Spine Journal最新文献_第5页

Bodily growth and the intervertebral disc: a longitudinal MRI study in healthy adolescents 身体发育与椎间盘：健康青少年的纵向磁共振成像研究。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.013

Teija Lund MD, PhD , Leena Ristolainen DSc , Hannu Kautiainen PhD , Martina Lohman MD, PhD , Dietrich Schlenzka MD, PhD

<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated.</div></div><div><h3>PURPOSE</h3><div>This study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18.</div></div><div><h3>STUDY DESIGN</h3><div>This study was a prospective longitudinal cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59).</div></div><div><h3>OUTCOME MEASURES</h3><div>The morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI).</div></div><div><h3>METHODS</h3><div>The morphology of the lumbar discs was evaluated on T2-weighted midsagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18.</div></div><div><h3>RESULTS</h3><div>In the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02–1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60–68.7) and 7.92 (1.19–52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12–2.04) and for BMI 1.05 (1.01–1.09).</div></div><div><h3>CONCLUSIONS</h3><div>More relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar di

背景情况：儿童和青少年腰背痛（LBP）是一个日益受到全球关注的问题。椎间盘退化（DD）被认为是导致腰背痛临床症状的一个重要因素。当青少年步入成年期时，腰背痛和椎间盘退化症都会变得更加普遍。目的：本研究旨在评估青春期生长高峰期身体发育与 18 岁时腰椎间盘形态之间的关系：研究设计：这是一项前瞻性纵向队列研究：研究样本：随机抽取了一批健康儿童，分别在 8 岁、11 岁和 18 岁时进行检查。本次分析纳入了 11 岁和 18 岁时拥有完整数据集（半结构式访谈、人体测量和腰椎核磁共振成像）的参与者（n=59）：结果测量：通过磁共振成像评估腰椎间盘的形态特征。人体测量包括身高、坐高和体重，以计算体表面积（BSA）和体重指数（BMI）：采用 Pfirrmann 分类法在 T2 加权中矢状磁共振成像上对腰椎间盘的形态进行评估。18 岁时，Pfirrmann 分级为 3 或更高的椎间盘被视为退化。评估了11至18岁之间的相对增长（根据性别和基线值进行调整）与18岁时椎间盘退变之间的关系。为了分析 BSA 相对增长与 DD 之间的关系，参与者被分为三个大小相等的类别（三等分）。对于所有其他人体测量指标，则根据 11 至 18 岁期间各项指标的相对增幅进行分析：在 BSA 相对增幅最高的三等分组（≥43%）中，76% 的参与者在 18 岁时至少有一个椎间盘达到或超过 Pfirrmann 3 级，而在最低和中等三等分组中，分别只有 10% 和 21% 的参与者有 DD。经性别和基线调整后，BSA每增加10%，18岁时出现DD的几率比（OR）为1.08（1.02至1.15）。身高和坐高每增加 10%，18 岁时 DD 的性别和基线调整 OR（95% CI）分别为 10.5（1.60 至 68.7）和 7.92（1.19 至 52.72）。体重每增加 10%，18 岁时侏儒症的调整 OR 为 1.51（1.12 至 2.04），BMI 为 1.05（1.01 至 1.09）：结论：11 岁至 18 岁期间的相对增长与成年后 DD 的发生有显著相关性。在调查的各项指标中，身高和坐高是不可改变的。在青春期生长高峰期保持理想体重可能有利于腰椎间盘的健康。

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引用次数: 0

Long-term mechanical failure in well aligned adult spinal deformity patients 对齐良好的成人脊柱畸形患者的长期机械损伤

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.019

Sleiman Haddad MD, PhD , Caglar Yilgor MD , Eva Jacobs MD, PhD , Lluis Vila MD , Susana Nuñez-Pereira MD, PhD , Manuel Ramirez Valencia MD , Anika Pupak PhD , Maggie Barcheni BS , Javier Pizones MD, Phd , Ahmet Alanay MD , Frank Kleinstuck MD , Ibrahim Obeid MD , Ferran Pellisé MD, PhD , European Spine Study Group

