Global Spine Journal最新文献

Study DesignRetrospective study.ObjectiveTo evaluate and compare bone density along the traditional pedicle trajectory(TPT), cortical bone trajectory(CBT), and modified cortical bone trajectory(mCBT) using computed tomography(CT)-derived Hounsfield unit(HU) measurements.MethodsCT scans of the lumbar spine (L1-L5) of adult patients undergoing CT for non-spinal indications (predominantly younger adults) were retrospectively analyzed. Three pedicle screw trajectories were virtually simulated: TPT, CBT, and mCBT. For each trajectory, CTHU values were measured in sagittal section at four anatomical points along the screw path: posterior cortex, mid-pedicle, mid-vertebral body, and anterior vertebral body cortex using multiplanar reconstruction. Mean CTHU values, maximum screw lengths were compared across trajectories, and subgroup analyses were performed for age and sex.ResultsA total of 350 patients (1750 vertebrae) were analyzed. Mean CTHU values differed significantly among trajectories: CBT (538.2 ± 73.1HU) >mCBT (472.6 ± 87.9HU) >TPT (362.8 ± 68.4HU) (P < .001). At the posterior cortex, density was highest for CBT (1128.9 ± 147.6 HU), followed by mCBT (962.4 ± 192.7 HU) and TPT (582.1 ± 162.3HU). Across mid-pedicle, mid-body, and anterior cortex, CBT and mCBT showed comparable values, both significantly greater than TPT. mCBT showed significantly increased length of screw compared to CBT and TPT(P < .001). Age negatively correlated with CTHU across all trajectories, most pronounced in TPT (r = -0.36,R² = 0.13). Gender differences were significant only for TPT (P < .05).ConclusionIn this radiographic anatomical study of predominantly young adults, CBT and mCBT trajectories traversed higher CT-HU than the traditional pedicle path. These observations are hypothesis-generating and require validation in DEXA-verified osteoporotic cohorts and biomechanical and clinical studies before clinical recommendations can be made.

Study DesignSystematic Review.ObjectivesTo compare clinical, radiological, and complication outcomes between three-level hybrid surgery [combining cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF)] and three-level ACDF alone in patients with multilevel cervical degenerative disease.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. Nine retrospective cohort studies (704 patients: 450 HS, 254 ACDF) were included. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated for clinical, radiological, perioperative, and complication outcomes.ResultsBoth HS and ACDF significantly improved disability and myelopathy scores, with no differences in NDI or mJOA. HS preserved better the operated-level ROM (MD + 5.79°; 95% CI 2.38 - 9.21; P = 0.0009), while adjacent segment motion did not differ. Arm pain improvement showed a non-significant trend favouring HS (MD -2.63; P = 0.08), and neck pain was similar. Both procedures improved segmental lordosis; global alignment remained stable. Complications differed: instrumentation failure was more common with ACDF (33.3% vs 5.2%, P = 0.02), while HO occurred in 41.2% of hybrid constructs, reflecting loss of arthroplasty motion.ConclusionThree-level HS and ACDF provide comparable clinical outcomes. HS is a promising alternative, providing better motion preservation but at the cost of a higher risk of heterotopic ossification, while ACDF may be associated with a higher rate of instrumentation failure. Long-term prospective studies are still needed to strengthen these conclusions.

