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Incidental Durotomy During Transforaminal Lumbar Interbody Fusion (TLIF) Surgery with Expandable Interbody Spacers: A Retrospective, Single-Center Analysis of Complications and Outcomes.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-08 DOI: 10.1177/21925682251332547
Linda Bättig, Francis Kissling, Stefan Motov, Felix C Stengel, Yesim Yildiz, Laurin Feuerstein, Gregor Fischer, Thomas Schöfl, Daniele Gianoli, Nader Hejrati, Benjamin Martens, Martin N Stienen, Lorenzo Bertulli

Study DesignRetrospective cohort study.ObjectivesTo evaluate the frequency, risk factors, and impact of incidental durotomy on adverse events and outcomes after TLIF with expandable interbody spacers.MethodsWe reviewed 433 consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA®, Globus Medical Inc) on 538 levels between December 2018 and September 2023. Patients with incidental durotomy (ID) and cerebrospinal fluid leakage were compared to patients without ID, focusing on patient-specific and surgery-related factors, adverse events, clinical outcomes (MacNab criteria), and radiological outcomes at discharge, 3, and 12 months.ResultsThe ID rate was 9.0% (39/433 patients). Patients with ID had lower BMI (26.1 ± 5.2 vs 28.0 ± 5.3 kg/m2, P = .03), longer surgery duration (358 ± 132 vs 305 ± 128 minutes, P = .01), and extended hospital stays (14.7 ± 12.8 vs 10.9 ± 8.2 days, P < .01). More postoperative adverse events (51.3% vs 28.7%, P = .004) with higher severity (28.2% vs 13.2% moderate to severe, P = .019) occurred at discharge. No differences were found in outcomes at 3 or 12 months. ID patients showed higher risks for impaired wound healing (adjusted OR, 4.39; 95% CI, 1.90-10.2; P = .001) and pulmonary embolism (adjusted OR, 3.52; 95% CI, 1.13-10.9; P = .029).ConclusionsIncidental durotomy was associated with longer surgery time, hospital stays, and increased early postoperative complications. While not affecting mid-to-long-term outcomes, ID increased risks for wound healing difficulties and pulmonary embolisms.

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引用次数: 0
Advancements and Challenges in Computer-Assisted Navigation for Cervical Spine Surgery: A Comprehensive Review of Perioperative Integration, Complications, and Emerging Technologies.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-04 DOI: 10.1177/21925682251329340
Hania Shahzad, Aziz Saade, Shannon Tse, Samuel Simister, Anthony Viola, Sathish Muthu, Hardeep Singh, Luca Ambrosio, Javad Tavakoli, Sven Yves Vetter, Philip Louie, Samuel Cho, Sangwook Tim Yoon, Amit Jain, Hai Le

Study DesignA narrative review of the current literature on the application of Computer-Assisted Navigation (CAN) in cervical spine surgeries.ObjectiveTo analyze the perioperative integration, types of CAN systems, technical considerations, and clinical applications of CAN in cervical spine surgeries, as well as to assess the associated complications and potential strategies to minimize these risks.MethodsA comprehensive review of published studies between 2015 and 2024 was conducted to evaluate the usage, benefits, and challenges of CAN in cervical spine surgeries. The review covered perioperative integration, system types, complications, and emerging technologies, including augmented reality (AR) and robotics.ResultsThe use of CAN in cervical spine surgeries provides improved accuracy in screw placement and reduced neurovascular complications. However, the review identified several limitations, such as a steep learning curve, cost considerations, and potential inaccuracies related to cervical spine mobility.ConclusionsCAN offers significant benefits in cervical spine surgeries, including enhanced precision and reduced complications. Despite the current limitations, advancements in AR and robotics hold promise for improving the safety and effectiveness of CAN in cervical procedures. The future focus should be on overcoming the existing challenges to increase the adoption of CAN in cervical spine surgeries.

