Global Spine Journal最新文献

Study DesignRetrospective cohort study.ObjectiveSpinal metastases are common in patients with breast cancer, and accurate estimation of postoperative survival is crucial for selecting appropriate candidates for metastasis surgery. This study investigated the association between breast cancer subtype, according to the St. Gallen classification, and survival after surgery for spinal metastases with the aim of improving prognostic assessment and supporting informed patient counselling.MethodsThis study included 110 patients with breast cancer who underwent surgery for spinal metastases identified from the Swedish Spine Register and the Swedish National Quality Register of Breast Cancer. Patients were categorized in terms of the breast cancer subtype according to the St. Gallen classification. Postoperative survival was analysed using Kaplan-Meier estimates and a Cox proportional hazards model.Results: The overall median survival following spinal surgery was 25 months (95% CI 19-31), while the median postoperative survival by subtype was 39 months (95% CI 28-50) for luminal A patients, 20 months (95% CI 9-31) for luminal B patients, and 48 months (95% CI 20-76) for luminal B/HER2+ patients. The median survival was not reached for the nonluminal HER2+ group, whereas patients with triple-negative breast cancer had a median survival of only 5 months (95% CI 4-6). The St. Gallen subtype was significantly associated with postoperative survival according to univariable (P<0.001) and multivariable analyses (P = 0.011).ConclusionsBreast cancer subtype according to the St. Gallen classification was significantly associated with survival after surgery for spinal metastases. These findings indicate that the St. Gallen classification may serve as a valuable prognostic tool in the metastatic spine setting. Incorporation of molecular subtype information may improve estimation of postoperative survival and support informed patient counselling, expectation management, and individualized surgical decision-making in patients with breast cancer spinal metastases.

Study DesignRetrospective multicenter cohort study.ObjectivesSpine surgery for multiple myeloma (MM) is associated with an increased intraoperative blood loss. Therefore, this study aims to examine prognostic factors for higher intraoperative blood loss in spine surgery for patients with MM.MethodsIn total, 158 adult patients with MM undergoing spine surgery between May 2001 and December 2021 were included. The main outcome for intraoperative blood loss was the Bleeding Index (BI), next to the visually estimated blood loss (EBL). Two separate multivariable generalized linear models (GLMs) were utilized to assess the associations between the predictors and these two outcomes.ResultsThe average BI was 4.4 and average EBL was 750 mL. Compared to corpectomy with stabilization, other types of surgery (decompression with stabilization, sole decompression, sole stabilization) were associated with a lower expected BI, ranging from a 26.5% to 39% decrease. A cervical location of surgery was associated with a 40.3% reduction of expected BI compared to a lumbar location (P = 0.006). Lower platelet count (P = 0.003) and longer duration of surgery (P < 0.001) were associated with a higher expected BI. For EBL, ECOG score, surgery type, and duration of surgery were found as independent predictors.ConclusionsThis study identified lower platelet count, type of surgery, location of operated spinal levels, and a longer duration of surgery as independent predictors of higher intraoperative BI in MBD-related spine surgery. These outcomes can be relevant for preoperative screening, shared decision making, and perioperative blood transfusion deliberation or planning.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate clinical and patient reported outcomes between operative and non-operative management strategies for sacral U-type fractures.MethodsThis retrospective review included patients with sacral U-type fractures from a 12-year period at a Level 1 trauma center. Demographic, Modified 5-Item Frailty Index (mFI-5), complications, outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) data were collected. Fractures were classified by the AO Spine Sacral Injury Classification System (AOSSIC) and analyzed by subtype and treatment modality (trans-sacral screw fixation (TSF) or lumbopelvic fixation (LPF) vs non-operative). Statistical significance was P < .05.ResultsSixty-five patients met inclusion criteria (mean age 59.7 ± 21.3 years, 49% male). Forty-seven (72%) were treated operatively (10 LPF, 37 TSF) and 18 non-operatively. Among C0 fractures, PROMIS Pain Interference (PI) and Physical Function (PF) scores were similar between operative and non-operative groups (62.96 vs 66.08, P = .48; 30.01 vs 32.40, P = .62). Similar findings were observed for C3 fractures (PI 62.62 vs 64.23, P = .58; PF 30.29 vs 29.3, P = .78). mFI-5 frailty scores were higher among non-operative C3 fracture patients compared to operative cases (2.25 vs 0.90, P < .001). Complication rates were low and comparable between groups. Symptomatic screw removal occurred in 8% of TSF cases.ConclusionsOperative and non-operative management of AOSSIC Type C sacral fractures yield comparable PROMIS outcomes and complication rates when frailty scores are considered. TSF was associated with higher rates of symptomatic screw removal. Further investigation is needed to determine the optimal treatment and impact of frailty metrics for these injuries.

