Spine Journal最新文献

Background context: Bone disease in patients with multiple myeloma (MM) is associated with vertebral complications, which include vertebral fractures and spinal cord compression (SCC). Bone-modifying agents (BMAs), namely bisphosphonates and denosumab, are recommended to reduce skeletal-related events in MM, yet their efficacy in preventing vertebral fractures and SCC remains unclear.

Purpose: To determine the efficacy of bone-modifying agents (BMAs) in reducing the risk for vertebral fractures and SCC in adults with MM.

Study design: Systematic review and meta-analysis following PRISMA guidelines.

Methods: A systematic search of PubMed, Embase, and Web of Science databases was performed on July 11, 2024. Risk of bias, reporting bias, and evidence certainty were evaluated using the RoB 2 tool, funnel plot and Egger's test, and the GRADE approach, respectively. Relevant data were extracted and pooled for pairwise and network meta-analysis.

Results: After removing duplicates, 1,354 studies were screened, 108 full-text studies were reviewed for inclusion, and 11 randomized trials were included in the analysis. Compared to no treatment or placebo, lower-potency bisphosphonates were associated with a reduction in the risk for vertebral fractures, with a pooled RR of 0.72 (95% CI: 0.61-0.85, p=.0001), suggesting a 28% reduction in risk. Zoledronate was the most efficacious bisphosphonate in the network meta-analysis, with a 64% reduction in vertebral fracture risk compared to no treatment or placebo (RR=0.36, 95% CI: 0.16-0.77, p=.009). None of the included studies reported the clinical significance of these vertebral complications, and no studies that investigated denosumab met inclusion criteria. Meta-analysis for the SCC outcome was inconclusive due to limited evidence.

Conclusions: The body of literature indicates that bisphosphonates, particularly zoledronate, significantly reduce the risk for vertebral fractures in patients with MM, at least in trial conditions. Additional evidence is necessary to evaluate the real-world clinical impact of these findings, clarify the effects on risk for SCC, and investigate denosumab.

Background: Metabolic and bariatric surgery (MBS), employing mechanisms like malabsorption, volume restriction, and metabolic changes via the gastrointestinal tract, is the most effective long-term treatment for obesity and related metabolic disorders. Obesity affects over one-third of the U.S. population and is closely linked to low back pain (LBP) due to increased spinal loading and altered alignment. Weight loss following surgery may alleviate LBP symptoms and improve spinal health by reducing mechanical stress.

Purpose: This systematic review and meta-analysis evaluated the impact of MBS on LBP, quality of life, and spinal pathologies in morbidly obese patients, focusing on improvements in spinal alignment, intervertebral disc health, and related outcomes.

Study design/setting: Systematic review and meta-analysis conducted according to PRISMA guidelines and the PICOS framework.

Patient sample: Adult morbidly obese patients (body mass index ≥40 kg/m²) with LBP who underwent MBS (sleeve gastrectomy, Roux-en-Y gastric bypass, or gastric banding) were included.

Outcome measures: Primary outcomes included changes in LBP (measured by visual analog scale [VAS]), quality of life (measured by SF-36), and spinal health (evaluated by MRI or X-rays).

Methods: The review adhered to PRISMA guidelines and followed the PICOS framework. Eligible studies included adult morbidly obese patients with LBP who underwent MBS. Studies compared outcomes between surgical and nonsurgical interventions. Data were extracted from prospective, cross-sectional, and retrospective studies published between 2000 and 2025. A meta-analysis was conducted using RevMan 5.4 software, with standardized mean differences and risk ratios.

Results: A total of 13 studies met inclusion criteria, representing 390 participants. MBS significantly reduced LBP, with presurgery VAS scores ranging from 6.8 to 7.6 and postsurgery scores decreasing to 3.0 to 4.1. Quality of life, assessed through the SF-36 and Oswestry Disability Index, showed substantial improvements, particularly in physical function and daily activities. Spinal imaging studies reported increased intervertebral disc height and improved lumbar lordosis postoperatively. However, changes in spinopelvic alignment were inconsistent across studies.

