bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observational, Multicenter Study of the Efficacy and Safety of Cervical Disk Arthroplasty With Mobi-C in the Treatment of Cervical Degenerative Disk Disease. Results at 10 years Follow-Up
Authors: Steib Jean-Paul , Dufour Thierry , Beaurain Jacques , Bernard Pierre , Huppert Jean 
Published: February 2023

Background.
Cervical disk arthroplasty replacement (CDA) was developed to avoid specific disadvantages of cervical fusion. The purpose of this paper is to provide 10-year follow-up results of an ongoing prospective study after CDA.

Methods.
Three hundred eighty-four patients treated using the Mobi-C (ZimVie, Troyes, France) were included in a prospective multicenter study. Routine clinical and radiologic examinations were reported preoperatively and postoperatively with up to 10-year follow-up. Complications and revision surgeries were also documented.

Results.
At 10 years showed significant improvement in all clinical outcomes [Neck Disability Index, visual analog scale (VAS) for arm and neck pain, physical component summary of SF36, and mental component summary of SF36). Motion at the index level increased significantly over baseline (mean range of motion=7.6 vs. 8 degrees at five years and 6.0 degrees preoperatively; P<0.001) and 71.3% of the implanted segments remained mobile (range of motion>3 degrees). Adjacent disks were also mobile at 10 years with the same mobility as preoperatively. At 10 years, 20.9% of the implanted segments demonstrated no heterotopic ossification. Thirty-four patients (8.9%) experienced 41 adverse events, with or without reoperation during the first five years. We found only two additional surgeries after five years. We observed an increased percentage of working patients and a decrease in medication consumption. Regarding the overall outcome, 94% of patients were satisfied.

Conclusions.
Our 10-year results showed significant improvement in all clinical outcomes, with low rates of revision or failure. This experience in patients with long-term follow-up after CDA endorses durable, favorable outcomes in properly selected patients.
Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review
Authors: Plener Joshua , da Silva-Oolup Sophia , To Daphne , Csiernik Ben , Hofkirchner Corey , Cox Jocelyn , Chow Ngai , Hogg-Johnson Sheilah , Ammendolia Carlo 
Published: February 2023

Study Design.
Systematic review.

Objective.
The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature.

Summary of Background Data.
A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic.

Materials and Methods.
We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies.

Results.
Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom (i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively.

Conclusions.
Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.
Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up
Authors: Bullock Garrett , Sangio Christian A. , Beck Edward C. , Gowd Anirudh K. , Miller Evan , Danelson Kerry , James O’Gara Tadhg 
Published: February 2023

Study Design.
Prospective cohort study

Objective.
To report reoperation rates after lumbar tubular microdecompression (LTM) and to compare patient-reported outcomes (PROs) six years after surgery between those who did and did not need revision at the index level.

Summary of Background Data.
Long-term data describing PROs and reoperation rates after LTMs are lacking.

Materials and Methods.
Patients with lumbar spinal stenosis underwent one or more of three LTM procedures. Demographic, PROs [Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain], and reoperation data were collected. Failure of an index LTM was defined as any revision surgery at the index level. Revision LTM at a different level was not considered failure. Failure and revision LTM incidence at a different level and cumulative incidence were prospectively collected up to six years. Mixed effects linear regressions with 95% CIs were performed to assess potential differences in ODI and reported VAS back and leg pain between patients that reported failure and those that did not.

Results.
A total of 418 patients were included with median follow-up of 3.0 (1.9, 4.1) years. In all, 25% had a reoperation by six years. Sixty-five (16%) failed and 35 (9%) underwent a second LTM at another level. Cumulative failure incidence was 9% within the first two years. Failure patients had a statistically higher ODI [12.1 (95% CI, 3.2, 20.1) and VAS back [2.3 (95% CI, 0.9, 3.8)] and leg pain [1.6 (95% CI, 0.2, 3.1)] throughout follow-up. The overall dural tear rate was 7.2%.

Conclusions.
LTM is an effective treatment for lumbar spinal stenosis with sustained six-year PROs. Most failures occur within two years postoperatively and stabilize to 4% yearly incidence by year 5. The yearly incidence of reoperation with LTM stabilizes at 3% by year 6 postoperatively.

Level of Evidence.
2.
Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy
Authors: Murata Shizumasa , Takami Masanari , Endo Toru , Hashizume Hiroshi , Iwasaki Hiroshi , Tsutsui Shunji , Nagata Keiji , Murakami Kimihide , Taiji Ryo , Kozaki Takuhei , Heller John G. , Yamada Hiroshi 
Published: February 2023

Study Design.
A prospective cohort study

Objective.
To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.
Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression.

