Global Spine Journal最新文献

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.

Study DesignSystematic review.ObjectiveTo identify and classify intervertebral foraminal morphologies associated with failed indirect decompression (IND), with the goal of developing a preoperative classification system to assess candidacy for this procedure.MethodsA systematic review of PubMed, EMBASE, and Google Scholar was conducted. All reported cases of failed indirect decompression secondary to abnormal foraminal morphology were included. Imaging findings were reviewed to identify distinct morphological patterns.ResultsThirteen studies describing 22 patients with failed indirect decompression due to abnormal foraminal morphology were identified. Four distinct imaging patterns were observed: (1) hypertrophic superior articular process variant, (2) prominent posterior inferior osteophyte variant, (3) osseous ring variant, and (4) foramen crowded by disco-ligamentous material variant.ConclusionsWe propose a simple, intuitive classification system for preoperative evaluation of the foramen in candidates for indirect decompression. Each variant is presented with supporting literature implicating it in failed indirect decompression. Future studies should aim to determine the prevalence, clinical significance, and failure rates associated with each morphology type.

Study DesignSurvey based study.ObjectivesTo evaluate current patterns for managing SCI among spine surgeons in North America.MethodsA survey of the North American Clinical Trials Network (NACTN) and other institutions collected institutional demographics and specific practices on acute SCI management. Variables included trauma level designation, annual case volumes (patient number, spine fracture and surgery performed), steroid usage, emergent cervical traction, magnetic resonance imaging (MRI) access, surgical decompression timing, intraoperative ultrasound and neuromonitoring use, mean arterial pressure (MAP) and spinal cord perfusion pressure (SCPP) targets, lumbar drain use, and the influence of American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade on decision-making.ResultsThirty surgeons from 23 institutions responded (93.3% Level 1 trauma centers). Most centers (93.3%) had immediate MRI access; about 70% of physicians did not use steroids. Emergent cervical traction was used by 60%. An aim of surgical decompression within 24 h was reported by 90%, with 20% operating immediately upon arrival. MAP goals were used by 93.3%, most targeting 85-90 mmHg for ≥5 days. Lumbar drains for SCPP optimization were used in 30%, typically targeting intrathecal pressure (ITP) < 15 mmHg and SCPP >60 mmHg. Management varied by AIS grade in 43.4%.ConclusionDespite agreement in the general scope of acute SCI care, significant implementation heterogeneity exists across North American spine centers. Variability was pronounced in steroid use, timing of decompression (90% within 24 h), cervical traction, and lumbar drain utilization. These findings call for evidence-based protocols to guide acute SCI management and reduce inter-institutional practice variation.

Study DesignRetrospective cohort study.ObjectiveTo evaluate the impact of age ≥75 years on postoperative complications and sagittal alignment following open transforaminal lumbar interbody fusion (TLIF).MethodsA retrospective review was performed for patients undergoing primary open TLIF from 2017 to 2021. Patients were divided into 2 cohorts: age <75 and ≥75 years. Groups were 1:1 propensity score matched based on gender, body mass index (BMI), hypertension, diabetes, and Charlson Comorbidity Index (CCI). Radiographic sagittal parameters were analyzed preoperatively and at 1 year postoperatively. Complication rates, including reoperations, adjacent segment disease, and subsidence, were compared between matched cohorts.ResultsPrior to the PSM, a total of 489 patients fit the initial exclusion criteria with 448 in the younger (18-75 years) cohort and 40 in the older (≥75 years) cohort. After matching, 80 patients were included (40 per group) with no significant differences in demographics or perioperative variables. Postoperative radiographic parameters were similar between groups. The overall complication rates were comparable (P = 0.546). However, elderly patients experienced significantly higher rates of revision surgery (27.5% vs 5.7%, P = 0.013).ConclusionPatients ≥75 years old achieved similar radiographic alignment and experienced comparable complication rates following open TLIF. However, they may be at greater risk for revision surgery. These findings support the safety and effectiveness of open TLIF in elderly patients, though larger and longer-term studies are needed to further define outcomes in this population.Level of EvidenceIII.

