Spine最新文献

Study design: Retrospective cohort study.

Objectives: In adult spinal deformity (ASD) surgery patients, we sought to:1)report preoperative/postoperative lordosis apex, number-of-vertebrae in lower/upper lordosis arc, and inflection point, and 2)determine their impact on postoperative outcomes.

Summary of backgrounds data: Impact of lordosis apex, arcs, and inflection point on postoperative outcomes remains unclear.

Methods: ASD patients (2009-2021) with ≥5-level fusion, sagittal/coronal deformity, and ≥2-year follow-up was analyzed. Primary exposures were pre/postoperative lordosis apex, vertebrae in upper/lower arcs, and inflection point. Outcomes included mechanical complications, reoperations, patient-reported outcome measures, and postoperative alignment. Multivariable regression controlled for age, body mass index (BMI), and comorbidities.

Results: Among 202 patients (mean age:64.4±16.7 y,77.2% females): Lordosis Apex: Most common preoperative apex was L5(32.7%), followed by L4(20.3%). Postoperatively, 125(61.9%) had an apex change-89(71%) cranially-directed and 36(29%) caudally-directed. Cranially shifts led to 6.3±14.1° decrease in L4-S1 lordosis, caudal change showed 3.7±13.9° increase(P=0.002). Lordosis Arcs: Mean vertebrae in lower and upper lordotic arcs were 1.4±1.0 and 2.6±1.1, which postoperatively increased by 0.2±0.8 and 0.5±1.5(P=0.043), respectively. Greater increase in upper-arc vertebrae correlated with higher 2-year numeric rating scale (NRS)-back pain (ρ=0.020,P=0.030;β=0.40, 95%CI:0.03-0.78,P=0.036). Inflection Point: Preoperatively, 86(42.6%) patients had a T12/L1 inflection point, of which 72(83.7%) remained at T12/L1 postoperatively. Of 116(57.4%) patients with inflection point above/below T12/L1, 59(50.9%) transitioned to T12/L1 postoperatively. Preoperative inflection point above/below T12/L1 was linked to more spinopelvic complications (38.8% vs. 22.1%,P=0.012;OR=0.49, 95%CI:0.25-0.94,P=0.033). Postoperative T12/L1 inflection was associated with higher radiographic proximal junctional kyphosis (PJK) (56.0% vs. 40.8%,P=0.041;OR=1.96, 95%CI=1.03-3.72,P=0.040).

Conclusion: After ASD surgery, most patients showed a cranial lordotic apex shift, with greater increase in upper than lower arc vertebrae-highlighting the difficulty of restoring lordosis caudally. Cranial apex shift was associated with smaller L4-S1 lordosis and greater 2-year back pain, while a preoperative inflection point outside T12/L1 increased the risk of spinopelvic complications. Incorporation of Roussouly principles may help spine surgeons improve outcomes and mitigate complications.

Study design: Retrospective study.

Objective: To determine the prevalence of new chronic pain conditions within one-year of whiplash and factors associated with chronic pain following whiplash exposure.

Summary of background data: Whiplash is among the most common injuries that occur following motor vehicle accidents. Many have postulated that whiplash is a progenitor for the development of chronic pain. Prior research in this arena has been limited.

Methods: We retrospectively identified TRICARE beneficiaries who sustained a whiplash injury between 2017-2023. The records of eligible beneficiaries were abstracted to obtain age at the time of injury, race, sex, US census region, sponsor rank, mental health diagnoses, environment of care, beneficiary status, time-period of injury and number of co-morbidities. We considered junior enlisted sponsor rank indicative of lower socioeconomic strata. The primary outcome was development of a chronic pain condition. We used multivariable logistic regression with re-weighting to account for confounders. We examined interactions between sex/mental health conditions, sex/socio-economic status and sex/time-period to address secular trends.