<div><h3>BACKGROUND CONTEXT</h3><div>Mechanical complications (MC) are frequently linked to suboptimal postoperative alignment and represent a primary driver of revision surgery in the context of adult spinal deformity (ASD). However, it's worth noting that even among those deemed "well aligned," the risk of experiencing MCs persists, hinting at the potential influence of factors beyond alignment.</div></div><div><h3>PURPOSE</h3><div>The aim was to assess the incidence of MCs among well-aligned patients and delving into the relevant risk factors and surgical outcomes that come into play within this specific subgroup.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective analysis was conducted using data from a prospective multicenter database dedicated to ASD.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study focused on patients aged 55 years or older, who had a minimum follow-up period of 2 years, and exhibited a Global Alignment and Proportion (GAP) score of 2 points or less (excluding age) within 6 weeks of their index surgery.</div></div><div><h3>OUTCOME MEASURES</h3><div>Mechanical complications such as rod fractures, pseudarthrosis, or junctional kyphosis or failure.</div></div><div><h3>METHODS</h3><div>Patients who developed mechanical complications were identified. Comparative analyses were performed, encompassing both continuous and categorical variables. Furthermore, binary logistic regression tests were employed to pinpoint risk factors, and ROC curves were used to determine the optimal threshold values for these variables.</div></div><div><h3>RESULTS</h3><div>A total of 83 patients met the inclusion criteria for this study, with a mean age of 66 years. On average, they had 10 instrumented levels, and 77% of them had fusion extending to the pelvis. Additionally, 27% of the patients had undergone 3-column osteotomies (3-CO). Among them, 33 patients (40%) experienced at least 1 MC during an average follow-up period of 4 years, which included 14 cases of proximal junctional kyphosis (PJK) and 20 cases of nonunion or rod breakage. 15 patients (18%) required revision surgery specifically for MC. In univariable analyses, patients who developed MC were characterized by higher body weight, poorer baseline general health (as indicated by worse SF-36 scores), and less favorable preoperative coronal and sagittal alignment. They also had longer hospital stays, a greater number of instrumented levels, and achieved less favorable postoperative coronal and sagittal alignment. Interestingly, factors such as 3-column osteotomies, postoperative bracing, and the addition of an anterior approach did not significantly alter the risk of MC in well-aligned ASD patients. Binary regression models revealed that independent risk factors for MC included the residual coronal lumbosacral curve, the number of instrumented levels, and relative spinopelvic alignment (RSA). ROC curves identified an optimal threshold of a residual lumbosacral curve of ≤4

背景情况：机械并发症（MC）经常与术后对位不理想有关，是成人脊柱畸形（ASD）翻修手术的主要原因。然而，值得注意的是，即使在那些被认为 "对位良好 "的患者中，发生机械并发症的风险依然存在，这暗示着对位以外因素的潜在影响。研究目的：目的是评估对位良好患者中机械并发症的发生率，并深入研究在这一特定亚群中发挥作用的相关风险因素和手术结果：研究设计/设置：利用专门用于ASD的前瞻性多中心数据库中的数据进行回顾性分析：研究对象：年龄在55岁或55岁以上，随访时间至少为两年，且在指数手术后六周内全球对齐和比例（GAP）评分为两分或两分以下（不包括年龄）的患者：机械并发症，如杆骨折、假关节、交界性后凸或失败。对连续变量和分类变量进行比较分析。此外，还采用了二元逻辑回归测试来确定风险因素，并利用 ROC 曲线来确定这些变量的最佳阈值：共有 83 名患者符合本研究的纳入标准，平均年龄为 66 岁。他们平均有10个器械水平，其中77%的融合延伸至骨盆。此外，27%的患者接受了三柱截骨术（3-CO）。其中，33 名患者（40%）在平均 4 年的随访期间至少经历了一次 MC，包括 14 例近端交界性脊柱后凸（PJK）和 20 例不愈合或骨棒断裂。15名患者（18%）因MC而需要进行翻修手术。在单变量分析中，出现 MC 的患者体重较重、基线总体健康状况较差（SF-36 评分较差）、术前冠状位和矢状位对齐情况较差。他们的住院时间也更长，使用器械的层面更多，术后的冠状位和矢状位对齐情况也更差。有趣的是，三柱截骨、术后支撑和增加前方入路等因素并未显著改变对位良好的成人脊柱畸形（ASD）患者发生MC的风险。二元回归模型显示，MC的独立风险因素包括腰骶部残余冠状曲线、器械水平数和相对脊柱骨对齐度（RSA）。ROC曲线确定了腰骶部残余曲线≤4°和RSA≤3°的最佳阈值。此外，MC 的发生率在 GAP 比例组中呈逐步上升趋势，GAP=0 为 31%，GAP=1 为 54%，GAP=2 为 75%，其中 RSA 是影响最大的参数。最后，MC 患者在最后一次随访评估中表现出较差的功能和放射学结果：结论：在矢状位 "对齐良好 "的 ASD 患者中，MC 的发生率仍然较高，这可能是由于残余矢状位和冠状位对齐不理想，进而导致功能预后较差。这项研究再次证实了MCs的多面性，并强调了术后实现完美对位的重要性，尤其是在存在其他风险因素的情况下，如广泛手术矫正、高杠杆臂（涉及器械椎体）、体重过重和体弱（由SF-36评分显示）。

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引用次数: 0

Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically 从生物力学角度看，泄漏的骨水泥与邻近椎体终板之间的接触会诱发椎体骨水泥增量术后邻近椎体骨折的更大风险。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.021

Shiming Xie MD , Liqiang Cui MD , Chenglong Wang MD , Hongjun Liu MD , Yu Ye MD , Shuangquan Gong MD , Jingchi Li PhD