{"title":"Advancements and Challenges in Computer-Assisted Navigation for Cervical Spine Surgery: A Comprehensive Review of Perioperative Integration, Complications, and Emerging Technologies.","authors":"Hania Shahzad, Aziz Saade, Shannon Tse, Samuel Simister, Anthony Viola, Sathish Muthu, Hardeep Singh, Luca Ambrosio, Javad Tavakoli, Sven Yves Vetter, Philip Louie, Samuel Cho, Sangwook Tim Yoon, Amit Jain, Hai Le","doi":"10.1177/21925682251329340","DOIUrl":"10.1177/21925682251329340","url":null,"abstract":"<p><p>Study DesignA narrative review of the current literature on the application of Computer-Assisted Navigation (CAN) in cervical spine surgeries.ObjectiveTo analyze the perioperative integration, types of CAN systems, technical considerations, and clinical applications of CAN in cervical spine surgeries, as well as to assess the associated complications and potential strategies to minimize these risks.MethodsA comprehensive review of published studies between 2015 and 2024 was conducted to evaluate the usage, benefits, and challenges of CAN in cervical spine surgeries. The review covered perioperative integration, system types, complications, and emerging technologies, including augmented reality (AR) and robotics.ResultsThe use of CAN in cervical spine surgeries provides improved accuracy in screw placement and reduced neurovascular complications. However, the review identified several limitations, such as a steep learning curve, cost considerations, and potential inaccuracies related to cervical spine mobility.ConclusionsCAN offers significant benefits in cervical spine surgeries, including enhanced precision and reduced complications. Despite the current limitations, advancements in AR and robotics hold promise for improving the safety and effectiveness of CAN in cervical procedures. The future focus should be on overcoming the existing challenges to increase the adoption of CAN in cervical spine surgeries.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251329340"},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationship of T10-Pelvic Angle With Conventional Sagittal Parameters and Legacy Alignment Schemes in Adult Spinal Deformity Surgery.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-03 DOI: 10.1177/21925682251333703
Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee

Study DesignRetrospective analysis.ObjectiveTo investigate the relationship of T10-pelvic angle (T10PA) with conventional sagittal parameters and legacy alignment schemes.Summary of Background DataT10PA is a newly introduced sagittal parameter to predict the development of proximal junctional kyphosis (PJK). However, its relationship with conventional sagittal parameters and legacy alignment schemes remains unknown.MethodsPatients with fusion from the pelvis to the upper-instrumented vertebra at or above the T10 were included. Based on the 6-week T10PA, the patients were divided into 3 groups as follows: undercorrection, functional alignment, and overcorrection. Conventional sagittal parameters and alignment status based on the Schwab's pelvic incidence (PI)-lumbar lordosis (LL) modifiers and age-adjusted PI-LL were compared according to the T10PA groups. The PJK rates were compared among the alignment schemes.ResultsOverall, 219 patients were enrolled in this study. At 6 weeks postoperatively, 33.3%, 37.0%, and 29.7% of the patients demonstrated undercorrection, functional alignment, and overcorrection relative to the T10PA, respectively. Conventional sagittal parameters significantly differed according to the T10PA groups. Linear regression analysis revealed that T10PA was significantly affected by PI (β = .562) and LL (β = - .411). The correction statuses of the Schwab's PI-LL modifiers and age-adjusted PI-LL were significantly differentiated between the T10PA correction groups. However, only 32.9% of patients with functional alignment relative to T10PA belonged to matched correction category for the age-adjusted PI-LL. Overcorrection relative to age-adjusted PI-LL and T10PA significantly increased PJK risks.ConclusionT10PA significantly correlated with conventional sagittal parameters, particularly PI and LL. Although the T10PA correction status correlated with that of the legacy alignment schemes, a notable discrepancy in the optimal correction was observed between the T10PA and age-adjusted PI-LL schemes. Overcorrection relative to T10PA and age-adjusted PI-LL should be avoided to mitigate PJK development.

