搜索结果：North American Spine Society journal

This study analyzes cervical spine injuries using the National Electronic Injury Surveillance System (NEISS), a database representing ~100 US emergency departments (EDs), over a 10-year period. To identify the distribution of cervical spine injuries in US EDs to inform clinical management and prevention strategies. Understanding the epidemiology and trends of cervical spine injuries is essential for improving clinical management and developing prevention strategies. NEISS was queried for all cases involving neck fractures, sprains, and strains. An automated text analysis program was used to exclude injuries unrelated to the cervical spine. Data collection was restricted to injuries recorded between January 1, 2014 and December 31, 2023. From 2014 to 2023, a total of 14,293 cervical spine injuries were identified, resulting in a national estimate (NE) of 622,517 over the study period. Annual rates of cervical spine injury increased significantly (P=0.021, &#x3b2;=2838, 95% CI: [553, 5,122]), peaking in 2019 (NE 84,561, 13.6% of all injuries). Cervical spine injuries led to hospitalization 23.2% of the time. Hospitalization rate was higher among males than females (25.7% vs. 21.0%, P<0.0001), and only males had a significant increase in cervical spine injuries over the study period. Among age groups, ages 65-84 accounted for the largest number of injuries (NE 163,960, 26.4% of all injuries), and 80-year-olds presented with more cervical spine injuries than any other year (NE 9819). Ages 85 and older had the highest hospitalization rate (50.8%), and ages 0-13 had the lowest (1.6%). Cervical spine injuries are significantly increasing in the United States, particularly in males and those aged 65-84. Future research should be focused on the mitigation of cervical spine injuries, as well as home-focused preventative strategies for the aging population of the United States.

Patients' perspectives are central measures of success in healthcare delivery. The association of postoperative changes in patient-reported outcome measures (PROM) and expectation fulfillment is not well established. This study's primary objective was to assess the association between changes in PROMs (e.g., ODI or EQ-5D) and patient multidimensional expectations fulfillment at 1 year following elective lumbar spine surgery. The secondary objectives included measuring changes in PROMs across various levels of expectation fulfillment and identifying the PROM instrument that explains the highest variability in each expectation domain. Retrospective cohort study from the prospectively collected registry data. Data were obtained from the Canadian Spine Outcome Research Network (CSORN) registry, which prospectively enrolls adults undergoing elective spine surgery in Canada. We included adults who underwent elective lumbar spine surgery between January 2015 and December 2022. The study's primary outcome was the extent of expectation fulfillment at one-year follow-up in surgical patients. Demographic, lifestyle, clinical, and multidimensional expectation data were collected using the North American Spine Society Lumbar Spine Questionnaire. Postoperative changes in PROMs were the primary exposure variables. Baseline sociodemographic and clinical characteristics were summarized descriptively, and ordinal logistic regression was used to examine associations between expectation fulfillment and changes in PROMs, adjusting for confounders. We included 6,260 patients. Females represented 50% of the study sample, and the median age was 62 years. The median change in postoperative leg pain scores (NRS) was -6 (-8, -4), -3 (-5, -1), and -1 (-2, 1) points for patients whose expectations were completely met, somewhat met, and unmet, respectively. ODI changed by -28 (-40, -16), -15 (-26, -4), and -4 (-4, 4); p<0.001 for those whose expectations were completely met, somewhat met, and unmet, respectively. PCS scores changed by 16.6 (8.6, 24.1), 8.7 (2.2, 15.2), and 2 (-3.7, 8.6); p<0.001 for patients with expectations that were completely met, somewhat met, and unmet, respectively. A similar association was observed between changes in PROMs and expectation fulfillment in other expectation domains. Changes in the leg pain and back pain score were strongly associated with expectation fulfillment regarding reduction in Leg pain and Back pain, respectively. Similarly, changes in ODI, EQ-5D and SF-12 PCS scores were strongly associated with expectation fulfillment for Improvement in General Physical Capacity. Postoperative changes in PROMs are strongly associated with patient expectation fulfillment following elective lumbar spine surgery at one-year follow-up. Changes in PROMs may provide insights into patients' perceived postoperative outcome. Different PROM instruments reflect distinct aspects of patient experience, with domain- specific alignment between measured outcomes and perceived benefit. While PROM improvements closely mirror patient-perceived success, they do not fully capture expectation fulfillment in all cases.