Materials and Methods.
We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery.

Results.
The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated.

Conclusions.
Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS.

Level of Evidence.
Level 3
Trends in Outpatient Cervical Spine Surgery: Are There Emerging Disparities?
Authors: Amen Troy B. , Bovonratwet Patawut , Rudisill Samuel S. , Barber Lauren A. , Jordan Yusef J. , Chatterjee Abhinaba , Mok Jung K. , Varady Nathan H. , Qureshi Sheeraz A. 
Published: February 2023

Study Design.
Retrospective analysis on prospectively collected data.

Objective.
The purposes of this study were to (1) assess disparities in relative utilization of outpatient cervical spine surgery between White and Black patients from 2010 to 2019 and (2) to measure how these racial differences have evolved over time.

Summary of Background Data.
Although outpatient spine surgery has become increasingly popularized over the last decade, it remains unknown how racial disparities in surgical utilization have translated to the outpatient setting and whether restrictive patterns of access to outpatient cervical spine procedures may exist.

Methods.
A retrospective cohort study from 2010 to 2019 was conducted using the National Surgical Quality Improvement Program database. Relative utilization of outpatient (same-day discharge) for anterior cervical discectomy and fusion (OP-ACDF) and cervical disk replacement (OP-CDR) were assessed and trended over time between races. Multivariable regressions were subsequently utilized to adjust for baseline patient factors and comorbidities.

Results.
Overall, Black patients were significantly less likely to undergo OP-ACDF or OP-CDR surgery when compared with White patients (P<0.03 for both OP-ACDF and OP-CDR). From 2010 to 2019, a persisting disparity over time was found in outpatient utilization for both ACDF and CDR (e.g. White vs. Black OP-ACDF: 6.0% vs. 3.1% in 2010 compared with 16.7% vs. 8.5% in 2019). These results held in all adjusted analyses.

Conclusions.
To our knowledge, this is the first study reporting racial disparities in outpatient spine surgery and demonstrates an emerging disparity in outpatient cervical spine utilization among Black patients. These restrictive patterns of access to same-day outpatient hospital and surgery centers may contribute to broader disparities in the overall utilization of major spine procedures that have been previously reported. Renewed interventions are needed to both understand and address these emerging inequalities in outpatient care before they become more firmly established within our orthopedic and neurosurgery spine delivery systems.
Trends in Short Construct Lumbar Fusions Over the Past Decade at a Single Institution
Authors: Lambrechts Mark J. , Siegel Nicholas , Issa Tariq Z. , Karamian Brian A. , Bodnar John G. , Canseco Jose A. , Woods Barrett I. , Kaye I. David , Hilibrand Alan S. , Schroeder Gregory D. , Vaccaro Alexander R. , Kepler Christopher K. 
Published: February 2023

Study Design.
Retrospective cohort

Objective.
(1) To compare the rates of fusion techniques over the last decade; (2) to identify whether surgeon experience affects a surgeon’s preferred fusion technique; (3) to evaluate differences in complications, readmissions, mortality, and patient-reported outcomes measures (PROMs) based on fusion technique.

Summary of Background Data.
Database studies indicate the number of lumbar fusions have been steadily increasing over the last two decades; however, insufficient granularity exists to detect if surgeons’ preferences are altered based on additive surgical experience.

Methods.
A retrospective review of continuously collected patients undergoing lumbar fusion at a single urban academic center was performed. Rates of lumbar fusion technique: posterolateral decompression fusion (PLDF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion + PLDF (ALIF), and lateral lumbar interbody fusion + PLDF (LLIF) were recorded. Inpatient complications, 90-day readmission, and inpatient mortality were compared with χ2 test and Bonferroni correction. The Δ 1-year PROMs were compared with the analysis of variance.

Results.
Of 3938 lumbar fusions, 1647 (41.8%) were PLDFs, 1356 (34.4%) were TLIFs, 885 (21.7%) were ALIFs, and 80 (2.0%) were lateral lumbar interbody fusions. Lumbar fusion rates increased but interbody fusion rates (2012: 57.3%; 2019: 57.6%) were stable across the study period. Surgeons with <10 years of experience performed more PLDFs and less ALIFs, whereas surgeons with >10 years’ experience used ALIFs, TLIFs, and PLDFs at similar rates. Patients were more likely to be discharged home over the course of the decade (2012: 78.4%; 2019: 83.8%, P<0.001). No differences were observed between the techniques in regard to inpatient mortality (P=0.441) or Δ (postoperative minus preoperative) PROMs.

