Spine Surgery Research Updates

In a single-center cohort of geriatric patients (≥65 years) undergoing trauma team activation and whole-body CT after falls (n=349), ground-level falls were common in older, more comorbid patients on antithrombotic therapy and were associated with more severe head/cervical‑spine injuries, while higher falls produced more thoracic and extremity injuries. Although ISS and GTOS did not differ by fall height, overall in-hospital mortality was 27.5% and was highest after ground-level falls (35.8%); multivariable analysis identified age, ISS, and head/cervical‑spine injury severity as mortality predictors and found increasing fall height was independently associated with lower adjusted mortality (aOR 0.59).

In a propensity-matched cohort of patients undergoing primary hip arthroscopy for femoroacetabular impingement, 94 patients with confirmed subspine impingement who received arthroscopic subspine decompression (SSD) were matched 1:2 to 188 controls without SSI. SSD patients showed significant improvements in all patient-reported outcomes at minimum 5-year follow-up (p < .0001), with comparable rates of MCID and PASS and similar survivorship (5.3% converted to total hip arthroplasty/hip resurfacing); time to revision arthroscopy was longer in the SSD group (52.0 vs 32.8 months, p = .04).

Economic evaluation alongside two multicenter randomized trials (n=220 randomized; 187 with 12-month data) compared biportal endoscopic spine surgery (BESS) and microscopic spine surgery (MSS) for single-level lumbar degenerative disease and found mean 1-year QALYs of 0.823 for BESS versus 0.801 for MSS and total costs of USD 3,028 versus USD 3,080, respectively, with confidence intervals for incremental costs and QALYs crossing zero. At a willingness-to-pay threshold of USD 21,429 per QALY, BESS had a 94.9% probability of being cost-effective, leading the authors to conclude BESS is a cost-effective alternative to MSS over 12 months without significant differences in cost or QALYs.