Growing evidence supports stereotactic body radiation therapy (SBRT) over conventional radiation therapy for spine bone metastases, with an expanding role in non-spine bone metastases (NSBM). Our case-based review aims to inform radiation oncologists in the appropriate utilization of SBRT for representative cases of NSBM. Three cases were selected for discussion: (1) rib, (2) skull base, and (3) femur. Relevant literature was reviewed, and areas for future investigation were discussed. SBRT can be effectively delivered in NSBM with appropriate patient selection, target volume delineation, prescription dose, organs at risk dose constraints, and treatment planning. The Radiosurgery Society's case-based review offers guidance on the appropriate use of SBRT in NSBM with discussions and consensus recommendations from experts. SBRT can be considered for an oligometastatic patient with favorable prognosis in whom the goal is durable local control and/or symptom relief. It can be considered for radioresistant histologies and improved OAR sparing. Available MRI or PET/CT should be fused to improve target volume delineation. A CTV margin, generally of 5 mm, should be considered to cover microscopic disease. As bones are easily visualized on daily images acquired for accurate and precise set-up of patients, a PTV margin should be kept less than or equal to 3 mm. While SBRT can be delivered in 1 fraction, fractionated SBRT may be preferred to meet dose constraints when the CTV is adjacent to the OARs. NSBM of long bones that are weight bearing, lytic, or have a high MIRELS score should be evaluated by an orthopedic surgeon.

In 2023, there was a sudden decline in the popularity of Accreditation Council for Graduate Medical Education (ACGME) Pain Medicine fellowship programs, as demonstrated by National Resident Matching Program (NRMP) application and match data. In comparison, little is known about the application rates and match performance of the North American Spine Society (NASS)-recognized Interventional Spine and Musculoskeletal Medicine (ISMM) fellowships established in 2020. We aimed to compare the characteristics of NASS-recognized ISMM applicants and their match results with those of NRMP-sponsored Pain Medicine applicants to determine whether both pathways faced similar challenges in recruiting and successfully matching trainees in recent years. This longitudinal observational study examines and describes the total number of applicants, match rate, and position fill percentage results of the ACGME NRMP and NASS ISMM from 2020 to 2025, stratified by gender and primary specialty. Over the study period, match rates did not markedly change for ISMM, but for ACGME they increased suddenly in 2023 and remained at this level. For ISMM and ACGME, the percentage of positions filled through the match trended downward. For both, the number of female applicants remained low and stable despite fluctuations in the total number of applicants. The distribution of applicants by primary specialties changed for the ACGME; notably, Anesthesiology applicants decreased by 65% from 2021 to 2025, while applications from all other specialties increased, including an increase in Emergency Medicine applicants by 221%. Since its inception, the NASS ISMM match has been primarily composed of Physical Medicine and Rehabilitation (PM&R) physicians, who accounted for 88% of applicants and 90% of successful matches. ACGME and NASS ISMM pain fellowships have been at the forefront of evolving trends in program fill rates from 2020 to 2025. Match rates for applicants remained high, reflecting a less competitive and more accessible process for those pursuing careers in pain and spine care.In 2025, male PM&R physicians were the largest group of applicants across both fellowship pathways, highlighting continued strong engagement from this specialty. Although overall applicant numbers have shifted, these trends present an opportunity to broaden outreach, strengthen early mentorship programs, and expand the pipeline of future pain and spine specialists.

Although spine surgeons may intuitively presume that clinical improvement drives patient satisfaction, some patients remain satisfied despite limited clinical improvement. Therefore, in patients undergoing degenerative lumbar spine surgery who did not achieve minimum clinically important difference (MCID), we sought to identify predictors of long-term postoperative satisfaction. A prospective, single-institution registry (2010-2023) was retrospectively queried to identify patients undergoing elective, degenerative lumbar spine surgery who did not achieve MCID at 12 months, defined as <30% improvement in the Oswestry Disability Index or Visual Analog Scale pain scores from baseline. Primary outcome was 12-month postoperative satisfaction, assessed using the North American Spine Society questionnaire. Bivariate and multivariable logistic regression identified predictors of satisfaction in the absence of MCID, both overall and stratified by procedure type. Among 3547 patients, 611 (17.2%) did not achieve MCID for disability or pain, of whom 334 (54.7%) remained satisfied. Older age (odds ratio [OR]: 1.02, 95% CI: 1.00-1.04, P = .035) and private insurance (OR: 1.63, 95% CI: 1.03-2.57, P = .035) independently increased the odds of satisfaction. Specifically, each additional decade of age conferred a 22% higher odds of 12-month satisfaction. Fusion: Among 2133 fusion patients, 390 (18.3%) did not achieve MCID, of whom 219 (56.2%) still reported satisfaction. Older age again increased odds of satisfaction (OR: 1.04, 95% CI: 1.00-1.09, P = .036), whereas baseline independent ambulation decreased odds (OR: 0.22, 95% CI: 0.08-0.58, P = .002). Decompression: Among 1386 decompression patients, those with a diagnosis of stenosis were three-times more likely to report satisfaction than those with other primary diagnoses (OR: 3.04, 95% CI: 1.06-8.72, P = .039). More than half of patients who did not achieve MCID still felt surgery was worthwhile, suggesting that long-term satisfaction is shaped by broader patient expectations and sociodemographic context. To optimize patients' perceived benefit of surgery, surgeons should engage in individualized counseling to understand patients' priorities and expectations, rather than selecting interventions based solely on their potential to maximize symptom relief.

