Extracellular matrix (ECM) dysregulation plays a significant role in the development of intervertebral disc disease (IVDD). The ECM around the chondrocytes in the nucleus pulposus (NP) is unique in that it contains ColVI. While linked to chondrocyte proliferation in cartilage, ColVI’s specific role in IVD degeneration is less clear. Our aim was to determine the expression of ColVI in NP cells from degenerative IVDs, along with the effects of soluble ColVI on NP cells. Thus, we compared the expression levels of ColVI in human degenerated IVD samples, along with the effect of soluble ColVI on primary human NP cells. A higher Pfirrmann grade was associated with increased COL6A1 mRNA expression, with a 4.4-fold increase in Pfirrmann grade IV (p = 0.024) and a 5.3-fold increase in grade V compared to grade III (p = 0.014). Soluble ColVI increased NP cell proliferation compared to untreated controls, from 1.204-fold for 5 µg/mL (p < 0.001) and 1.335-fold for 10 µg/mL (p = 0.001). The most upregulated gene was IGF-1 (7.9-fold increase). Co-treatment of NP cells with ColVI and an ERK inhibitor showed significantly less IGF-1 mRNA upregulation compared to ColVI treatment alone (6.2-fold vs. 12.4-fold; p = 0.009). Our findings suggest that degenerating discs are associated with COL6A1 upregulation by NP cells; moreover, the addition of soluble ColVI to NP cells increases NP cell proliferation and IGF-1 expression.

Study Design: Retrospective Cohort Study. Objective: Recent studies have explored the negative impact that respiratory conditions have on outcomes after anterior discectomy and fusion (ACDF). However, the impact that asthmatic status has on postoperative outcomes remains unclear. The purpose of this study was to compare postoperative outcomes between patients with and without asthma who undergo ACDF. Methods: Patients who underwent a primary, elective 1–4 level ACDF (2014–2020) with complete preoperative and 1-year postoperative Neck Disability Index (NDI) surveys were identified. Asthmatic status was determined and stratified into severity. Demographic, comorbidity, perioperative, and PROM data were collected. PROMs included the Visual Analog Scale (VAS) Neck and Arm, Mental Component Summary (MCS), Physical Component Summary (PCS), Modified Japanese Orthopaedic Association (mJOA) score, and NDI. Each PROM was assessed preoperatively and postoperatively at 12 months, with P < 0.05 considered significant. Results: 1195 patients were included (81 (6.78%) had a history of asthma and 1114 (93.2%) did not). Of the asthmatic patients, 37 (45.8%) had well-controlled asthma and 44 (54.3%) had controlled asthma. Asthmatic patients were younger (52.7 vs. 56.1, P = 0.008) and had higher CCI scores (1.04 vs. 0.52, P < 0.001). There were no other differences in demographic variables, ED or readmission rates, 1-year reoperation rates, or PROMs between groups. Conclusion: Patients with well-controlled asthma performed equally as well after anterior cervical fusion as those without asthma. Both groups had similar clinical and patient-reported outcomes, suggesting that having a preoperative diagnosis of well-controlled asthma does not increase risk of postoperative complications after ACDF. Level of Evidence: III.

Study Design.: Retrospective Cohort Study Objective.: This study aimed to: (1) compare demographic differences between spine-first and hip-first patients; (2) identify differences in perioperative outcomes; (3) determine whether surgical sequencing between hip and spine surgery influences patient reported outcomes (PROMS). Summary of Background Data.: Hip-spine syndrome refers to coexisting lumbar degenerative stenosis and hip osteoarthritis. Surgical counseling remains challenging due to the symptomatic overlap between hip and spine disease, and there is no clear consensus on which disease should be addressed first. Methods.: A retrospective review of a tertiary care center was performed (2002-2025). Patients were included if they had undergone a lumbar spinal fusion and a total hip arthroplasty in any sequence with an available 12-month Hip Disability and Osteoarthritis Outcome Score (HOOS). Patients were excluded if they had a history of spine revision surgery prior to hip surgery or hip revision surgery prior to spine surgery. HOOS scores were the primary outcome. Descriptive statistics were performed, and bivariate comparisons were made as appropriate. Multivariable analysis was performed to identify predictors of 1-year improvement in HOOS scores. Results.: 179 patients (116 Spine-first, 63 Hip-first) were included. Overall, there were no significant demographic differences between groups. A greater number of patients with severe hip osteoarthritis underwent spine surgery first rather than hip surgery (66 vs. 18, P= 0.006). There were no significant differences regarding hip and spine revision surgeries between both groups. Spine-first patients underwent their second surgery in less time compared to hip-first patients (2.24 y vs. 4.03 y, P< 0.001). Furthermore, spine-first patients were more likely to have their second surgery within 1-year (45.7% vs. 11.1%), P< 0.001). Regarding PROMS, spine-first patients reported better 1-year improvement in HOOS scores (37.6 vs. 30.2, P= 0.045). Multivariable analysis revealed that undergoing spine surgery first was an independent predictor of 1-year HOOS improvement (β: 8.04 [0.47-15.60], P= 0.039). Conclusion.: In this retrospective cohort, undergoing spine surgery first was associated with a modest 1-year HOOS improvement in hip-spine syndrome patients. It is important to note that these findings cannot speak towards causality, and further work is needed to validate these findings in prospective settings.

Study Design.: Retrospective Cohort Study Objective.: This study aimed to: (1) identify demographic differences based on the interval between surgeries; (2) compare differences in perioperative outcomes; (3) determine whether the interval between hip/spine surgery influences patient-reported outcomes (PROMs). Summary of Background Data.: The presence of concurrent hip and spine disease in hip-spine syndrome creates a unique challenge in surgical decision-making given overlapping disease, with ideal timing between index spine and hip procedures remaining unclear. Methods.: A retrospective review was performed at a tertiary care center (2002-2025). Patients were included if they had undergone primary total hip arthroplasty and primary lumbar fusion in any sequence with an available 12-month HOOS score. Patients were divided based on the interval between surgery (1-year). Outcomes included patient reported outcomes (PROMs), number of revision surgeries, and time between procedures. Bivariate comparisons were made using t-tests and chi-square tests as appropriate. Results.: 179 patients (119>1-year, 60<1-year) were included, with no significant differences in demographics. Patients undergoing surgery within 1-year were more likely to have severe hip osteoarthritis and less likely to have mild disease compared to those whose procedures were greater than 1-year apart( P =0.003). There were no differences in revision rates. Order of surgery was associated with interval between procedures (P< 0.001). Patients in the <1-year group were more likely to receive spine surgery first ( P <0.001), started off with higher baseline ODI ( P= 0.034), and showed greater improvement after 12 months ( P= 0.004). HOOS scores improved in both groups, with most patients achieving MCID regardless of surgical interval. Conclusion.: In patients with hip-spine syndrome, those treated within 1-year experienced larger improvements in ODI scores and similar 12-month PROMs compared with those treated more than 1-year part. These findings suggest that there may be a benefit to a shorter interval between surgeries in hip-spine syndrome patients, especially in patients with severe hip osteoarthritis.