Global Spine Journal最新文献

Study DesignRetrospective cohort study.ObjectivesAnterior cervical discectomy and fusion (ACDF) provides clinical improvement for cervical radiculopathy. Recently, it was determined that foraminal decompression via uncinate process resection could lead to faster and greater improvement of arm pain. Total uncinatectomy (TU) and partial uncoforaminotomy (PU) are commonly used for direct foraminal decompression. But the advantages and pitfalls of the two techniques remain unknown.MethodsConsecutive patients(n = 306) who underwent single-level ACDF for degenerative cervical radiculopathy and who were followed up for >2 years were retrospectively reviewed.ResultsGroupTU had a significantly higher degree of subsidence than GroupPU. The 1-year and 2-year fusion rates were higher in GroupPU than those in GroupTU. Postoperative arm pain VAS score, neck pain VAS score, and NDI scores did not demonstrate significant intergroup differences at all time points. GroupTU had a significantly longer operative time, greater EBL, higher dysphagia rate, and more severe retropharyngeal soft tissue swelling than GroupPU did. There was one case (0.7%) of cerebral infarction due to vertebral artery injury in GroupTU.ConclusionPU resulted in lesser complications, shorter operative time, and lesser intraoperative bleeding than did TU. Moreover, the uncinate process was partially preserved in PU as a potential stabilizer, causing lesser subsidence and higher fusion rates. However, the clinical efficacy of PU was comparable to that of TU. Thus, resection of only the posterior part of the uncinate process provides sufficient direct foraminal decompression. Therefore, PU could be an effective and safer alternative to TU for foraminal decompression during ACDF.

Study DesignSystematic review of clinical studies.ObjectiveTo identify neurological, anatomical, and technical predictors of failure in closed cranial traction (CCT) for traumatic cervical facet dislocations (CFD) in adults, and to synthesize evidence to guide early surgical decision-making.MethodsA systematic search was conducted across five databases: PubMed, PubMed Central (PMC), SciELO, Scopus, and Web of Science, for studies published from January 2000 to May 2025. Eligible studies included patients ≥16 years with traumatic CFD managed initially with CCT, reporting both success/failure rates and predictive variables. Data extraction focused on demographics, injury patterns, reduction techniques, and outcomes.ResultsEight studies met the inclusion criteria, encompassing 631 patients. Overall, the success rate of closed reduction was 73.3% (463/631), ranging from 56% to 92%. Consistently reported predictors of failure included complete neurological deficit (ASIA A-B; four studies), absence of a contralateral perched facet, involvement of the C7-T1 level, inferior endplate fracture, and attempts without general anesthesia. When open reduction was required after failed CCT, posterior approaches achieved higher success rates than anterior approaches (100% vs 45%).ConclusionsIn adults with traumatic cervical facet dislocations, CCT is more likely to fail with complete neurological deficits (ASIA A-B), C7-T1 involvement, absence of a contralateral perched facet, and awake traction protocols; GA-first strategies showed higher success in available cohorts. Unlike prior technique-focused overviews, this review consolidates predictors of CCT failure and proposes a practical algorithm to triage patients for early open reduction.

Study DesignRetrospective cohort study.ObjectivesTo evaluate the mid-term clinical effectiveness, radiographic fusion rates, and safety profile of unilateral biportal endoscopic fusion-extension surgery (UBE-FES) in patients with symptomatic adjacent segment disease (ASD) after prior lumbar fusion.MethodsWe reviewed patients treated with UBE-FES between March 2020 and March 2023, each with ≥24 months of follow-up. Inclusion required new radicular or back pain from adjacent-level stenosis or Grade I-II spondylolisthesis. Clinical outcome measures were collected preoperatively and at 3, 6, 12, and 24 months. Operative time, blood loss, hospital stay, and complications were recorded. Fusion status was assessed on 12-month CT (Bridwell grades).ResultsMean operative time was 176 ± 22 min, blood loss was 185 ± 33 mL per level, and hospital stay was 6 ± 2 days. At 24 months, VAS-Back fell from 6.8 ± 0.5 to 0.1 ± 0.3 and VAS-Leg from 6.6 ± 0.6 to 0.1 ± 0.3 (both P < 0.001). ODI improved from 31.6 ± 5.0% to 3.5 ± 1.2% (P < 0.001). SF-36 PF increased from 16.1 ± 4.4 to 68.5 ± 18.2 and BP from 26.9 ± 6.4 to 72.3 ± 19.5 (P < 0.001). Fusion was achieved in 96.9%. Complications included one incidental durotomy (3.1%) and two asymptomatic cage subsidence events (6.3%); no infections or new neurologic deficits occurred.ConclusionsUBE-FES provides significant pain relief, functional improvement, and high fusion rates with minimal morbidity in ASD patients. These findings support UBE-FES as a viable alternative to open revision.