Surgical management of cervical spondylotic myelopathy (CSM) aims to improve neurological deterioration. However, long-term predictors of outcome are unknown. The present study examined highest and lowest patient-reported satisfaction at the 5-year follow-up. The authors hypothesized that the most satisfied patients experience durable long-term improvement and have distinct characteristics compared to the least satisfied patients. Prospectively collected data from the Spine CORe&#x2122; study group of the Quality Outcomes Database cervical spine module were retrospectively reviewed. Patients were stratified by North American Spine Society (NASS) satisfaction scores of 1 (most satisfied) and 4 (least satisfied). Demographics, surgical characteristics, and patient-reported outcome measures (PROMs) were compared between cohorts at baseline and 24 and 60 months of follow-up. A mixed-effects logistic regression assessed independent predictors of those who were most and least satisfied at 60 months. Univariate and multivariable analyses were repeated in the subsample of most satisfied patients at 2 years. Univariate analysis was completed for the subsample of least satisfied patients at 2 years. Of 1085 patients with CSM, 895 (82%) completed the 60-month follow-up. Of these 895 patients, 106 died within 5 years of surgery of unrelated causes, and 785 provided satisfaction scores at 60 months of follow-up. Of the 785 patients, 621 patients met inclusion criteria of reporting an NASS score of 1 or 4 at 60 months: 560 (90.2%) were most satisfied and 61 (9.8%) were least satisfied. The most satisfied cohort included more patients with bachelor's degrees (25% vs 13%, p = 0.043), more anterior cervical discectomies and fusions (61% vs 48%, p = 0.038), shorter hospitalizations (1.7 &#xb1; 1.8 vs 2.8 &#xb1; 2.6 days, p = 0.002), fewer laminectomies (23% vs 39%, p = 0.004), and fewer smokers (p = 0.036). Most satisfied patients reported higher baseline EuroQol visual analog scale (EQ-VAS) scores (60.8 &#xb1; 21.3 vs 51.5 &#xb1; 24.8, p = 0.008), but other baseline PROMs were similar. In multivariable analysis, college education (OR 2.54, p = 0.004), preoperative depression (OR 2.75, p = 0.043), higher baseline EQ-VAS score (OR 1.02, p = 0.009), and shorter hospitalization (OR 0.81, p = 0.003) independently predicted the most satisfaction at 60 months. Among 60-month least satisfied patients, 28% were most satisfied at 24 months. Among 60-month most satisfied patients, 2.9% were least satisfied at 24 months. Among 24-month most satisfied patients, maintenance of most satisfaction at 60 months was independently predicted by older age (OR 1.09, p = 0.045), preoperative pain (OR 9.28, p = 0.013), and higher 24-month neck pain numeric rating scale (NP-NRS) score (OR 1.58, p = 0.047). Neck Disability Index- and modified Japanese Orthopaedic Association (mJOA)-based independence measures correlated with a bidirectional satisfaction shift between 2 and 5 years. Highest NASS satisfaction scores at 5 years after surgery for CSM are predicted by college education of the patients, preoperative depression, higher baseline EQ-VAS scores, and shorter hospital length of stay. Younger age, lack of preoperative pain, and lower 2-year NP-NRS scores predict movement from most satisfied to least satisfied. After surgery for CSM, the majority of patients report the highest satisfaction NASS rating at 5 years, but delayed satisfaction reversals exist and warrant monitoring.

Hollow viscus perforation following spine surgery is uncommon but associated with substantial morbidity and mortality when diagnosis is delayed. Early recognition is challenging because presenting symptoms frequently overlap with expected postoperative bowel dysfunction, and imaging findings may initially be subtle. Despite its clinical significance, the literature remains fragmented across case reports and small series, and a consolidated, mechanism-based framework specific to spine surgery is lacking. We performed a single-institution case series of five patients who developed hollow viscus perforation or significant postoperative intra-abdominal pathology after spine surgery, combined with a comprehensive review of the published literature. Data were analyzed to identify common mechanisms of injury, clinical presentation patterns, diagnostic pathways, management strategies, and preventive considerations. Hollow viscus perforation after spine surgery occurred through four principal mechanisms: direct mechanical injury, functional distension related to acute colonic pseudo-obstruction physiology, delayed hardware or graft migration, and medication-associated ulceration or diverticular perforation. Early clinical findings frequently overlapped with expected postoperative bowel dysfunction, contributing to delayed recognition. Diagnosis depended on identifying deviations from expected recovery trajectories and obtaining timely computed tomography imaging. Preventive strategies included recognition of preoperative abdominal risk factors, meticulous exposure-specific surgical technique, optimization of postoperative bowel function, and judicious use of medications that impair gastrointestinal motility or tissue integrity. Hollow viscus perforation following spine surgery is an uncommon but potentially catastrophic complication arising from distinct mechanical, functional, hardware-related, and medication-associated pathways. Because early signs are often nonspecific, a low threshold for imaging and general surgical evaluation is essential. Improved preoperative risk stratification, intraoperative vigilance, and structured postoperative monitoring may reduce delays in diagnosis and improve outcomes in this high-risk population.

