Global Spine Journal最新文献

Study DesignNarrative Review.ObjectivesBone health optimization before spine surgery is an important but overlooked determinant of long-term postoperative outcomes. Compromised bone quality is associated with hardware loosening, pseudoarthrosis, proximal junctional failure, and revision surgery. This narrative review aims to highlight the importance of preoperative bone optimization and propose a pragmatic clinical pathway for spine surgeons. Specifically, we aimed to: (1) outline risk assessment and diagnostic strategies, including clinical risk factors, laboratory testing, and imaging such as dual-energy x-ray absorptiometry (DEXA) and opportunistic CT-based Hounsfield Unit (HU) analysis; (2) evaluate therapeutic options, emphasizing pharmacologic agents (teriparatide, romosozumab, denosumab, and bisphosphonates) alongside non-pharmacologic measures including nutrition and lifestyle modification; and (3) explore future directions, including therapy duration and economic barriers to wider adoption of newer agents.MethodsThis narrative review synthesizes the current literature on preoperative bone health management in spine surgery. Risk assessment strategies were discussed including imaging, laboratory testing, and clinical picture analysis. Therapeutic options evaluated emphasize pharmacologic agents alongside non-pharmacologic measures.ResultsDespite the clinical relevance of compromised bone quality to poor surgical outcomes, bone health assessment remains inconsistently incorporated into surgical planning. Current evidence supports a multimodal approach combining targeted assessment and timely intervention to mitigate risk of adverse bone-related events following spine surgery.ConclusionsPreoperative bone health optimization is a crucial opportunity to improve long-term outcomes for patients undergoing spine surgery. Adoption of a standardized clinical pathway for risk stratification, diagnosis, and treatment may provide a valuable framework for improving fixation stability and fusion rates.

Study design/settingRetrospective longitudinal study.PurposeOsteoporotic vertebral fractures (OVF) are common in middle-aged and elderly populations. However, few studies have predicted the risk of OVF from the perspective of the bone heterogeneity. This study conducted a longitudinal study to predict the risk of OVF in individuals over 50 years old based on habitat radiomics which can quantify heterogeneity of vertebral trabecular bone.MethodsIndividuals aged over 50 years who had not experienced OVF and underwent CT scans between 2016 and 2023 were enrolled and followed up until 2024. During the follow-up period, 107 cases developed new OVF, and 270 individuals without fractures were selected as the control group. Radiomic features of each pixel within the vertebra were extracted, and the optimal segmentation of vertebral sub-regions was determined using the K-means unsupervised clustering method.ResultsThe habitat radiomics model significantly outperformed the CT value model (AUC = 0.702, DeLong test P-value = 0.001) and also surpassed the traditional radiomics model. The Cox proportional hazards analysis showed that the habitat radiomics risk score could serve as an independent predictor of vertebral fractures (hazards ratio = 1.092, 95% confidence interval (CI): 1.074 - 1.111, P < 0.001). The C-index of the habitat radiomics nomogram model was 0.803 in the training set (95% CI: 0.752 - 0.854) and 0.748 in the validation set (95% CI: 0.667 - 0.829).ConclusionThe habitat radiomics model can predict vertebral fractures based on vertebral heterogeneity, with better performance than traditional bone density prediction methods.

Study DesignRetrospective cohort study.ObjectiveTo examine national and regional trends in preoperative patient optimization and surgical outcomes among patients undergoing posterior lumbar interbody fusion (PLIF) in the United States from 2011 to 2022.MethodsPatients who underwent PLIF were identified in the PearlDiver Patient Claims Database using ICD-9, ICD-10 and CPT codes. Demographic characteristics, comorbidities, and postoperative outcomes were analyzed over 11 years and by U.S. region (Midwest, Northeast, South, West). Variables included age, body mass index, tobacco use, Charlson Comorbidity Index (CCI), opioid use, 30-day complications, 90-day readmissions, infection, and hospital length of stay (LOS). Statistical analysis was performed using R (α = 0.05).Results434 214 patients underwent PLIF from 2011 to 2022. Nationally, LOS, 30-day complication, and 90-day readmission worsened over time. Hospital LOS increased (P < .0001) and infection rate decreased for all regions (P < .001). The Northeast showed significant improvement, whereas the South, Midwest and West all had rising complications and readmissions. Patients in 2021-2022 were older, with more comorbidities, more likely to use tobacco, and had higher rates of overweight and obesity. Significant decreases were observed in preoperative opioid use (P < .0001).ConclusionsDespite an emphasis on preoperative optimization and demonstrated reductions in preoperative opiate use, surgical outcomes including 30-day complications, 90-day readmissions, and length of stay increased in recent years. Worsening outcomes imply potential gaps in optimization efforts and regional outcome variability may suggest a need for region-specific preoperative optimization strategies.

