What’s New in Spine Surgery 2024

Recent findings in spine surgery on topics such as lumbar facet arthroplasty, pain management, nicotine use, and more are presented in the new JBJS Guest Editorial What’s New in Spine Surgery. Here, we highlight the 5 most compelling studies, as selected by co-author Melvin D. Helgeson, MD. 

Cervical Degenerative Conditions

The clinical efficacy of a 10-day, postoperative intravenous administration schedule of Cerebrolysin (EVER Pharma) following decompressive surgery for degenerative cervical myelopathy was assessed in a prospective randomized controlled trial (RCT). Both the Cerebrolysin group (60 patients) and the placebo group (30 patients) demonstrated improvement in the modified Japanese Orthopaedic Association (mJOA) and visual analog scale for pain scores at all follow-up points, although mJOA scores at 1 year and neurological improvement were superior in the Cerebrolysin group. Neither group experienced any adverse reactions¹. 

A cost-utility analysis of anterior cervical discectomy, anterior cervical discectomy and fusion (ACDF), and anterior cervical disc arthroplasty (ACDA) in the treatment of cervical radiculopathy was performed with use of a net benefit approach in the NEtherlands Cervical Kinetics (NECK) trial, which included 109 patients. Quality-adjusted life-years did not significantly differ among the treatment groups, nor did societal costs; however, total health-care costs during the first year were higher in the ACDA group. ACDF was found to be the most cost-effective strategy at 4 of the 5 willingness-to-pay thresholds, although this was mainly due to differences in initial surgical costs rather than follow-up costs². 

Lumbar Degenerative Conditions

One-year outcomes were reported for the investigational arm of the Total Posterior Spine (TOPS; Premia Spine) investigational device exemption trial. Patients who underwent lumbar facet arthroplasty with the TOPS device demonstrated maintenance of motion at the index level, a low complication rate (7.2%), and improvement in patient-reported outcome measures³. As noted by Guest Editorial authors Dr. Helgeson et al., the device was approved by the U.S. Food and Drug Administration in June 2023 for use in patients with degenerative spondylolisthesis with associated spinal stenosis. 

Postoperative Management

An award-winning animal study showed that varenicline, a pharmaceutical adjunct for smoking cessation, mitigated the negative effects of nicotine on postoperative spinal fusion rates. The control group and the nicotine plus varenicline group each had a significantly higher fusion rate (93.3%) than the nicotine group (33.3%; p = 0.007 for both)⁴. These findings underscore the importance in spine surgery of “maintaining control of perioperative variables such as nicotine use,” write Dr. Helgeson et al.  

In a double-blinded RCT that included 171 patients undergoing a 1 or 2-level lumbar spinal fusion, the effect of intravenous ketorolac, administered every 6 hours for the first 48 hours postoperatively, on in-hospital opioid use was evaluated and compared with that of intravenous placebo and intravenous acetaminophen. Intravenous ketorolac resulted in less opioid use at 72 hours and a shorter length of stay without a difference in the fusion rate⁵. 

What’s New in Spine Surgery is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Foot and Ankle Surgery, What’s New in Sports Medicine, and What’s New in Hand Surgery. 

References 

1. Sharma A, Agrawal H, Naseem A, Marathe N, Gajbhiye K, Subramanian S, Rocos B. Prospective randomized control trial to compare the role of injection Cerebrolysin for 10 days duration against placebo in operated cases of degenerative cervical myelopathy. Spine (Phila Pa 1976). 2023 Mar 1;48(5):295-300. 
2. Heijdra Suasnabar JM, Vleggeert-Lankamp CLA, Goedmakers CMW, de Vries F, Arts MP, van den Akker-van Marle ME. Cost effectiveness of implanting a prosthesis after anterior cervical discectomy for radiculopathy: results of the NECK randomized controlled trial. Spine J. 2023 Jun;23(6):851-8. Epub 20230211. 
3. Pinter ZW, Freedman BA, Nassr A, Sebastian AS, Coric D, Welch WC, Steinmetz MP, Robbins SE, Ament J, Anand N, Arnold P, Baron E, Huang J, Whitmore R, Whiting D, Tahernia D, Sandhu F, Chahlavi A, Cheng J, Chi J, Pirris S, Groff M, Fabi A, Meyer S, Kushwaha V, Kent R, DeLuca S, Smorgick Y, Anekstein Y; TOPS Study Group. A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: results from the Total Posterior Spine System (TOPS) IDE Study. Clin Spine Surg. 2023 Mar 1;36(2):E59-69. 
4. Karamian BA, Levy HA, Yalla GR, D’Antonio ND, Heard JC, Lambrechts MJ, Canseco JA, Vaccaro AR, Markova DZ, Kepler CK. Varenicline mitigates the increased risk of pseudarthrosis associated with nicotine. Spine J. 2023 Aug;23(8):1212-22. 
5. Iyer S, Steinhaus ME, Kazarian GS, Zgonis EM, Cunningham ME, Farmer JC, Kim HJ, Lebl DR, Huang RC, Lafage V, Schwab FJ, Qureshi S, Girardi FP, Rawlins BA, Beckman JD, Carrino JA, Chazen JL, Varghese JJ, Muzammil H, Lafage R, Sandhu HS. Intravenous ketorolac substantially reduces opioid use and length of stay after lumbar fusion: a randomized controlled trial. Spine (Phila Pa 1976). 2024 Jan 15;49(2):73-80.