Global Spine Journal最新文献

Study DesignMeta-analysis.ObjectivesSpinal tumors and metastases remain a challenge for spine surgeons, with a significant risk of perioperative blood loss, which might require blood transfusions and lead to increased complications. Tranexamic acid (TXA) is an antifibrinolytic agent widely used in various surgical procedures; however, its efficacy in spinal oncology surgery remains unclear. This meta-analysis aims to evaluate the clinical effectiveness of TXA on perioperative outcomes, mainly blood loss, among patients with oncological spines undergoing surgery.MethodsPubMed, Scopus, and Web of Science were systematically searched from inception for eligible articles. We included studies assessing TXA vs no TXA or placebo on perioperative outcomes among patients with spinal tumors or metastases.ResultsAfter a comprehensive search, seven studies were included. Blood loss (MD -111.75 mL; 95% CI -217.08 to -6.43; P = 0.04; I² = 83.8%), postoperative drain (MD -90.49 mL; 95% CI -150.17 to -30.81; P < 0.01; I² = 68.1%), hospitalization duration (MD -1.88 days; 95% CI -3.33 to -0.44; P = 0.004; I² = 0%), and overall complication rate (OR 0.54; 95% CI 0.34 to 0.87; P = 0.011; I² = 0.0) were significantly reduced in TXA group. There was no significant difference in operation time, transfusions, or thrombosis events.ConclusionRetrospective data suggest TXA may reduce blood loss in spinal tumor surgery. However, its effect on hospital stay and complications remains uncertain. Despite appearing safe, evidence remains limited by bias and heterogeneity. High-quality RCTs are needed to confirm its efficacy and define clinical guidelines.

Study DesignSystematic Review.ObjectivesEnhanced Recovery After Surgery (ERAS) is a widely acknowledged approach for improving surgical outcomes. This review aims at analyzing the characteristics of study populations, interventions and outcomes in spine patients.MethodsEmbase and Ovid were searched from inception until March 2025. We followed PRISMA guidelines. Study quality and risk of bias were assessed. In addition to a narrative synthesis of the evidence, a meta-analysis of RCTs evaluating length of stay (LOS) for a lumbar spine population was conducted. This review was registered prospectively on PROSPERO (No. CRD42025638293).Results1431 records were identified, from which 81 studies were included. Reports of ERAS predominantly exist for degenerative spine pathologies (n = 35/81, 43.2%) and spinal deformities (n = 29/81, 35.8%). Most studied interventions were postoperative analgesia, early mobilisation (both n = 61/81, 75.3%) and patient education (n = 60, 74.1%). The most frequently used outcome measures were LOS (n = 65/81, 92.9%) and complication rates (n = 40/81, 49.4%). The overall median complication rate for ERAS patients was found to be lower (8.8% vs 15.6%). There was a statistically non-significant tendency for ERAS shortening LOS for 1 day in lumbar spine patients [95%CI -2.77, 0.71; P = 0.25].ConclusionsERAS in spine surgery appears to be effective in terms of reducing LOS and complication rates. Further efforts at refining pain management and targeted disease-specific interventions are required. Whether ERAS interventions applied to individuals with significant neurological impairment and/or medical frailty, can influence surgical outcomes needs to be further studied.

Study DesignSystematic Review.ObjectivesTo evaluate the impact of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers) on spinal fusion outcomes.MethodsA systematic search of PubMed (MEDLINE) was conducted for studies published between January 2000 and July 2025 using Title/Abstract terms for PPIs, H2 blockers, spine, and fusion. Eligible studies were English-language articles assessing the relationship between acid suppression and spinal fusion outcomes. Two reviewers independently screened studies and extracted data.ResultsOf 798 records screened, five studies met inclusion criteria: three retrospective cohort studies, one animal study, and one prospective study evaluating H2 blocker use. Four of the five studies evaluated PPIs. All three clinical studies observed higher pseudarthrosis rates among postoperative PPI users undergoing spinal fusion. The animal model found no significant fusion impairment. The H2 blocker study showed reduced inflammatory markers but did not assess osseous union.ConclusionsCurrent evidence suggests an association between PPI use and impaired spinal fusion, particularly in the cervical and lumbar spine. In contrast, H2 blockers appear to have a more neutral skeletal profile, though no studies have directly evaluated their impact on spinal fusion or pseudarthrosis rates. Most available data on PPIs are derived from retrospective studies or animal models, with substantial heterogeneity in surgical level, fusion construct, PPI type, and follow-up duration. Future research should prioritize prospective, randomized studies or large registry-based analyses to clarify the causal relationship between acid suppression therapy and spinal fusion.

