Global Spine Journal最新文献

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.

Study DesignRetrospective Study.ObjectivesLumbar epidural steroid injections (LESIs) are frequently used to manage symptoms and pain stemming from degenerative conditions of the lumbar spine. This study aimed to determine the incidence and risk factors of complications after LESI.MethodThe Merative MarketScan Commercial and Medical Supplemental databases were queried for LESIs in 18+ patients. LESIs were distinguished based on the approach: interlaminar or transforaminal. Complications were categorized into overall, procedural, and medical. Generalized estimating equations logistic regression with repeated measures, clustered by patient identifier, were used to identify factors associated with complications at 7 and 30 days after the LESI.ResultsThe study cohort consisted of 362,976 patients who underwent a total of 722,366 LESIs from 2014 to 2021. Complication rates after LESIs were 2.5% within 7 days and 8.8% within 30 days. 45.0% of LESIs utilized the interlaminar approach, while the transforaminal approach was used in 54.0% of LESIs. The patient factors independently associated with the greatest odds of complications included older age [85+ vs 18-34, 7 day OR: 1.32 (1.20, 1.45); P < 0.001], heart failure [7 day OR: 1.95 (1.84, 2.06); P < 0.001], renal dysfunction [7 day OR: 1.51 (1.41, 1.63); P < 0.001], neurological deficits [7 day OR: 1.37 (1.31, 1.44); P < 0.001], and anticoagulant prescriptions [7 day OR: 3.28 (3.10, 3.48); P < 0.001].ConclusionsLESIs were associated with a rare but non-negligible risk of complications, which continued to occur until 30-days post injection. Several patient factors were associated with the risk of post-procedure complications.

Study DesignProspectively Enrolled Cohort Study.ObjectiveTo compare the time of return to baseline ambulatory function after undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) vs traditional open posterolateral fusion (OF).MethodsPatients undergoing TLIF or OF with an iPhone were prospectively enrolled. Participants voluntarily shared information from the pre-installed Apple Healthkit package, which provided baseline activity data. Daily steps and distance were tracked until a patient returned to within 90% of their pre-operative baseline for 2 consecutive days. Patient-reported outcome measure scores (PROMs) were collected at the pre-operative and subsequent follow-up visits.ResultsA total of 23 MIS-TLIF and 25 OF patients were enrolled. Patients undergoing MIS-TLIF had an average preoperative baseline of 3576 steps (SD 2185); these patients returned to 90% of baseline steps at an average of 10.57 days. Those undergoing OF had an average preoperative baseline of 2280 steps (SD 1295) and required 15.32 days to return to 90% of pre-operative step count. There were no significant correlations between pre-operative demographic factors or PROMs with time to return to 90% of baseline ambulation. After matched analysis was performed, the average treatment effect of MIS vs OF operation was estimated, though this was not statistically significant.ConclusionsThis study quantifies pre- and post-operative ambulatory function for 2 cohorts of patients undergoing lumbar surgery. This work further builds on the existing uses of Apple HealthKit data to establish ambulatory baseline in the lumbar spine surgery population, as well as comparison of objective ambulation data with PROMs.

Study DesignRetrospective comparative study.ObjectiveTo investigate the relationship between pedicle Hounsfield Unit (HU) values and transpedicular screw malposition in scoliosis surgery and to determine a predictive HU threshold for malposition risk.MethodsPatients who underwent free transpedicular screw fixation for idiopathic or degenerative scoliosis between 2011 and 2024 and had both preoperative and early postoperative spinal computed tomography (CT) scans available were retrospectively reviewed. Screw malposition was identified on postoperative CT, and pedicle HU values and the widths of malpositioned screws were measured on the corresponding preoperative CT images and compared with contralateral and control pedicles. Receiver operating characteristic (ROC) analysis was used to determine a predictive HU threshold for screw malposition.ResultsThe study included 121 patients. Mean HU values were significantly higher in malpositioned pedicles compared to controls in both the idiopathic (692 vs 299.5; P < 0.001) and degenerative scoliosis (343.5 vs 250; P < 0.001) groups. ROC analysis determined the HU cut-off value to be 479 and above to predict screw malposition (AUC = 0.796; 95% CI: 0.717-0.876; sensitivity 73.6%, specificity 79.6%). The location of screw malposition according to the convex and concave sides, and the location above and below the apex did not show any significant differences.ConclusionHigher pedicle HU values are significantly associated with screw malposition in scoliosis surgery. A HU threshold of 479 may help identify pedicles at increased risk of malposition during free screw placement in both idiopathic and degenerative scoliosis. Preoperative pedicle HU assessment may contribute to surgical planning and risk reduction strategies.