研究设计回顾性分析目的研究T10-骨盆角(T10PA)与传统矢状面参数和传统对位方案的关系。背景数据摘要T10PA是一个新引入的矢状面参数,用于预测近端交界性脊柱后凸(PJK)的发展。方法纳入从骨盆到T10或以上上部器械椎体融合的患者。根据 6 周的 T10PA,患者被分为以下 3 组:矫正不足组、功能性对位组和矫正过度组。根据 T10PA 组别,比较了传统矢状面参数和基于 Schwab 骨盆入量(PI)-腰椎前凸(LL)调节器和年龄调整后的 PI-LL 的对位状态。结果共有 219 名患者参与了这项研究。术后6周,分别有33.3%、37.0%和29.7%的患者表现出相对于T10PA的矫正不足、功能性对齐和矫正过度。T10PA组的常规矢状面参数有明显差异。线性回归分析显示,T10PA受到PI(β = .562)和LL(β = - .411)的显著影响。施瓦布 PI-LL 修饰符的校正状态和年龄调整后的 PI-LL 在 T10PA 校正组之间存在明显差异。然而,只有 32.9% 的患者相对于 T10PA 具有功能对齐,属于年龄调整后 PI-LL 的匹配校正类别。结论T10PA与常规矢状面参数,尤其是PI和LL显著相关。虽然T10PA的矫正状态与传统的对齐方案相关,但T10PA与年龄调整后的PI-LL方案在最佳矫正方面存在明显差异。应避免相对于T10PA和年龄调整后的PI-LL的过度矫正,以减轻PJK的发展。
{"title":"Relationship of T10-Pelvic Angle With Conventional Sagittal Parameters and Legacy Alignment Schemes in Adult Spinal Deformity Surgery.","authors":"Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1177/21925682251333703","DOIUrl":"10.1177/21925682251333703","url":null,"abstract":"<p><p>Study DesignRetrospective analysis.ObjectiveTo investigate the relationship of T10-pelvic angle (T10PA) with conventional sagittal parameters and legacy alignment schemes.Summary of Background DataT10PA is a newly introduced sagittal parameter to predict the development of proximal junctional kyphosis (PJK). However, its relationship with conventional sagittal parameters and legacy alignment schemes remains unknown.MethodsPatients with fusion from the pelvis to the upper-instrumented vertebra at or above the T10 were included. Based on the 6-week T10PA, the patients were divided into 3 groups as follows: undercorrection, functional alignment, and overcorrection. Conventional sagittal parameters and alignment status based on the Schwab's pelvic incidence (PI)-lumbar lordosis (LL) modifiers and age-adjusted PI-LL were compared according to the T10PA groups. The PJK rates were compared among the alignment schemes.ResultsOverall, 219 patients were enrolled in this study. At 6 weeks postoperatively, 33.3%, 37.0%, and 29.7% of the patients demonstrated undercorrection, functional alignment, and overcorrection relative to the T10PA, respectively. Conventional sagittal parameters significantly differed according to the T10PA groups. Linear regression analysis revealed that T10PA was significantly affected by PI (β = .562) and LL (β = - .411). The correction statuses of the Schwab's PI-LL modifiers and age-adjusted PI-LL were significantly differentiated between the T10PA correction groups. However, only 32.9% of patients with functional alignment relative to T10PA belonged to matched correction category for the age-adjusted PI-LL. Overcorrection relative to age-adjusted PI-LL and T10PA significantly increased PJK risks.ConclusionT10PA significantly correlated with conventional sagittal parameters, particularly PI and LL. Although the T10PA correction status correlated with that of the legacy alignment schemes, a notable discrepancy in the optimal correction was observed between the T10PA and age-adjusted PI-LL schemes. Overcorrection relative to T10PA and age-adjusted PI-LL should be avoided to mitigate PJK development.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333703"},"PeriodicalIF":2.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to Letter to the Editor Regarding Rod Contour Angle and Postoperative Thoracic Kyphosis: Key Predictors of Proximal Junctional Kyphosis in Pediatric Neuromuscular Scoliosis After Spinopelvic Fusion.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-02 DOI: 10.1177/21925682251333409
Pochih Shen, Carson Keeter, Tyler Sullivan, Nancy Hadley-Miller, Mark A Erickson
{"title":"Response to Letter to the Editor Regarding Rod Contour Angle and Postoperative Thoracic Kyphosis: Key Predictors of Proximal Junctional Kyphosis in Pediatric Neuromuscular Scoliosis After Spinopelvic Fusion.","authors":"Pochih Shen, Carson Keeter, Tyler Sullivan, Nancy Hadley-Miller, Mark A Erickson","doi":"10.1177/21925682251333409","DOIUrl":"10.1177/21925682251333409","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333409"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive Value of Social Determinants of Health on 90-Day Readmission and Health Utilization Following ACDF: A Comparative Analysis of XGBoost, Random Forest, Elastic-Net, SVR, and Deep Learning.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-02 DOI: 10.1177/21925682251332556
Samuel G Reyes, Pranav M Bajaj, Daniel E Herrera, Steven S Kurapaty, Austin Chen, Rushmin Khazanchi, Anitesh Bajaj, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi

Study DesignRetrospective cohort.ObjectiveDespite numerous studies highlighting patient comorbidities and surgical factors in postoperative success, the role of social determinants of health (SDH) in anterior cervical discectomy and fusion (ACDF) outcomes remains unexplored. This study evaluates the predictive impact of SDH on 90-day readmission and health utilization (HU) in ACDF patients using machine learning (ML).MethodsWe analyzed 3127 ACDF patients (2003-2023) from a multisite academic center, incorporating over 35 clinical and demographic variables. SDH characteristics were assessed using the Social Vulnerability Index. Primary outcomes included 90-day readmission and postoperative HU. ML models were developed and validated by the area under the curve (AUC) for readmission and mean absolute error (MAE) for HU. Feature importance analysis identified key predictors.ResultsBalanced Random Forest (AUC = 0.75) best predicted 90-day readmission, with length of stay, Elixhauser score, and Medicare status as top predictors. Among SDH factors, minority status & language, household composition & disability, socioeconomic status, and housing type & transportation were influential. Support Vector Regression (MAE = 1.96) best predicted HU, with perioperative duration, socioeconomic status, and minority status & language as key predictors.ConclusionsFindings highlight SDH's role in ACDF outcomes, suggesting the value of stratifying for interventions such as targeted resource allocation, language-concordant care, and tailored follow-up. While reliance on a single healthcare system and proxy SDH measures are limitations, this is the first study to apply ML to assess SDH in ACDF patients. Further validation with direct patient-reported SDH data is needed to refine predictive models.