Study DesignRetrospective cohort study.ObjectiveDetermine if the use of a Wilson kyphosis frame during single level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) at L4-5 or L5-S1 impacts postoperative lumbar lordosis.MethodsA retrospective analysis of patients who underwent a single level MIS TLIF at L4-5 and L5-S1 from 1/1/2016 to 1/1/2021 was performed. Patient demographics were collected, and radiographic measurements preoperatively and 6 months postoperatively were performed. Our primary outcome was "delta lumbar lordosis" (delta LL), or the difference between pre-operative and 6 month postoperative lumbar lordosis. Statistical analysis was performed using step-wise multivariate linear regressions.ResultsA total of 180 patients were included. Mean age was 58.5 ± 11.8 years and 48.3% were female. Mean BMI was 28.6 ± 5.6. Wilson positioning frames were used in 96/180 (53.3%) procedures. Use of a Wilson Frame was independently predictive of 2.5° reduced delta LL (Coeff -2.5, 95% CI -4.1 to -0.9). However, use of a Wilson frame was not found to be independently associated with postoperative mismatch between pelvic incidence and lumbar lordosis.ConclusionsUse of a Wilson kyphosis frame during single level MIS TLIF at L4-5 and L5-S1 resulted in a loss of 2.5° of lordosis compared with those patients who had a MIS TLIF without a Wilson frame. The clinical impact of this loss over long-term follow-up will be the subject of future studies.

Study DesignProspective study.ObjectivesTo understand the patient's priority in terms of various variables and asses the difference in priority of these variables pre and post-operatively.MethodsIn this single-surgeon prospective study, patients that had undergone spine surgery from January 2022 to September 2024 (excluding those with deformity correction, spinal infections, trauma, or tumors) completed a 12-variable questionnaire designed by us. The variables included scar size, preferred surgery type (open, minimally invasive, or no preference), limb pain relief, back pain relief, numbness relief, heaviness relief, disability relief, neurological improvement, operative site pain, discharge timing (same day, next day, or no preference), surgery duration (<1 h, >1 h, or no preference), and cost. Patients prioritized each variable by numbering tick boxes.ResultsA total of 228 forms (pre and post-operative each) were completed and ready for review. Order of priority varied pre and post-operatively. Priorities shifted post-operatively, with leg pain relief dropping from the top pre-operative priority to 11th, and back pain relief rising to third. Cost ranked fifth post-operatively, while incision size remained a low priority in both lists.ConclusionBased on the findings of our study, we can conclude that the patient's priority shifts after surgery. Effective pre-operative counseling is crucial for bridging this gap. Therefore, it is crucial to assess the patient's expectations and needs pre-operatively to ensure satisfaction post-surgery.

Study DesignNarrative review.ObjectivesBack pain is one of the leading causes of disability worldwide. While conventional imaging interpretation remains subjective and expertise-dependent, radiomics offers quantitative, data-driven analysis of medical images. We aimed to evaluate the current literature for the application of radiomics in: (1) soft tissue characterization, (2) hard tissue analysis, and (3) treatment outcome prediction in back pain conditions.MethodsWe conducted a PRISMA-style literature search across PubMed, Google Scholar, Wiley, Springer, and IEEE Xplore, focusing on studies from the past 4 years. From 296 identified articles, 22 met inclusion criteria based on their use of radiomic methods and association with pain outcomes.ResultsCurrent literature demonstrates that in many, but not all cases, using radiomics improves clinical models for soft and hard tissue diagnostics as well as for prognosis and treatment prediction. However, the improvements can be minor. There also exist limitations that prevent widespread clinical adoption of radiomics, including a lack of standardization in image acquisition/analysis protocols, homogeneity of patient populations studied, and inadequate integration with existing clinical imaging systems. Additionally, much current work is based on retrospective data instead of real-world data, where there is often an added complexity. Yet, there is increasing work in developing combined models where clinical features, demographics, and patient history are used to enhance the output and accuracy of radiomics.ConclusionsRadiomics can improve back pain diagnosis and treatment. Future directions should focus on developing generalizable radiomics models applicable to broad patient populations, imaging systems, and clinician-interpretable interfaces.