Biportal endoscopic (BE) spine surgery has gained increasing attention as a minimally invasive alternative to conventional spinal procedures, yet the distribution of procedural applications and anatomic targets within influential BE-specific publications has not been clearly synthesized. This study aimed to synthesize influential publications on BE spine surgery to describe the evolution of procedural applications, anatomic focus, and clinically relevant themes reflected in the literature. A comprehensive search of the Web of Science database was performed using terms related to biportal and multiportal endoscopic spine techniques. Influential articles were identified using citation frequency as a screening criterion, and relevant study characteristics, including publication year, authorship, institutional affiliation, geographic region, journal, and spinal region addressed, were extracted. Full-text screening confirmed inclusion of true biportal endoscopic spinal procedures and categorized the anatomical region and surgical technique addressed. Publications spanned 1997 to 2023, with a marked increase after 2018 and peak productivity in 2022. Influential publications were most frequently published in World Neurosurgery, with substantial contributions originating from South Korea, including work by Dae-Jung Choi. Most studies focused on lumbar procedures, primarily decompression techniques and transforaminal lumbar interbody fusion. Overall, this review highlights the rapid clinical growth of BE spine surgery, with influential literature emphasizing lumbar applications and underscoring the need for further research on outcomes, learning curves, and broader international adoption.

Minimal clinically important difference (MCID) thresholds are widely used to evaluate outcomes after surgery for cervical spondylotic myelopathy (CSM), but they may not fully reflect patient satisfaction. The authors hypothesized that discordance exists between MCID achievement in Neck Disability Index (NDI) score and satisfaction at long-term follow-up in a minority of patients after surgery for CSM. The 14-site Spine CORe&#x2122; study group performed a post hoc analysis of their prospectively collected data from the Quality Outcomes Database, which included 1085 patients who underwent surgery for CSM. Patients with complete baseline and 5-year NDI scores as well as 5-year satisfaction data were included. Satisfaction was assessed using the North American Spine Society (NASS) satisfaction index, and the MCID was defined for the NDI score. Baseline characteristics and patient-reported outcomes were compared between satisfied and dissatisfied patients within the cohort who met the MCID for NDI score. Multivariate logistic regression identified predictors of dissatisfaction despite the MCID. In total, 1085 patients underwent surgery for CSM. The 5-year follow-up rate was 82% (106 died within 5 years, and 782 had both 5-year satisfaction and NDI data). At 5 years postoperatively, 497 patients (63.6%) achieved the MCID in NDI score. Among MCID achievers, 463 (93%) were satisfied and 34 (7%) were not satisfied. On univariate analysis, of those who met the MCID, dissatisfied patients were more likely to be current smokers (32.4% vs 15.8%, p = 0.029) and less likely to participate in outside activities (58.8% vs 85.1%, p < 0.001). They also presented with greater baseline disability (NDI score: 47.9 &#xb1; 18.2 vs 41.1 &#xb1; 19.5, p = 0.021), lower quality of life (EQ-5D score: 0.50 &#xb1; 0.19 vs 0.58 &#xb1; 0.22, p = 0.029), and lower preoperative functional status (mJOA score: 11.2 &#xb1; 2.8 vs 12.3 &#xb1; 2.7, p = 0.025) compared with satisfied patients. On multivariate analysis, of those who met the MCID, smoking showed a trend toward higher odds of dissatisfaction (OR 2.12, p = 0.065), while participation in outside activities was protective (OR 0.28, p < 0.001). In this study, only 7% of patients were dissatisfied despite achieving the MCID for NDI score. Participation in outside activities was independently associated with greater satisfaction, whereas smoking showed a trend toward increased dissatisfaction despite meeting the MCID for NDI score. The MCID and satisfaction capture distinct yet complementary aspects of recovery and should be jointly considered during preoperative counseling and postoperative outcome assessment.