Conclusions: MBS significantly reduces LBP severity, improves quality of life, and may contribute to spinal health improvements in morbidly obese patients. Additionally, weight loss increases disc height and enhances lumbar lordosis. These improvements are primarily attributed to weight loss and its alleviating effects on mechanical stress on the spine. Future studies with longer follow-up and standardized imaging assessments are needed to further elucidate its impact on spinal biomechanics.

Background: Low back pain is the leading cause of disability worldwide and the burden is expected to rise due to increases in ageing and population growth. The 2018 Lancet Low Back Pain Series proposed urgent actions to reverse the rising trend of disability due to low back pain including the need for a set of data indicators to routinely monitor progress in achieving these actions worldwide.

Purpose: To reach international consensus on a national minimum dataset of low back pain indicators that could be used across all countries to monitor progress in improving care and reducing disability from low back pain.

Study design: Modified Delphi study.

Sample: Nineteen participants attended a preliminary workshop at the 2023 International Back and Neck Pain Forum, The Netherlands. Subsequently, 305 and 339 participants (researchers, clinicians, policy makers, educators, and consumers) completed Delphi surveys Rounds 1 and 2, respectively.

Outcome measures: A 9-point Likert scale rated importance and feasibility of low back pain indicators (1 = not important or feasible; 9 = extremely important or feasible, 0 unsure). In Round 2, indicators that achieved consensus on importance and feasibility were ranked "most important" (top-ranked) to "least important."

Methods: Workshop participants were divided into four groups and asked to independently consider the importance and feasibility of 105 indicators identified from previous reviews divided into six themes. Participants could remove indicators considered unimportant or not feasible. This required unanimous agreement from independent workshop groups. Participants could also suggest improvements to the wording of indicators, the best unit of measure and additional missing indicators.

Results: Thirty-eight indicators were recommended by workshop participants for inclusion in the Delphi study. Survey responses over two rounds reached consensus for 21 indicators (11 burden, 10 care) ranked from most to least important after reaching consensus on importance and feasibility in Round 1. Number of work days lost and number of opioid prescriptions for low back pain were the highest ranked indicators for burden and care, respectively. Importance rankings were similar across subgroups comparing high-income and low- and middle-income countries, and consumers and non-consumers.

Conclusion: We reached international consensus that 21 indicators could be used to monitor progress in improving care and outcomes for people with low back pain globally. Future work is needed to confirm the acceptability and feasibility of these indicators across countries, and, if implemented, to determine their value over time.

Background context: Degeneration of the intervertebral discs (IVDs) causes significant biomechanical changes and structural defects, often leading to pain or disability. These defects impair both the biomechanics and physiology of the IVD, contributing to further structural failure of the IVD. Although the function and structure of the annulus fibrosus (AF) affect overall disc function, its structural change during degeneration is not fully characterized.

Purpose: The objective of this study was to investigate AF microdamage and mechanical function in mildly degenerated discs.

Study design: Basic laboratory study using human cadaveric intervertebral discs.

Methods: Microdamage and its functional implications in the AF of human IVDs with mild degeneration were assessed through a comprehensive approach focusing on biomechanical, and structural analyses. Eighteen fresh-frozen human cadaveric discs (T10-L5, n=3 spines, 43-58 years old) were analyzed from anterior, posterior, and lateral regions of the inner and outer AF. Collagen microdamage was assessed using Collagen Hybridizing Peptide (CHP), and Second Harmonic Generation (SHG) imaging to provide high-resolution insights into collagen fiber structure. Mechanical testing was performed on the same regions.

Results: Damage analyses showed no significant differences between the degenerative grades except in the posterior outer AF, where Grade 3 discs showed higher CHP and SHG signal intensity compared to Grade 2. Plus, mechanical properties did not differ significantly between the grades, although large variances were observed, particularly in the posterior outer AF.

Conclusions: Despite limited mechanical differences, early structural damage was found in the posterior outer AF. This indicates that this part is the initial site of AF damage and biological response during IVD degeneration.

Clinical significance: These findings highlight the posterior outer AF as a potential target for early diagnostic and therapeutic interventions to mitigate further degeneration and preserve disc function.