研究设计回顾性队列.目的尽管有许多研究强调了患者的合并症和手术因素对术后成功的影响,但健康的社会决定因素(SDH)在颈椎前路椎间盘切除和融合术(ACDF)结果中的作用仍未得到探讨。本研究使用机器学习(ML)评估了 SDH 对 ACDF 患者 90 天再入院和健康利用率(HU)的预测影响。方法我们分析了一个多地点学术中心的 3127 名 ACDF 患者(2003-2023 年),其中包含超过 35 个临床和人口统计学变量。SDH特征使用社会脆弱性指数进行评估。主要结果包括 90 天再入院和术后 HU。建立了ML模型,并通过再入院率的曲线下面积(AUC)和HU的平均绝对误差(MAE)进行了验证。结果平衡随机森林(AUC = 0.75)对 90 天再入院的预测效果最好,住院时间、Elixhauser 评分和医疗保险状况是预测效果最好的因素。在 SDH 因素中,少数民族身份和语言、家庭组成和残疾、社会经济地位以及住房类型和交通都有影响。支持向量回归(MAE = 1.96)对 HU 的预测效果最佳,围手术期、社会经济状况、少数民族状况和语言是关键的预测因素。结论研究结果凸显了 SDH 在 ACDF 结果中的作用,表明了分层干预的价值,例如有针对性的资源分配、语言协调的护理和量身定制的随访。虽然依赖单一的医疗保健系统和替代 SDH 测量方法存在局限性,但这是第一项应用 ML 评估 ACDF 患者 SDH 的研究。还需要利用患者直接报告的 SDH 数据进行进一步验证,以完善预测模型。
{"title":"Predictive Value of Social Determinants of Health on 90-Day Readmission and Health Utilization Following ACDF: A Comparative Analysis of XGBoost, Random Forest, Elastic-Net, SVR, and Deep Learning.","authors":"Samuel G Reyes, Pranav M Bajaj, Daniel E Herrera, Steven S Kurapaty, Austin Chen, Rushmin Khazanchi, Anitesh Bajaj, Wellington K Hsu, Alpesh A Patel, Srikanth N Divi","doi":"10.1177/21925682251332556","DOIUrl":"10.1177/21925682251332556","url":null,"abstract":"<p><p>Study DesignRetrospective cohort.ObjectiveDespite numerous studies highlighting patient comorbidities and surgical factors in postoperative success, the role of social determinants of health (SDH) in anterior cervical discectomy and fusion (ACDF) outcomes remains unexplored. This study evaluates the predictive impact of SDH on 90-day readmission and health utilization (HU) in ACDF patients using machine learning (ML).MethodsWe analyzed 3127 ACDF patients (2003-2023) from a multisite academic center, incorporating over 35 clinical and demographic variables. SDH characteristics were assessed using the Social Vulnerability Index. Primary outcomes included 90-day readmission and postoperative HU. ML models were developed and validated by the area under the curve (AUC) for readmission and mean absolute error (MAE) for HU. Feature importance analysis identified key predictors.ResultsBalanced Random Forest (AUC = 0.75) best predicted 90-day readmission, with length of stay, Elixhauser score, and Medicare status as top predictors. Among SDH factors, minority status & language, household composition & disability, socioeconomic status, and housing type & transportation were influential. Support Vector Regression (MAE = 1.96) best predicted HU, with perioperative duration, socioeconomic status, and minority status & language as key predictors.ConclusionsFindings highlight SDH's role in ACDF outcomes, suggesting the value of stratifying for interventions such as targeted resource allocation, language-concordant care, and tailored follow-up. While reliance on a single healthcare system and proxy SDH measures are limitations, this is the first study to apply ML to assess SDH in ACDF patients. Further validation with direct patient-reported SDH data is needed to refine predictive models.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251332556"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pelvic vs Lumbar Fusion in Neuromuscular Scoliosis - A Systematic Review.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-02 DOI: 10.1177/21925682251328620
Venla Soini, Sini Karkkola, Arimatias Raitio, Johanna Syvänen, Ilkka Helenius

