The Effect of Smoking on the Fusion Rate of Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

Clinical Utility and Patient Compliance With Mobile Applications for Home-Based Rehabilitation Following Transforaminal Lumbar Interbody Fusion

STUDY DESIGN

Retrospective chart review.

OBJECTIVES

Transforaminal lumbar interbody fusion (TLIF) via open or minimally invasive (MI) techniques is commonly performed. Mobile applications for home-based therapy programs have grown in popularity. The purpose of this study was to (1) compare patient-reported outcome measures (PROMs) between postoperative patients who were the most and least compliant in using the mobile-based rehabilitation programs, (2) compare PROMs between open vs MI-TLIF cohorts, and (3) quantify overall compliance rates of home-based rehabilitation programs.

METHODS

A retrospective chart review was performed. Patients were automatically enrolled in the rehabilitation program. Patient-Reported Outcomes Measurement Information System (PROMIS) and Oswestry Disability Index (ODI) scores were collected. Patients were separated into two study groups. Compliance rate was calculated as the difference between the number of active participants at the preoperative phase and final follow-up.

RESULTS

220 patients were included. Average follow-up time was 23.2 months. No difference was found in the change in (∆) PROMIS scores (P = 0.261) or ∆ODI scores (P = 0.690) regardless of patient compliance. No difference was found in outcome scores between open vs MI-TLIF techniques stratified by download compliance (downloaded, DL+; did not download, DL-) and phone reminder compliance (set reminder, R+; did not set reminder, R-) postoperatively. Both cohorts demonstrated clinical improvement exceeding minimal clinically important difference at final follow-up. Overall patient compliance was 71% at final postoperative follow up.

CONCLUSION

Despite high long-term compliance and rising popularity, mobile applications for home-based postoperative rehabilitation programs have low clinical utility in patients undergoing TLIF.

Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery

ABSTRACT

Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.

Assessing the potential role of ChatGPT in spine surgery research

Purpose

Since its release in November 2022, Chat Generative Pre-Trained Transformer 3.5 (ChatGPT), a complex machine learning model, has garnered more than 100 million users worldwide. The aim of this study is to determine how well ChatGPT can generate novel systematic review ideas on topics within spine surgery.

Methods

ChatGPT was instructed to give ten novel systematic review ideas for five popular topics in spine surgery literature: microdiscectomy, laminectomy, spinal fusion, kyphoplasty and disc replacement. A comprehensive literature search was conducted in PubMed, CINAHL, EMBASE and Cochrane. The number of nonsystematic review articles and number of systematic review papers that had been published on each ChatGPT-generated idea were recorded.

Results

Overall, ChatGPT had a 68% accuracy rate in creating novel systematic review ideas. More specifically, the accuracy rates were 80%, 80%, 40%, 70% and 70% for microdiscectomy, laminectomy, spinal fusion, kyphoplasty and disc replacement, respectively. However, there was a 32% rate of ChatGPT generating ideas for which there were 0 nonsystematic review articles published. There was a 71.4%, 50%, 22.2%, 50%, 62.5% and 51.2% success rate of generating novel systematic review ideas, for which there were also nonsystematic reviews published, for microdiscectomy, laminectomy, spinal fusion, kyphoplasty, disc replacement and overall, respectively.

Conclusions

ChatGPT generated novel systematic review ideas at an overall rate of 68%. ChatGPT can help identify knowledge gaps in spine research that warrant further investigation, when used under supervision of an experienced spine specialist. This technology can be erroneous and lacks intrinsic logic; so, it should never be used in isolation.

Level of Evidence

Not applicable.

Conditioned Medium of Intervertebral Disc Cells Inhibits Osteo-Genesis on Autologous Bone-Marrow-Derived Mesenchymal Stromal Cells and Osteoblasts

Low back pain (LBP) is associated with the degeneration of human intervertebral discs (IVDs). Despite progress in the treatment of LBP through spinal fusion, some cases still end in non-fusion after the removal of the affected IVD tissue. In this study, we investigated the hypothesis that the remaining IVD cells secrete BMP inhibitors that are sufficient to inhibit osteogenesis in autologous osteoblasts (OBs) and bone marrow mesenchymal stem cells (MSCs). A conditioned medium (CM) from primary human IVD cells in 3D alginate culture was co-cultured with seven donor-matched OB and MSCs. After ten days, osteogenesis was quantified at the transcript level using qPCR to measure the expression of bone-related genes and BMP antagonists, and at the protein level by alkaline phosphatase (ALP) activity. Additionally, cells were evaluated histologically using alizarin red (ALZR) staining on Day 21. For judging ALP activity and osteogenesis, the Noggin expression in samples was investigated to uncover the potential causes. The results after culture with the CM showed significantly decreased ALP activity and the inhibition of the calcium deposit formation in alizarin red staining. Interestingly, no significant changes were found among most bone-related genes and BMP antagonists in OBs and MSCs. Noteworthy, Noggin was relatively expressed higher in human IVD cells than in autologous OBs or MSCs (relative to autologous OB, the average fold change was in 6.9, 10.0, and 6.3 in AFC, CEPC, and NPC, respectively; and relative to autologous MSC, the average fold change was 2.3, 3.4, and 3.2, in AFC, CEPC, and NPC, respectively). The upregulation of Noggin in residual human IVDs could potentially inhibit the osteogenesis of autologous OB and MSC, thus inhibiting the postoperative spinal fusion after discectomy surgery.

Smoking and degenerative spinal disease: A systematic review

Smoking is a major cause of morbidity and mortality worldwide and is responsible for the death of more than 8 million people per year globally. Through a systematic literature review, we aim to review the harmful effects of tobacco smoking on degenerative spinal diseases (DSD). DSD is a debilitating disease and there is a need to identify if smoking can be an attributable contender for the occurrence of this disease, as it can open up avenues for therapeutic options. Sources such as PubMed and Embase were used to review literature, maintaining tobacco smoking and spinal diseases as inclusion factors, excluding any article that did not explore this relationship. Risk of bias was assessed using analysis of results, sample size and methods and limitations. Upon review of the literature, tobacco smoking was found to be a major risk factor for the occurrence of DSDs, particularly lumbar spinal diseases. Smokers also experienced a greater need for surgery and greater postoperative wound healing complications, increased pain perception, delay in recovery and decreased satisfaction after receiving surgery. These effects were noted along the entire spine. Many mechanisms of action have been identified in the literature that provide plausible pictures of how smoking leads to spinal degeneration, exploring possible primary targets which can open up opportunities to develop potential therapeutic agents. More studies on cervical and thoracic spinal degeneration would be beneficial in identifying the effect of nicotine on these spinal levels. Some limitations included insufficient sample size, inconclusive evidence and lack of sufficient repeat studies. However, there appears to be a sufficient amount of research on smoking directly contributing to lumbar spinal pathology.

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Smoking is a risk factor for the occurence of degenerative spinal disease (DSD).

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There are numerous pathological mechanisms attributed to spinal pathology by smoking.

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Smoking appears to be a significant risk factor for lumbar DSDs, with smoke studies also suggesting its role in cervical DSDs.

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There is insufficient research on the effect of smoking on the thoracic spine.

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Smoking leads to worse outcomes and potential complications post-surgery, as well as increased pain perception and poorer subjective response post-surgery.