Study DesignRetrospective Single-center propensity score-matched cohort study.ObjectiveAdjacent segment disease remains a major cause of revision surgery after multilevel lumbosacral fusion, and muscle-preserving approaches may help reduce this risk. This study compared clinical and radiographic outcomes between a muscle-preserving fusion combining standalone anterior plus lateral lumbar interbody fusion (A + LLIF) vs circumferential lateral plus posterior lumbar interbody fusion (L + PLIF).MethodsPatients who underwent multilevel lumbosacral fusion (2016-2023) with either A + LLIF or L + PLIF were included. L + PLIF patients with contraindications to standalone A + LLIF were excluded. Propensity score matching, based on age, BMI, PI-LL mismatch and stenosis severity, yielded 90 1:1-matched patients. The primary outcome was revision surgery. Secondary outcomes included spinopelvic alignment, cage subsidence, and perioperative metrics.ResultsBaseline characteristics were comparable between groups (mean age 57 ± 10 years; median fusion levels: 2 [range 2-4]). The 5-year cumulative incidence of revision surgery was significantly lower with A + LLIF (1/45 events; 2.2%) than with L + PLIF (14/45 events; 31.1%; P < .001), with superior perioperative outcomes and comparable radiographic alignment.Operative time, blood loss, and length of stay were significantly lower in the A + LLIF group (P < .001 for all). Spinopelvic parameters were largely equivalent, except for improved distal lordosis and LPA-PI mismatch in the A + LLIF group (P = .003 and P = .019, respectively). Cage subsidence rates were low and similar between groups.ConclusionsIn carefully selected patients, combined standalone anterior and lateral interbody fusion offers a paraspinal muscle-preserving alternative to circumferential fusion, with significantly lower revision rates, favorable perioperative outcomes, and comparable radiographic alignment.

Study designA retrospective cohort study.ObjectiveSevere rigid spine deformity presents major challenges in surgical correction. Although three-column osteotomies (3-CO) provide powerful correction, they are associated with prolonged operative time, increased blood loss, and high neurological risk. This study aimed to compare the radiographic correction, surgical parameters, and complication profiles between staged halo-pelvic traction combined with posterior spinal fusion (HPT+PSF) and one-stage posterior spinal fusion (PSF) in patients with severe rigid spine deformity requiring 3-CO.MethodsThis retrospective cohort study included 110 patients (mean age, 25.7 ± 8.5 years) with severe rigid deformity (Cobb angle or maximal kyphosis >90°, flexibility <30%) who underwent either staged HPT+PSF (n = 60) or single-stage PSF (n = 50) between 2016 and 2023. Radiographic parameters, including the main curve Cobb angle and maximal kyphosis (MK), were measured preoperatively, post-traction, postoperatively, and at the latest follow-up. Operative time (ORT), estimated blood loss (EBL), osteotomy grade, intraoperative neuromonitoring (IONM) alerts, and complications were compared between groups. Pulmonary function tests (PFTs) were evaluated longitudinally.ResultsFollowing traction, the main curve Cobb angle and MK in the HPT+PSF group improved from 132.4° ± 23.3° to 65.1° ± 20.7° and from 122.3° ± 29.7° to 53.3° ± 24.1°, respectively. At the last follow-up, the correction rate of the main curve and MK were significantly higher in the HPT+PSF group than in the PSF group (62.9% vs 55.2%, P = 0.004; 67.7% vs 54.5%, P < 0.001). The HPT+PSF group demonstrated significantly reduced ORT (298.3 ± 64.7 vs 361.9 ± 76.3 min, P < 0.001) and EBL (490.5 ± 183.3 vs 1010.6 ± 252.1 mL, P < 0.001). The rate of IONM alerts (3.3% vs 20.0%, P = 0.005) and neurological deficits (3.3% vs 14.0%, P = 0.042) were markedly lower in the HPT+PSF group. Although traction-related complications occurred in 16.7% of patients, all were transient and resolved after adjustment of HPT devices.ConclusionStaged HPT followed by PSF provides a safe and effective strategy for the management of severe rigid spine deformities. In terms of radiographic correction and perioperative safety profile, this staged approach demonstrated significant advantages over one-stage 3-CO, notably reducing operative time, blood loss, and neurological risks. Preoperative traction effectively decreases deformity stiffness and magnitude, facilitating safer and less invasive surgical correction.