Study DesignSystematic literature review.ObjectivesPosterior spinal fusion is the golden standard in the treatment of neuromuscular scoliosis. There are different views on whether pelvic fusion is necessary.MethodsA systematic literature review according to PRISMA guidelines was performed. A total of 628 articles were screened. Original articles of neuromuscular scoliosis patients with reference to posterior spinal fusion in the population of ≤20 years of age were included. Operative technique with lumbar pedicle screws was required. Case reports, articles with missing data on pelvic parameters or with a postoperative follow-up of less than 2 years were excluded. A final of 29 original articles were included in the review.ResultsA total of 1611 patients undergoing posterior spinal fusion for neuromuscular scoliosis were included in the analysis with a mean age of 14.0 ± 1.0 years and a mean number of 15.5 ± 0.8 levels fused. Spinal fusion was extended to the pelvis in 1222 cases, while in 389 patients had fusion limited to the lumbar spine. The percentage of main curve correction was slightly higher in pelvic fusion patients 63 ± 10% compared to 58 ± 9% in lumbar fusion group, P < 0.001. Pelvic obliquity correction was superior in the pelvic fusion group, 58% compared to 42% in the spinal fusion group, P < 0.001. Operative time, complication rate and perioperative bleeding were greater in the pelvic fusion group.ConclusionsPelvic fusion in posterior spinal fusion for neuromuscular scoliosis results in small but statistically significant differences in curve correction and pelvic obliquity but increases the risk for perioperative bleeding and other complications. The impact on quality of life should be addressed in future research.

{"title":"Pelvic vs Lumbar Fusion in Neuromuscular Scoliosis - A Systematic Review.","authors":"Venla Soini, Sini Karkkola, Arimatias Raitio, Johanna Syvänen, Ilkka Helenius","doi":"10.1177/21925682251328620","DOIUrl":"10.1177/21925682251328620","url":null,"abstract":"<p><p>Study DesignSystematic literature review.ObjectivesPosterior spinal fusion is the golden standard in the treatment of neuromuscular scoliosis. There are different views on whether pelvic fusion is necessary.MethodsA systematic literature review according to PRISMA guidelines was performed. A total of 628 articles were screened. Original articles of neuromuscular scoliosis patients with reference to posterior spinal fusion in the population of ≤20 years of age were included. Operative technique with lumbar pedicle screws was required. Case reports, articles with missing data on pelvic parameters or with a postoperative follow-up of less than 2 years were excluded. A final of 29 original articles were included in the review.ResultsA total of 1611 patients undergoing posterior spinal fusion for neuromuscular scoliosis were included in the analysis with a mean age of 14.0 ± 1.0 years and a mean number of 15.5 ± 0.8 levels fused. Spinal fusion was extended to the pelvis in 1222 cases, while in 389 patients had fusion limited to the lumbar spine. The percentage of main curve correction was slightly higher in pelvic fusion patients 63 ± 10% compared to 58 ± 9% in lumbar fusion group, <i>P</i> < 0.001. Pelvic obliquity correction was superior in the pelvic fusion group, 58% compared to 42% in the spinal fusion group, <i>P</i> < 0.001. Operative time, complication rate and perioperative bleeding were greater in the pelvic fusion group.ConclusionsPelvic fusion in posterior spinal fusion for neuromuscular scoliosis results in small but statistically significant differences in curve correction and pelvic obliquity but increases the risk for perioperative bleeding and other complications. The impact on quality of life should be addressed in future research.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251328620"},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and Radiological Outcomes of Intermuscular "Raising Roof" Modified Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Study of at Least 2 Years Follow-Up.
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1177/21925682251333285
Xinhang Li, Haosen Wu, Liran Xu, Xueshi Tian, Gengyu Han, Yu Sun, Shengfa Pan, Yanbin Zhao, Feifei Zhou