Study DesignRetrospective case-control study.ObjectivesTo identify risk factors for proximal junctional kyphosis (PJK) after long-segment fusion in adult degenerative scoliosis (ADS) and to develop a machine learning-based prediction model with external validation.MethodsWe retrospectively analyzed 142 ADS patients from two institutions undergoing posterior long-segment fusion with ≥24 months follow-up. Patients from center A (n = 105) formed the training cohort, and those from center B (n = 37) served as the external validation cohort. Demographic, radiographic, and surgical parameters were compared between patients with and without PJK. Independent predictors were determined with multivariate logistic regression. Least absolute shrinkage and selection operator (LASSO) regression identified key variables. Six supervised machine learning algorithms were trained using center A data and validated on center B data. Model interpretability was assessed using Local Interpretable Model-agnostic Explanations (LIME).ResultsPJK occurred in 24 patients (16.9%). Logistic regression identified lower T-score, higher T1-pelvic angle, and female sex as independent predictors, with ASA grade III showing a marginal effect. LASSO retained five features: T score, ASA grade, T1PA, sacral slope, and pelvic incidence. Among algorithms, the back-propagation neural network with LASSO feature selection yielded the best discrimination (external validation AUC = 0.882). LIME analysis confirmed T score, T1PA, and PI as the most influential predictors.ConclusionsReduced bone density, impaired sagittal balance, and higher ASA grade increase PJK risk after long-segment fusion in ADS. A neural network combined with LASSO feature selection demonstrated superior predictive performance, supporting its potential for individualized preoperative risk assessment and surgical planning.

Study DesignRetrospective cohort study.ObjectivesThis study aimed to compare the clinical efficacies of endoscopic surgery and nonsurgical treatment in patients with extruded or sequestered lumbar disc herniation (LDH).Population613 patients with extruded or sequestrated LDH were included (endoscopic: n = 276; nonsurgical: n = 337).MethodsPatients received either endoscopic discectomy or structured nonsurgical management. Longitudinal VAS and ODI trajectories were analyzed using linear mixed-effects models. Return to work (RTW) outcomes were evaluated using Kaplan-Meier survival curves and Cox proportional hazards models. Spearman correlation was used to assess the association between resorption and symptom improvement.ResultsBoth cohorts had comparable sex, BMI, and herniation levels (P > .05), but differed in age (P < .001), which did not influence outcomes after adjustment. VAS and ODI improved in both groups over time (P < .001). Endoscopic discectomy provided faster symptom relief within 6 months (P < .001), whereas mid to long-term outcomes were comparable between groups (P > .05). Disc resorption occurred in 58.2% of nonsurgical patients (median time 6.9 months). Resorption was correlated with greater improvements in ODI and VAS (P < .05). Surgical complications included transient neurological deficits (17.4%), dural tears (1.1%), and epidural hematomas (0.7%). Postoperative recurrence occurred in 8.3% of patients. RTW time was unaffected by treatment, sex, BMI, or herniation level (P > .05), but was influenced by age (HR = 0.948, P < .001) and occupational demands (HR = 0.697, P < .001).ConclusionsEndoscopic discectomy provides faster early pain and functional improvement (≤6 months), while nonsurgical management achieves comparable outcomes thereafter. Disc resorption contributes to symptom recovery. RTW time is determined primarily by age and occupational demands.

Study DesignUmbrella systematic review.ObjectiveTo qualitatively synthesise systematic reviews evaluating the prevalence, correlates, and outcomes of mental illnesses in individuals with traumatic spinal cord injury (tSCI).MethodsSystematic reviews reporting on depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorders (SUD), cognitive impairment, and related psychological outcomes in tSCI populations were identified and synthesized as per PRISMA guidelines. Data on prevalence, risk factors, assessment tools, and interventions were extracted. Methodological quality was appraised using AMSTAR 2, and primary study overlap was assessed.ResultsTwenty systematic reviews published between 2005 and 2025 were included. Depression was the most frequently studied condition (n = 16), followed by anxiety (n = 10), PTSD (n = 6), and SUD (n = 4), with several reviews addressing multiple conditions. Primary study sample sizes ranged from 3152 to over 50 000 participants, with wide variation in injury characteristics, study design, and outcome measures. Pooled prevalence estimates indicated a substantial burden: depression affected up to 43% of community-dwelling individuals, anxiety symptoms around 27%, PTSD up to 62%, and hazardous alcohol use ≥50% in some cohorts. Common risk factors included pain, injury severity, incomplete injury, low social support, maladaptive coping, and co-occurring psychological symptoms. Evidence for effective interventions was limited, and few studies used standardised, validated tools across settings.ConclusionsMental health conditions are highly prevalent in the tSCI population, yet intervention research remains limited. Standardised assessment, longitudinal designs, and targeted, evidence-based interventions are urgently needed to address this critical but under-recognised aspect of tSCI care.

Study designRetrospective single-center cohort study.ObjectiveTo investigate the predictive value of preoperative endplate Hounsfield unit (HU) measurements for cage subsidence (CS) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), and to propose threshold values for risk stratification.MethodsA total of 169 patients undergoing one- and two-level MI-TLIF with preoperative lumbar CT imaging were included. Endplate HU values were quantified within a 5-mm region of interest at the cage-endplate interface. Mild and severe CS was defined as 2-4 mm and ≥4 mm migration of the interbody cage into the adjacent vertebral endplate. Logistic regression analyses were employed to identify risk factors for CS.ResultsCS occurred in 39 of 464 endplates. Significantly lower L1 vertebral HU, reduced endplate HU at the surgical site, and obesity (BMI >25 kg/m²) were observed in the CS group. In multivariate analysis, obesity and endplate HU were independent predictor of CS (OR = 2.508; 95% CI, 1.135-5.546; OR = 0.989; 95% CI, 0.983-0.995). Among patients with L1 HU <117, those with endplate HU <221 had a significantly increased risk of CS (OR = 4.444; P = 0.0023). The area under the receiver operating characteristic curve for the combination of obesity (BMI >25 kg/m²) and endplate HU was 0.727 (95% CI 0.655-0.800).ConclusionsSurgical site endplate sclerosis at the surgical site may be a protective factor against CS following MI-TLIF. Preoperative endplate HU assessment may assist in identifying patients at risk of CS following MI-TLIF.

Study DesignRetrospective comparative study.ObjectiveNeuromuscular scoliosis (NMS) is a complex deformity requiring individualized surgical strategies focused on improving sitting balance and quality of life. This study aimed to evaluate the clinical efficacy and safety of multilevel asymmetrical Ponte osteotomy (MAPO) in NMS patients, compared to conventional posterior fusion without osteotomy.MethodsA retrospective review was conducted on 90 patients with NMS who underwent posterior spinal correction between 2015 and 2021. Patients were divided into a MAPO group (n = 52) and a control group (n = 38). Radiographic parameters and health-related quality of life (SRS-22) were assessed preoperatively, postoperatively, and at ≥2-year follow-up. Perioperative data, including operative time, blood loss, transfusion volume, and complications, were analyzed.ResultsBaseline characteristics were comparable. The MAPO group achieved significantly greater correction in major curve angle (49.75% vs 46.34%, P = 0.031), pelvic obliquity (25.26% vs 20.81%, P = 0.048), and sagittal vertical axis (33.99% vs 30.08%, P = 0.045). Postoperative satisfaction (4.43 ± 0.55 vs 4.11 ± 0.57, P = 0.026) and function scores (4.39 ± 0.48 vs 4.10 ± 0.61, P = 0.040) were also significantly higher in the MAPO group. However, MAPO was associated with longer operative time (311 vs 229 min, P < 0.001), greater blood loss (685 vs 289 mL, P < 0.001), and a trend toward increased complications, including wound issues and CSF leaks.ConclusionsMAPO offers improved deformity correction and higher patient satisfaction compared to non-osteotomy procedures in NMS, though with increased surgical complexity. It may serve as a valuable option for selected patients when balancing benefits and risks.