<div><h3>BACKGROUND CONTEXT</h3><div>Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty in patients with osteoporotic vertebral compressive fracture (OVCF). Studies have demonstrated that intervertebral cement leakage (ICL) can increase the incidence of AVF, but others have reached opposite conclusions. The stress concentration initially increases the risk of AVF, and dispersive concentrated stress is the main biomechanical function of the intervertebral disc (IVD).</div></div><div><h3>PURPOSE</h3><div>This study was designed to validate the hypothesis that direct contact between the leaked cement and adjacent bony endplate (BEP) can inhibit this biomechanical function, trigger adjacent vertebral stress concentration and increase the risk of AVF.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective study and corresponding numerical mechanical simulations.</div></div><div><h3>PATIENT SAMPLE</h3><div>Clinical data from 97 OVCF patients treated by bone cement augmentation operations were reviewed in this study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical assessments involved measuring ICL and cement-BEP contact status in patients with and without AVF. Numerical simulations were conducted to compute stress values in adjacent vertebral body's BEP and cancellous bone under various body positions.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Radiographic and demographic data of 97 OVCF patients (with an average follow-up period of 11.5 months) treated using bone cement augmentation operation were reviewed in the present study. The patients were divided into 2 groups: those with AVF and those without AVF. Bone cement leakage status was judged via 2 different methods: with or without IVD cement leakage and with and without adjacent vertebral endplate contact. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. Patients without IVD cement leakage, with IVD cement leakage but without adjacent vertebral endplate cement contact, and with direct adjacent vertebral endplate cement contact were simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to the AVF were computed and recorded in these surgical models.</div></div><div><h3>RESULTS</h3><div>Radiographic analysis revealed that the incidence of AVF was numerically higher, but was not significantly higher in patients with IVD cement leakage. In contrast, patients with direct adjacent vertebral endplate cement contact had a significantly greater incidence of AVF, which has also been proven to be an independent risk factor for AVF. In addition, numerical mechanical simulations revealed an obvious stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral body in the model with endplate cement contact.</div></div><div><h3>CONCLUSIONS</h3><div

背景情况：相邻椎体骨折（AVF）是骨质疏松性椎体压缩性骨折（OVCF）患者经皮椎体成形术后经常观察到的并发症。研究表明，椎体间骨水泥渗漏（ICL）会增加 AVF 的发生率，但也有研究得出了相反的结论。应力集中最初会增加 AVF 的风险，而分散集中应力是椎间盘（IVD）的主要生物力学功能。研究目的：本研究旨在验证以下假设：泄漏的骨水泥与邻近骨终板（BEP）直接接触会抑制这一生物力学功能，引发邻近椎体应力集中，增加 AVF 的风险：研究设计：回顾性研究和相应的数值力学模拟：本研究回顾了97名接受骨水泥增量手术治疗的OVCF患者的临床数据：临床评估包括测量有无动静脉瘘患者的ICL和骨水泥-BEP接触状态。进行数字模拟，计算不同体位下相邻椎体 BEP 和松质骨的应力值：本研究回顾了 97 例采用骨水泥增量手术治疗的 OVCF 患者（平均随访时间为 11.5 个月）的影像学和人口统计学数据。患者分为两组：有动静脉瘘和无动静脉瘘。骨水泥渗漏情况通过两种不同的方法进行判断：有无 IVD 骨水泥渗漏和有无邻近椎体终板接触。对有和无 AVF 患者的数据进行比较，并通过回归分析确定独立的风险因素。使用之前构建并验证的腰椎有限元模型模拟了无 IVD 骨水泥渗漏、有 IVD 骨水泥渗漏但无相邻椎体终板骨水泥接触以及相邻椎体终板骨水泥直接接触的患者，并计算和记录了这些手术模型中与 AVF 相关的生物力学指标：结果：影像学分析表明，IVD骨水泥渗漏患者的动静脉畸形发生率在数值上较高，但并无明显增加。相比之下，与邻近椎体终板骨水泥直接接触的患者发生 AVF 的几率明显更高，这也被证明是 AVF 的一个独立风险因素。此外，数值力学模拟显示，在有椎体终板骨水泥接触的模型中，相邻椎体有明显的应力集中趋势（最大等效应力值更高）：结论：邻近椎体终板骨水泥直接接触会导致局部生物力学环境恶化，从而诱发更高的房室纤维化风险。因此，当发生 IVD 骨水泥渗漏时，应终止骨水泥注射，以减少相邻椎体终板骨水泥接触，降低由此导致的 AVF 生物力学风险。

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引用次数: 0

Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach 原发性椎体骨髓炎的定义千差万别：用元流行病学方法探索统一诊断框架之路。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.018

Francesco Petri MD , Omar K. Mahmoud MD , Said El Zein MD , Seyed Mohammad Amin Alavi MD , Matteo Passerini MD , Felix E. Diehn MD , Jared T. Verdoorn MD , Aaron J. Tande MD , Ahmad Nassr MD , Brett A. Freedman MD , M. Hassan Murad MD , Elie F. Berbari MD, MBA

BACKGROUND CONTEXT

Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome.

PURPOSE

To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering.

STUDY DESIGN/SETTING

Meta-epidemiological study with a systematic review of definitions.

PATIENTS SAMPLE

An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms.

OUTCOME MEASURES

Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria.

METHODS

We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams.

RESULTS

The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology.

CONCLUSIONS

Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.