Study DesignSystematic Review.ObjectivesTo determine whether actively controlled exoskeletons or passively controlled exoskeletons are better at rehabilitating patients with SCIs.MethodsA literature search between January 2011 to June 2023 on Pubmed Central, Pubmed, Web of Science and Embase was carried out. Exoskeletons were classified as actively controlled if they detect bioelectrical signals (HAL). All other exoskeletons were classified as passively controlled (ReWalk, Ekso, H-MEX, Atlante, Indego, Rex Bionics, SuitX Phoenix, Lokomat and HANK). Functional outcomes used were 6 minute walk test (6MWT) distance and 10 metre walk test (10MWT) speed. Further subgroup analysis was carried out for acute and chronic SCI patients. All outcomes were examined without the aid of the exoskeleton device. Secondary outcomes including continence, pain and quality of life were also examined.Results555 articles were identified in the initial search and 27 were included in the review resulting in a total of 591 patients and 10 different exoskeleton models. HAL was the only exoskeleton to show improvements in both mobility and all secondary health outcomes. HANK and Ekso also showed improvements in mobility. Rewalk showed improvements in all secondary health outcomes with Ekso only showing improvements in QoL. No other exoskeletons showed significant improvements.ConclusionIn conclusion, the actively controlled exoskeleton HAL showed improvement in all outcomes of interest suggesting that neuroplasticity could be induced with HAL rehabilitation allowing the weakened bioelectrical signals to transcend the SCI to show genuine improvements.

Study DesignRetrospective Cohort Study.ObjectiveIsthmic spondylolisthesis is frequently encountered in spine surgical practice, though there is a significant variation in surgical management strategies. We sought to evaluate revision rates between patients who underwent anterior-approach lumbar interbody fusion (ALIF) alone, posterolateral fusion (PLF) alone, PLIF/TLIF, and ALIF+PSF.MethodsThis retrospective study utilized a large commercial insurance claims database of patients ≤65 years-old. Patients with isthmic spondylolisthesis who underwent single-level instrumented arthrodesis were included, and those who underwent revision surgery, surgery for deformity, multi-level surgery, or surgery for traumatic, infectious, or neoplastic etiologies were excluded, as determined by ICD-10-CM and CPT codes. Patients were assigned to surgical cohorts of ALIF alone, PLF alone, PLIF/TLIF, and ALIF+PSF based on CPT codes. Additional independent variables included age, sex, decompression at index surgery, and region. The primary outcome was revision arthrodesis or decompression, defined using CPT codes. Kaplan-Meier analysis and Cox Proportional Hazards regression were utilized to assess differences in revision occurrence between cohorts.Results1014 patients who underwent single-level arthrodesis for isthmic spondylolisthesis were included. The mean age was 48.6 years, with a mean follow-up of 637.6 days. The majority of patients underwent PLIF/TLIF (60.6%, n = 614), followed by ALIF+PSF (18.5%, n = 188), PLF alone (14.4%, n = 146), and ALIF alone (6.5%, n = 66). The 5-year revision-rate was 11.0% for all patients in the Kaplan-Meier analysis. In multivariable analysis adjusting for confounding factors, ALIF-alone demonstrated significantly higher occurrence of revision compared to both ALIF+PSF (HR 5.0, P = 0.0026) and PLIF/TLIF (HR 5.8, P < 0.0001) groups. Similarly, PLF alone demonstrated significantly higher occurrence of revision surgery compared to PLIF/TLIF (HR 2.4, P = 0.0379) while other comparisons were not statistically significant.ConclusionsIn this analysis of single-level arthrodesis for isthmic spondylolisthesis, patients who underwent ALIF alone had higher revision rates than those who underwent PLIF/TLIF and ALIF+PSF surgery, and those who underwent PLF alone had higher revision rates than those who underwent PLIF/TLIF. Surgical strategies providing both anterior and posterior column support resulted in lower real-world revision rates.

Study DesignRetrospective cohort analysis.ObjectivesTo evaluate the effectiveness of the Lamartina-Berjano (L-B) classification in reducing mechanical complications in patients with adult spinal deformities, with a minimum follow-up of 10 years.MethodsThe study included cases of adult deformity with at least 10 years of follow-up. The rate of clinically-relevant mechanical complications, defined as any implant-related issue requiring revision surgery, was estimated. The independent variable was adherence to the treatment guidelines of the L-B classification. The analysis was limited to patients with thoracolumbar deformities, and the population was stratified according to postoperative alignment using GAP scores.ResultsA total of 121 patients met the inclusion and exclusion criteria. In this cohort, the revision surgery rate for clinically-relevant mechanical complications was 49.6% (60 out of 121 patients). Of these, 90 patients (74%) had surgery following the L-B classification guidelines. A lower risk of complications was observed in aligned patients whose surgeries adhered to the L-B classification. Additionally, the survival curve showed significant differences between patients who followed L-B guidelines and those who did not.ConclusionOur retrospective analysis shows that following the L-B classification guidelines leads to a reduction in mechanical complications in patients with thoracolumbar deformities, particularly in a long-term follow-up scenario.