Study Design Retrospective Cohort Study. Objectives To determine whether age independently predicts minimal clinically important difference (MCID) achievement in physical function (PF) and pain interference (PI) following elective cervical spine surgery, and to examine how age-related expectation-achievement discordance influences postoperative satisfaction. Methods Adult patients undergoing elective cervical spine surgery at a single academic center (2022-2025) were included if they completed preoperative and 12-month Patient-Reported Outcomes Measurement Information System (PROMIS) PF and PI computerized adaptive tests (CATs) and a preoperative expected outcome assessment. MCID was defined as an 8-point PROMIS T-score change. Patients were stratified into five age groups (<45, 45-54, 55-64, 65-74, ≥75). Multivariable logistic regression modeled age continuously, adjusting for BMI, levels fused, sex, smoking, revision status, and pathology. Results Among 129 patients, MCID achievement declined significantly with age for both domains (trend p<0.001). Each additional year of age independently reduced odds of achieving MCID (PF: OR 0.95, p=0.007; PI: OR 0.96, p=0.02). Adjusted MCID probability fell below 50% at 45.9 years for PF and 49.1 years for PI. The expectation-achievement gap was widest in middle-aged patients (45-64), who held expectations comparable to younger patients yet achieved outcomes consistent with older cohorts. Among non-achievers, satisfaction increased with advancing age (trend p=0.05 for PF). Conclusions After adjusting for the covariates assessed, age continuously and independently predicts failure to achieve MCID after cervical spine surgery, with probability falling to 50% by the late forties. Despite this, older non-achievers report high satisfaction, suggesting MCID is not a universal prerequisite for surgical success and underscoring the need for age-specific preoperative counseling.
Study Design Retrospective analysis. Objectives To analyze the immediate post-operative effects on osteoblast activity, and long-term impact on bone healing, of intrawound vancomycin powder following posterior lumbar fusion (PLF). Methods This study had two phases: (1) an in vitro analysis of vancomycin effects on osteoblasts and (2) a retrospective chart review—spanning over a decade—analyzing outcomes of vancomycin use in PLF patients. Cellular metabolic and osteogenic activities were evaluated using well-established in vitro assays. The retrospective chart review included patients ages 18+ who underwent PLF (four levels or fewer) between January 2007-December 2015. Patients were divided into two groups: the pre-vancomycin group (PVG) and the vancomycin group (VG). Statistical analyses included descriptive and comparative analyses across groups. Results Phase One included 56 patients. Drain vancomycin concentrations peaked at POD 0, averaging 1253.67 ng/µL. Osteoblasts exposed to vancomycin concentrations of 1,250 ng/µL had significantly lower ALP activity compared to those exposed to 0, 245, 285, and 500 ng/µL (ps<0.05). Phase Two included 425 patients: 232 in the PVG and 193 in the VG. SSIs requiring debridement were observed in 3.02% of PVG patients compared to 2.07% of VG patients (p=0.761). There were no differences in pseudoarthrosis across cohorts (p=0.886), but lucency was more common in the VG (25.39%) than the PVG (11.64%; p<0.001). Conclusions Local drain concentrations of vancomycin decreased significantly across the postoperative period, suggesting its effects on osteoblasts are limited to the early inflammatory phase. In the long-term, intrawound vancomycin may not impact risk of SSI or pseudoarthrosis.