背景情况：原发性椎体骨髓炎（NVO）的发病率呈上升趋势，但临床疗效仍然不佳，复发率高且长期后遗症严重。2015 年《IDSA 临床实践指南》引发了关于 NVO 的学术活动热潮，揭示了该综合征的定义和众多同义词的交替使用。研究目的：系统总结这些定义，评估其内容、随时间推移的分布和主题聚类：研究设计/设置：对定义进行系统回顾的元流行病学研究：患者样本：对多个数据库进行了广泛搜索，目标是 2005 年至今的试验和队列研究，这些研究提供了 NVO 及其同义词的定义：结果测量：对构成定义的诊断标准进行分析，并根据诊断标准的可能组合对定义进行细分：我们采用布尔逻辑对已发表的定义进行了专题综合，每项纳入的研究都得出了一个或多个定义。我们使用八个预定义的诊断标准对定义进行了标准化，重点关注所使用的最小必要组合。使用桑基图对定义的组成部分进行了可视化：文献检索共发现 8460 篇参考文献，其中 171 项研究报告了 21963 名患者。其中 91.2% 为回顾性研究，7.6% 为前瞻性研究，1.2% 为 RCT 研究。大多数定义来自作者，29.2%的定义参考了资料来源。我们在文献中发现了 92 种独特的诊断标准组合。我们发现了 13 种主要模式，其中最常见的是临床特征与影像学相结合，其次是临床特征与影像学和微生物学相结合，最后是影像学与微生物学相结合：我们的研究结果表明，有必要共同努力制定标准化的诊断标准。我们主张专家们在未来达成德尔菲共识，建立统一的 NVO 诊断框架，强调临床特征和磁共振成像的核心要素，同时结合微生物学和组织病理学的见解，以改善患者预后并促进研究进展。

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引用次数: 0

Osteoporosis is not associated with reoperation or pseudarthrosis after anterior cervical discectomy and fusion through 4-years’ follow-up: a retrospective cohort study of US academic health centers 骨质疏松症与颈椎前路椎间盘切除和融合术后四年随访期间的再次手术或假关节炎无关：美国学术健康中心的回顾性队列研究。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.031

Anthony N. Baumann DPT , Robert J. Trager DC , Davin C. Gong MD , Omkar S. Anaspure BA , John T. Strony MD , Ilyas Aleem MD

BACKGROUND CONTEXT

Osteoporosis has been proposed as a risk factor for reoperation after anterior cervical discectomy and fusion (ACDF), yet this potential association has been understudied, with conflicting results to date.

PURPOSE

This study examines the hypothesis that adults with osteoporosis would have an increased risk of reoperation after ACDF compared to matched adults without osteoporosis.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Two matched cohorts (mean age: 62 years; 75% female), each with 1,019 patients, who underwent primary ACDF. Cohorts were determined by the presence or absence of a diagnosis of osteoporosis.

OUTCOME MEASURES

Incidence of reoperation occurring over 4 years postoperatively, with our primary outcome being the risk ratio (RR) of reoperation with 95% confidence intervals (CI). Secondary outcomes included risk and mean count of oral opioid prescriptions and risk of pseudoarthrosis.

METHODS

We utilized the TriNetX network to identify adults undergoing their first ACDF from 2004 to 2020, excluding those with serious pathology, and divided patients into 2 cohorts: osteoporosis and nonosteoporosis. Patients were propensity matched according to key risk factors for reoperation.

RESULTS

Patients with osteoporosis had no statistically significant or meaningful difference in risk of reoperation compared to nonosteoporotic patients over 4-years’ follow-up [95% CI] (17.3% vs 16.5%; RR: 1.05 [0.86, 1.27]; p=.6361). Similarly, there were no significant differences in the risk of pseudoarthrosis (26.5% vs 29.1%; RR: 0.91 [0.79, 1.05]; p=.1820), oral opioid prescription (75.0% vs 76.0%; RR: 0.99 [0.94, 1.04]; p=.6067), or mean oral opioid prescription count (11.5 vs 11.8; p=.7040).

CONCLUSIONS

Compared to matched nonosteoporosis controls, osteoporosis was not associated with a statistically significant or clinically meaningful increase in risk of reoperation in adults over 4 years after ACDF. Furthermore, osteoporosis was not associated with a significant or meaningful risk of pseudoarthrosis or oral opioid prescription after ACDF, although more research is needed for corroboration. Additional research is needed to clarify whether those with osteoporosis have meaningful differences in pain and function compared to those without osteoporosis following ACDF.

背景情况：目的：本研究探讨了一个假设，即与没有骨质疏松症的成年人相比，患有骨质疏松症的成年人在颈椎前路椎间盘切除和融合术（ACDF）后再次手术的风险会增加：患者样本：两个匹配队列（平均年龄：62 岁；75% 为女性），每个队列中有 1,019 名患者接受了初级 ACDF。根据是否诊断出骨质疏松症确定队列：术后四年内再次手术的发生率，我们的主要结果是再次手术的风险比 (RR)，以及 95% 的置信区间 (CI)。次要结果包括口服阿片类药物处方的风险和平均次数以及假关节的风险：我们利用 TriNetX 网络识别了 2004-2020 年间首次接受 ACDF 手术的成年人，排除了有严重病变的患者，并将患者分为两个队列：骨质疏松症和非骨质疏松症。根据再次手术的主要风险因素对患者进行倾向匹配：在四年的随访中，骨质疏松症患者与非骨质疏松症患者相比，再次手术的风险没有显著或有意义的统计学差异[95% CI]（17.3% 对 16.5%；RR：1.05 [0.86, 1.27]；P=0.6361）。同样，假关节风险（26.5% 对 29.1%；RR：0.91 [0.79, 1.05]；P=0.1820）、口服阿片类药物处方（75.0% 对 76.0%；RR：0.99 [0.94, 1.04]；P=0.6067）或平均口服阿片类药物处方数（11.5 对 11.8；P=0.7040）也无明显差异：结论：与匹配的非骨质疏松症对照组相比，骨质疏松症与成人 ACDF 术后四年内再次手术风险的增加无统计学意义或临床意义。此外，骨质疏松症与 ACDF 后发生假关节或口服阿片类药物的显著或有意义的风险无关，但还需要更多的研究来证实。还需要进行更多的研究，以明确骨质疏松症患者与无骨质疏松症患者相比，在 ACDF 术后的疼痛和功能方面是否存在有意义的差异。