Study DesignA multicenter study.ObjectiveTo develop a machine learning algorithm to predict when magnetic resonance imaging (MRI) may change the thoracolumbar AO Spine injury severity score (TLAOSIS) treatment recommendation for thoracolumbar fractures (TLFs) without neurological deficits.MethodsThree trauma centers recruited 619 neurologically intact TLFs (AO Spine A-fractures) who underwent computed tomography (CT) and MRI. CT findings indicating posterior ligamentous complex (PLC) injury were defined as facet malalignment, horizontal laminar fracture, spinous process fracture, and interspinous widening ≥4 mm. A single positive CT finding indicated an M1 modifier. The primary outcome was any change in the TLAOSIS treatment recommendation among conservative (≤3), grey zone (4-5), and surgical (>5) groups after MRI. The derivation and validation sets utilized 80% and 20% of the samples, respectively. A classification and regression tree (CART) was developed using the M1 modifier, AO fracture subtype (A1-A4), and spine level. Model discrimination was quantified using the area under the receiver operating curve (AUC).ResultsMRI altered TLAOSIS recommendations in 82 (13.2%) cases. The CART used the M1 modifier, A subtype, and spine level (importance = 0.914, 0.055, and 0.031, respectively). The model achieved an AUC of 0.93, sensitivity of 87.5%, specificity of 96.3%, and mean accuracy of 92.9% (±12.0%) in cross-validation in predicting TLAOSIS recommendation change.ConclusionThe CART model accurately predicted changes in the TLAOSIS recommendation after MRI. This algorithm provides cost-effective indications for MRI in neurologically intact AO A-type fractures, ensuring accurate PLC assessment while minimizing unnecessary imaging.

Study DesignRetrospective study.ObjectiveThis study aimed to investigate the association between preoperative patient expectations and postoperative satisfaction in elderly patients with adult spinal deformity (ASD), with particular emphasis on identifying potential dose-response relationships.MethodsWe conducted a retrospective cohort study of elderly patients (aged ≥65 years) with ASD undergoing thoracolumbar fusion surgery at our institution. Participants were stratified into satisfied and dissatisfied cohorts based on postoperative the North American Spine Society (NASS) satisfaction scores assessed at follow-up. Comprehensive data collection included demographic characteristics, radiological parameters, surgical variables, and perioperative outcomes. Propensity score matching using the nearest-neighbor method was applied to both groups of patients. Conditional logistic regression models adjusted for confounders were employed to assess associations. Nonlinear relationships were investigated through smoothed curve fitting with covariate adjustment. Threshold effects were analyzed using piecewise regression models, with receiver operating characteristic (ROC) curve analysis validating optimal cutoff values.ResultsIn our study involving 234 elderly patients with ASD undergoing thoracolumbar fusion surgery between September 2019 and September 2022, we analyzed statistically significant differences between a case group (patient dissatisfied) and a control group (patient satisfied). We matched 82 patients in each group using nearest-neighbor matching. Despite this matching, there were still significant differences in key variables such as American Society of Anesthesiologists (ASA), Age-adjusted Charlson Comorbidity Index (ACCI), complications, previous spine surgery, perioperative outcomes, and preoperative expectation (P < .05). In our fully adjusted model, we found that higher expectation scores were associated with lower satisfaction levels. Our curve-fitting analysis revealed that the risk of decreased patient satisfaction increased notably when the expectation score exceeded 53 points. Two-piecewise regression confirmed this threshold (OR = 0.29, 95% CI 0.17 ∼ 0.38, P < .001), corroborated by Receiver operating characteristic (ROC) analysis (AUC = 0.808, sensitivity 83.6%, specificity 63.2%).ConclusionOur findings identify 53 points as the critical threshold on preoperative expectation scales where satisfaction risk markedly escalates in elderly spinal deformity patients undergoing thoracolumbar fusion. The demonstrated dose-response relationship underscores the clinical importance of preoperative expectation management in this population.

Study DesignSystematic Review.ObjectivesA vast array of historical subaxial cervical spine fracture classifications. This initially comprised crude non-hierarchial schemes based upon mechanism on injury alone including compression, flexion, extension or lateral flexion. Allen and Ferguson advanced this by offering 6 categories of subaxial cervical spine injuries. Beyond this, Aebi and Nazarian appreciated the nuances of whether was was ligamentous injury in addition to pure bony involvement. These existing simplistic classifications failed to guide clinicians as to whether operative or non-operative management is appropriate. We describe the evolution of existing subaxial cervical spine classification systems and the development of the AO Cervical Spine Injury Classification System.MethodsA systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify all existing subaxial cervical spine classification systems.Results483 articles were initially retrieved which were distilled to 11 articles which pioneered individual classification systems. The AO Cervical Spine Injury Classification System resolves this with its hallmark 3 categories of escalating injury types from the type A compression injuries, to type B tension band injuries and finally the grossly unstable type C translation/displacement injuries. The addition of modifiers such as critical disc herniation or stiffening bony disease further strengthens the encompassing nature of this classification.ConclusionsThe AO Spine Cervical Spine Injury Classification System is a testament of the historical classification grading schemes but provides a structured means of evaluating injuries. This progressive system provides a foundation upon which objective scoring management methods can be developed to guide operative or non-operative management.

