Medical Literature Digest

In a nationwide time-varying cohort of 1,620,585 individuals aged ≥50 (2010–2022), degenerative spine disease (SPINE_DX) and spinal fusion (SPINE_FUSION) were modeled as exposures and compared with controls for incident hip osteoarthritis (HOA) and progression to total hip arthroplasty (THA). Both SPINE_DX (HR 1.66, 95% CI 1.64–1.68) and SPINE_FUSION (HR 1.22, 95% CI 1.19–1.25) were associated with increased HOA incidence, and among those with HOA progression to THA was higher with SPINE_FUSION (HR 2.32, 95% CI 2.06–2.62) and SPINE_DX (HR 1.51, 95% CI 1.41–1.62); results were consistent after inverse probability weighting.

In a survey of 19 expert NTOS surgeons given six standardized case scenarios, the most common investigation was cervical spine or brachial plexus MRI; when supraclavicular plexus exposure was indicated, experts preferred a supraclavicular approach and most recommended concomitant pectoralis minor tenotomy. Experts generally reserved surgery for patients without motor symptoms until conservative treatment failed, favored comprehensive simultaneous decompression when distal double-crush neuropathies were suspected (though some preferred a distal-first approach), and—compared with other specialties—hand surgeons showed tendencies toward rib-sparing scalenectomy over first rib resection and consideration of staged or concomitant distal-site procedures.

In 86 adults undergoing minimally invasive surgery for adult spinal deformity with >2‑level fusion and 4‑year follow-up, mean cost was ~$73,000 and cost-utility at 4 years was $233,000 with 44% meeting cost-effectiveness at 4 years. Higher baseline disability and frailty, lower comorbidity burden, and better correction of pelvic incidence–lumbar lordosis mismatch were associated with achieving cost-effectiveness, while major complications and reoperation markedly reduced the likelihood of cost-effectiveness.