Global Spine Journal最新文献

Study designA retrospective cross-sectional study.ObjectivesTo evaluate the impact of coronal plane imbalance in adult degenerative scoliosis (ADS) on the severity and side-specific pattern of hip osteoarthritis (OA).MethodsPatients older than 50 years with Cobb angle >10° who underwent preoperative EOS images were retrospectively recruited. Hip OA severity was assessed using Kellgren-Lawrence (KL) grades and categorized into mild (KL <3 bilaterally) or severe (≥ one hip with KL ≥3). Coronal parameters-including Cobb angle, apical vertebral translation (AVT), pelvic obliquity (PO), and coronal balance distance-along with sagittal spinopelvic parameters were measured. Associations between radiographic variables and OA severity (worse, concave, and convex sides) were evaluated using Spearman correlation and multivariate logistic regression.ResultsAmong 189 patients, those with severe hip OA demonstrated significantly greater AVT and PO despite similar Cobb angles. AVT correlated with worse-side OA (r = 0.259, P < 0.001), convex-side OA (r = 0.154, P = 0.034), and concave-side OA (r = 0.246, P < 0.001); PO correlated with worse-side and concave-side OA. Logistic regression identified AVT as an independent risk factor for worse-side (OR 1.062) and concave-side OA (OR 1.077), whereas Cobb angle appeared protective for convex-side OA (OR 0.942). Sagittal parameters (PT, PI-LL, SVA) were also elevated in severe OA patients, consistent with hip-spine compensatory mechanisms.ConclusionCoronal imbalance in ADS, particularly increased AVT and pelvic obliquity, is associated with the severity and asymmetry of hip OA independent of Cobb angle magnitude. AVT may serve as a radiographic marker for identifying ADS patients at higher risk of asymmetric hip degeneration.

Study DesignRetrospective Propensity-Matched Analysis.ObjectivesOptimal control of postoperative pain while minimizing opioid consumption is paramount in spine surgery. While gabapentinoids have robust utilization for the treatment of neuropathic pain and neuroprotective effects, their interplay in multimodal analgesia following ACDF is unclear. The objective of the present study was to investigate the association between postoperative gabapentinoid use and postoperative opioid use following ACDF.MethodsWe conducted a retrospective cohort study using the TriNetX Research network, identifying adult patients who underwent ACDF between 2003-2023. Patients with chronic opioid use were excluded. After 1:1 propensity score matching, cohorts were constructed based on receipt of postoperative gabapentinoids vs acetaminophen monotherapy. Outcomes included opioid utilization and surgical/systemic complications across standardized follow-up intervals (30 days, 90 days, 6 months, 1 year, 2 years, and 5 years). Risk ratios with 95% confidence intervals were calculated, and Kaplan-Meier analyses assessed time-to-event outcomes.ResultsAfter matching, 32 455 patients were included in each group. Gabapentinoid use was associated with higher opioid consumption at every interval, persisting through 5 years (2.29% vs 0.51% at 5 years, RR 4.61, P < 0.001). Gabapentinoid recipients had a greater risk of pneumonia and respiratory failure across multiple timepoints. Kaplan-Meier curves demonstrated durable separation between groups for pneumonia, respiratory failure, and opioid use (all log-rank P < 0.001).ConclusionGabapentinoids use following ACDF was associated with increased opioid utilization and higher complication rates, challenging their presumed benefit in this setting. These findings suggest that gabapentinoids may not be an effective adjunct in multimodal pain regimens for ACDF.

Study DesignRetrospective cohort study.ObjectiveTo evaluate the predictive performance (discrimination and calibration) of the mFI-5 for major postoperative complications in thoracolumbar spine surgery, and to compare its effectiveness in low-, moderate-, and high-complexity procedures.MethodsThe study was conducted on adult patients (>18 years) who underwent thoracolumbar spine surgery at a single tertiary care center between 2017 and 2020. The primary outcome was the incidence of major complications within 90 days. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and calibration was evaluated with calibration-in-the-large (CITL), calibration slope, and the Hosmer-Lemeshow test.ResultsA total of 839 patients were included (mean age: 62.8 years; SD: 16.8). Major complications occurred in 8.2% of cases. The mFI-5 demonstrated fair discrimination (AUROC: 0.66; 95% CI: 0.60-0.70) and excellent calibration (slope = 1, CITL = 0; Hosmer-Lemeshow P = .99). Stratified analysis showed improved discrimination in high-complexity surgeries (AUROC: 0.74; 95% CI: 0.64-0.84), compared to moderate (0.62; 95% CI: 0.48-0.74) and low complexity (0.63; 95% CI: 0.50-0.74) procedures. Readmission rates were 7% at 30 days and 9% at 90 days, with a 6-month mortality rate of 1%.ConclusionThe mFI-5 is a valuable tool for predicting major complications in thoracolumbar spine surgery, particularly in high-complexity procedures. Its predictive performance is limited in lower-complexity surgeries. Further prospective studies are needed to validate its use and enhance preoperative risk stratification.

