Global Spine Journal最新文献

Study DesignVignette-based cross-sectional study.ObjectiveGenerative artificial intelligence (AI) programs such as large language models (LLMs) are reshaping treatment decision-making, yet applications in minimally invasive spine surgery (MISS) are still scarce. This study examines whether OpenAI's ChatGPT-5 Pro and Google's Gemini 2.5 Pro reproduce expert management categories from published MISS cases and measures agreement at procedural and binary triage levels.MethodsWe constructed 90 clinical vignettes from published case reports and prompted each LLM to assign 1 or more of ten predefined categories with two-sentence rationales. Agreement with reference was assessed using Jensen-Shannon divergence (JSD), Stuart-Maxwell tests, Cohen's κ, and McNemar's test for surgical vs non-surgical triage.ResultsDivergence from reference was small, with Jensen-Shannon divergence 0.115 (ChatGPT-5 Pro) and 0.112 (Gemini 2.5 Pro), and smaller between models at 0.073. Paired multinomial tests found differences from the reference (Stuart-Maxwell χ²(9) = 24.8 and 26.0; P = 0.007 and 0.006) but not between models (14.4; P = 0.108). Case-level agreement was slight for ChatGPT-5 Pro and fair for Gemini 2.5 Pro (κ = 0.146 and 0.245). Collapsing categories to surgical vs non-surgical improved agreement (κ = 0.415 and 0.587 vs reference; 0.692 between models) with no bias in rates (P ≥ 0.401).ConclusionsLLMs may differentiate between surgical and non-surgical triage, but procedure selection should remain expert-led until systems mature. These findings establish a baseline for integrating LLMs into surgical triage workflows and highlight promise and limitations of generative AI in precision spine care.

Study DesignRandomized Controlled Trial.Background and ObjectivesThe Schroth method has emerged as a promising rehabilitation approach for Adolescent Idiopathic Scoliosis (AIS). This study compared the effects of Schroth and conventional exercise programs on spinal curvature, cortical thickness, and white matter pathways using structural MRI and Diffusion Tensor Imaging (DTI).MethodsThirty-six individuals with AIS were randomly assigned to a Schroth Exercise Group (SEG) or a Traditional Exercise Group (TEG). A healthy control group (n = 18) was also included. The sample size was calculated to provide 80% power (d = 0.60), and post hoc analysis indicated strong power (>0.99) for the observed treatment effect (d = 3.59). Both exercise groups completed supervised home-based programs for four months. Post-intervention MRI and DTI analyses were performed. The study was registered at ClinicalTrials.gov (NCT06410456).ResultsAfter adjusting for baseline severity, the SEG showed a significantly greater improvement in Cobb angle compared to the TEG (adjusted mean difference = 8.07°, P < .001). Although the SEG achieved a significantly lower post-treatment Cobb angle compared to the TEG, residual curvature remained significantly different from the healthy controls (P < .001), reflecting the structural nature of scoliosis. Additionally, after adjusting for age and intracranial volume, cortical thickness in sensorimotor regions and tractography metrics of the right corticospinal tract in the SEG were comparable to controls and significantly different from the TEG.ConclusionSchroth exercises were associated with brain structural features suggestive of adaptive neuroplastic responses. These exploratory findings highlight potential neurobiological mechanisms and support further longitudinal research.

Study DesignPilot randomized controlled trial.ObjectivesIatrogenic nerve injury is a major complication in endoscopic spinal surgery, potentially causing serious neurological deficits. Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has shown promise for intraoperative nerve root identification. This study assessed the feasibility, optimal dosing, safety, and mechanism of ICG fluorescence for nerve root visualization, transitioning from preclinical to clinical phases.MethodsIn the preclinical phase, 36 rabbits were assigned to ICG dose groups (1.4, 2.8, or 5.5 mg/kg, corresponding to 0.5, 1, or 2 mg/kg in humans) and observation times (3, 6, 12, or 24 hours). Fluorescence signals in lumbar nerve roots were quantified by signal-to-background ratio (SBR) and mean fluorescence intensity (MFI). Histological analyses explored ICG retention mechanisms. In the clinical phase, 40 patients undergoing unilateral biportal endoscopic surgery for lumbar disc herniation were randomized into different ICG dose groups (0, 0.5, 1, or 2 mg/kg), administered 1.5 hours preoperatively. Intraoperative fluorescence parameters, nerve root identification time, and perioperative outcomes (VAS and ODI scores) were assessed.ResultsIn preclinical studies, the 2.8 and 5.5 mg/kg groups showed peak SBR and MFI at 3 hours post-injection. Histology revealed ICG accumulation in nerve root microvascular regions. In the clinical study, the 2 mg/kg group had the highest SBR and MFI, reducing nerve root identification time without significant adverse events.ConclusionICG fluorescence imaging is a feasible and safe technique for intraoperative nerve root visualization, with ICG accumulation attributed to the enhanced permeability and retention effect.