The minimal clinically important difference (MCID) is widely used to interpret patient-reported outcome measures (PROMs) in cervical spondylotic myelopathy (CSM). However, consensus on its definition is lacking, and its long-term consistency remains unknown. The objective of this study was to determine if MCID thresholds for PROMs at 5 years after surgery for CSM remained consistent when compared to previously established 2-year values. The Spine CORe&#x2122; study group performed a post hoc analysis of the prospective Quality Outcomes Database. Eight established anchor- and distribution-based methods were applied to define MCID thresholds for the following PROMs: Neck Disability Index (NDI), neck pain numeric rating scale (NP-NRS), arm pain numeric rating scale (AP-NRS), 5-dimension EuroQol health utility questionnaire (EQ-5D) for quality-adjusted life years, and modified Japanese Orthopaedic Association (mJOA) scores. Predictive validity was evaluated using area under the curve (AUC) analysis with North American Spine Society satisfaction as the anchor, and results were compared with calculated 2-year values from the same cohort using DeLong's test. A total of 1085 patients were originally enrolled, with &#x2265; 80% follow-up for all PROMs except the mJOA score (79%). At 5 years, optimal percentage change and &#x2265; 30% improvement methods were consistently highest performing for the NDI (AUC 0.71 and 0.68, respectively), NP-NRS (AUC 0.65 for both), and AP-NRS (AUC 0.73 and 0.72, respectively) scores. For the EQ-5D score, both the optimal numeric cutoff and one-half standard deviation methods performed best, yielding a consistent MCID threshold of 0.11 (AUC 0.64 for both). For the mJOA score, the severity-adjusted method provided the strongest discrimination, with an AUC of 0.74 at 5 years. MCID thresholds were consistent between 2 and 5 years, except for the severity-adjusted MCID for the mJOA score (0.74 at 5 years vs 0.65 at 2 years, p = 0.026). The 30% improvement threshold corresponded to absolute changes of 11.3 points for the NDI score, 1.5 points for the NP-NRS score, and 1.4 points for the AP-NRS score based on mean baseline scores. To the authors' knowledge, this represents the largest cohort of patients with CSM in the United States with validated, long-term 5-year MCID thresholds. This study establishes practical MCID definitions for NDI (&#x2265; 30% improvement threshold of 11.3 points), NP-NRS and AP-NRS (&#x2265; 30% improvement thresholds of 1.5 and 1.4 points, respectively), EQ-5D (optimal numeric cutoff of 0.11), and mJOA (severity-adjusted: &#x2265; 3 points for severe, &#x2265; 2 for moderate, &#x2265; 1 for mild) scores that can serve as benchmarks for evaluating improvement after CSM surgery in both research and routine clinical practice.

Surgical intervention for grade 2 lumbar spondylolisthesis is routinely performed, but outcomes in older patients, in whom the disease is most prevalent, remain poorly understood. The aim of this study was to compare patient-reported surgical outcomes between age groups (< 65 years of age vs &#x2265; 65 years of age) with 5 years of follow-up. The authors hypothesized that patients would have sustained improvement in outcomes in response to surgical treatment for grade 2 spondylolisthesis regardless of age. The multicenter prospectively collected Quality Outcomes Database by the Spine CORe&#x2122; study group was retrospectively analyzed for patients who underwent arthrodesis for grade 2 lumbar spondylolisthesis. Across 14 high-enrolling sites, 328 patients with 81% follow-up were identified. Baseline and postoperative 3-month, 1-year, 2-year, and 5-year outcomes including numeric rating scale (NRS) back pain (score 0-10), NRS leg pain (score 0-10), Oswestry Disability Index (ODI), EQ-5D scores, and patient satisfaction using the North American Spine Society (NASS) index, were evaluated. These outcomes were compared between younger (< 65 years of age, n = 188) and older (&#x2265; 65 years of age, n = 140) age groups using Wilcoxon rank-sum tests. EQ-5D and ODI scores were significantly improved postoperatively in the younger and older age groups (p < 0.001). ODI scores were not significantly different between the age groups at baseline (p = 0.37) or postoperatively at any time point (p > 0.05). EQ-5D scores were not significantly different between the younger and older patient groups at baseline (p = 0.47) or postoperatively at any time point (p > 0.05). NRS leg pain (p = 0.68) and back pain (p = 0.45) scores were not significantly different at baseline across age groups. NRS leg pain was not significantly different postoperatively (p > 0.05). Older patients had lower back pain scores (p = 0.03) at 3 months postoperatively, but not at any other time points (p > 0.05). Leg and back pain scores improved postoperatively up to 5 years of follow-up in all patients (p < 0.0001). A majority of the younger (83.5%) and older (89.5%) patients reported satisfaction with their surgical outcome up to 5 years after surgery, and postoperative NASS satisfaction scores were not significantly different between the younger and older age groups at any time point (p > 0.05). In response to surgical treatment, patients over 65 years of age have significant improvements similar to those of younger patients. Surgical treatment is a viable option for improvement regardless of age.

The objective of this study was to evaluate predictors of patient satisfaction following surgical treatment of Meyerding grade 2 lumbar spondylolisthesis. The authors hypothesized that postoperative improvements in patient-reported outcomes (PROs) would be the primary determinants of satisfaction. Patients with grade 2 lumbar spondylolisthesis were identified from the Spine CORe&#x2122; study group of the Quality Outcomes Database, a multicenter consortium of 14 participating sites. This cohort comprises 328 patients with a 60-month follow-up rate of 81%. Demographic, clinical, and surgical characteristics were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back (NRS-BP) and leg pain (NRS-LP), and EQ-5D, measured at baseline and at 60 months. The primary outcome was satisfaction at 60 months, assessed using the North American Spine Society patient satisfaction index. Satisfaction was defined as a score of 1 ("surgery met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same surgery again"). Minimal clinically important difference (MCID) thresholds were &#x2265; 14.3 for the ODI, &#x2265; 0.2 for the EQ-5D, &#x2265; 1.7 for the NRS-LP, and &#x2265; 1.6 for the NRS-BP. Univariate comparisons and logistic regression were performed to identify predictors of satisfaction. A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At 5 years, follow-up data was complete in 266 patients (81%). Of these patients, 25 died within 5 years of surgery of unrelated causes and 241 had complete satisfaction scores at 5 years. At 60 months, 208 of the 241 patients were satisfied with surgery. Baseline demographic, comorbidity, and operative characteristics were similar between groups. Lower rates of 90-day readmissions were observed in satisfied patients (1.6% vs 19.4% p < 0.001). At 60 months, satisfied patients reported lower mean NRS-BP (2.6 vs 5.3, p < 0.001), NRS-LP (2.3 vs 5.2, p < 0.001), and ODI scores (8.9 vs 19.5, p < 0.001). MCID achievement was higher in satisfied patients for NRS-BP (78.3% vs 54.5%, p = 0.008), NRS-LP (79.8% vs 54.5%, p = 0.003), ODI (53.4% vs 15.2%, p < 0.001), and EQ-5D (30.0% vs 3.0%, p < 0.001) scores. In multivariable analysis, greater 5-year improvements in ODI (OR 0.88, p = 0.010) and NRS-LP (OR 0.74, p = 0.010) scores, as well as lower baseline NRS-LP scores (OR 0.54, p = 0.001) were independently associated with higher odds of satisfaction. No baseline demographic, comorbidity, or surgical factor predicted satisfaction. Eighty-six percent of patients with grade 2 lumbar spondylolisthesis were satisfied with results 5 years after surgery. Satisfaction was primarily associated with improvements in disability (ODI), while baseline and perioperative characteristics were not predictive.