Study DesignRetrospective Cohort Study.ObjectivesTo compare 1-year postoperative outcomes and complication rates between single-level lumbar laminectomy and hemilaminectomy using a large, multicenter, propensity-matched dataset.MethodsWe queried the TriNetX global health research network (≥160 million patients) for adults undergoing single-level lumbar decompression between January 2005 and July 2025. Cohorts were defined by CPT codes: laminectomy and hemilaminectomy, with qualifying diagnoses of lumbar disc herniation, spinal stenosis, spondylolisthesis, or radiculopathy. Patients with fusion, prior lumbar surgery, or non-degenerative pathology were excluded. Outcomes included new postoperative events within 1 year: mortality, weakness, pain, sensory loss, cauda equina syndrome, radiculopathy, foot drop, CSF leak, and surgical-site infection. Propensity-score matching balanced demographics and comorbidities. Cox proportional hazards models, Kaplan-Meier curves, and relative risks were calculated.ResultsOf 167,177 patients, 80,440 underwent laminectomy and 86,737 hemilaminectomy. After matching, 50,853 patients per cohort were analyzed. One-year mortality was similar (0.57% vs 0.49%, HR 1.20; 95% CI 1.01-1.42; P = 0.045). Laminectomy conferred significantly higher risks of CSF leak (1.41% vs 1.00%; RR 1.41), surgical-site infection (1.45% vs 1.00%; RR 1.45), cauda equina syndrome (0.36% vs 0.22%; RR 1.62), and persistent weakness (4.12% vs 3.67%; RR 1.12). Persistent radiculopathy was modestly less frequent after laminectomy (10.5% vs 12.0%; RR 0.87). Other outcomes, including pain and foot drop, were comparable.ConclusionsHemilaminectomy was associated with lower perioperative complication rates compared to laminectomy, while laminectomy provided a modest reduction in persistent radiculopathy. These findings highlight a tradeoff between safety and decompressive efficacy, emphasizing the importance of patient-specific surgical selection.

Study DesignBasic Science Study.ObjectivesTo determine the impact of rod composition and bending method on metal debris production during fatigue testing of posterolateral lumbar fusion constructs.MethodsPosterolateral lumbar fusion constructs were embedded into Ultra-High Molecular Weight Polyethylene (UHMW-PE) blocks and subject to fatigue testing, following a modified ASTM F1717-21 protocol including cycles of compression with novel axial rotation. Variations in constructs included rod bending methods of pre-bent (PB) and surgeon-bent (SB) and rod compositions of titanium alloy (Ti) or cobalt chromium alloy (CC). Constructs were wrapped in lactated ringer solution-soaked cotton, which was dissolved and analyzed for metal particulate using inductively coupled mass spectrometry (ICP-MS).ResultsMetal debris produced by surgeon-bent cobalt chromium and pre-bent cobalt chromium constructs did not have significant differences in quantity or quality. Pre-bent cobalt chromium alloy rods produced a larger amount of chromium and cobalt metal debris than pre-bent titanium alloy rods.ConclusionsWe find that cobalt chromium alloy rods produce more metal debris than titanium alloy rods. We find no evidence that rod bending method affects metal debris quality or quantity. In considering factors that impact susceptibility to corrosion and metallosis, our data supports that rod composition, but not bending method, contributes significantly to metal debris production.