Global Spine Journal最新文献

Study DesignSystematic review and meta-analysis.ObjectiveTo establish and validate region-specific MRI-derived vertebral bone quality (VBQ) thresholds predictive of mechanical complications following cervical and lumbar spinal fusion.MethodsPubMed, EMBASE, MEDLINE, and the Cochrane Library were searched to September 2025 for observational studies reporting VBQ in patients with and without postoperative mechanical complications. Data were pooled using random-effects models with Hartung-Knapp adjustment. Diagnostic accuracy was evaluated using a bivariate random-effects meta-analysis to estimate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC).ResultsTwenty-four studies comprising 3122 patients were included. Patients who developed complications had significantly higher VBQ scores (SMD = 1.13, 95% CI 0.91-1.35). Pooled diagnostic performance demonstrated strong discrimination (sensitivity = 0.79, specificity = 0.79, DOR = 14.6, AUC = 0.83). Accuracy was higher in cervical than lumbar cohorts (AUC = 0.89 vs 0.83). Region-specific thresholds of 2.75 for cervical and 3.22 for lumbar fusion optimally balanced sensitivity and specificity. Validation analyses confirmed progressively increasing complication risk above these cut-offs.ConclusionsMRI-derived VBQ scores provide reliable, radiation-free predictors of mechanical complications after spinal fusion. Region-specific thresholds (2.75 cervical, 3.22 lumbar) offer clinically applicable tools for preoperative risk stratification and bone health optimisation.

Study DesignSystematic Review and Meta-analysis.ObjectivePoor preoperative bone quality is a key risk factor for postoperative cage subsidence (CS) following degenerative lumbar fusion surgery. Computed tomography (CT)-based Hounsfield unit (HU) values, and magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) and endplate bone quality (EBQ) scores, are reliable tools for assessing bone quality. This study is the first meta-analysis comparing the predictive value of HU, VBQ, and EBQ for postoperative CS.MethodsA comprehensive literature search was conducted through databases such as PubMed up to April 5, 2025. The QUADAS-2 was used to evaluate the quality of included studies. Calculate the pooled sensitivity, specificity and hierarchical summary receiver operating characteristic (HSROC) curve, and perform subgroup analyses and meta-regression to identify sources of heterogeneity.Results20 studies involving a total of 2648 patients were included. The quality of these studies was relatively low. The areas under the HSROC curves for HU value, VBQ, and EBQ were 0.78 (95% CI, 0.74-0.81), 0.86 (95% CI, 0.83-0.89), and 0.83 (95% CI, 0.79-0.86), respectively. The pooled sensitivities were 0.84, 0.82, and 0.80, while the pooled specificities were all 0.76. The corresponding diagnostic odds ratios (DORs) were 16.34 (95% CI, 7.43-35.93), 14.67 (95% CI, 10.51-20.48), and 12.24 (95% CI, 5.63-26.61), respectively.ConclusionThe HU value, VBQ, and EBQ all demonstrate relatively high efficacy in predicting CS, with the VBQ showing a modest advantage. Collectively, these indicators can provide valuable information for preoperative risk stratification and individualized surgical decision-making.

Study DesignRetrospective Cohort Study.ObjectiveObesity rates have risen over recent decades, with many affected individuals experiencing degenerative spine conditions. A parallel increase in spine surgeries has raised questions about how to best optimize care in obese patients. Those with extremely high BMI (>50), classified as "Super Morbidly Obese (SMO)", may face higher risks of poor surgical outcomes. To better understand the challenges in treating this population, we compared complications, and operative characteristics between morbidly obese (MO), and SMO.MethodsA single-institution retrospective review was conducted on patients with a BMI over 40 who underwent a neurosurgical procedure from 2017 to 2023. Inclusion criteria were (1) patient age >17 years, (2) BMI >40, and (3) surgical interventions performed by a member of the department of neurological surgery. Demographic, clinical, surgical, and post-operative follow-up were analyzed.ResultsPatients were split into SMO (BMI 50+) and MO (BMI 40-50) groups. SMO received more intra-operative imaging radiation (P = 0.0169), experienced longer hospital stays (P < 0.0005) and experienced more post-operative complications than MO patients (P = 0.008). SMO patients experienced more complications when discharged home than their MO counterparts (P = 0.0002, RR = 12.2 [2.7-53.4]).ConclusionRisk in SMO spine surgery can be reduced through weight loss, modified surgical approaches, and better discharge planning. Regardless of comorbidities, SMO patients discharged home face higher complication rates than MO patients and may benefit from early discussions about skilled nursing placement. Larger studies are needed to better assess surgical management and outcomes in this population.