Study DesignProspective cohort study.ObjectivePostoperative cerebrospinal fluid leakage (CSFL) is a common complication following thoracic spinal stenosis (TSS) surgery. This study aimed to evaluate the therapeutic effects of different fluid supplementation strategies on intracranial hypotension symptoms (IHS) caused by CSFL.MethodsPatients who developed CSFL after TSS surgery at a single center over a 3-year period were prospectively enrolled. All patients received standardized postural and drainage management. In addition, they were administered either low-sodium or high-sodium solution supplementation alongside standard medications. The incidence and severity of IHS and changes of blood electrolyte levels were compared between the two groups.ResultsThe incidence of IHS in low-sodium group is 57.5%, and in high-sodium group is 40% (P = .117). Although, there was no statistically significant difference in the improvement of IHS between the two fluid supplementation strategies. However, statistical differences in blood electrolyte levels were observed. On postoperative days 2 and 3, serum sodium levels were significantly lower in the low-sodium group (139.9 ± 2.08 vs 141.1 ± 3.1, P = .022; 140.0 ± 3.0 vs 141.25 ± 3.85, P = .034).ConclusionWhile high-sodium fluid supplementation tended to reduce the incidence of IHS following CSFL, the difference compared to low-sodium fluids was not statistically significant. Nonetheless, the observed differences in electrolyte level of sodium suggest a potential physiological impact. Further studies with larger sample sizes are needed to confirm these findings.

Study DesignSystematic Review.ObjectivesCervical disc arthroplasty (CDA) is a motion-preserving alternative to fusion for degenerative cervical disc disease. Implant dislocation, though rare, can lead to severe complications. Despite growing CDA adoption, no systematic synthesis of dislocation risk factors exists, leaving clinicians without evidence-based guidelines. To our knowledge, our study is the first detailed systematic review on CDA-related implant migrations. Our study aims to synthesize literature on CDA-related migration, identify risk factors and evaluate overall management outcomes.MethodsA structured literature review was conducted, identifying 16 relevant studies through PubMed. Data were extracted on study design, patient demographics, prosthesis type, migration direction and timing, risk factors, management approaches, and clinical outcomes.ResultsAmong 40 dislocation cases, anterior migration predominated (70.0%), linked to trauma, hyperlordosis, or poor osseointegration. Posterior migration (17.5%) was associated with polyethylene wear or osteolysis. 5 cases were of unspecified direction (12.5%). 62.5% of the patients underwent revision surgery, with anterior cervical discectomy and fusion (ACDF) making up 88% of these revision surgeries. Two deaths occurred due to postoperative complications.ConclusionsCareful patient selection, optimal implant sizing, and adherence to surgical technique are critical to minimizing dislocation. Surgeons should avoid CDA in kyphotic patients and consider constrained designs in high-risk cases. Early recognition and prompt surgical intervention lead to favourable outcomes.