Study DesignRetrospective study.ObjectiveTo evaluate diagnostic concordance between CT-derived Hounsfield Units (HU) and DXA T-scores in spinal surgery candidates, and to identify factors related to discordance.MethodsWe analyzed 180 patients (mean age 72.4 ± 8.2 years) who had lumbar CT and DXA. DXA osteoporosis was defined by the lowest T-score (lumbar spine or hip) ≤ -2.5, and CT osteoporosis was defined as HU ≤ 100. Patients were classified into concordant positive (DXA+/HU+), concordant negative (DXA-/HU-), and two discordant groups (DXA+/HU-, DXA-/HU+). Analyses included correlation, ROC analysis, and comparisons of age, BMI, sex, and the DXA site yielding the lowest T-score.ResultsHU and T-scores showed correlation (Spearman's ρ = 0.467, P < 0.001) with discrimination (AUC = 0.700; 95% CI 0.614-0.781). Concordance was 72.2% (130/180; DXA-/HU- = 94, DXA+/HU+ = 36); discordance was 27.8% (50/180; DXA+/HU- = 24; DXA-/HU+ = 26). DXA+/HU + patients were older than DXA-/HU- (75.9 ± 6.5 vs 71.1 ± 9.1 years; P = 0.003), and both DXA + groups had lower BMI (22.9 ± 3.8 and 22.7 ± 4.8 vs 24.8 ± 3.8 kg/m²; P = 0.009 and 0.029). The HU 100-150 "gray zone" was not associated with discordance (23.3% vs 30.8%, P = 0.311).ConclusionsHU values show moderate agreement with DXA and are useful for opportunistic screening. Given ∼27% discordance-especially in older or lower-BMI patients-HU should be interpreted alongside DXA for comprehensive assessment.

Study DesignRetrospective study.ObjectivesThis study aimed to assess clinical and radiological outcomes of temporary occiput-C2 fixation(TOC2F) as an alternative to halo-vest immobilization in unstable atlas fractures.MethodsAfter ethics approval, 43 patients treated for C1 fractures between 2011-2018 were reviewed.Inclusion criteria were acute traumatic C1 fractures managed with TOC2F and at least two years of follow-up after implant removal. Exclusion criteria were polytrauma affecting follow-up, pathological fractures, prior cervical surgery, congenital anomalies, and incomplete data. Preoperative imaging included MRI, CT, MR angiography, and X-ray. Union was evaluated with CT at 3 and 6 months. Functional outcomes were assessed using NDI, SF-36 (MCS/PCS), and goniometric cervical rotation.ResultsThe cohort consisted of 23 patients(16 male,7 female).According to Landells classification,78.2% had type II and 21.7% type III fractures. Radiological union was achieved in all patients by 6 months, with hardware removal at a mean of 6.3 months. Cervical rotation significantly improved from 103.78° ± 12.02 at day 4 to 153.78° ± 9.29 at two years(P < .05).NDI scores improved from 12.21 ± 3.66 to 2.14 ± 0.94(P < .05).Final SF-36 MCS/PCS scores were favorable 56.33/56.09).No neurological deterioration occurred; one superficial wound complication was documented.ConclusionTOC2F demonstrates potential as a viable and effective alternative for the management of unstable C1 burst fractures.This technique provides immediate postoperative stability, facilitates reliable fracture union, and allows restoration of physiological cervical motion following implant removal.The favorable functional outcomes, low complication rate, and preserved long-term mobility observed in this study suggest that temporary fixation may offer substantial advantages over halo-vest immobilization and permanent fusion in appropriately selected patients.

Study DesignRetrospective cohort study.ObjectiveTo compare in-hospital mortality, complications, and resource utilization among patients undergoing fusion, decompression/discectomy, or instrumentation for spine trauma at Level I vs Level II trauma centers.MethodsThe National Trauma Data Bank was queried for adult patients with isolated spine trauma who underwent fusion, decompression/discectomy, or instrumentation at a Level I or Level II center. Multivariable logistic and linear regression models were used to adjust for patient demographics, injury severity, comorbidities, and hospital characteristics, comparing in-hospital mortality, complications, and length of stay (LOS).ResultsWe identified 10 295 patients (6588 at Level I; 3707 at Level II). Level I patients were younger, had more severe spinal injuries, and had a higher incidence of spinal cord injury, particularly involving the cervical spine. Unadjusted outcomes showed similar mortality, but longer hospital and ICU LOS at Level I centers. After risk adjustment, treatment at a Level I center was associated with a 34% lower adjusted odds of in-hospital mortality (OR 0.66; 95% CI 0.46-0.96; P = .030). There were no significant differences in adjusted odds of any in-hospital complication or in adjusted hospital and ICU LOS.ConclusionTreatment at a Level I trauma center was associated with a significant survival benefit for patients undergoing operative management for spinal trauma. This mortality advantage was achieved without increasing complications or LOS. Given the retrospective design, causality cannot be inferred. Nevertheless, these findings suggest that Level I centers are associated with a distinct survival advantage for this high-acuity patient population.