Study DesignRetrospective cohort study of a national database.ObjectivesThis study investigates the association between preoperative antidepressant use and postoperative opioid utilization as well as overall outcomes following primary anterior cervical fusion (ACF) and posterior cervical fusion (PCF).MethodsWe conducted parallel retrospective cohort analyses utilizing TriNetX for patients aged ≥18 years old with ≥2-year follow-up undergoing primary ACF and PCF between December 31, 2006, and December 31, 2022. Cohorts were thoroughly matched resulting in 4575 ACF and 3497 PCF pairs. Medical outcomes, opioid abuse, healthcare utilization, mechanical and surgical outcomes were assessed through risk ratios (RR), risk differences, P-values, and Kaplan-Meier analysis.ResultsAntidepressant use was associated with increased new opioid prescriptions from 2 weeks to 2 years (ACF RR 1.090-1.130, P < 0.001; PCF RR 1.060-1.078, P < 0.001), higher hospital readmissions (RR 1.484, P < 0.001), prolonged inpatient stays (RR 1.329, P < 0.001), and ED visits from 6 weeks to 2 years (ACF RR 1.150-1.184, P < 0.001; PCF RR 1.092-1.144, P ≤ 0.034). Postoperative infections were elevated at 2 years (ACF RR 1.679-2.060, P ≤ 0.008; PCF RR 1.375-1.677, P ≤ 0.020). Opioid abuse was higher at 2 years (ACF RR 2.8000, P = 0.003; PCF RR 2.667, P = 0.001), and pulmonary embolism increased in ACF at 2 years (RR 1.633, P = 0.032). Reoperations were elevated at 1 and 2 years (RR 1.238-1.371, P ≤ 0.045), with reduced 2-year reoperation-free survival in ACF (P = 0.001) and PCF (P = 0.045).ConclusionPreoperative antidepressant use is associated with significantly increased risks of postoperative opioid utilization and both medical and surgical complications, including sepsis, infections, adjacent segment disease, and reoperations, up to 2 years after primary anterior or posterior cervical fusion.

Study DesignRetrospective cohort study.ObjectiveDialysis dependent patients have been found to have greater healthcare utilization, rates of postoperative complications, and mortality after cervical spine surgery. However, there is a gap in the literature investigating the impact of dialysis dependency on outcomes after posterior cervical decompression and fusion (PCDF) specifically. To compare perioperative outcomes in dialysis-dependent and non-dialysis-dependent patients after PCDF from 2016 to 2022 using the National Inpatient Sample (NIS) database.MethodsThe NIS was queried for adult patients who were dialysis dependent and underwent PCDF between 2016 and 2022. Data regarding demographics, comorbidities, cost, discharge disposition, hospital characteristics, adverse events, and mortality were collected. Survey-weighted chi-square tests and t-tests were used to compare groups. A multivariable regression was performed to determine whether dialysis dependency was independently predictive of complications, discharge disposition, and inpatient mortality.ResultsOf the 167,995 weighted PCDF admissions identified, 1080 (0.64%) were dialysis dependent. Dialysis patients were more frequently male (66.2% vs 53.0%; P < 0.001), Black (44.4% vs 12.8%; P < 0.001), and from distressed communities. Dialysis dependency was independently associated with increased odds of cardiovascular complications (OR 2.52, 95% CI 1.87-3.41, P < 0.001), sepsis (OR 2.68, 95% CI 1.17-6.15, P = 0.020, and non-routine discharge (OR 1.45, 95% CI 1.05-1.99, P = 0.022). Inpatient mortality was greater in our dialysis dependent cohort (1.9% vs 0.3% P < 0.001).ConclusionDialysis dependency causes increased morbidity, healthcare utilization, and mortality in patients undergoing PCDF. These findings highlight a need for more judicial surgical selection and perioperative management in patients with this comorbidity.Level of EvidenceIII.