Study DesignRetrospective cohort study.ObjectivesPrior studies have shown that adult spinal deformity (ASD) patients undergoing revision surgery due to mechanical complications had less radiographic improvement and worsening patient-reported outcomes scores. The combination of customized 3D planning and personalized implants has been shown to contribute to improved achievement of alignment goals. This study aimed to determine whether such improved correction also results in a correspondingly lower revision surgery rate due to mechanical complications.MethodsPre- and postoperative radiographic alignment measures, including lumbar lordosis (LL), distal lumbar lordosis (DLL), pelvic incidence (PI) - LL mismatch, and L1 pelvic angle (L1PA), as well as data on mechanical complications leading to reoperation were collected on 115 ASD patients with personalized interbody implants and minimum 2-year follow-up. This cohort was statistically compared to a multicenter dataset (ISSG) of 997 ASD patients treated using stock devices and using the same reoperation classifications.ResultsPostoperatively achieved alignment measures correlated significantly with their respective preoperative alignment goals, with the following average offsets from plan: 2.4° LL, -0.2° DLL, -2.4° PI-LL, 0.3° L1PA. Compared to the ISSG cohort that utilized stock interbody implants, the cohort utilizing 3D preoperative planning and personalized interbody implants resulted in significantly fewer revisions for mechanical complications up to 2 years postoperatively: 5/115 (4.3%) vs 166/997 (16.6%), P < 0.001.ConclusionsThese findings suggest that achieving planned alignment targets with personalized interbody devices is associated with reduced revision surgery for mechanical complications, a result which may have positive implications for improved patient outcomes and reduced cost.

Study DesignNetwork Meta-analysis.ObjectiveTo evaluate the clinical efficacy and safety of minimally invasive (MIS-), full endoscopic (FE-), and biportal endoscopic (BE-) transforaminal lumbar interbody fusion (TLIF).MethodsPubMed, Embase, Cochrane Library, and ClinicalTrials.gov registry were searched up to August 2025. Randomized controlled trials and nonrandomized studies of intervention comparing MIS-TLIF, FE-TLIF, and BE-TLIF for lumbar degenerative diseases were included. Network meta-analysis was conducted using the frequentist framework, with meta-regressions assessing effect modifiers.Results49 studies (4188 patients) were included. FE-TLIF and BE-TLIF significantly reduced back pain vs MIS-TLIF from 1 month postoperatively through final follow-up. However, leg pain showed no significant differences among the three approaches. FE-TLIF and BE-TLIF demonstrated superior short- and mid-term functional outcomes, with FE-TLIF achieving the shortest hospital stay. Both endoscopic techniques reduced blood loss compared to MIS-TLIF. Long-term functional improvement, fusion rates, and complication rates were comparable, though FE-TLIF and BE-TLIF required longer operative times. Meta-regression suggested greater back pain relief in older patients following FE-TLIF.ConclusionBE-TLIF and FE-TLIF are safe techniques offering advantages over MIS-TLIF, including greater back pain reduction, improved short-term function, shorter hospital stays, and reduced blood loss. However, both require longer operative times. Meta-regression analysis suggested a promising signal that FE-TLIF may provide greater back pain relief in older patients. MIS-TLIF remains viable for those with higher anesthesia risk or significant cardiopulmonary comorbidities. Further high-quality randomized controlled trials are needed to validate these findings and refine patient selection criteria.

Study DesignSystematic Review.ObjectiveTo review the effect of NSAID administration on postoperative outcomes following posterior spinal surgery, with specific attention to pain control, opioid reduction, bleeding risk, and fusion outcomes.MethodsPubMed, Google Scholar, Cochrane Library, Embase, Scopus, and Web of Science were queried through September 2025. Studies were included if they included adult patients undergoing posterior spinal procedures, including both fusion and non-fusion surgeries. In addition, studies had to report perioperative NSAID use in posterior spinal surgery with relevant clinical outcomes: Postoperative pain, opioid consumption, blood loss, wound complications, nonunion, and hardware failure. Bias was assessed with MINORS and Newcastle-Ottawa Scales.ResultsEleven studies (396,206 patients) were included. Across posterior fusion and non-fusion procedures, short-term NSAID use consistently reduced postoperative opioid consumption and improved early pain control, with no clinically meaningful increase in bleeding or wound complications. However, prolonged NSAID use was associated with increased risks of nonunion, hardware failure, and wound complications in fusion cohorts. Significant variability in NSAID type, dose, timing, and study design exists.ConclusionsShort-term NSAID use appears safe and effective as an opioid-sparing strategy in non-fusion posterior spinal surgery. Prolonged or high-dose administration may compromise fusion outcomes. Future high-quality studies are needed to definitively define the optimal postoperative NSAID window, dosing, and administration route.