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引用次数: 0

Biomechanical differences of three cephalic fixation methods for patients with basilar invagination and atlantoaxial dislocation in the setting of congenital atlas occipitalization: a finite element analysis 针对先天性寰枕内陷和寰枢关节脱位患者的三种头颅固定方法的生物力学差异：有限元分析。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.08.023

Qiang Jian MD , Shaw Qin JD , Zhe Hou MD , Xingang Zhao MD , Yinqian Wang MD , Cong Liang MD , Dean Chou MD , Xiuqing Qian PhD , Tao Fan MD, PhD

Background context

In cases of basilar invagination-atlantoaxial dislocation (BI-AAD) complicated by atlas occipitalization (AOZ), the approach to cranial end fixation has consistently sparked debate, generally falling into two categories: C1–C2 fixation and occipitocervical fixation. Several authors believe that C1–C2 fixation carries a lower risk of fixation failure than occipitocervical fixation.

Purpose

To study the biomechanical differences among 3 different cranial end fixation methods for BI-AAD with AOZ.

Study design

This was a finite element analysis.

Patient sample

A 35-year-old female patient diagnosed with congenital BI-AAD and AOZ.

Outcome measures

range of motion (ROM), peak von Mise stress (PVMS), cage micro-subsidence, cage micro-slippage.

Method

Four finite element models were constructed, including unstable group (BI-AAD with AOZ), C1 lateral mass screw group, occipital plate group, occipitocervical rod group. The flexion and extension (FE), lateral bending (LB) as well as axial rotation (AR) were simulated under a torque of 1.5 Nm. Parameters include C1–C2 ROM, PVMS on screw-rod construct, cage micro-subsidence, cage micro-slippage.

Results

The ROM of the C1 lateral mass screw group was smaller than that of the other fixation groups in LB and AR, but not FE. Compared with the occipitocervical rod group, the ROM in LB and AR of the occipital plate group was higher, but not in FE. The PVMS of C1 lateral mass screw group was significantly higher than that of the other groups. The ROM and PVMS of the occipitocervical rod group were in between the other 2 groups. Regarding the screws at the cranial end, the PVMS of the 4-screw occipitocervical rod group was significantly lower than that of the other groups. In general, the cage micro-motion follows the ascending order: C1 lateral mass group < occipitocervical rod group < occipital plate group.

Conclusions

In cases of BI-AAD with AOZ, the C1 lateral mass screw group provided the least ROM and cage micro-motion, but the screw-rod PVMS was the largest. The advantage of occipital plate fixation lies in the lowest screw-rod PVMS, but the ROM and cage micro-motion is the highest. Four-screw fixation at the cranial end of occipitocervical rod group helps to reduce the PVMS and may prevent screw failure at the cranial end.

背景情况：在基底动脉内陷-寰枢脱位（BI-AAD）并发寰枕脱位（AOZ）的病例中，颅骨末端固定的方法一直引发争论，一般分为两类：C1-C2 固定和枕颈固定。一些学者认为，C1-C2 固定比枕颈固定发生固定失败的风险更低。目的：研究 BI-AAD 与 AOZ 的三种不同颅端固定方法的生物力学差异：研究设计：这是一项有限元分析：结果测量：活动范围(ROM)、峰值von Mise应力(PVMS)、骨笼微下沉、骨笼微滑移方法：构建了四个有限元模型，包括不稳定组(BI-AAD与AOZ)、C1侧块螺钉组、枕骨钢板组、枕颈杆组。在 1.5 牛米的扭矩下模拟了屈伸（FE）、侧弯（LB）和轴向旋转（AR）。参数包括 C1-C2 ROM、螺钉连杆结构上的 PVMS、骨笼微下沉、骨笼微滑动：结果：C1外侧质量螺钉组的ROM在LB和AR中小于其他固定组，但在FE中没有小于其他固定组。与枕骨颈椎杆组相比，枕骨钢板组在LB和AR的ROM较高，但在FE的ROM较低。C1侧块螺钉组的PVMS明显高于其他组。枕骨颈椎杆组的ROM和PVMS介于其他两组之间。至于颅端螺钉，四螺钉枕颈杆组的 PVMS 明显低于其他组。总体而言，保持架微动的顺序由高到低：结论：结论：在伴有AOZ的BI-AAD病例中，C1侧块螺钉组提供的ROM和保持架微动最小，但螺钉杆PVMS最大。枕骨钢板固定的优势在于螺钉杆PVMS最低，但ROM和骨笼微动最大。枕骨颈椎杆组的颅端四螺钉固定有助于降低PVMS，并可防止颅端螺钉失效。