Surgical site infection (SSI) remains a major cause of morbidity following elective spine surgery, with incidence rates up to 3%. Current guidelines recommend cefazolin as the first-line prophylactic antibiotic due to its efficacy against methicillin-sensitive Staphylococcus aureus (MSSA) and coagulase-negative staphylococci (CoNS). However, reported B-lactam allergies are commonly cited in clinical practice as a reason for substitution with vancomycin, which provides inferior coverage for MSSA and limited gram-negative activity. Prior single center studies suggest higher SSI risk with vancomycin, but large-scale evidence remains limited. A retrospective cohort analysis was conducted using the TriNetX US Collaborative Network (2015-2023). Adults undergoing elective spine surgery, including transforaminal or posterior interbody fusion (TLIF/PLIF), multilevel lumbar fusion, posterior cervical fusion, anterior cervical discectomy and fusions (ACDF), and microdiscectomy, were identified. Patients receiving perioperative cefazolin or vancomycin within 24 hours of surgery were included. 1:1 propensity score matching controlled for demographics, comorbidities, and infection risk factors. The primary outcome was 90-day SSI, assessed using ICD-10 diagnosis codes. Risk ratios (RR) were estimated using Cox proportional hazards models. After matching, 12,996 patients were included across 5 procedure cohorts. Cefazolin prophylaxis was associated with lower or comparable SSI risk compared with vancomycin across all procedures. Statistically significant differences were observed for TLIF/PLIF (0.82% vs. 2.30%; RR 0.36, 95% CI 0.18-0.7; p = .0019) and microdiscectomy (0.34% vs. 0.69%; RR 0.50, 95% CI 0.27-0.93; p = .025). Nonsignificant trends favored cefazolin for posterior cervical fusion (0.88% vs. 1.41%), multilevel lumbar fusion (1.25% vs. 1.51%), and ACDF (0.30% vs. 0.54%). Cefazolin prophylaxis is associated with significantly lower SSI risk in elective spine procedures. These findings support cefazolin as the preferred perioperative antibiotic and emphasize the need for accurate B-lactam allergy assessment to optimize infection prevention and antimicrobial stewardship in spine surgery.

Background/Objectives: Postoperative cervical spine radiographs are routinely obtained during in-hospital and follow-up period. We aim to evaluate the utility of postoperative radiographs for identifying instrumentation failure and the subsequent need for revision surgery in patients with traumatic cervical spine injuries. Materials and Methods: A retrospective chart review of patients who had surgical treatment for traumatic cervical spine injury was conducted. Clinical notes and radiographic reports were evaluated. Postoperative radiographs were obtained prior to discharge from the hospital, and subsequently at 2, 6, 12, 24 weeks, and 1 year. Patients who underwent revision surgery, described as any reoperation, were identified. The patients' indications for surgery were evaluated. The results of postoperative radiographs that prompted a change in management and reoperation were analyzed. Sensitivity and specificity for postoperative radiographs were calculated. Results: A total of 295 patients were reviewed. The rate of revision surgery was 3.7% (n = 11). All 11 patients presented changes in clinical findings and physical exam, but only 3 patients (1%) were identified to have undergone revision surgery due to instrumentation failure seen on radiographs at 13, 89, and 112 days postoperatively, and none within the inpatient period. Two patients underwent revision surgery due to epidural hematoma, and six patients due to wound infection. The overall sensitivity and specificity of routine postoperative radiographs were 27% and 100%, respectively. Conclusions: Postoperative radiographs after cervical spine trauma have low clinical utility for predicting instrumentation failure in the absence of clinical findings, particularly in the inpatient period.