Study designRetrospective study.ObjectivesThe aim of this study was to evaluate the outcomes of a new modified laminoplasty, intermuscular "raising roof" laminoplasty for patients with cervical spondylotic myelopathy.Methods98 patients with cervical spondylotic myelopathy were involved into the study, including 44 patients underwent intermuscular "raising roof" laminoplasty (RL) and 54 patients underwent unilateral muscle-preserve laminoplasty (UL). The data, including sagittal parameters and clinical scale was collected at preoperative stage and final follow-up (at least 2 years) and compared between RL group and UL group. Multivariable liner regressions were preformed to evaluate the relationship between parameters with significant changes at the final follow-up and changes of CL, postoperative NDI and JOA. The cumulative sum (CUSUM) analysis was used for quantitative assessment of RL learning curve. All cases were divided into the learning phase and the proficiency phase according to the peak of CUSUM curve.ResultsNo significant difference was found between RL group and UL group preoperatively. At final follow-up, patients in RL group showed higher JOA scores and recovery rate (RR) but lower NDI scores. For the cervical alignment, the ROM of RL group was greater significantly than UL group, whereas the T1S of RL group was lower than UL group. For the decompression, the RL group had larger CSA of spinal canal than UL group (C4: 278.16 ± 50.40 vs 233.84 ± 42.71, P < .001; C5: 279.12 ± 63.88 vs 232.41 ± 48.38, P < .001). For the muscle-preserve effect, the CSA of left-side PM in RL group decreased significantly compared to the preoperative stage on C5 level (2.92 ± 0.66 vs 3.16 ± 1.08, P < .05), and RL group showed better postoperative symmetry than UL group. The regression results indicated postoperative CSA of right-side PM on C4 level had positive impact on the change of CL (positive value increasing, P = .023). And the postoperative symmetry of PM at C4 had positively correlation with postoperative NDI (P = .034). However, the ages of patients showed negative correlation (P = .012) with postoperative JOA. Operation time of learning phase was significantly longer than proficiency phase (166 ± 34.78 vs 120.65 ± 20.36, P < .001), and blood loss of learning phase was significantly higher than proficiency phase (251.90 ± 171.27 vs 148.88 ± 82.02, P < .001).ConclusionCompared to UL, RL showed similar recovery of neurological functions, but with better improvement of quality of life, cervical mobility and decompression effect at 2-year follow-up. It provides a new treatment approach for degeneration cervical myelopathy.

{"title":"Clinical and Radiological Outcomes of Intermuscular \"Raising Roof\" Modified Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Study of at Least 2 Years Follow-Up.","authors":"Xinhang Li, Haosen Wu, Liran Xu, Xueshi Tian, Gengyu Han, Yu Sun, Shengfa Pan, Yanbin Zhao, Feifei Zhou","doi":"10.1177/21925682251333285","DOIUrl":"10.1177/21925682251333285","url":null,"abstract":"<p><p>Study designRetrospective study.ObjectivesThe aim of this study was to evaluate the outcomes of a new modified laminoplasty, intermuscular \"raising roof\" laminoplasty for patients with cervical spondylotic myelopathy.Methods98 patients with cervical spondylotic myelopathy were involved into the study, including 44 patients underwent intermuscular \"raising roof\" laminoplasty (RL) and 54 patients underwent unilateral muscle-preserve laminoplasty (UL). The data, including sagittal parameters and clinical scale was collected at preoperative stage and final follow-up (at least 2 years) and compared between RL group and UL group. Multivariable liner regressions were preformed to evaluate the relationship between parameters with significant changes at the final follow-up and changes of CL, postoperative NDI and JOA. The cumulative sum (CUSUM) analysis was used for quantitative assessment of RL learning curve. All cases were divided into the learning phase and the proficiency phase according to the peak of CUSUM curve.ResultsNo significant difference was found between RL group and UL group preoperatively. At final follow-up, patients in RL group showed higher JOA scores and recovery rate (RR) but lower NDI scores. For the cervical alignment, the ROM of RL group was greater significantly than UL group, whereas the T1S of RL group was lower than UL group. For the decompression, the RL group had larger CSA of spinal canal than UL group (C4: 278.16 ± 50.40 vs 233.84 ± 42.71, <i>P</i> < .001; C5: 279.12 ± 63.88 vs 232.41 ± 48.38, <i>P</i> < .001). For the muscle-preserve effect, the CSA of left-side PM in RL group decreased significantly compared to the preoperative stage on C5 level (2.92 ± 0.66 vs 3.16 ± 1.08, <i>P</i> < .05), and RL group showed better postoperative symmetry than UL group. The regression results indicated postoperative CSA of right-side PM on C4 level had positive impact on the change of CL (positive value increasing, <i>P</i> = .023). And the postoperative symmetry of PM at C4 had positively correlation with postoperative NDI (<i>P</i> = .034). However, the ages of patients showed negative correlation (<i>P</i> = .012) with postoperative JOA. Operation time of learning phase was significantly longer than proficiency phase (166 ± 34.78 vs 120.65 ± 20.36, <i>P</i> < .001), and blood loss of learning phase was significantly higher than proficiency phase (251.90 ± 171.27 vs 148.88 ± 82.02, <i>P</i> < .001).ConclusionCompared to UL, RL showed similar recovery of neurological functions, but with better improvement of quality of life, cervical mobility and decompression effect at 2-year follow-up. It provides a new treatment approach for degeneration cervical myelopathy.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251333285"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers. 微创 Tlif 与开放 Tlif 的前瞻性随机比较:铁路工人的临床疗效和工作能力恢复。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-03-25 DOI: 10.1177/21925682241242039
Vadim A Byvaltsev, Andrei A Kalinin, Yurii Ya Pestryakov, Dmitriy V Hozeev, Rustem A Kundubayev, Mikhail Y Biryuchkov, K Daniel Riew