Study DesignProspective cohort study.ObjectivesTo evaluate postoperative opioid use in opioid-naive patients undergoing lumbar or cervical spine surgery and assess the impact of surgical approach (open vs minimally invasive) and number of operative levels on opioid consumption.MethodsA prospective cohort of 217 opioid-naive patients undergoing outpatient spine surgery from August 2023 to December 2024 was analyzed. Patients were stratified by surgical approach (open, tubular, endoscopic) and by single-vs multilevel procedures. Opioid usage was measured in total morphine milligram equivalents (MME) based on patient-reported pill counts at 2 weeks and follow-up interviews at 3 months.ResultsPatients undergoing single-level procedures used significantly fewer opioids than those undergoing multilevel procedures (75.1 ± 97.0 MME vs 167.3 ± 239.6 MME; P = .0068). Among lumbar surgeries, endoscopic procedures had the lowest average opioid use (48.6 ± 57.8 MME), significantly less than open procedures (164.7 ± 223.7 MME; P = .0021). Overall, 17.5% of patients required no postoperative opioids, with the highest rate seen in the single-level endoscopic group (36.3%).ConclusionMinimally invasive spine surgery techniques, particularly endoscopic and tubular approaches, were associated with reduced postoperative opioid use and fewer refill requests compared to open procedures within this heterogeneous cohort of lumbar and cervical procedures. Multilevel surgeries were associated with higher opioid consumption. These findings support the development of tailored opioid prescribing protocols for opioid-naive patients, potentially reducing overprescription and improving pain management. Patient education on non-opioid analgesia and standardized prescribing guidelines may further reduce opioid reliance after spine surgery.

Study DesignRetrospective Multicenter Cohort Study.ObjectivesTo develop and validate an AI-based high-speed multi-class instance segmentation system for lumbar spinal endoscopic surgery using multicenter surgical video data and to assess performance across hardware environments.MethodsEndoscopic videos from 112 patients at 5 hospitals (2020-2025) were analyzed. One frame per 300 frames was sampled, yielding 58,087 annotated images for 7 classes (instrument, fat, soft tissue, bone, nerve, disc, vessel). A Segment Anything Model (SAM)-assisted workflow improved annotation efficiency, followed by expert refinement. A YOLOv11-seg model was trained with a patient-level 4:1 split. Performance was evaluated using precision, recall, F1-score, mAP50, and mAP50-95, stratified by surgical approach. Inference speed was benchmarked across CPU (Intel i5/i7) and GPU (RTX 4080/5080) configurations.ResultsIn the biportal group, overall precision, recall, F1-score, and mAP50 were 0.975, 0.633, 0.768, and 0.629, respectively. The uniportal group demonstrated 0.659, 0.670, 0.664, and 0.682, respectively. Class-wise performance varied substantially by surgical approach: the instrument class showed exceptionally high mAP50 (0.949) in uniportal settings, whereas anatomical structures like vessels were detected with superior accuracy in biportal settings (mAP50 = 0.863). Benchmarking yielded 21.86-27.45 FPS with CPU-only, ∼92 FPS with RTX 4080, and ∼117 FPS with RTX 5080.ConclusionsThis multicenter study highlights the potential of high-speed, multi-class instance segmentation in endoscopic spine surgery. Improving model robustness in visually degraded environments requires further research. Prioritizing high precision to prevent surgeon distraction, supported by rapid inference to maintain temporal continuity, is a practical direction for future surgical AI models.

