This post spotlights 2 new studies in JBJS that examined outcomes of spine surgery using nationwide databases.
Patients with degenerative lumbar disease may turn to acupuncture or epidural steroid injection (ESI) to address back pain. Does preoperative use of these treatments increase the risk of infection following elective lumbar spinal fusion?
Sung et al. explored that question in a study performed at Yonsei University College of Medicine in Seoul, South Korea. Access the study along with a downloadable visual abstract at JBJS.org: Effect of Preoperative Acupuncture and Epidural Steroid Injection on Early Postoperative Infection After Lumbar Spinal Fusion
The investigators used a nationwide insurance claims database to identify patients >50 years of age who underwent spinal fusion due to degenerative lumbar disease from 2010 to 2019. Procedural codes were used to identify patients who underwent acupuncture and/or ESI.
The primary outcome was the occurrence of spinal infection within 90 days following surgery. A total of 207,806 patients were included, with infection analyzed by dividing patients into 4 groups: those who underwent neither acupuncture nor ESI, those who underwent acupuncture only, those who underwent ESI only, and those who underwent both acupuncture and ESI.
Their findings? Acupuncture and ESI performed more than 2 weeks prior to surgery did not increase the risk of infection. ESI within 2 weeks before surgery was associated with an increased risk, leading the authors to recommend that invasive procedures immediately before surgery be avoided. Increasing age and male sex were also found to be risk factors.
Further perspective on the study is offered by Patricia Lipson, BS, and Philip K. Louie, MD, in their commentary: Balancing Act: Infection Risks of Nonoperative Treatments Before Lumbar Fusion. “While there are limitations to the study by Sung et al. involving the use of nationwide claims data, it provides insights into the risks of infection in spine surgery as more people seek nonoperative pain treatments prior to surgery,” they write.
Also in the February 5, 2025 issue of JBJS, Nilssen et al. present the results of a study involving the largest reported series of spondylolisthesis surgery in young patients (<21 years of age). The investigators, from Cedars-Sinai Medical Center in Los Angeles, used data from the PearlDiver database to assess surgical approaches and to compare reoperation rates over time. Access the study at JBJS.org:
Among 33,945 patients with spondylolisthesis, 578 (1.7%) underwent lumbar spinal fusion between 2010 and 2020. The mean age at surgery was 16.5 years, and 60.2% of the patients who underwent surgery were female.
Looking at surgical approach, 40.8% of the patients with operative treatment had posterior spinal fusion with posterior instrumentation (PSF), 37.9% had posterior spinal fusion with posterior instrumentation plus interbody (PSF+I), 11.4% had anterior spinal fusion without posterior instrumentation (ASF), and 9.9% had anterior spinal fusion plus posterior instrumentation (A+PSF).
The overall 5-year reoperation-free survival rate was 85.5% (95% CI, 82.5% to 88.6%). The approach with the lowest rate of revisions within 5 years was A+PSF. Furthermore, the authors concluded, “The 5-year risk of reoperation of 31.8% for a stand-alone ASF appeared to be unacceptably high compared with other approaches, and was over 4 times higher than A+PSF (7.0%). Consistent with previous clinical series, the addition of an interbody fusion to a PSF did not decrease the reoperation rate and did not appear to offer any advantages to a PSF alone.”
Read the study by Nilssen et al.
Other Spine articles now available at JBJS.org: