Global Spine Journal最新文献

Study DesignRetrospective Study.ObjectivesSpinal cord injury (SCI) has become a major health threat, and existing diagnostic tools such as MRI and CT have limitations. This study aims to investigate the expression changes of miR-200a-3p and its target PTEN in SCI and explore their potential diagnostic and therapeutic values.MethodsA total of 148 SCI patients were enrolled. An in vitro SCI model was established using PC12 cells treated with LPS. The levels of miR-200a-3p and PTEN were measured using qRT-PCR. The diagnostic value of both for SCI was evaluated using ROC curve analysis. The targeting relationship between miR-200a-3p and PTEN was validated through dual-luciferase reporter assays, and RNA pull-down experiments. Cell viability and apoptosis were analyzed using MTT and flow cytometry. ELISA was used to measure pro-inflammatory cytokines. Levels of ROS, CAT, and SOD were determined using respective kits.ResultsmiR-200a-3p was significantly decreased, while PTEN was upregulated in SCI patients. Both miR-200a-3p and PTEN could distinguish SCI patients from individuals with normal neurological function, as well as complete vs incomplete SCI. Furthermore, miR-200a-3p directly targets and suppresses PTEN; overexpression of miR-200a-3p enhanced cell viability, reduced inflammation and oxidative stress, and inhibited apoptosis. Conversely, PTEN overexpression reversed these protective effects.ConclusionsmiR-200a-3p and PTEN have certain diagnostic value for SCI, and miR-200a-3p exerts neuroprotective effects by targeting PTEN to reduce inflammation and oxidative stress. This study provides promising biomarkers and therapeutic targets for the early diagnosis and intervention of SCI.

Study DesignRetrospective analysis and case series.ObjectivesThis study evaluates the differences in electromyography (EMG) recordings when using a novel table rotation technique for the placement of dilators and retractors compared to the standard technique for a prone transpsoas (PTP) lateral lumbar interbody fusion at L4-5.MethodsTen patients underwent single-level PTP surgery at L4-5, with EMG recordings anteriorly and posteriorly on top of the psoas muscle and at the disc space. EMG recordings were evaluated with the bed in a neutral position and again after the operating table was rotated 30° away from the surgeon.ResultsAll 10 patients had significantly improved EMG values at all points after table rotation. Before table rotation, the posterior EMG values were in the risk zone (<6 mA) for 7 of 10 patients when measured on top of the psoas and for 5 of 10 patients when measured at the disc space. After the table rotation, no patient had posterior EMG recordings in the risk zone. Similarly, all anterior EMG recordings demonstrated improvement after table rotation.ConclusionsThe table rotation technique was effectively used with the PTP approach to safely access the L4-5 disc space farther from the lumbar plexus in our patients, with EMG recordings at safer thresholds.

Study DesignRetrospective Database Study.ObjectivesAnterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common procedures performed for cervical spondylosis. Sparse data exists comparing the utilization and reimbursement rates associated with these procedures. This study seeks to compare Medicare utilization of single- and multilevel ACDF to CDA between 2011 and 2021. Additionally, this study evaluates Medicare reimbursement rate changes for ACDF with structural allograft, ACDF with cage, and CDA between the years 2016 and 2021.MethodsThis study used the publicly available Medicare National Summary Data Files to aggregate annual utilization and reimbursement rates for ACDF procedures as well as CDA procedures based on Current Procedural Terminology codes. Reimbursement rates were adjusted for inflation through use of the U.S. Bureau of Labor Statistics' 2021 Consumer Price Index. Changes in reimbursement rates and utilization were calculated and compared between procedures.ResultsIn 2011, 27 974 single-level ACDF procedures were performed on Medicare Part B patients compared to 34 683 performed in 2021. This represents a growth in procedure utilization of 24% over the study period. Over the course of the same study period CDA procedures grew by 1087.3%, from 118 in 2011 to 1401 in 2021. Throughout the reimbursement study period, Medicare reimbursements per case for single-level CDAs had an average annual percent change of 9.96%, rising from $1636 in 2016 to $2779 in 2021. Reimbursement per case for single-level ACDF with allograft had an average annual change of -1.25%, falling from $3408 in 2016 to $3206 in 2021. Medicare reimbursement per case for single-level ACDF with cage had an average annual change of 1.19%, from $3379 in 2017 to $3547 in 2021.ConclusionAll procedures saw an increase in utilization throughout the study period, with CDAs showing significant growth within the Medicare population. While the reimbursement for ACDFs remained relatively constant, the reimbursement for CDAs demonstrated a moderate increase.

Study DesignSystematic review.ObjectiveIntracardiac cement embolism (ICE), a rare but life-threatening complication of vertebral augmentation (VA), is poorly characterized. Our review summarizes the incidence, clinical characteristics, treatment and outcome of this complication.MethodsMedline, Embase, and Cochrane databases were systematically searched from inception to April 1, 2025. References were cross-checked to identify additional relevant articles. Included publications underwent quality assessment using the Case Report (CARE) Guidelines and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, with pooled analysis of incidence, clinical characteristics, treatment, and outcomes.Results4 case-series and 96 case reports (181 cases) were included. The overall reporting rate for each study was relatively high, but low reporting rates in 11 sub-items may introduce bias. Among 115 cases with epidemiological data, osteoporotic fractures predominated (n = 83), followed by other diseases (n = 32). The incidence was low, but the exact value was unclear. Common symptoms included dyspnea and chest pain, with onset typically within 48 h postoperatively, though delays of months to 5 years occurred. Diagnosis relied on chest imaging. Treatment was individualized, but most reports lacked objective evidence to guide decisions. Asymptomatic patients required monitoring, while symptomatic ones may need surgery intervention. The outcome was uneventful for all but 10 patients.ConclusionsICE was reported only in case report or case-series. A comparative analysis of pre- and postoperative chest X-ray is recommended for screening, while patients with chest discomfort after VA warrant immediate CT imaging. The simplified decision-making flowchart we have developed may provide valuable insights.Systematic Review RegistrationPROSPERO identifier CRD 42023455121.

Objectives: Loeys-Dietz syndrome (LDS) is a rare autosomal dominant connective tissue disorder that may be associated with spinal abnormalities, but no comprehensive review exists on this subject. Therefore, this systematic review synthesized information specifically on spinal pathology in patients with LDS.

Methods: A systematic review of spinal pathology in LDS was conducted via PRISMA guidelines using the online databases PubMed/MEDLINE, Embase, and Scopus. Studies were included if they detailed spinal pathology in LDS with extractable dada. Studies were excluded if they did not involve spinal pathology in LDS, did not have extractable data, involved spinal pathology not directly due to LDS, were review articles, or were nonhuman studies. Study quality and risk of bias were evaluated using the Newcastle-Ottawa scale.

Results: A total of 21 studies encompassing 564 LDS patients were included. All articles were single-institution retrospective studies from between 2009-2024. The most common spinal pathologies were scoliosis (n = 154), cervical instability/deformity (n = 97), dural ectasia (n = 58), and spondylolisthesis (n = 32). Patients with cervical anomalies and spondylolisthesis required surgery at higher rates than for scoliosis. Spinal pathologies in LDS were often early-onset and progressive, with many patients failing conservative management. All studies were of limited quality and most had high risk of bias.

Conclusions: The most common spinal pathologies in LDS were scoliosis, cervical instability/deformity, dural ectasia, and spondylolisthesis. Most scoliosis cases did not require surgery. Cervical pathology and spondylolisthesis required surgery at higher rates in these patients, particularly when progressive and early-onset. There is a need for prospective, larger-cohort studies for these patients.

Study DesignNarrative Review.ObjectivesTo summarize the scientific contributions generated from the AO Spine Knowledge Forum Tumor (AOSKFT) databases, focusing on primary spine tumors, and highlight key findings, research trends, and future directions.MethodsData from the Primary Tumor Retrospective (PT-Retro) and Primary Tumor Research Outcome Network (PTRON) registries were analyzed. The nineteen studies included were peer-reviewed manuscripts focused on primary spine tumors, excluding abstracts, book chapters, systematic reviews, and metastatic studies.ResultsThe PT-Retro registry compiled data from 1495 patients across 18 primary tumor histologies, offering insights into recurrence, survival, and treatment paradigms. Key findings emphasize the importance of Enneking-appropriate (EA) resection in improving survival and reducing recurrence in tumors such as chordoma, chondrosarcoma, and osteosarcoma. Genetic markers, including hTERT promoter mutations and rs2305089 SNP, were linked to prognosis in specific histologies. Benign tumors, such as giant cell tumors and aneurysmal bone cysts, demonstrated variable outcomes with different surgical approaches and selective arterial embolization.ConclusionsThe AOSKFT registries have significantly advanced knowledge in primary spine tumor management, emphasizing preoperative staging, surgical margins, and multidisciplinary approaches. International, multicentric registries are essential for studying rare diseases like primary spine tumors, enabling robust data collection, improved statistical power, and broader applicability of findings across diverse clinical settings. Ongoing prospective data collection through PTRON will further refine evidence-based care for these rare and challenging conditions.

Study DesignRetrospective cohort study.ObjectivesPostoperative surgical site infections (SSI) remain a major cause of morbidity and cost in spine surgery. Existing risk calculators have limited applicability in this population. This study introduces a literature-informed, point-based SSI calculator designed to complement standard preoperative assessment. GPT-4 (OpenAI, San Francisco, CA) was used solely for structured literature synthesis and preliminary variable weighting.MethodsAdult patients undergoing spine surgery at a single academic center (2019-2025) were retrospectively reviewed. A 29-variable AI-assisted risk calculator integrating demographic, clinical, laboratory, and surgical factors was developed. SSI was defined using CDC/NHSN criteria with a 90-day window. Risk calculator performance was evaluated using receiver operating characteristics (ROC) curve analysis, bootstrap optimization correction, and calibration and decision curve analyses. A stratified analysis was performed comparing performance by procedure types and spinal regions.ResultsA total of 338 patients were included (SSI: 177; controls: 161). Median risk scores were significantly higher in infected vs non-infected patients (18 vs 10; P < .001). Discrimination was strong (AUC 0.7978, 95% CI 0.7521-0.8427). The optimal threshold was 17 points, yielding 61.0% sensitivity, 84.2% specificity, and 72.1% accuracy. Bootstrap validation showed minimal optimism (corrected AUC 0.7974). Calibration was excellent (calibration-in-the-large <0.001; slope 1.045; Brier score 0.1833). At the study prevalence (52.3%), PPV was 0.8106 and NPV 0.6540, with expected PPV reduction at real-world prevalence. Patients with scores ≥17 had significantly higher infection risk (RR 2.42; OR 8.31; P < .001). Stratified analyses showed consistent performance across procedure types and spinal regions.ConclusionThis internally validated, AI-assisted SSI calculator demonstrated strong discrimination and calibration. Prospective external validation is needed to determine clinical utility.

ObjectivesInstrumentation failure remains a significant complication in spinal surgery. Preoperative bone health assessment is critical prior to spinal fusion surgery. Currently, bone mineral density (BMD) and Hounsfield Unit (HU) are common preoperative assessments, although it remains unclear which is more predictive of screw fixation strength. We aimed to identify the most reliable preoperative evaluation method for predicting screw insertional torque in patients undergoing lumbar fusion surgery.MethodsPatients who underwent lumbar fusion surgery utilizing pedicle screws between 2021 and 2023, were prospectively registered in our database. All participants underwent preoperative lumbar CT and Dual-Energy X-ray Absorptiometry (DEXA) scans. We analyzed data from 109 patients who underwent lumbar fusion surgery with 6.5 mm pedicle screws. Preoperative BMD was measured via DEXA (lumbar spine and femur), and HU values were obtained from preoperative lumbar CT scans. Insertional torque of the screws was measured intraoperatively using a calibrated torque wrench. Correlations between insertional torque and BMD/HU as well as patients' demographic/lab data were analyzed.ResultsA total of 335 pedicle screws were analyzed. Femoral BMD exhibited the strongest correlation with insertional torque (r = 0.557, P < 0.001), compared with lumbar BMD and HU. Age, ASA grade, BMI, serum calcium, and albumin showed weak correlations.ConclusionsFemoral BMD demonstrated the strongest, although still moderate, association with intraoperative insertional torque among all preoperative bone quality measures evaluated, suggesting that it may offer a more informative estimate of underlying bone strength in patients undergoing lumbar fusion.

Study DesignSystematic Review and Meta-Analysis.ObjectivesDespite a surge in the use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in spine surgery candidates, evidence on their perioperative use remains unclear. This meta-analysis aimed to synthesize the evidence on the safety and efficacy of GLP-1 RA use in patients undergoing spine surgeries.MethodsA systematic search of PubMed (MEDLINE), Embase, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Studies that compared spine surgery outcomes in GLP-1 RA users and non-users were included. Two reviewers independently selected articles. (PROSPERO: CRD420251061447).ResultsEleven retrospective studies reporting on 27,143 patients were included. Three studies focused on the cervical spine, 6 on the lumbar spine, and 2 included all spinal fusions. Risk of bias was deemed to be low in all studies. There were no significant differences in the GLP-1 RA users and non-users in pooled estimates for pseudoarthrosis (odds ratio: 1.29 [95% CI: 0.09 - 19.23]), surgical site infections (0.97 [0.74 - 1.27]), pneumonia (1.19 [0.30 - 4.68]), deep vein thrombosis (1.34 [0.86 - 2.08]), acute kidney injury (1.27 [0.93 - 1.74]), readmission rate (1.06 [0.94 - 1.18]), and emergency department visits (0.95 [0.10 - 8.99]).ConclusionsCurrently available level 4 evidence suggests that perioperative GLP-1 RA use in spine surgery candidates does not affect the risk of postoperative complications. However, these studies are based on administrative databases and may be confounded by indication. Future studies should include glycemic control and weight loss to better elucidate the impact of GLP-1 RA.

Study DesignConducted in vivo and in vitro modeling investigations.ObjectiveThe present research aims to explore the regulatory role of microRNA (miR)-369-3p in spinal cord injury inflammatory response and its targeting mechanism.MethodsA female mouse model with T8-T10 spinal cord injury (SCI) was established. The motor function assessment (BMS) score was employed to evaluate motor function. BV2 microglial cells were treated with lipopolysaccharide (LPS) in vitro to construct an inflammatory cell model. Real-time fluorescence quantitative PCR was applied to assess miR-369-3p, M1 (CD86, iNOS), and M2 (Arg-1) polarization markers. Enzyme-linked immunosorbent assay (ELISA) determined the concentration of inflammatory factors (TNF-α, IL-6, and IL-1β). Additionally, RNA pull-down, RNA immunoprecipitation, and Dual-luciferase reporter experiments were performed to verify that miR-369-3p targets Pellino E3 ubiquitin protein ligase 1 (PELI1).ResultsmiR-369-3p was noticeably down-regulated in SCI mice spinal cord tissues and LPS-induced BV2 cells, while PELI1 expression was upregulated. Raising miR-369-3p improved BMS scores (for moto function) and reduced inflammatory cytokines in spinal cord tissues. Mechanistically, miR-369-3p targeted PELI1. LPS treatment increased inflammatory factor mRNA levels and concentrations, which were significantly reversed by raising miR-369-3p and restored by PELI1. Also, raising miR-369-3p suppressed CD86 and iNOS and induced Arg-1 expression in LPS-activated microglia, while PELI1 reversed this effect.ConclusionmiR-369-3p mitigates inflammation and suppresses microglia polarization by targeting PELI1, ultimately mitigating the progression of spinal cord injury. Our research suggests miR-369-3p as a potential therapeutic target for spinal cord injury.