Unemployment following surgery incurs significant societal costs. The authors aimed to identify predictors of return to work (RTW) following surgery for patients with grade 1 lumbar spondylolisthesis. This Spine CORe&#x2122; study is a post hoc analysis of prospectively collected data from the Quality Outcomes Database (QOD) grade 1 lumbar spondylolisthesis module. Patients were divided into 2 groups: employed preoperatively and unemployed preoperatively. Univariate and multivariate instruments were used to identify predictors of RTW/employment within 5 years postoperatively. Across the 12 highest enrolling QOD sites (Spine CORe&#x2122; group), 608 patients were enrolled with 81% having Oswestry Disability Index (ODI) follow-up data. Of these 608 patients, 604 patients had baseline employment status recorded. Of 275 patients who were employed preoperatively, 249 had RTW follow-up data. Of the 329 patients unemployed preoperatively, 218 had RTW follow-up data. The study cohort follow-up for RTW was 77%. By 5 years postoperatively, 87.1% (n = 217) of those employed preoperatively and 22.0% (n = 48) of those unemployed preoperatively returned to work. In each cohort, there were no differences in age, sex, BMI, and American Society of Anesthesiologists class between those who did and those who did not RTW. These results remained consistent in the subgroup analysis of patients younger than 65 years at baseline. However, the only difference observed in this age group was within the preoperatively unemployed cohort, where the RTW group had a lower BMI (28.4 &#xb1; 5.5 vs 32.8 &#xb1; 9.0, p = 0.001). On multivariate analysis for the preoperatively employed cohort, college degree (OR 3.6, 95% CI 1.3-12.2) and active employment (OR 6.0, 95% CI 1.9-19.8) remained independent predictors of returning to work. For those preoperatively unemployed, a college degree (OR 2.2, 95% CI 1.1-4.4) independently predicted RTW. Approximately 87% of patients employed preoperatively RTW, and 22% of patients unemployed preoperatively returned to the workforce within 60 months after surgery for grade 1 spondylolisthesis. College-level education independently predicted RTW for both preoperatively employed and preoperatively unemployed patients.

The objective of this study was to determine the time frame of clinical improvement in patient-reported outcomes (PROs) following surgical decompression for cervical spondylotic myelopathy (CSM). Based on previously published 12-month data from this group, the authors hypothesized that the average time to minimal clinically important difference (MCID) improvement would primarily occur by 3 months postoperatively regardless of preoperative myelopathy severity. They also hypothesized that there would be minimal additional improvement between 3 months and 5 years after surgery. This was a post hoc analysis of prospectively collected data from the 14-site Spine CORe&#x2122; study group of the Quality Outcomes Database (QOD). Patients were stratified according to myelopathy severity using the modified Japanese Orthopaedic Association (mJOA) myelopathy scale into mild (mJOA score 15-17), moderate (mJOA score 12-14) or severe (mJOA score < 12). PRO measures included the Neck Disability Index (NDI), numeric rating scale (NRS) for neck and arm pain, and EQ-5D for quality-adjusted life years. PROs were recorded at baseline, 3-month, 12-month, 2-year, and 5-year intervals. MCID thresholds were calculated using previously validated methods in this cohort. Time to meet the MCID cutoff and the proportion of patients achieving MCID at each time point were determined. A total of 1085 patients (with &#x2265; 80% follow-up at 60 months for all PRO measures [PROMs]) were enrolled. Patients with more severe myelopathy had worse baseline comorbidities (e.g., BMI, American Society of Anesthesiology class, ambulation dependence) and lower PRO scores. Average PROs met the MCID threshold in each category at 3 months postoperatively, regardless of baseline myelopathy severity. Of the patients with complete 5-year follow-up data, the majority achieved the MCID cutoff threshold for PROMs at 3 months (50%-73%, depending on the PROM). A minority of patients went on to meet the MCID for PROMs at 12 months (12%-21%), 2 years (4%-8%), and 5 years (1%-6%). Between 4% and 25% of patients never achieved MCID cutoffs at any time point. On average, patients achieved clinically meaningful improvement in PROs at 3 months postoperatively, regardless of preoperative severity. While the majority (50%-73%, depending on the PROM) reached MCID within 3 months, an additional 12%-21% improved by 12 months, 4%-8% by 2 years, and only 1%-6% by 5 years; 4%-25% never reach the MCID. This 5-year follow-up study clarifies the timeline of clinical improvement after surgery for CSM and provides a useful tool for both surgeon planning and patient counseling.