Study designA prospective nonrandomized observational cohort study.ObjectiveTo compare the clinical efficacy of arthroscopic-assisted uniportal spinal surgery combined with unilateral laminotomy bilateral decompression (AUSS-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment stable degenerative lumbar spondylolisthesis (DLS).MethodsA total of 168 patients (AUSS-ULBD n = 86, MIS-TLIF n = 82) with single-segment stable DLS were included. The patients were followed up for at least 2 years. The primary outcome was Oswestry disability index (ODI). Other perioperative indicators, clinical, and radiological outcomes were also compared.ResultsFor ODI, the adjusted mean differences (AUSS-ULBD minus MIS-TLIF) were 1.20 (95% CI -0.85 to 3.25) at 3 months, -1.74 (-3.65 to 0.17) at 12 months, and -0.68 (-2.79 to 1.43) at 24 months. The excellent and good rates of efficacy for the AUSS-ULBD and MIS-TLIF groups were 90.7% and 93.9%, respectively. AUSS-ULBD group had a higher reoperation rate than MIS-TLIF group (difference 4.7%, 95% CI -2.7% to 11.4%, P > .05). The operation time, blood loss, incision length, and hospital stay in the AUSS-ULBD group were lower than those in the MIS-TLIF group (P < .001). At 24 months, lumbar lordosis and slippage improved significantly after MIS-TLIF (P < .05), but not after AUSS-ULBD (P > .05).ConclusionsIn single-level, stable DLS, AUSS-ULBD offered advantages in operative morbidity, while achieving 2-year improvements in pain and disability that were comparable to those of MIS-TLIF. By contrast, MIS-TLIF showed better radiographic correction and lower reoperation rate that did not reach statistical significance.

Study DesignRetrospective Cohort Study.ObjectivesAdolescent idiopathic scoliosis (AIS) with a concomitant pars defect poses the surgical challenge of balancing stress avoidance at the lytic segment, deformity correction, and mobility preservation. Data on lowest instrumented vertebra (LIV) selection are limited. This study aimed to identify a safe LIV in posterior spinal fusion (PSF) to minimize pain and slip progression.MethodsRetrospective review of AIS patients (10-18 years) with spondylolysis or spondylolisthesis who underwent PSF (2016-2023) with ≥ 2-year follow-up. Variables included demographics, curve characteristics, Meyerding grade, LIV selection, and mobile segments between LIV and lytic level. Primary outcome was back pain (VAS). Secondary outcomes included slip progression, subjacent curve, mechanical complications, and revision. Between-group comparisons used Mann-Whitney U; regression assessed effects of mobility preservation and subjacent curvature on pain.ResultsOf 462 AIS patients, 29 met inclusion criteria (mean age 15.5 ± 1.5 years; 24% spondylolisthesis). Fusion ended at or above L3 in 76% and below in 24%. Follow-up VAS pain was higher in patients with <3 mobile segments between LIV and lytic level (4.5 ± 1.4 vs 2.8 ± 1.5; P = .003) and in fusions extending below L3 (5.0 ± 1.3 vs 3.0 ± 1.4; P = .004). Regression showed each additional mobile segment decreased pain (β = -0.77, P = .001), while greater subjacent curvature increased pain (per 10°, β = 0.92, P = .043). Two patients progressed to grade 1 slip; three were indicated for revision with distal junctional failure or persistent pain.ConclusionsIn AIS with coexisting spondylolysis, selecting LIV proximal to L3 minimizes pain while preserving mobile segments, without excessive slip progression.