Study DesignRetrospective cohort study.ObjectiveTo provide updated rates for approach-related postoperative motor deficits following lateral lumbar interbody fusion (LLIF) and identify risk factors.Methods1000 stand-alone LLIF procedures between 2006 and 2024 were reviewed and divided into the first decade (2006-2015, n = 395) and the second decade (2016-2024, n = 605). Electronic records were screened for iliopsoas and quadriceps deficits preoperatively and postoperatively (at discharge, 6 weeks, 3 months, 6 months, 1 year, and last follow-up) defined as a decline in MRC strength grades relative to baseline.ResultsThe incidence of postoperative ≥1 MRC grade iliopsoas deficits declined from 12.7% to 4.1% and quadriceps deficits from 5.3% to 1.7% at 6 weeks (P < 0.001 and P = 0.002, respectively). In the second decade, persistent iliopsoas or quadriceps weakness was observed in 0.8% and 0.5% (n = 3) of patients at 6 months and 1 year, respectively. At 2 years, only 1 of 605 patients had residual ≥1 MRC grade quadriceps weakness, and no patient had persistent iliopsoas weakness. Independent predictors of deficits were surgery at L4/5 (iliopsoas: OR 2.2, 95% CI 1.1-4.5; quadriceps: OR 5.9, 95% CI 1.3-26.5) and operative time [per hour] (iliopsoas: OR 1.4, 95% CI 1.2-1.6; quadriceps: OR 1.4, 95% CI 1.1-1.7).ConclusionsRates of postoperative motor deficits after standalone LLIF have improved significantly over the past decade. Increased surgical time and surgery at L4/5 remain key risk factors, but most deficits are transient. LLIF at L4/5 can be considered safe in appropriately selected patients.

Study DesignRetrospective cohort study.ObjectiveTo evaluate the therapeutic effects of postoperative repetitive transcranial magnetic stimulation (rTMS) on neuropathic pain (NP) and neurological recovery in patients with degenerative cervical myelopathy (DCM).MethodsFifty-nine DCM patients who underwent cervical decompression between 2017 and 2024. Twenty-seven received postoperative rTMS (20 Hz, 20 trains of 40 pulses at 90% resting motor threshold over the biceps brachii for 5 consecutive days) in addition to routine care, while 32 received routine care only. Pain intensity at the neck, upper limbs, and below-neck regions was assessed using the 10-cm Visual Analog Scale (VAS). NP was identified by a Douleur Neuropathique 4 (DN-4) score ≥4. Hand dexterity, myelopathy severity, and conduction function were evaluated by the 10-second grip-and-release test, modified Japanese Orthopedic Association (mJOA) scale, and somatosensory/motor evoked potentials (SSEP/MEP) respectively.ResultsAmong patients with NP (n = 25), rTMS significantly reduced VAS pain scores in the upper limbs and below-neck regions (P < 0.05), but not in the neck. No effect was observed in non-NP patients (n = 34). rTMS also improved hand dexterity, mJOA scores, and recovery rates compared with controls, particularly in patients with preoperative mJOA ≤14 (P < 0.05). These benefits persisted for 6 months. However, SSEP and MEP results were comparable between groups, suggesting that rTMS did not alter cervical conduction.ConclusionFive-day postoperative rTMS was associated with NP and functional recovery in DCM, especially in severe cases, possibly by modulating higher central pathways.

Study DesignRetrospective study and prospective cohort study.ObjectiveOsteoporotic vertebral compression fracture (OVCF) is a frequent and disabling complication of osteoporosis. This study aimed to identify independent risk factors for OVCF, develop and validate a predictive model, and evaluate a risk-stratified surgical strategy comparing percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP).MethodsThe study consisted of 3 stages. A retrospective cohort of 316 patients was used to identify risk factors and construct a predictive model, which was externally validated in an independent cohort of 274 patients. A prospective cohort of 206 OVCF patients was then enrolled to compare clinical and radiographic outcomes of PVP and PKP. Patients with a predicted risk score >0.5 were classified as high risk and preferentially treated with PKP. Pain, functional outcomes, radiographic parameters, and complications were evaluated preoperatively and at 1 week, 3 months, and 6 months postoperatively.ResultsMultivariate analysis identified age ≥70 years, body mass index <20 kg/m², bone mineral density T-score ≤-3.0, history of falls, and 25-hydroxyvitamin D deficiency as independent risk factors. The predictive model showed good calibration and clinical utility. Both PVP and PKP significantly improved pain and function. Within the risk-stratified strategy, PKP was associated with greater improvements in pain relief, functional recovery, and radiographic restoration, as well as lower rates of cement leakage and refracture.ConclusionA validated predictive model for OVCF was established and may support individualized surgical decision-making. Risk-stratified use of PKP appears to provide superior short- to mid-term outcomes in high-risk patients.