Study DesignRetrospective cohort study.ObjectiveTo establish a novel lumbar subcutaneous adipose classification (LSAC) based on sagittal MRI and determine its predictive value for surgical site infection (SSI) and postoperative adverse events (PAE) following posterior lumbar fusion.MethodsA retrospective analysis of 1122 patients undergoing posterior lumbar interbody fusion was performed. Lumbar subcutaneous adipose distribution at the L3 endplate level was categorized into five types (Low, Cranial, Caudal, Cranial-Caudal, and Diffuse). Surgical segment subcutaneous fat thickness (SFT), facet joint to lumbar dorsal fascia distance (FJ-LDF), paraspinal muscle cross-sectional area, paraspinal muscle fat infiltration, and Modic changes were assessed. Associations between LSAC and SSI/PAE were examined using multivariate logistic regression.ResultsLSAC demonstrated excellent inter- and intra-observer reliability. Significant differences in patient characteristics were observed among the five types, with type 5 and type 2 showing higher BMI, diabetes and spondylolisthesis rate. SSI and PAE incidence were highest in type 5, followed by type 2. Multivariate analyses identified LSAC (OR 1.534, P = 0.007), BMI (OR 1.156, P = 0.010), transfusion (OR 1.002, P < 0.001), and smoking (OR 2.646, P = 0.035) as independent predictors of SSI; and LSAC (OR 1.477, P = 0.002), age (OR 1.037, P = 0.016), smoking (OR 2.607, P = 0.007), and higher drainage volume (OR 1.001, P < 0.001) as predictors of PAE. ROC curve demonstrated that LSAC was more sensitive than BMI and SFT to predict the SSI and PAE.ConclusionThe LSAC system provides a simple, reproducible method for quantifying lumbar subcutaneous fat distribution and outperforms traditional single adiposity indices such as BMI or SFT in predicting postoperative complications. Type 5 and type 2 represent high-risk phenotypes requiring enhanced perioperative optimization and surveillance.

Study DesignRetrospective cross-sectional.ObjectiveDegeneration of paraspinal muscles and intervertebral discs has been associated with adverse outcomes. While vascular influences on lumbar degeneration are known, cervical associations remain unclear. The objective is to evaluate the relationship between carotid artery stenosis (CAS) and cervical paraspinal muscle atrophy as well as its association with intervertebral disc integrity.MethodsPatients undergoing primary cervical spine surgery (2009-2018) with cervical MRI and CTA ≤12 months apart were included. MRIs from C3-C7 quantified fatty infiltration (FI) and functional cross-sectional area (fCSA) in sternocleidomastoid (SCM), anterior group (AG), scalenus (SN), posteromedial (PM), posterolateral (PL), and trapezius (TP) groups. Disc degeneration was evaluated using the Disc Signal Intensity score. Maximum and mean CAS were measured on CTA.ResultsSixty-five patients were included. In multivariable linear regression models, higher mean stenosis was significantly associated with increased FI in multiple muscle groups at C3, as well as the PM at C4 and SCM at C5 (P < 0.05), and with reduced fCSA in the PM and SCM at C4 (P < 0.05). Higher maximum stenosis was associated with increased FI in the SCM and TP at C3 and the PL at C4, along with reduced fCSA in the SCM at C4 (P < 0.05). No significant associations were observed with disc degeneration.ConclusionCAS was associated with cervical muscle atrophy, suggesting a potential link with vascular health. In contrast, disc degeneration showed no association with CAS, suggesting that muscle atrophy and disc degeneration may follow distinct pathways.

Study DesignCross-sectional, web-based international survey study.ObjectivesTo assess spine surgeons' perspectives on the importance of Enhanced Recovery After Surgery (ERAS) components and barriers to implementing ERAS programs in degenerative lumbar fusion.MethodsIn May 2024, a web-based survey was distributed to AOSpine members. The survey covered eight ERAS components derived from the 2021 consensus statement for perioperative care in lumbar fusion. Respondents selected up to three components with the biggest perceived impact on recovery and up to three with the greatest room for improvement. Responses were summarized in a priority matrix. Demographics, perceived barriers, and implementation support needs were analyzed using descriptive statistics.ResultsThe survey was accessed by 400 individuals, yielding 322 responses (80.5%) and a 76.7% completion rate. Respondents represented academic (50.6%), private (28.9%), and local/community hospitals (20.5%) worldwide. ERAS components perceived to have the biggest impact on recovery were multimodal opioid-sparing analgesia (73.3%), early mobilization (63.8%), and preoperative education & counselling (58.6%), which were also identified as having the greatest room for improvement (39.4%, 41.4%, and 62.6%, respectively). Key barriers were the absence of clear protocols and guidelines (56.2%), staff shortages (53.8%), and difficulties coordinating implementation and adherence (43.0%).ConclusionMultimodal opioid-sparing analgesia, early mobilization, and preoperative education & counselling were identified as ERAS components with the biggest perceived impact on patient recovery and the greatest room for improvement. Targeted efforts in these domains may represent an important opportunity to enhance perioperative care and support the implementation of ERAS programs in lumbar spinal fusion.