Results: The development of new chronic pain conditions occurred in 23.4%. After adjusting for confounders, we found that women (OR 1.57, 95% CI 1.49, 1.65), pre-existing mental health conditions (OR 1.35; 95% CI 1.28, 1.42) and our proxy for lower socioeconomic status (OR 1.15; 95% CI 1.04, 1.27) were significantly associated with the likelihood of developing chronic pain disorders within 1-year of whiplash injury. There were interactions between women and mental health conditions, as well as women and socio-economic status.

Conclusions: This represents the largest study that longitudinally surveys for the development of chronic pain conditions following whiplash. The incidence of chronic pain after whiplash is lower than has been previously postulated. We believe these findings can inform management in the post-injury time-period and recommendations for surveillance.

Study design: Multi-center retrospective cohort study.

Objective: To investigate whether preoperative cervical extension range of motion (eROM) and flexion range of motion (fROM) predict postoperative kyphotic change and affect clinical outcomes after laminoplasty for degenerative cervical myelopathy (DCM).

Summary of background data: Cervical laminoplasty is a standard procedure for DCM; however, postoperative kyphotic change due to loss of cervical lordosis (CL) is a major concern. Although small eROM and large fROM may predict postoperative CL loss, their impact on clinical outcomes is unclear.

Methods: We analyzed 147 patients with DCM ≥60 years who underwent C3-C6 laminoplasty with ≥2 years of follow-up. Radiographic parameters (CL, eROM, and fROM) were measured pre- and postoperatively. Kyphotic change was defined as CL loss ≥10°. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) for neck pain, EuroQol 5-dimension 5-level instrument (EQ-5D-5L), and Neck Disability Index (NDI). Logistic regression was used to identify predictors of kyphotic change, and clinical outcomes were compared between predictor-defined groups up to 2 years postoperatively.

Results: Kyphotic change occurred in 35 patients (23.8%) at 2 years postoperatively. Logistic regression revealed that small eROM (≤9°) and large fROM (≥37°) independently predicted postoperative kyphotic change at 1 and 2 years postoperatively. Its incidence in the small eROM and large fROM groups was significantly higher than that in their respective counterpart groups. No significant group differences were found in JOA score, VAS for neck pain, EQ-5D-5L, or NDI changes.

Conclusion: Preoperative small eROM and large fROM independently predicted postoperative kyphotic change after laminoplasty for DCM. However, these factors did not negatively affect neurological recovery, neck pain, quality of life, or cervical function for up to 2 years postoperatively. Laminoplasty remains an effective option for patients with DCM with eROM ≤9° or fROM ≥37°, despite potential CL loss.

Level of evidence: III.

Study design: Prospective Cohort Study.

Objective: To establish a simple and clinically available paraspinal muscle and bone density (PMBD) score to predict mechanical complications after lumbar fusion.

Summary of background data: Mechanical complications are common issues in posterior lumbar interbody fusion (PLIF). Current evaluations are often unidimensional and complex, with lack of clinical relevance for treatment.

Methods: The study analyzed a cohort of 255 patients (165 women and 90 men) followed for at least 1 year after posterior lumbar interbody fusion. The PMBD score comprised 3 parameters identified by binary logistic regression analysis: paraspinal muscle endurance and morphology (PMEM) score, L1 vertebral body computed tomography Hounsfield Units value (L1CT), and age. The statistical weights of each parameter were created by rounding odds ratios (OR) to the nearest integer. The predictive performance of the PMBD score was evaluated by the area under the receiver operating characteristic curve (AUC).

Results: 53 patients (20.7%) experienced mechanical complications. The PMBD score ranged from 0 to 4. Patients with higher PMBD score exhibited higher rates of mechanical complications (P<0.001). Binary logistic regression revealed that the PMBD score was an independent factor of mechanical complications (P<0.001). The AUC of the score was 0.818, significantly higher than PMEM score (AUC=0.761, P<0.05), L1CT (AUC=0.690, P<0.05), and age (AUC=0.634, P<0.05). Sensitivity of PMBD was 0.714 (30/42) and specificity was 0.822 (175/213). In terms of the PMBD categories, patients were categorized as low (0-1 score), moderate (2 score), high risk (3-4 score) with a progressive complications rate (7.0%, 31.1%, and 62.5%, P<0.001).