The aim of this study was to assess whether the severity of systemic illness affects outcomes following surgery for grade 2 spondylolisthesis by using prospectively collected data from the Quality Outcomes Database (QOD) spondylolisthesis database. This retrospective analysis of patients who underwent surgery for grade 2 degenerative lumbar spondylolisthesis used a prospective national longitudinal registry of data collected from 14 sites. The American Society of Anesthesiologists (ASA) physical classification system was used to assess systemic illness and compare patients categorized as ASA classes I and II with patients categorized as ASA classes III and IV. Baseline demographics, comorbidities, and clinical variables were collected for comparison. Primary outcomes were Oswestry Disability Index (ODI) and EQ-5D scores 3, 12, 24, and 60 months after surgery, and multiple linear regression was used to determine whether ASA class significantly predicted postoperative change in patient-reported outcome measures. Of the 328 patients in the grade 2 spondylolisthesis QOD cohort, 172 (52.4%) were categized as having a low ASA class (ASA class I or II) and 156 (47.6%) with a high ASA class (ASA class III or IV). There was a > 80% follow-up rate 5 years after surgery. Compared with patients in the low ASA class group, those in the high ASA class group were older (mean age 64.1 [SD 10.1] years vs 57.3 [SD 13.2] years, p < 0.001), had a higher BMI (mean 31.9 [SD 7.2] vs 28.8 [SD 5.9], p < 0.001), and had higher rates of comorbidities (diabetes, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease). The hospital length of stay and readmission rate did not differ significantly between the two groups. At baseline, ODI scores were significantly higher in the high ASA class group (mean 23.8 [SD 7.2] vs 21.5 [SD 8.3], p = 0.01), but there was not a significant difference in the ODI score 3, 12, 24, and 60 months after surgery. There were no significant differences in the mean EQ-5D score between the two groups at all time points. Multiple linear regression showed that ASA class was not a significant predictor of change in the ODI or EQ-5D score from baseline to 60 months postoperatively. Patients with higher systemic illness, categorized as ASA classes III or IV, had a higher baseline ODI score compared with those with low ASA classes (I or II), but had similar ODI scores 3, 12, 24, and 60 months postoperatively. There were no significant differences in the length of stay or readmission rate between groups. These findings suggest that patients with high ASA classes benefit from surgery for grade 2 spondylolisthesis and experience significant improvements in disability status.

Blood loss is a major perioperative concern in metastatic spine tumor surgery (MSTS). Allogeneic blood transfusion (ABT) remains the standard method of blood replacement but is associated with well-recognised complications. Salvaged blood transfusion (SBT) using intraoperative cell salvage may mitigate many of these risks; however, its oncological safety and long-term outcomes in MSTS remain controversial. This was a prospective cohort study of patients who underwent MSTS between 2014 and 2017. Clinical outcomes included overall survival (OS) and tumor progression (TP), assessed using RECIST (version 1.1). A propensity score-matched cohort was generated using relevant predictors of treatment allocation and outcomes of interest to enable comparison between patients receiving SBT and ABT. A total of 98 patients (mean age 60 years) were included, of whom 33 received SBT, 39 received ABT, and 26 received no blood transfusion. Median estimated blood loss was 400 mL (IQR 200-900 mL), and median blood transfusion volume was 328.5 mL (IQR 0-1042 mL). Propensity score matching yielded 30 patients in the ABT group and 28 in the SBT group. There was no significant difference in overall survival between patients receiving SBT and ABT (p=.250). Importantly, SBT was not associated with an increased risk of 4-year TP (p=.908). SBT demonstrates comparable long-term survival and TP outcomes to ABT in patients undergoing MSTS, while avoiding the known complications associated with ABT. This study represents the first long-term propensity score-matched analysis of SBT in MSTS, supporting its oncological safety and clinical utility in contemporary spine oncology practice.

Primary osseous sarcomas of the spine provide a challenge due to their anatomic location and aggressiveness. While chemotherapy, radiation, and surgery are frequently employed as treatments for these neoplasms, their efficacy has not been compared between children and adults. Using the Surveillance, Epidemiology, and End Results database (2000-2021), 455 patients were identified with confirmed osteosarcoma, Ewing's sarcoma, or chondrosarcoma. Demographic, tumor, and treatment characteristics were analyzed. Cox proportional hazard models were used to evaluate mortality predictors, and Kaplan-Meier survival analysis was performed. For the entire cohort, increasing age (hazard ratio [HR]=1.03; 95% confidence interval [CI]=1.01-1.04; p<.001), an osteosarcoma diagnosis (HR=2.06; CI=1.17-3.61; p=.0019), and increasing tumor size (HR=1.01, CI=1-1.02, p=.007) increased mortality risk. For adults, age, an osteosarcoma diagnosis, male sex (HR=1.94; CI=1.07-3.52; p=.0297) and Black race (HR=3.16; CI=1.07-9.34; p=.0374) conferred a poor prognosis. Subtotal tumor resection was protective for adults (HR=0.29; CI=0.09-0.92; p=.0355). For children, only increasing age (HR=1.13; CI=1.03-1.23; p=.00678) decreased survival. Kaplan-Meier analysis revealed cohort-wide median cancer-specific survival (CSS) of 82 months, with 5- and 10-year survival rates of 53% and 47%. Adult median CSS was 34 months, with 5- and 10-year survival rates of 44% and 37%. Median CSS was not reached in the pediatric cohort, with 5- and 10-year CSS rates of 69% and 64%. Children experienced improved CSS compared to adults. While resections were associated with survival in adults, survival in pediatric patients was not significantly influenced by treatment-related variables. These findings suggest that patient age and histology should guide prognosis and treatment strategy.