{"title":"Biomechanical differences of three cephalic fixation methods for patients with basilar invagination and atlantoaxial dislocation in the setting of congenital atlas occipitalization: a finite element analysis","authors":"Qiang Jian MD , Shaw Qin JD , Zhe Hou MD , Xingang Zhao MD , Yinqian Wang MD , Cong Liang MD , Dean Chou MD , Xiuqing Qian PhD , Tao Fan MD, PhD","doi":"10.1016/j.spinee.2024.08.023","DOIUrl":"10.1016/j.spinee.2024.08.023","url":null,"abstract":"<div><h3>Background context</h3><div>In cases of basilar invagination-atlantoaxial dislocation (BI-AAD) complicated by atlas occipitalization (AOZ), the approach to cranial end fixation has consistently sparked debate, generally falling into two categories: C1–C2 fixation and occipitocervical fixation. Several authors believe that C1–C2 fixation carries a lower risk of fixation failure than occipitocervical fixation.</div></div><div><h3>Purpose</h3><div>To study the biomechanical differences among 3 different cranial end fixation methods for BI-AAD with AOZ.</div></div><div><h3>Study design</h3><div>This was a finite element analysis.</div></div><div><h3>Patient sample</h3><div>A 35-year-old female patient diagnosed with congenital BI-AAD and AOZ.</div></div><div><h3>Outcome measures</h3><div>range of motion (ROM), peak von Mise stress (PVMS), cage micro-subsidence, cage micro-slippage.</div></div><div><h3>Method</h3><div>Four finite element models were constructed, including unstable group (BI-AAD with AOZ), C1 lateral mass screw group, occipital plate group, occipitocervical rod group. The flexion and extension (FE), lateral bending (LB) as well as axial rotation (AR) were simulated under a torque of 1.5 Nm. Parameters include C1–C2 ROM, PVMS on screw-rod construct, cage micro-subsidence, cage micro-slippage.</div></div><div><h3>Results</h3><div>The ROM of the C1 lateral mass screw group was smaller than that of the other fixation groups in LB and AR, but not FE. Compared with the occipitocervical rod group, the ROM in LB and AR of the occipital plate group was higher, but not in FE. The PVMS of C1 lateral mass screw group was significantly higher than that of the other groups. The ROM and PVMS of the occipitocervical rod group were in between the other 2 groups. Regarding the screws at the cranial end, the PVMS of the 4-screw occipitocervical rod group was significantly lower than that of the other groups. In general, the cage micro-motion follows the ascending order: C1 lateral mass group < occipitocervical rod group < occipital plate group.</div></div><div><h3>Conclusions</h3><div>In cases of BI-AAD with AOZ, the C1 lateral mass screw group provided the least ROM and cage micro-motion, but the screw-rod PVMS was the largest. The advantage of occipital plate fixation lies in the lowest screw-rod PVMS, but the ROM and cage micro-motion is the highest. Four-screw fixation at the cranial end of occipitocervical rod group helps to reduce the PVMS and may prevent screw failure at the cranial end.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 389-400"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299484","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

Incorporation of whole-body metabolic tumor burden into current prognostic models for nonsmall cell lung cancer patients with spine metastasis 将全身肿瘤代谢负担纳入非小细胞肺癌脊柱转移患者的现有预后模型中

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.012

Yoontae Hong MD , Yeon-koo Kang MD, PhD , Eun Bi Park MD , Min-Sung Kim MD, PhD , Yunhee Choi PhD , Siyoung Lee MD , Chang-Hyun Lee MD, PhD , Jun-Hoe Kim MD , Miso Kim MD, PhD , Jin Chul Paeng MD, PhD , Chi Heon Kim MD, PhD

BACKGROUND CONTEXT

Numerous prognostic models are utilized for surgical decision and prognostication in metastatic spine tumors. However, these models often fail to consider the whole-body tumor burden into account, which may be crucial for the prognosis of metastatic cancers. A potential surrogate marker for tumor burden, whole-body metabolic tumor burden (wMTB), can be calculated from total lesion glycolysis (TLG) obtained from ¹⁸F-Fludeoxyglucose positive emission tomography (¹⁸F-FDG PET) images.

PURPOSE

We aimed to improve prognostic power of current models by incorporating wMTB for nonsmall cell lung cancer (NSCLC) patients with spine metastases.

DESIGN

Retrospective analysis using a review of electrical medical records and survival data.

PATIENT SAMPLE

In this study, we included 74 NSCLC patients with image proven spine metastases.

OUTCOME MEASURES

Increase in Integrated Discrimination Improvement (IDI) index after incorporation of wMTB into prognostic scores.