Conclusion: The PMBD score was a practical assessment tool integrating muscle and bone density to predict mechanical complications after PLIF, with a superior predictive performance compared to previous evaluation methods. Surgeons could utilize the PMBD score for preoperative risk stratification and might formulate individualized surgery procedure.

Study design: Multicenter prospective study.

Objective: The present study investigates in-construct measurements of sagittal angles (SA) within the fusion from C2 to various thoracic vertebrae, which can be used as targets for CD correction.

Summary of background data: Correcting cervical deformity (CD) has the potential to significantly improve patient function. However, previously described radiographic parameters cannot be measured intraoperatively.

Methods: Patients with CD that had a LIV at T1 or caudal were included. Patients were categorized into the failed outcome group if they had a cSVA of more than 4 cm within 3 months postoperatively. The in-construct measurements were based on patients' LIV. All patients had a C2-T1 SA. C2-T4 SA were compared between groups with LIV below T4, and C2-T10 SA between groups with LIV below T10. Change in C2-LIV SA described the correction within the fusion for each patient. Linear regression analysis was used to determine the C2-T1, C2-T4, C2-T10 SA measures corresponding to a cSVA = 4 cm.HRQL analysis was done in patients with 1-year follow-up.

Results: Among 143 patients (mean age 63, 60% female), 51% had radiographic failure. Multivariate regression showed that postoperative C2-T1 SA independently predicted failed alignment (OR = 1.22, CI 1.10-1.35; P < 0.001). A cSVA of 4 cm correlated with a C2-T1 SA of -9.6° and C2-T10 SA of 14.7° (r > 0.38, P < 0.05). ΔDJKA was found to significantly correlated with the C2-T10 SA (r > 0.57, P = 0.02). Though HRQL outcomes did not differ significantly between groups, greater C2-LIV SA correction was associated with improved neck pain (r > 0.42, P = 0.036).

Conclusion: Failure to restore cSVA and development of DJK was independently associated with under correction as evidenced by significantly larger postoperative in-construct angles.

Study design: Retrospective cohort study.

Objective: To investigate the association between postoperative complications after ALIF and prior abdominal surgery.

Summary of background data: Anterior lumbar interbody fusion (ALIF) is a common spinal surgery associated with a variety of complications. Previous abdominal surgery is thought to influence the rate at which these postoperative complications occur.

Methods: Using PearlDiver, patients were identified who had undergone an ALIF from 2010 to 2024. Patients were separated based on surgical history (cesarean section, non-obstetric abdominal surgery, any abdominal surgery or no prior abdominal surgery). Complications were measured (30 d, 90 d, 1 y). Univariate and multivariate logistic regression were performed. Significance was set at P<0.05.

Results: Among 1,123,841 ALIF patients, complications occurred in 2.6% at 30 days, 3.5% at 90 days, and 5.4% at 1 year. On unadjusted analysis, prior non-obstetric abdominal surgery (ABD) or any abdominal surgery (ANYABD) more than doubled complication risk (1-year OR 2.3, 95% CI 2.2-2.4; P<0.0001), while cesarean section (CSEC) showed no significant increase (OR 1.16, 95% CI 0.99-1.35; P=0.07). After adjusting for age, sex, and comorbidities, no significant differences remained. Comorbidity burden (ECI) emerged as the strongest predictor (OR 1.08, 95% CI 1.07-1.09; P<0.0001).

Conclusions: While complications after ALIF are not uncommon, prior studies have suggested a higher risk among patients with a history of abdominal surgery. While raw complication rates appear significantly higher in patients with prior abdominal surgery, these differences become nonsignificant once comorbidity burden is adjusted for. Our findings demonstrate that prior abdominal surgery itself does not independently increase postoperative complications, rather, patients with prior abdominal operations tend to have a greater comorbidity burden, which likely explains their higher unadjusted complication rates.

