Journal of Craniovertebral Junction and Spine最新文献

Context: Hospital procedural volume is often linked to outcomes and costs, but whether this relationship holds for posterior cervical fusion (PCF) remains unclear.

Aims: The objective of this study was to evaluate whether hospital PCF volume is associated with complications, discharge disposition, and hospital costs.

Settings and design: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS) from 2016 to 2022.

Subjects and methods: Elective PCF encounters were analyzed, with hospitals stratified by annual PCF volume (low, intermediate, high). Survey-weighted multivariable logistic regression estimated odds of cardiovascular complications, overall adverse events, and nonroutine discharge; linear regression assessed total costs and lengths of stay (LOS). Models adjusted for demographic, clinical, and hospital covariates.

Statistical analysis used: Survey-weighted regression with odds ratios (ORs), coefficients, and 95% confidence intervals (CIs). Significance was set at P < 0.05.

Results: We included 163,230 weighted elective PCF cases. Baseline characteristics differed across volume groups (P < 0.001) except for sex (P = 0.163). Compared with low-volume hospitals, high-volume hospitals had higher odds of cardiovascular complications (OR 1.87, 95% CI 1.70-2.06, P < 0.001), overall adverse events (OR 1.30, 95% CI 1.21-1.40, P < 0.001), and non-routine discharge (OR 1.09, 95% CI 1.02-1.16, P = 0.008). High-volume hospitals were also associated with higher total costs (coefficient: $4298; 95% CI $3468-$5128; P < 0.001), with no significant difference in LOS (P = 0.387).

Conclusions: Hospital PCF volume is tied to complications, nonroutine discharges, and higher costs, challenging the volume-outcome paradigm and underscoring adjustment for patient complexity and case mix in benchmarking and allocation.

Urge urinary incontinence (UI) due to brainstem disorders is not well known. Here, we report a case of UI due to a dural arteriovenous fistula (dAVF) in the craniocervical junction (CCJ). The cases were two men, aged 71 and 44 years, who developed the disease due to UI. Both patients developed quadriplegia within a few months, and further examination revealed dAVF of the CCJ. Treatment resolved the quadriplegia, but urinary problems persisted. Urge UI may be due to vascular disorders of the brain stem, so early diagnosis is important. If a dAVF is diagnosed, prompt surgical treatment is useful.

Personalized medicine (PM) is transforming spine care by shifting from standardized, "one-size-fits-all" treatments to patient-specific strategies informed by genetic, environmental, psychosocial, and technological factors. Spinal disorders remain a leading cause of disability and healthcare burden worldwide. PM offers a promising approach to addressing their complexity through genomics, advanced imaging, artificial intelligence (AI), and biomarker profiling, enabling tailored interventions that improve diagnostic accuracy, predict treatment outcomes, and guide decisions between surgical and conservative approaches. Key themes include genetic susceptibility to disc degeneration, integration of polygenic risk scores, genotype-based pharmacologic decisions, and AI-driven diagnostics and surgical planning. Innovative tools such as three-dimensional printing, robotic navigation, and wearable technologies are further personalizing care. However, significant barriers, such as high costs, fragmented data systems, workforce gaps, and ethical concerns, limit widespread adoption. Looking forward, emerging technologies like smart implants, clustered regularly interspaced short palindromic repeats-based therapies, and neural interfaces promise to reshape spine care. To fully realize these benefits, future efforts must address affordability, regulatory reform, and clinician training. While this review highlights promising trends, limitations include potential selection bias and rapidly evolving evidence that may outpace current literature. Overall, PM holds great promise to deliver more precise, effective, and patient-centered spine care.

Context: Semaglutide, a glucagon-like protein-1 receptor agonist used in diabetes and obesity management, has demonstrated perioperative benefits in other surgical populations. However, its role in spine surgery remains unclear.

Aims: This study aims to evaluate whether patients undergoing single-level lumbar fusion demonstrate: (1) fewer medical complications; (2) surgical complications; and (3) healthcare utilization as measured by readmissions and costs.

Settings and design: A retrospective cohort study using a national claims database from 2010 to 2021.

Subjects and methods: Patients with diabetes mellitus undergoing single-level lumbar fusion were identified and matched 1:5 using propensity scores based on age, sex, body mass index, smoking status, diabetes-related complications, insulin/metformin use, and Elixhauser Comorbidity Index (semaglutide: N =3452; controls: N =15,486). Outcomes included 90-day medical/surgical complications, readmissions, and costs. Multivariate logistic regression was used to calculate odds ratios, 95% confidence intervals, and P values, with statistical significance set at P < 0.003 after Bonferroni correction.

Statistical analysis used: Multivariate logistic regression for binary outcomes; cost comparisons conducted with appropriate statistical adjustments.