Study Design Retrospective cohort study. Objectives To characterize serial radiographic evolution after operative and non-operative management of isolated type II odontoid fractures in older adults and examine all-cause mortality. Methods Adults aged ≥65 years with isolated type II odontoid fractures treated at a Level I trauma center between 2010 and 2025 were included. Serial fracture displacement, angulation, and cervical alignment were assessed through 6 months. Mixed-effects models evaluated longitudinal changes, with fixation-technique comparisons explored within the operative subgroup. All-cause mortality from definitive treatment initiation was assessed using Kaplan–Meier analysis and age-adjusted Cox regression. Results Eighty-six patients were included: 33 operative and 53 non-operative. Among patients with available follow-up imaging, operative reduction was maintained, and no statistically significant progressive displacement or angulation was detected after non-operative management. No significant timepoint-by-technique interaction was detected for displacement (p=0.092) or angulation (p=0.823). Fifty deaths occurred. Non-operative management was not significantly associated with mortality compared with operative treatment (HR 0.93, 95% CI 0.51–1.70; p=0.806), whereas increasing age was independently associated with mortality (HR 1.09 per year, 95% CI 1.05–1.13; p<0.0001). Including calendar year did not materially alter the treatment estimate (HR 0.88, 95% CI 0.48–1.63; p=0.688). Conclusions Through 6 months, operative reduction was maintained and no statistically significant radiographic progression was detected after non-operative management among patients with available imaging. All-cause mortality was associated with age, whereas no significant association with treatment strategy was detected. These findings do not establish treatment superiority or equivalence.
Study DesignRetrospective secondary analysis.ObjectivesTo describe the frequency of concomitant disc abnormality on preoperative MRI in SpineJack®-treated thoracolumbar fractures and its association with fracture type and clinical parameters.MethodsFrom our published SpineJack® cohort (310 fractures, 2014-2022), 204 fractures in 176 patients with preoperative MRI were analyzed. Discs were graded (Sander et al.) by two readers independently, then by consensus; fractures by AOSpine or OF type. Analyses used exact tests, Spearman correlation and Firth logistic regression; the OVF-versus-VCF comparison was adjusted for age and sex. Other analyses were exploratory.Results119 fractures (58.3%) were OVFs (mean age 72.5 years) and 85 were VCFs (50.0 years). Superior, inferior and combined disc abnormality occurred in 68.1%, 58.3% and 53.9%. Superior abnormality was more frequent in OVFs than VCFs (73.9% vs 60.0%; crude OR 1.89, 95% CI 1.04-3.44), but not after adjustment (OR 1.29, 0.57-2.91). AOSpine type correlated with inferior disc grade in VCFs (ρ=0.247, p=0.023); OF type did not correlate with disc grade. Exploratory: higher inferior disc grade was associated with neurological deficit (7 events; OR per grade 1.93, 1.01-4.18) and less cement leakage (OR 0.59, 0.36-0.90).ConclusionsDisc abnormality is frequent in SpineJack®-treated thoracolumbar fractures. The higher frequency in OVFs is largely explained by age. Associations with neurological deficit and cement leakage are exploratory. Fracture classification alone does not predict disc abnormality severity.
Study Design Cross-Sectional. Objectives Whether cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF) yields better outcomes in cervical degenerative disc disease remains unsettled, and clinicians turn to evidence syntheses for guidance. These syntheses, however, may contain spin, a reporting bias that presents an intervention as more effective or safer than the data support. This study sought to characterize how often spin appears in reviews comparing ACDF and CDA, which forms it takes, and whether methodological quality, journal impact factor, or citation rate predicts spin outcomes. Methods PubMed, Web of Science, and Embase were searched for systematic reviews and meta-analyses directly comparing ACDF and CDA. Each article was assessed for spin using the Yavchitz classification system and for methodological quality (AMSTAR-2). Logistic and Poisson regression assessed whether study AMSTAR-2 rating, journal impact factor, and yearly citations predicted spin outcomes. Results 77 articles were included. Spin was identified in 49 (63.6%); all spin-positive reviews favored CDA. The most frequent types were claiming benefit despite high risk of bias (39.0%), overemphasis on efficacy (26.0%), and selective safety reporting (15.6%). AMSTAR-2 ratings were poor: 83.1% were critically low, 15.6% low, and 1.3% high. Lower AMSTAR-2 rating independently predicted spin (OR 0.182, 95% CI 0.048–0.689, p = 0.012); impact factor and citations did not. Conclusions Spin is prevalent in reviews comparing CDA with ACDF and uniformly favors CDA. Greater methodological rigor and balanced reporting are needed for evidence syntheses to reliably inform clinical decisions.