Study DesignRandomized Clinical Trial.ObjectiveTo compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease.Methods83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed.ResultsAt 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (P < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (P < .05).ConclusionsThe use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.

研究设计随机临床试验:方法:将 83 名有腰椎两级减压融合手术指征的患者随机分为两组:第一组(44 人)接受 MI-TLIF 手术,第二组(39 人)接受 O-TLIF 手术。术前、出院时、术后3、6和12个月时,采用SF-36、ODI和VAS对背痛和腿痛的功能状态进行评估。术后 1 年进行了 MRI 和 CT 检查。对术后 1 年重返工作岗位的患者比例、工作强度和重返工作岗位的时间进行了分析:结果:随访1年后,MI-TLIF组的ODI、VAS和SF-36评分明显优于O-TLIF组。术后核磁共振成像显示,MI 组的多裂肌萎缩程度明显低于开放组。在一年的随访中,MI 组与开放组的融合率相当。MI-TLIF术后,根据工作量的不同,与O-TLIF组相比,患者重返工作岗位的时间明显提前(P < .05),重返工作岗位率明显提高(P < .05):结论:与O-TLIF相比,在铁路工人中使用两级MI-TLIF可显著改善长期临床效果,降低手术并发症风险,减少肌肉萎缩和重返工作岗位的时间。
{"title":"Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers.","authors":"Vadim A Byvaltsev, Andrei A Kalinin, Yurii Ya Pestryakov, Dmitriy V Hozeev, Rustem A Kundubayev, Mikhail Y Biryuchkov, K Daniel Riew","doi":"10.1177/21925682241242039","DOIUrl":"10.1177/21925682241242039","url":null,"abstract":"<p><p>Study DesignRandomized Clinical Trial.ObjectiveTo compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease.Methods83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed.ResultsAt 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (<i>P</i> < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (<i>P</i> < .05).ConclusionsThe use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1508-1516"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery. 未经治疗的术前抑郁与脊柱手术后疼痛和疗效的关系
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-06-11 DOI: 10.1177/21925682241260642
Jae-Won Shin, Yung Park, Sung-Hoon Park, Joong Won Ha, Woo-Seok Jung, Hak-Sun Kim, Kyung-Soo Suk, Si-Young Park, Seong-Hwan Moon, Byung Ho Lee, Ji-Won Kwon, Jaeun Ahn

Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.

研究设计前瞻性队列研究:未经治疗的术前抑郁症可能会延长手术后疼痛的时间并阻碍康复。然而,有关未经治疗的手术前抑郁对脊柱手术后疼痛的影响的研究尚属空白。因此,本研究旨在评估患者手术前抑郁的情况,并分析其与手术后疼痛及手术后总体预后的关系:我们招募了 100 名因脊椎滑脱症、腰椎间盘退行性疾病和腰椎间盘突出症而计划接受腰椎手术的患者。精神科医生对他们进行了评估,以确定最终人选。我们评估了贝克抑郁量表(BDI)、日本骨科协会(JOA)、Oswestry残疾指数(ODI)、欧洲生活质量5维度(EQ-5D)评分、腰腿痛数字量表以及术前、术后6周、3个月和6个月的药物剂量数据:本研究共纳入 91 名患者,其中 40 人被分配到对照组,51 人被分配到抑郁组。手术前后的腿痛、背痛和功能评分没有差异。然而,与对照组相比,抑郁组在术后 3 个月的 ODI 和 EQ-5D 分数更高,JOA 分数更低。偏相关分析显示,术后3个月时,JOA和BDI评分呈反相关,EQ-5D和BDI评分呈正相关:结论:未经治疗的抑郁症会延长术后疼痛的时间并阻碍术后恢复。在脊柱手术前检测并治疗患者的抑郁症可改善他们的整体生活质量和功能恢复。
{"title":"Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery.","authors":"Jae-Won Shin, Yung Park, Sung-Hoon Park, Joong Won Ha, Woo-Seok Jung, Hak-Sun Kim, Kyung-Soo Suk, Si-Young Park, Seong-Hwan Moon, Byung Ho Lee, Ji-Won Kwon, Jaeun Ahn","doi":"10.1177/21925682241260642","DOIUrl":"10.1177/21925682241260642","url":null,"abstract":"<p><p>Study DesignProspective Cohort Study.ObjectiveUntreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes.MethodsWe recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery.ResultsNinety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively.ConclusionUntreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1725-1732"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Outcomes of One-Stage Combined Posteroanterior Procedure and Laminoplasty-Alone for Multilevel Degenerative Cervical Myelopathy With Concomitant Anterior and Posterior Compression: A Propensity Score Matching Analysis of 8-year Follow-Up. 一期后路联合手术和椎板成形术-Alone治疗伴有前后压迫的多级退行性颈椎病的长期疗效:8年随访倾向得分匹配分析》。
IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-07-20 DOI: 10.1177/21925682241265878
Ruomu Qu, Yiyuan Yang, Ben Wang, Zexiang Liu, Xiumao Li, Liang Jiang, Xiaoguang Liu, Zhongjun Liu