Results: No significant differences were observed in rates of cerebrovascular accidents, myocardial infarctions, venous thromboembolism, pneumonia, hypoglycemia, or surgical site infections (SSIs) (P > 0.05 for all). Semaglutide users had significantly lower 90-day readmission rates (8.7% vs. 11.4%, P < 0.0001) and reduced 90-day costs-of-care (P < 0.0001). A trend toward fewer SSIs was noted (2.5% vs. 3.2%, P = 0.018), though not statistically significant.

Conclusions: Semaglutide use before single-level lumbar fusion is associated with reduced 90-day readmissions and costs without increasing complication risk.

Multidisciplinary meetings (MDMs) are increasingly central to spinal oncology, where complex decision-making must balance neurological, oncological, biomechanical, and systemic factors. This review aims to analyze the structure, clinical value, limitations, and future directions of MDMs in the management of spinal tumors. Narrative review of the literature on MDMs in spinal oncology, focusing on their impact on diagnosis, treatment planning, surgical coordination, and longitudinal care. Articles were selected from PubMed and Google Scholar databases and supplemented with international consensus documents and high-level evidence on decision frameworks. MDMs improve diagnostic accuracy, reduce unnecessary surgeries, and enhance treatment sequencing and outcome, especially in cases of metastatic epidural spinal cord compression. Structured frameworks facilitate individualized decisions based on shared parameters. However, variability persists in access, role participation, and documentation practices. Emerging technologies may improve triage and equity, while standardized prognostic models support better outcome prediction. MDMs represent a critical element of modern spine tumor care but require standardization, institutional support, and integration of patient-centered tools. Future models should prioritize continuity across the disease course, equitable access, and the use of structured clinical frameworks to support data-driven and ethically grounded decision-making.

Introduction: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common treatments for cervical radiculopathy and myelopathy. While ACDF remains the gold standard, CDA is gaining popularity due to the benefit of motion preservation. However, national trends in outcomes between these procedures remain unclear.

Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients aged >18 who underwent ACDF or CDA between 2012 and 2022, using CPT codes 22551 and 22856. Annual rates of demographics, comorbidities, and 30-day complications were analyzed. Univariate analysis evaluated outcomes including readmission, reoperation, and length of stay (LOS).

Results: We identified 93,989 ACDF and 8708 CDA patients. From 2012 to 2022, the proportion of ACDF cases declined from 96.3% to 90.2%, while CDA cases increased from 3.7% to 9.9%. ACDF patients were older (55.7 vs. 46.8 years) and had higher body mass index (30.6 vs. 29.6) (P < 0.001). Diabetes increased in both cohorts (ACDF: 15.3%-20.7%; CDA: 5.9%-11.3%), as did hypertension (ACDF: +8.7%; CDA: +5.4%) (P < 0.001). Steroid use (+2.2%, P < 0.001) and chronic obstructive pulmonary disease (+1.0%, P = 0.021) rose in ACDF only. LOS decreased in ACDF (1.94-1.76 days, P < 0.001) but rose in CDA (1.10-1.15 days, P = 0.023). Readmissions increased in both (ACDF: 2.9%-3.25%; CDA: 0.74%-1.01%, P < 0.001).

Conclusion: CDA continues to show favorable short-term outcomes compared to ACDF but remains less utilized overall. These trends may guide surgical planning and patient counseling in cervical spine care.

Background: Atlantoaxial stabilization is indicated for traumatic or degenerative pathologies. The procedure is technically demanding due to delicate neurovascular anatomy and narrow bone corridors. Recent technologies such as neuronavigation and intraoperative computed tomography (iCT) may improve screw placement and reduce complications. This study reports our experience with C1-C2 stabilization using these tools.

Materials and methods: This retrospective single-center study included 15 consecutive patients who underwent C1-C2 stabilization. Clinical assessment was performed pre- and postoperatively using the Neck Disability Index and American Spinal Injury Association score. Fractures were classified using standard parameters; degenerative cases were assessed with positional magnetic resonance imaging. Other data collected included pathology, surgical technique, sagittal/coronal alignment, complications, and follow-up duration. All surgeries used iCT for navigation and intraoperative control. Screw accuracy was assessed with a modified Gertzbein-Robbins scale.

Results: Mean patient age was 63 years. Indications were traumatic (47%) or degenerative (53%). Screws were placed into C1-C2 lateral masses. Of 60 screws, 54 were grade A and 6 were grade B. One case required recalibration due to neuronavigation inaccuracy. Alignment was restored in all cases. Thirteen patients showed significant clinical improvement. Mean follow-up was 12 months, with no complications recorded.