METHODS

Enrolled patients’ baseline data, cancer characteristics and survival status were retrospectively collected. Five widely used prognostic scores (Tomita, Katagiri, Tokuhashi, Global Spine Tumor Study Group [GSTSG], New England Spine Metastasis Score [NESMS]), and TLG indexes were calculated for all patients. The relationships among survival time, prognostic models and TLG values were analyzed. Improvement of prognostic power was validated by incorporating significant TLG index into significant current models.

RESULTS

Among current prognostic models, Tomita (EGFR wild-type), Katagiri, GSTSG and Tokuhashi were significantly related to patient survival. Among TLG indexes, LogTLG3 was significantly related to survival. Incorporation of LogTLG3 into significant prognostic models resulted in positive IDI index until 3 years in all models.

Conclusions

This study showed that incorporation of wMTB improved prognostic power of current prognostic models of metastatic spine tumors.

背景情况：许多预后模型被用于转移性脊柱肿瘤的手术决策和预后判断。然而，这些模型往往没有考虑到全身肿瘤负荷，而这可能对转移性癌症的预后至关重要。肿瘤负荷的潜在替代标志物--全身代谢性肿瘤负荷（wMTB）可通过18F-氟代葡萄糖正电子发射断层扫描（18F-FDG PET）图像获得的总病变糖酵解（TLG）计算得出。目的：我们旨在通过纳入脊柱转移的非小细胞肺癌（NSCLC）患者的wMTB，提高现有模型的预后能力：设计：利用电子病历和生存数据进行回顾性分析：在这项研究中，我们纳入了 74 名经影像证实患有脊柱转移的非小细胞肺癌患者：在预后评分中加入 wMTB 后，综合鉴别改善指数（IDI）的增加情况：方法：回顾性收集入组患者的基线数据、癌症特征和生存状况。计算所有患者的五个广泛使用的预后评分（富田评分、片桐评分、德桥评分、全球脊柱肿瘤研究组评分[GSTSG]、新英格兰脊柱转移评分[NESMS]）和 TLG 指数。分析了生存时间、预后模型和 TLG 值之间的关系。通过将重要的 TLG 指数纳入重要的现有模型，验证了预后能力的提高：结果：在目前的预后模型中，Tomita（表皮生长因子受体野生型）、Katagiri、GSTSG 和 Tokuhashi 与患者的生存期显著相关。在TLG指数中，LogTLG3与生存率有明显关系。将LogTLG3纳入重要的预后模型后，所有模型中的IDI指数在三年前均为正数：本研究表明，纳入 wMTB 提高了当前转移性脊柱肿瘤预后模型的预后能力。

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引用次数: 0

The prevalence of congenital cervical stenosis differs based on race.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2025.01.011

Freddy Jacome, Sia Cho, Jason Tegethoff, Justin J Lee, David M Hiltzik, Srikanth N Divi, Alpesh A Patel, Wellington Hsu

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.

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引用次数: 0

Disparity in resource utilization of motion-sparing anterior cervical spine surgery: an analysis of NSQIP® and PearlDiver® database. 颈椎前路手术资源利用的差异：NSQIP® 和 PearlDiver® 数据库分析。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2025.01.017

Muhammad Umar Jawad, Haroon M Kisana, Victoria N Greenstein, Donnell B McDonald, Norman B Chutkan

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.

背景：与种族、性别、社会经济和保险相关的广泛差异已被普遍认为与使用新的和改进的外科技术（包括脊柱外科的各个方面）有关。目的：探讨颈椎手术中运动保护技术资源利用方面的差异：研究设计/环境：大型数据库回顾性研究患者样本：查询了2010-2021年的NSQIP®数据库和2010-2022年的PearlDiver®数据库。利用颈椎间盘关节置换术（CDA）和颈椎前路椎间盘切除及融合术（ACDF）的 CPT 编码来分离病例记录（表 1 和 3）：利用 NSQIP® 对术前临床、种族和性别数据进行了调查。PearlDiver®用于地区层面的家庭收入、教育、保险状况和失业率：方法：对单变量分类分析、连续分析和多变量分析分别采用了Chi-square、Kruskal-Wallis和Logistic回归方法：从NSQIP®和PearlDiver®中分别分离出5,912和32,625个CDA病例以及69,701和526,851个ACDF病例。年轻 "年龄、"亚太岛民 "种族和选择性手术（P结论：已观察到广泛的种族、性别和社会经济差异。确定这些差异是改变医疗保健政策的前哨，可减轻保险不足等问题，从而建立健康公平。

{"title":"Disparity in resource utilization of motion-sparing anterior cervical spine surgery: an analysis of NSQIP® and PearlDiver® database.","authors":"Muhammad Umar Jawad, Haroon M Kisana, Victoria N Greenstein, Donnell B McDonald, Norman B Chutkan","doi":"10.1016/j.spinee.2025.01.017","DOIUrl":"10.1016/j.spinee.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Purpose: </strong>To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery.</p><p><strong>Study design/ setting: </strong>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).</p><p><strong>Outcome measures: </strong>Preoperative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment.</p><p><strong>Methods: </strong>Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123990","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

Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network 经手术治疗的退行性颈椎病患者的满意度：加拿大脊柱结果与研究网络的观察性研究。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-02-01 DOI: 10.1016/j.spinee.2024.09.024

