Global Spine Journal最新文献

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.

Study DesignSystematic review.ObjectiveSurgery remains the gold standard in management of unstable spinal fractures in patients with spinal ankylosing disorders (SAD), especially in the presence neurodeficit. Certain studies have reported the effectiveness of non-surgical treatment in non-displaced and clinically stable fractures.MethodsOur systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted (15^th July, 2025) across 4 different databases to identify studies reporting outcomes of conservative treatment of spinal fractures in the context of ankylosed spine. The patients were subclassified as groups A (surgically-unfit) and B (stable fractures) for further analysis.Results13 studies (187 patients) were reviewed. The underlying etiology was DISH (diffuse idiopathic spinal hyperostosis) in 86.4%. Overall, cervical, thoracic/thoracolumbar (TL) and lumbar fractures were observed in 14.1%, 72.7% and 13.2%, respectively. There were 66% in group B; and a majority were neurologically intact (ASIA E: 97.3%). Different conservative strategies are described (combination of bed rest, orthosis and regular surveillance). Overall fracture healing was 69.5% (group A-47.1% and group B-91%). The morbidity and mortality in these fractures are high (particularly, group A). Halo-immobilization was associated with high complications (especially in debilitated individuals).ConclusionIn a selected group of patients with stable fracture patterns, conservative treatment is a viable management option in SAD patients with good healing rates. Based on our analysis of reviewed data, we have put forth criteria for decision-making and protocol for conservative management of these fractures.

Study DesignBiomechanical Simulation Study.ObjectivesSpinal injuries account for 30-40% of severe mountain biking (MTB) cases and may be mitigated by back protectors. Thoracolumbar compression fractures are linked to rolling impacts during forward falls, yet their biomechanical mechanisms remain poorly understood. It is unclear whether current back protectors, tested under perpendicular conditions (EN1621-2), adequately address the complex loading of real-world crashes.This work aims to investigate the biomechanical mechanisms of thoracolumbar fractures during MTB forward falls.MethodsForty-four back-impact scenarios were simulated using a THUMS V4 finite element model, based on velocities derived from prior multibody simulations. The analysis examined the effects of impact velocity, angle, friction, and body position on spinal loading and fracture pathways. Injuries were predicted using force, moment, stress, and strain.ResultsVertebral fractures were predicted in 84% of cases, occurring away from the impact site due to combined axial loading and hyperflexion. Three mechanical pathways leading to Magerl type A fractures were identified: (1) 45° lower-back impacts causing thoracolumbar (T12-L2) fractures; (2) flat (0°) lower-back impacts causing upper-thoracic injuries; and (3) upper-back impacts leading to lumbar (L4-L5) fractures through "whiplash-like" motion. Normal velocity was the strongest injury risk predictor, while impact angle determined fracture location.ConclusionSimulated fractures were not predicted at the impact site but at a distance, driven by combined axial loading and hyperflexion induced by normal and rotational velocities. Current back protector testing protocols do not reflect these mechanisms and may not adequately address real-world spinal loading conditions.

Study DesignRetrospective cohort study.ObjectivesSacral slanting is defined as the angle between the horizontal line and the upper endplate of the sacrum in the coronal plane. This study evaluated changes in disc wedge angle (DWA) below the lowest instrumented vertebra (LIV) and coronal balance over a 5-year follow-up in patients with adolescent idiopathic scoliosis (AIS) with structural lumbar curve exhibiting sacral slanting.MethodsThe study included 118 patients with AIS and structural lumbar curves who underwent posterior fusion to L3 or L4, with a minimum 5-year follow-up. Radiological parameters were evaluated preoperatively and at 5 years and compared between LIV-L3 and LIV-L4 groups, with subgroup analyses for high (≥5°) vs low (<5°) sacral slanting within each group.ResultsPreoperative radiographs showed no significant differences between groups, except for the Cobb angle. In the LIV-L3 group, patients with sacral slanting ≥5° presented greater DWA at 5 years, whereas those with slanting <5° demonstrated a gradual decrease in DWA. In the LIV-L4 group, patients with sacral slanting ≥5° showed a progressive increase in C7-cervical sagittal vertical line, which was significantly greater at 5 years. Scoliosis Research Society-22 scores were similar between high and low slanting groups at the 5-year follow-up.ConclusionsIn patients with AIS and structural lumbar curve, increased preoperative sacral slanting was associated with an increased DWA below LIV when selecting LIV-L3. However, this increase does not progress over time. Conversely, selecting LIV at L4 in patients with high sacral slanting was associated with progressive coronal decompensation.

Study designLiterature Review with clinical recommendations.ObjectiveTo highlight impactful studies on subaxial cervical fractures, identified by the AO Spine Knowledge Forum Trauma and Infection group, with recommendations for their integration into clinical practice.MethodsFour studies on subaxial cervical fractures that have the potential to shape current practice in subaxial cervical fractures were selected and reviewed. Each study was chosen for its contribution to a critical phase in subaxial fractures management: diagnosis and imaging, surgical vs conservative treatment, and selection of approach.ResultsFour studies were highlighted. Article 1: Rutsch et al evaluated the sensitivity and specificity of CT, MRI, plain radiography, and LODOX-Statscan in identifying cervical spine injuries. We strongly recommend the use of CT/MRI as gold standard for radiological workup in cervical spine injuries. Article 2: Cirillo et al performed a systematic review of predictor of failure to conservative treatment for isolated unilateral facet fractures. We conditionally recommend surgical treatment in floating lateral mass and greater fragment size. Article 3: Singh et al evaluated the predictors of failure after stand-alone ACDF in subaxial fractures. We conditionally recommend adding posterior fusion in PLL injury, bilateral facet joint dislocation and age above 60 years. Article 4: Kwon et al prospectively randomized and compared anterior vs posterior approach in unilateral facet joint injury. We conditionally recommend anterior surgical fixation in unilateral facet injuries without spinal cord injury.ConclusionThis article provides spine surgeons with evidence-based recommendations to enhance standardization and effectiveness of the management of subaxial spine fractures.