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.

Background context: Posterior cervical foraminotomy (PCF) cannot widen the neural foramen vertically, whereas anterior cervical discectomy and fusion (ACDF) could increase foraminal height (FH) by distracting the disc space.

Purpose: To compare the clinical and radiographic outcomes between ACDF and PCF in patients with cervical radiculopathy and vertically narrow foramina (FH <6 mm).

Study design: Retrospective cohort study.

Patient sample: Patients who underwent single- or multilevel ACDF (n=44) or PCF (n=33) between 2015 and 2022 and had at least one neural foramen with FH <6 mm were retrospectively analyzed.

Outcome measures: Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain and the Neck Disability Index, assessed preoperatively and at 3 months and 2 years postoperatively. Radiographic parameters included FH, C2-C7 sagittal vertical axis, and cervical range of motion. Revision surgery rates and causes were also evaluated.

Methods: Between-group comparisons of continuous variables were conducted using Student's t test, whereas categorical variables were analyzed using the chi-squared test. Paired t tests were used to compare repeated measures over time. Intraobserver reliability of radiographic measurements was assessed using intraclass correlation coefficients.

Results: Preoperative demographics and clinical scores were comparable between the groups. Postoperative FH significantly increased only in the ACDF group (p<.001) and was significantly greater than that in the PCF group at both 3 months and 2 years (p<.001). Neck and arm pain VAS scores significantly worsened in the PCF group between 3 months and 2 years postoperatively (p=.003 and p=.003, respectively) but remained stable in the ACDF group. At 2 years, the VAS scores for neck and arm pain were significantly worse in the PCF group (p=.004 and p=.036, respectively). Although the overall revision rates did not significantly differ (ACDF 6.8% versus PCF 12.1%, p=.161), all PCF revisions were owing to recurrence of radiculopathy at the index level (p=.030), whereas ACDF revisions were unrelated to index-level pathology.

Conclusions: In patients with vertically narrow foramina (FH <6 mm), ACDF provides superior long-term pain relief and better restoration of FH than PCF. In this subset of patients, PCF may be associated with an increased risk of symptomatic recurrence at the index level. FH should be considered when selecting a surgical approach for cervical radiculopathy.

Background context: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity often presenting during a critical period for psychological development. While AIS has been associated with increased rates of mental health disorders (MHDs), postoperative outcomes in patients with preoperative MHDs undergoing AIS surgery remain poorly understood.

Purpose: This study aimed to identify the perioperative prevalence of MHDs and evaluate the impact of preoperative MHDs on surgical outcomes and healthcare utilization in adolescents undergoing AIS correction.

Study design: Retrospective database study PATIENT SAMPLE: Patients aged 10-18 undergoing >7-level posterior spinal fusion for AIS between 2010 and 2023 OUTCOME MEASURES: Epidemiologic measures: MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs.

Methods: Our population of interest was identified in the PearlDiver national database. Patients were stratified by presence of MHDs within 1 year perioperatively, defined using DSM-5 categories. Outcomes included MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs. Pre- and postoperative rates of MHDs were compared using McNemar's test. Propensity score matching (3:1) was performed based on age, sex, and Elixhauser Comorbidity Index (ECI), followed by univariate analyses.

Results: Among 11,624 patients, 15.92% had a documented preoperative MHD. MHD prevalence rose in the year prior to surgery and remained stable within 1 year postoperatively. After matching, patients with MHDs had higher total opioid use, increased opioid use between 90 and 180 days postoperatively, and higher healthcare costs at 90 and 365 days. No significant differences were observed in complication, readmission, or revision surgery rates.

Conclusion: In our cohort, 15.92% of AIS patients were diagnosed with an MHD within 1 year preoperatively, a prevalence that remained stable postoperatively. While AIS surgery is safe in patients with preoperative MHDs, these individuals experience higher total opioid use and greater healthcare utilization. Future research should aim to identify specific drivers of healthcare utilization in patients with MHDs and evaluate the impact of targeted mental health interventions on both psychological well-being and physical recovery to optimize outcomes for AIS patients.

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.