Conclusions.
Preferred lumbar fusion technique varies by surgeon preference, but typically remains stable over the course of a decade. The preferred fusion technique did not correlate with differences in PROMs, inpatient mortality, and patient complication rates.

Levels of Evidence.
3—treatment.
Long-Term Clinical, Radiographic, and Cost Analysis of Corrective Spine Surgery for Adult Symptomatic Lumbar Deformity With a Mean of 7.5 years Follow-Up
Authors: Yagi Mitsuru , Shimizu Toshiyuki , Suzuki Satoshi , Takahashi Yohei , Ozaki Masahiro , Tsuji Osahiko , Nagoshi Narihito , Yato Yoshiyuki , Matsumoto Morio , Nakamura Masaya , Watanabe Kota ,   Keio Spine Research Group
Published: February 2023

Study Design.
Multicenter retrospective study.

Objective.
This study reports long-term clinical and radiographic outcomes in surgically treated patients with adult symptomatic lumbar deformity (ASLD).

Summary of Background Data.
The short-term results of corrective spinal surgery for ASLD are often favorable despite a relatively high complication profile. However, long-term outcomes have not been completely characterized.

Methods.
A total of 169 surgically treated consecutive ASLD patients (≥50 yr) who achieved minimum 5 year follow-up were included (average 7.5 yr observation window, average age 67±8 yr, 96% female). The subjects were stratified by current age (50s, 60s, and 70s) and compared. Kaplan-Meier analysis was used to estimate the cumulative incidence of unplanned reoperation stratified by age group. Initial and overall direct costs of surgery were also analyzed.

Results.
The SRS-22 at final follow-up was similar among the three groups (50s, 60s, and 70s; 4.0±0.5 vs. 3.8±0.7 vs. 3.8±0.7, respectively). The overall major complication rate was 56%, and 12% experienced late complications. The cumulative reoperation rate was 23%, and 4% required late reoperation. Patients in their 70s had a significantly higher reoperation rate (33%) and overall complication rate (65%). However, the late complication rate was not significantly different between the three groups (9% vs. 12% vs. 13%). Sagittal alignment was improved at two years and maintained to the final follow-up, whereas reciprocal thoracic kyphosis developed in all age groups. The direct cost of initial surgery was $45K±9K and increased by 13% ($53K±13K) at final follow-up.

Conclusions.
Long-term surgical outcomes for ASLDs were favorable, with a relatively low rate of late-stage complications and reoperations, as well as reasonable direct costs. Despite the higher reoperation and complication rate, ASLD patients of more advanced age achieved similar improvement to those in the younger age groups.
Treatment With Opioids Is Not Associated With Poor Outcomes Among Older Adults With Lumbar Spinal Stenosis Receiving Epidural Injections
Authors: Kolodge Gavin , Gold Laura S. , Jarvik Jeffrey G. , Turner Judith , Hansen Ryan N. , Heagerty Patrick J. , Suri Pradeep , Friedly Janna 
Published: February 2023

Study Design.
Secondary analysis of a randomized controlled trial.

Objective.
To assess how baseline treatment with opioids is associated with pain and function in older adults with lumbar spinal stenosis who receive epidural injections.

Summary of Background Data.
Data were obtained from the Lumbar Epidural Steroid injections for Spinal Stenosis trial, a double-blind, multisite, randomized controlled trial.

Methods.
Baseline treatment with opioids was assessed from electronic medical record prescription pharmacy data or from health utilization records collected from patients. We calculated adjusted changes in back pain numerical rating scale, leg pain numerical rating scale, and back-related disability (Roland Morris Disability Questionnaire scores) from baseline to three weeks and to six weeks among patients treated and not treated with opioids at baseline using generalized linear regression.

Results.
Baseline treatment with opioids was not significantly associated with back pain intensity (adjusted difference in means at three weeks of follow-up between patients treated with opioids at baseline versus not [±95% CI, 0.1 (−0.7, 0.7)], leg pain intensity [−0.2 (−0.9, 0.4)], or back-related function [−0.8 (−2.1, 0.4)]. We found similar results at six weeks of follow-up.