Study DesignEco-epidemiological study.ObjectivesVertebral fractures (VFs) are a major cause of morbidity, disability, and mortality in women, with risk increasing sharply after menopause due to accelerated bone loss. However, global patterns of VF burden by menopausal status and long-term projections remain poorly characterized.MethodsWe analyzed Global Burden of Disease (GBD) 2021 data on VF incidence, prevalence, and years lived with disability (YLDs) for 204 countries from 1990-2021. Women were categorized as premenopausal (15-49 years) or postmenopausal (≥50 years). Age-standardized rates (ASRs) were calculated per 100,000 population. Temporal trends were assessed using estimated annual percentage change and joinpoint regression. Socio-demographic disparities were examined with Slope Index of Inequality and Concentration Index. Decomposition analysis quantified contributions of population growth, aging, and epidemiologic change. Bayesian age-period-cohort models projected trends to 2050.ResultsIn 2021, 1.15 million VFs occurred in premenopausal women and 1.63 million in postmenopausal women, causing 50,060 and 206,652 YLDs, respectively. Absolute VF counts rose substantially since 1990, although ASRs declined in most regions. Postmenopausal women bore the highest burden, with marked geographic heterogeneity and persistent pro-poor inequality. Population growth and aging were the main drivers of increasing burden, and projections indicate that absolute VF cases will continue to rise globally through 2050 despite modest ASR declines.ConclusionsThe global burden of vertebral fractures in women is rising in absolute terms, especially among postmenopausal women. Targeted osteoporosis screening, fall-prevention programs, and equitable treatment access are needed to mitigate the projected growth.

Study DesignProspective multicenter cohort study.ObjectivesIntegration of robotic guidance with navigation represents a natural evolution in spine surgery technologies. Both modalities have independently demonstrated improved implant accuracy, reduced radiation exposure, and expanded minimally invasive capabilities, yet data on integrated platforms remain limited. The Prospective Robotic-Guided Registry of Spine Surgery (PRoGRSS) evaluates surgical, clinical, and patient-reported outcomes across a broad range of procedures performed with an integrated robotic-assisted navigation system.MethodsAdults undergoing navigated robotic thoracolumbar surgery between 2020 and 2024 were enrolled by six surgeons across four centers. Demographic, surgical, and robot-related metrics were collected. Patient-reported outcomes included ODI and PROMIS Global Health, Physical Function, and Pain Interference. Complications, revision surgery, inpatient resource utilization, and return-to-work metrics were analyzed.ResultsOf 657 enrolled patients, 606 completed 12-month follow-up (92%). Median age was 60 years; 49.9% were female. Of 5166 planned screws, 99.2% were placed, with 98.4% accurately positioned and 1.5% malpositioned. Robot abandonment occurred in 0.6% of cases. Robot-related intraoperative or postoperative adverse events occurred in 0.3% of cases. Twelve-month revision surgery rate was 4.8%, including 0.3% robot-related revisions. Resource utilization was low: 5.2% required transfusion, 2.1% postoperative CT, median length of stay was 3 days, and 88.4% were discharged home. Patients demonstrated significant, clinically meaningful improvement across all PRO domains.ConclusionsThis large prospective evaluation of an integrated navigation-robotic platform demonstrates high accuracy, low complication and revision rates, efficient resource use, and substantial patient-reported outcome improvement, establishing a contemporary benchmark for navigated robotic spine surgery.