William Chu Kwan MD, PhD, FRCSC , Tamir Ailon MD, MPH, FRCSC , Nicolas Dea MD, MSc, FRCSC , Nathan Evaniew MD, Msc, FRCSC , Raja Rampersaud MD, FRCSC , W. Bradley Jacobs MD, FRCSC , Jérome Paquet MD, FRCSC , Jefferson R. Wilson MD, PhD, FRCSC , Hamilton Hall MD, FRCSC , Christopher S. Bailey MD, FRCSC , Michael H. Weber MD, PhD, FRCSC , Andrew Nataraj MD, MSc, FRCSC , David W. Cadotte MD, PhD, FRCSC , Philippe Phan MD, MSc, FRCSC , Sean D. Christie MD, FRCSC , Charles G. Fisher MD, MHSC, FRCSC , Supriya Singh MD, FRCSC , Neil Manson MD, FRCSC , Kenneth C. Thomas MD, FRCSC , Jay Toor MD, FRCSC , Raphaële Charest-Morin MD, FRCSC

Background Context

Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.

Purpose

Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.

Design

This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN).

Patient Sample

Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021.

Outcome Measures

Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale.

Methods

Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups.

Results

Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, −3%, −10%, −14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI=0.81–0.90). No patient demographic or surgical factors influenced satisfaction.

Conclusions

Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.

背景情况：医疗报销正朝着以价值为基础的模式发展，并与患者满意度密切相关。目的：我们的主要目的是确定颈椎退行性脊髓病（DCM）手术治疗后 3 个月和 12 个月的满意率和满意度预测因素：这是加拿大脊柱结果与研究网络（CSORN）的一项前瞻性队列研究：参与研究的患者均为接受过手术治疗的DCM患者，他们在2015年至2021年期间在CSORN完成了3个月和12个月的随访：分析的数据包括患者人口统计学、手术变量、患者报告的结果（NDI、NRS-NP、NRS-AP、SF-12-MCS、SF-12-PCS、ED-5Q、PHQ-8）、MJOA和自我报告的满意度（Likert量表）：方法：进行多变量回归分析，以确定与满意度相关的重要因素，解决多重共线性问题，并确保预测的准确性。这一过程在 3 个月和 12 个月的随访中分别进行：共纳入了 663 名患者，平均年龄为 60 岁，MJOA 评分（轻度、中度、重度）分布均匀。在 3 个月和 12 个月的随访中，满意率分别为 86% 和 82%。12 个月时，逻辑回归结果显示，MJOA、NDI、NRS-NP、NRS-AP、SF-12-MCS、SF-12-PCS 在基线和 12 个月之间每变化 1 分，满意的几率分别为 +24%、-3%、-10%、-14%、+3% 和 +12%。从基线到 12 个月期间，ED-5Q 每增加 0.1 分，满意度就会增加 11 倍。基线时，SF-12-MCS 每增加 1 分，满意度增加 7%。在 3 个月时，所有 PROs（除 NRS-AP 变化和基线 SF-12-MCS 外）均可预测满意度。所有逻辑回归分析均显示出极佳的预测准确性，12 个月的 AUC 最高为 0.86 (95%CI = 0.81 - 0.90)。患者人口统计学或手术因素均不影响满意度：结论：患者报告结果和MJOA的改善与DCM术后患者满意度密切相关。唯一与12个月满意度相关的基线PRO是SF-12-MCS。任何可改变的患者基线特征或手术变量都与满意度无关。

{"title":"Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network","authors":"William Chu Kwan MD, PhD, FRCSC , Tamir Ailon MD, MPH, FRCSC , Nicolas Dea MD, MSc, FRCSC , Nathan Evaniew MD, Msc, FRCSC , Raja Rampersaud MD, FRCSC , W. Bradley Jacobs MD, FRCSC , Jérome Paquet MD, FRCSC , Jefferson R. Wilson MD, PhD, FRCSC , Hamilton Hall MD, FRCSC , Christopher S. Bailey MD, FRCSC , Michael H. Weber MD, PhD, FRCSC , Andrew Nataraj MD, MSc, FRCSC , David W. Cadotte MD, PhD, FRCSC , Philippe Phan MD, MSc, FRCSC , Sean D. Christie MD, FRCSC , Charles G. Fisher MD, MHSC, FRCSC , Supriya Singh MD, FRCSC , Neil Manson MD, FRCSC , Kenneth C. Thomas MD, FRCSC , Jay Toor MD, FRCSC , Raphaële Charest-Morin MD, FRCSC","doi":"10.1016/j.spinee.2024.09.024","DOIUrl":"10.1016/j.spinee.2024.09.024","url":null,"abstract":"<div><h3>Background Context</h3><div>Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.</div></div><div><h3>Purpose</h3><div>Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.</div></div><div><h3>Design</h3><div>This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN).</div></div><div><h3>Patient Sample</h3><div>Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021.</div></div><div><h3>Outcome Measures</h3><div>Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale.</div></div><div><h3>Methods</h3><div>Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups.</div></div><div><h3>Results</h3><div>Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, −3%, −10%, −14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI=0.81–0.90). No patient demographic or surgical factors influenced satisfaction.</div></div><div><h3>Conclusions</h3><div>Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 265-275"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0