patients with spinal metastases yielded poor to fair discrimination and poor calibration. Survival prediction models may inform decision-making in patients with spinal metastases, provided that recalibration using recent patient data is performed.