Conclusions.
Among older adults with lumbar spinal stenosis who are receiving epidural injections, those treated with opioids at baseline had similar outcomes to those who were not.
Cervical Disc Arthroplasty Usage Has Leveled Out From 2010 to 2021
Authors: Ratnasamy Philip P. , Rudisill Katelyn E. , Maloy Gwyneth C. , Grauer Jonathan N. 
Published: February 2023

Study Design.
Descriptive epidemiologic study.

Objective.
To compare trends in utilization and predictive factors for single-level cervical disc arthroplasty (CDA) relative to anterior cervical discectomy and fusion (ACDF) over the years.

Background.
CDA is an alternative to ACDF for the treatment of cervical spine pathologies. With both procedures performed for similar indications, controversy on best practices exists.

Materials and Methods.
Patients who underwent single-level CDA or ACDF were identified in the 2010 through 2021 PearlDiver M151Ortho data set. The yearly number of CDAs performed and proportionality was assessed. Predictive patient factors for undergoing CDA as opposed to ACDF were determined. Kaplan Meyer survival analysis with an endpoint of cervical spine reoperation compared 5-year outcomes between CDA and ACDF.

Results.
From 2010 to 2021, 19,301 single-level CDAs and 181,476 single-level ACDFs were identified. The proportional utilization of CDA relative to ACDF increased from 4.00% in 2010 to 14.15% in 2018 (P < 0.0001), after which there was a plateau between 2018 and 2021 where proportional utilization was 14.47% (P = 0.4654). Multivariate analysis identified several predictors of undergoing CDA rather than ACDF, including: younger age [odds ratio (OR) per decade decrease: 1.72], having surgery performed in the Midwest, Northeast, or West (relative to South, OR: 1.16, 1.13, 2.26, respectively), having Commercial insurance (relative to Medicare, OR: 1.75), and having surgery performed by an orthopedic surgeon (relative to a neurological surgeon, OR: 1.54) (P < 0.0001 for each). There was no statistically significant difference in 5-year survival to further cervical spine surgery between CDA and ACDF at 5 years (97.6% vs. 97.7%, P = 0.4249).

Conclusions.
Although the use of CDA relative to ACDF rose from 2010 to 2018, its use has subsequently plateaued between 2018 and 2021 and remained a relatively low percentage of the single-level anterior cervical surgeries performed (14.47% in 2021). The causes for such changes in the trend are unclear.
The Effect of Local Administration of Vancomycin Suspended in Fibrin Glue for Prevention of Surgical Site Infection After Spinal Instrumentation: Comparison by Probability of Treatment Weighting Model
Authors: Higashi Takayuki , Kobayashi Naomi , Ide Manabu , Uchino Yosuke , Inoue Tetsuhiko , Inaba Yutaka 
Published: February 2023

Study Design.
A retrospective cohort study.

Objective.
To compare the surgical site infection (SSI) rate in patients undergoing spinal instrumentation surgery who received vancomycin suspended in fibrin glue at the surgical site and those who did not.

Summary of Background Data.
The intrawound application of vancomycin powder for preventing SSI after spinal surgery remains controversial. Vancomycin suspended in fibrin glue is another option for local administration that may be effective. The present study assessed whether vancomycin suspended in fibrin glue could prevent SSI after spinal instrumentation surgery.

Materials and Methods.
We enrolled patients who underwent posterior spinal instrumentation surgery with or without fusion for degenerative conditions, spinal trauma, or tumor. A multiple logistic regression model with inverse probability of treatment weighting based on propensity score was used to assess the efficacy of vancomycin suspended in fibrin glue and to account for confounding. A secondary multivariate logistic regression analysis was performed to identify the risk factors associated with SSI.

Results.
Of the 264 patients enrolled in this study, 134 underwent application of vancomycin suspended in fibrin glue at the surgical site and 130 did not. The incidence of SSI was lower in patients who were treated with vancomycin suspended in fibrin glue (2.2% vs. 8.5%) even after inverse probability of treatment weighting adjustment (adjusted odds ratio: 0.25; 95% CI, 0.0768–0.91; P=0.03). Multivariate logistic regression analysis showed that the treatment with vancomycin suspended in fibrin glue was significantly associated with a lower odds of SSI (odds ratio: 0.2; 95% CI, 0.05–0.85; P=0.03).

Conclusions.
The administration of vancomycin suspended in fibrin glue was significantly associated with a lower likelihood of SSI in patients undergoing spinal instrumentation surgery.