Study DesignSystematic review and meta-analysis.ObjectiveDirect head-to-head comparison of machine learning models aiming to predict outcomes in Anterior Cervical Discectomy and Fusion (ACDF) is necessary because existing studies typically evaluate algorithms in isolation, using heterogeneous datasets, features, and performance metrics, which limits interpretability and prevents meaningful comparison of predictive performance.MethodsWe conducted a systematic review and meta-analysis according to PRISMA guidelines, searching PubMed, Embase, Web of Science and Cochrane through December 2024. We identified 26 studies (n = 443 445 patients) that developed ML models for ACDF outcomes. Algorithms were categorized into five classes by taxonomy: Logistic regression, tree-based, boosting ensembles, kernel methods and NNs. Pooled ML models' AUCs and accuracy were extracted and estimated via random-effects inverse-variance model.ResultsOverall discrimination ranged from 0.59 for major complications to 0.81 for adjacent-level disease. Logistic regression led in predicting unfavorable discharge (AUC 0.76), readmission/reintervention (0.68) and cost of care (0.83). Boosting ensembles excelled in predicting thromboembolic events (AUC 0.74; 0.68-0.80; P < 0.0001). Neural networks achieved the highest discrimination for opioid prescription (AUC 0.80; 0.75-0.85; P = 0.02) and adjacent-level disease (AUC 0.81; 0.72-0.91; P < 0.01). Kernel methods delivered an exceptional AUC of 0.97 (0.96-0.97) for adjacent-level fusion but underperformed for other outcomes (AUC 0.43-0.49). Decision-tree and mixed-ensemble approaches demonstrated intermediate performance for various outcomes (AUC range 0.54-0.75).ConclusionLogistic regression and gradient-boosting models offer robust, generalizable discrimination across diverse ACDF outcomes. Neural networks and kernel methods showed endpoint-specific strengths. These data support prospective validation and rapid integration of ML-driven risk calculators into perioperative workflows.

Study designRetrospective study.ObjectivesThis study aimed to measure cervical sagittal alignment parameters on upright digital tomosynthesis (DTS) and supine magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and evaluate the difference and correlation of cervical curvature in different postures.Methods101 CSM patients underwent both standing DTS and supine MRI. Parameters including O-C2 angle, cervical lordosis (CL), C2-7 sagittal vertical axis (C2-7 SVA), neck tilt (NT), T1 slope (T1S), thoracic inlet angle (TIA), cervical tilt, and cranial tilt were measured. Intraclass correlation coefficients (ICC) was used to assess inter-observer reliability. Paired t-tests and Pearson correlation analyses were applied to investigate the difference and correlation of parameters in standing and supine position.ResultsAll parameters measured on DTS and MRI showed excellent reliability (ICC >0.8). Significant differences were observed in O-C2 (DTS: -24.2 ± 11.2° vs MRI: -14.3 ± 6.6°, P < 0.001), CL (DTS: -15.2° ± 4.4° vs MRI: -8.1° ± 3.6°, P < 0.001), C2-7 SVA (DTS: 23.6 ± 11.0 mm vs MRI: 16.5 ± 8.5 mm, P < 0.001), T1S (DTS: 26.3° ± 8.4° vs MRI: 18.2° ± 6.6°, P < 0.001), Cervical tilt (DTS: 16.4° ± 5.6° vs MRI: 11.9° ± 6.5°, P < 0.001), and cranial tilt (DTS: 9.8° ± 9.3° vs MRI: 6.6° ± 8.3°, P = 0.015). Strong correlations existed for O-C2 (r = 0.834, P < 0.001), CL (r = 0.870, P < 0.001), and T1S (r = 0.875, P < 0.001).ConclusionsDTS reliably quantifies standing cervical alignment, particularly for cervicothoracic junction (CTJ) parameters obscured on radiography. Positional variations between standing and supine postures significantly impact cervical sagittal alignment. O-C2, CL and T1S obtained in supine position are considered meaningful parameters for evaluating cervical alignment in standing position.