Conclusions: Neuronavigation with iCT for C1-C2 screw placement proved safe and accurate. Our data show 90% grade A and 10% grade B screws, with a mean deviation of 0.13 mm and no intra-or postoperative complications attributable to the technique.

Background: The Barricaid annular closure device (Intrinsic Therapeutics, Inc., Woburn, MA) functions to prevent reherniation in patients undergoing primary discectomies for L4-L5 or L5-S1 disc herniation with large annular defects. However, there are limited investigations assessing patient safety. This study analyzed clinical data on device malfunctions and adverse events to inform potential areas for improvements.

Methods: Adverse event reports related to the Barricaid device filed from January 1, 2020, to February 28, 2025, were retrieved from the U. S. Food and Drug Administration Manufacturer and User Facility Device Experience database. Event date, device type, device malfunction, and adverse event were recorded.

Results: 101 adverse event reports were included in this study. The most common malfunction was device migration (30.7%), followed by unsuccessful implantations (26.7%), which were addressed either intraoperatively (22.8%) or in revision surgeries (4.0%). Reherniation was the most frequently reported device-related adverse event (36.6%), while other postoperative complications were anticipated following spine surgeries that involved implants. Revision surgeries were performed in 67 reports following discoveries of device malfunction and/or adverse events (66.3%). 46 reoperations involved partial or complete device removal (45.5%).

Conclusion: Device malfunctions and adverse events inform the importance of careful patient selection, meticulous device handling, and improved device design in enhancing patient safety and outcomes. Patients with frailty, comorbidities, or postimplant adverse events could be subject to increased morbidity and reoperations. Continued postmarketing improvements are needed to mitigate device malfunctions and adverse events.

Context: Posterior spinal fixation surgery can improve performance status (PS), alleviate neurological deficits, and reduce pain in patients with metastatic spinal tumors. However, surgical indications and timing vary based on individual patient conditions.

Aims: To evaluate postoperative course and improvement in PS following posterior spinal fixation surgery for metastatic spinal tumors.

Settings and design: Single-center and retrospective case-series study.

Subjects and methods: We included 33 patients who underwent posterior spinal fixation surgery for metastatic spinal tumors from April 2017 to April 2024. PS and modified Frankel classification for paralysis were assessed 2 weeks' postsurgery.

Statistical analysis used: Fisher's exact test and Kaplan-Meier survival curves with a log-rank test were used for the analysis.

Results: The cohort included 33 patients (25 men, 8 women; average age, 69 years). Lung cancer was the most common primary tumor (n = 10). Surgical sites included the cervical (n = 4), thoracic (n = 14), thoracolumbar junction (n = 10), and lumbar/sacral (n = 5) regions. The median postoperative survival time was 25 months. Preoperative PS was 0-2 in 23 cases and 3-4 in 10 cases. Preoperative modified Frankel classification included A (n = 3), B (n = 2), C (n = 3), D (n = 9), and E (n = 16). Significant PS improvement was observed in the PS 0-2 group compared with that in the PS 3-4 group (P = 0.0209). Paralysis improvement was observed in 3 cases.

Conclusions: Spinal fixation can improve PS in patients with preoperative PS of 0-2. Patients with poor initial PS may not experience expected improvements, requiring cautious surgical intervention, and thorough prognostic evaluation.

Introduction: Chiari I malformation (CMI) is a complex condition characterized by cerebellar herniation through the foramen magnum and is frequently coincident with other craniovertebral junction abnormalities. Symptoms are varied, and the complete disease etiology is poorly understood. The primary aim of our study is to assess atlantal facet geometry in CMI patients to further elucidate disease pathogenesis.

Materials and methods: Forty-six CMI-affected female patients (29.48 years ± 8.35) (Chiari1000 database) and 55 female controls (32.11 years ± 4.81) (New Mexico Decedent Image Database [NMDID]) were included. Twenty 3D landmarks were placed around the perimeter of each facet by a blinded landmarker. Coordinates were subjected to a generalized Procrustes superimposition. A between-groups principal component analysis (bgPCA) was used to explore differences between groups. The protocol was completed by a second landmarker to validate results.

Results: The bgPCA scores were significantly different between CMI patients and controls (W = 689, P = 0.00022). Chiari malformation patients tended to have more negative overall scores, which coincided with smaller, more horizontally oriented facets. These differences were driven largely by the anterior aspect of the facets, which in CMI patients were notably blunted, lacking the typical medial angulation that contributes to the facet's usually reniform shape. The error study conducted by the second blinded landmarker yielded similar differences between CMI and control groups (W = 704, P = 0.00104).

Conclusions: The geometric analysis suggests distinct facet differences in CMI facet shape. CMI etiology is complex, and wholistic anatomical assessment using geometric or multiplanar methods may identify new clinical targets or provide a fresh approach to morphologically driven pathogenesis.