Study DesignRetrospective cohort study.ObjectivesTo compare 5-year clinical and radiographic outcomes between single-level Bryan and ProDisc-C cervical disc arthroplasty (CDA).MethodsPatients undergoing single-level Bryan or ProDisc-C arthroplasty for cervical spondylosis radiculopathy and/or myelopathy between March 2004 and August 2014 were enrolled. Clinical outcomes included Visual Analog Scales for arm/neck pain (VAS-A/N), Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores. Radiographic evaluation included cervical lordosis, range of motion (ROM), functional spinal unit (FSU) height, cervical sagittal vertical axis (cSVA), T1 slope, heterotopic ossification (HO), and adjacent segment degeneration (ASD). Evaluations were performed preoperatively and postoperatively within 3 months, 1 year and 5 years.ResultsAmong 113 patients with 5-year follow-up (51 Bryan, 62 ProDisc-C), both groups showed significant improvements in VAS-N, VAS-A, NDI, and mJOA scores at all timepoints (all P < .001). No significant intergroup differences were detected between the two cohorts at baseline (all P > .05). ROM and cervical alignment remained stable in both cohorts. Compared to Bryan arthroplasty, ProDisc-C demonstrated greater index-level segmental lordosis (4.3° ± 5.0° vs 1.2° ± 4.7°; P = .001), more FSU height restoration (35.2 ± 3.4 mm vs 32.9 ± 3.6 mm; P < .001), and less segmental kyphosis incidence (21.0% vs 39.2%; P = .032). However, ProDisc-C arthroplasty had higher rates of ASD (58.1% vs 37.3%; P = .028) and HO (67.7% vs 33.3%; P < .001).ConclusionBoth prostheses achieved comparable 5-year clinical outcomes. ProDisc-C arthroplasty better maintained cervical sagittal alignment, whereas Bryan arthroplasty demonstrated lower ASD and HO incidence.

Study DesignRetrospective cohort study.ObjectivesGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for obesity and type 2 diabetes mellitus (T2DM) and exhibit anti-inflammatory and osteogenic effects which may influence fusion outcomes. This study evaluated the association between preoperative GLP-1RA use and perioperative complications, resource utilization, and revision rates after anterior cervical discectomy and fusion (ACDF) in patients with T2DM.MethodsThe TriNetX Global Network was queried for patients with T2DM undergoing single-level or multi-level ACDF. GLP-1RA users were defined by prescriptions within 6 months before and after surgery. Propensity score matching controlled for demographics, comorbidities, and socioeconomic factors. Outcomes included medical and surgical complications, revision rates, and healthcare utilization at 90 days, 6 months, and 1 year.Results608 single-level and 639 multi-level GLP-1RA users were compared with matched nonusers. GLP-1RA use was associated with lower revision rates after single-level ACDF at 90 days (OR:0.445, P = 0.032) and 6 months (OR:0.489, P = 0.034). Pseudarthrosis risk was reduced across all timepoints for both single-level and multi-level ACDF (OR:0.296-0.608, all P ≤ 0.008). GLP-1RA users also had lower dysphagia risk following single-level ACDF across all timepoints (OR:0.506-0.661, all P ≤ 0.030). Resource utilization was decreased, with fewer readmissions (single-level: OR:0.401-0.634; multi-level: OR:0.418-0.593, all P ≤ 0.003) and ED visits (single-level: OR:0.563-0.697, all P ≤ 0.007) across all timepoints. On multivariate Cox regression, GLP-1RA use independently predicted reduced pseudarthrosis at 1 year (HR:0.665, 95% CI:0.570-0.775, P = 0.005).ConclusionPerioperative GLP-1RA therapy was associated with reduced rates of pseudarthrosis, revision, dysphagia, and healthcare utilization following ACDF without increased adverse events.