Study DesignProspective Cohort Study.ObjectiveThis prospective observational study aimed to compare differences in the incidence of Cutibacterium acnes isolation in intervertebral discs from patients undergoing surgery for degenerative vs non-degenerative spinal pathology, and to assess differences in Modic changes and Pfirrmann grades between culture-positive and culture-negative discs.MethodsIntervertebral disc tissue was obtained from patients undergoing discectomy or interbody fusion for degenerative pathology, or from traumatic or oncological indications without degenerative pathology. Samples were cultured for Cutibacterium acnes. MRI scans were assessed for Modic changes and Pfirrmann grades.ResultsThere were 92 samples (91.1%) collected from 60 patients with degenerative pathology, while nine samples were obtained from seven patients with non-degenerative pathology. Cutibacterium acnes was cultured in 10/92 (10.87%) degenerative and 2/9 (22.22%) non-degenerative samples (P = 0.338). Samples from the cervical spine had a significantly higher incidence of Cutibacterium acnes culture (25.71% vs 4.76, P = 0.002). No significant differences were observed in Modic changes and Pfirrmann grades between culture-positive and culture-negative samples in either group. Higher Pfirrmann grades were observed in the degenerative pathology patient group (P < 0.001).ConclusionThe lack of significant differences in Cutibacterium acnes isolation between patient groups suggests that the presence of Cutibacterium acnes cultured from disc tissues is likely from contamination. This finding adds to the growing body of work examining the role of Cutibacterium acnes in degenerative disc disease, although the study is underpowered to draw firm conclusions. Further investigation involving larger patient groups is needed to build on these preliminary observations.

IntroductionSocial determinants of health have been shown to influence various outcome measures after elective orthopaedic procedures, including spine surgery. However, there has been limited research investigating the influence between social determinants of health and healthcare resource utilization after elective spine surgery. The purpose of this study was to investigate the influence of social vulnerability on opioid use, healthcare utilization, and patient-report outcome measures (PROMs) after elective lumbar decompression procedures.MethodsPatients undergoing elective 1- or 2- level lumbar decompression procedures between 2013 and 2018 at a single tertiary medical center were retrospectively identified. Various demographic variables, including the ZIP code of residence for each patient were reported. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) scores were calculated for each patient. Social vulnerability was defined as combined socioeconomic and housing vulnerability scores in the upper quartile. Several outcome measures were compared between patients with or without social vulnerability. The outcomes of interest included healthcare utilization and patient-reported outcome measures - pain interference (PI) and physical function (PF) within 1 year postoperatively. Healthcare utilization metrics included opioid use, emergency department visits, urgent care visits, MRI studies, pain management referrals, and revision surgeries. The minimal clinically important difference (MCID) was defined as 8 for both PI and PF scores.ResultsA total of 216 patients were included in the cohort -58 patients met criteria for social vulnerability. Patients with social vulnerability were more likely to be female and ASA class 2. Otherwise, patient demographics and medical comorbidities were similar between the 2 groups. Patients with social vulnerability were more likely to utilize the emergency department within 1-year postoperatively and to have persistent opioid use at both 6 months and 1 year postoperatively. On multivariate regression, SVI was independently associated with pre-operative opioid use, post-operative emergency department utilization, and persistent opioid use after surgery. Relative improvement in PI and PF scores and rates of MCID attainment were similar between groups.ConclusionsPatients with social disparities were more likely to utilize the emergency department and have persistent opioid use at 6 months and 1 year postoperatively from elective lumbar decompression procedures.