Study DesignRetrospective cohort study.ObjectiveThis study aimed to investigate the long-term outcomes of laminoplasty-alone (LP) and combined procedure (CP), consisting of laminoplasty and single-level anterior cervical discectomy and fusion, in comparable patients who had multilevel degenerative cervical myelopathy (MDCM) with concomitant anterior and posterior compression (CAPC).MethodsConsecutive MDCM patients with CAPC underwent LP or CP between 2012 and 2015 from a same surgical group were enrolled and followed up for a minimum of 8 years. Preoperative demographic, radiological, and clinical variables were collected. Propensity score matching (PSM) analysis was performed to match patients with comparable conditions. The outcomes were evaluated by postoperative Japanese Orthopedic Association (JOA) score improvement, JOA recovery rate (JOARR) and complications.ResultsA total of 230 patients were included, of whom 146 underwent LP and 84 underwent CP. After PSM, 84 pairs of comparable patients were matched. The matched groups presented fair comparability in preoperative conditions. The CP group had significantly prolonged surgery time and greater blood loss. At the final follow-up, the postoperative JOA scores of LP and CP groups were 14.51 ± 1.79 and 15.47 ± 1.81 (P < 0.001) and the JOARR were 42.5% ± 53.3% and 68.5% ± 35.4%, respectively (P < 0.001). Three (3.6%) patients in the LP group underwent reoperations because of recurrent symptoms (P = 0.081).ConclusionBoth LP and CP demonstrated considerable long-term neurological recovery in patients with CAPC. The CP showed a significantly higher JOA improvement and JOARR. The combined decompression might be a safe and effective alternative in treating MDCM with CAPC in experienced hands.

研究设计回顾性队列研究:本研究旨在探讨单纯椎板成形术(LP)和联合术(CP)(包括椎板成形术和单水平颈椎前路椎间盘切除术和融合术)在多水平退行性颈椎脊髓病(MDCM)合并前后压迫(CAPC)患者中的长期疗效:方法: 2012年至2015年期间,同一手术组连续对接受LP或CP治疗的多椎间孔变性颈椎病(MDCM)合并前后压迫症(CAPC)患者进行了登记和至少8年的随访。收集术前人口统计学、放射学和临床变量。进行倾向评分匹配(PSM)分析,以匹配病情相似的患者。通过术后日本骨科协会(JOA)评分改善情况、JOA恢复率(JOARR)和并发症对结果进行评估:结果:共纳入 230 名患者,其中 146 人接受了 LP,84 人接受了 CP。经过 PSM,84 对具有可比性的患者进行了配对。配对组在术前条件方面具有相当的可比性。CP 组的手术时间明显延长,失血量增加。最终随访时,LP 组和 CP 组的术后 JOA 评分分别为(14.51 ± 1.79)和(15.47 ± 1.81)(P < 0.001),JOARR 分别为(42.5% ± 53.3%)和(68.5% ± 35.4%)(P < 0.001)。LP组有3名(3.6%)患者因症状复发而再次手术(P = 0.081):结论:LP和CP均可使CAPC患者的神经功能得到显著的长期恢复。结论:LP 和 CP 对 CAPC 患者的长期神经恢复都很明显,CP 的 JOA 改善和 JOARR 明显更高。在治疗伴有 CAPC 的 MDCM 时,经验丰富的医生可能会将联合减压作为一种安全有效的替代方法。
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Global Spine Journal
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