Study design: Retrospective two-center external validation study conducted at two medical centers, collecting cervical spine MRI data from patients suspected of degenerative cervical myelopathy (DCM) between March 2022 and August 2024, forming a consecutive series with external validation.

Objective: To develop and validate a deep learning model utilizing YOLO11 architecture for automated detection of cervical spinal cord compression on MRI and evaluate its performance against expert annotations.

Summary of background data: DCM represents the leading cause of non-traumatic spinal cord injury in adults. While MRI facilitates early detection and provides the foundation for timely intervention, image interpretation remains subjective and dependent on physician experience, resulting in diagnostic variability and challenges in clinical consistency.

Methods: A YOLO11-based deep learning model was implemented with binary classification scheme (Normal vs. Compression). Five physicians annotated 1,431 sagittal T2-weighted cervical MRI images from 735 patients using standardized protocols, achieving excellent inter-observer agreement. Dataset comprised training/validation sets (577 patients, 1,141 images), internal test set (64 patients, 115 images), and external test set (94 patients, 175 images). Five-fold cross-validation assessed model robustness. Standardized preprocessing incorporating contrast enhancement, noise reduction, and normalization was applied. Gradient-weighted Class Activation Mapping enhanced model interpretability.

Results: Five-fold cross-validation yielded consistent performance with mAP50 ranging from 0.917 to 0.970, precision from 0.897 to 0.923, and recall from 0.922 to 0.946. External testing demonstrated statistically superior agreement with expert annotations (mAP50=0.944, 95% CI: 0.934-0.953) compared to mid-level physician annotations (mAP50=0.912, 95% CI: 0.908-0.919), with the difference being statistically significant (95% CI of difference: 0.015-0.043, P < 0.05).

Conclusion: The YOLO11-based model demonstrated stable two-center performance with close alignment to expert-level clinical standards. The rapid inference, high sensitivity, and integrated visualization system address key challenges related to efficiency and interpretability in clinical AI applications for cervical spinal cord compression assessment.

Study design: Retrospective Cohort Study.

Objective: To assess long-term changes in spinopelvic alignment following single-level lumbar fusion.

Summary of background data: Restoration of sagittal balance is known to influence outcomes in adult deformity surgery, but its relevance after short-segment fusion for degenerative disease remains uncertain. The durability of spinopelvic parameters after single-level fusion is not well defined.

Methods: Adult patients who underwent primary single-level fusion between L4-S1 (2010-2019) were retrospectively identified. Standing lateral radiographs were analyzed at baseline, immediately postoperatively, and at 6 months, 1 year, and 2-3 years. Parameters included lumbar lordosis (LL), segmental lordosis (SL), disc height (DH), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and PI-LL mismatch. Sagittal imbalance was defined as PT >20° or PI-LL >10°. Data were analyzed with t-tests or Mann-Whitney U tests as appropriate, and stepwise regression modeling identified predictors of imbalance.

Results: A total of 413 patients (mean age 62 y, 53% female) met inclusion criteria. SL decreased progressively, with a greater decline at 2-3 years than at 6 months (-1.48° versus -0.64°, P=0.028). Changes in LL, DH, SS, and PT were minimal across follow-up intervals. The proportion of patients with PI-LL mismatch >10° declined from 40.9% immediately postoperatively to 31.0% at 2-3 years (P <0.001). Similarly, PT >20° decreased from 67.6% to 56.9% (P <0.001). Despite these modest improvements, over half of patients remained imbalanced at final follow-up. Regression analysis showed that older age and greater number of decompressed levels were associated with persistent imbalance.

Conclusions: After single-level lumbar fusion, sagittal parameters stabilize by 6 months, with slight compensatory improvement thereafter. Most patients, however, continue to demonstrate imbalance, and the clinical significance of correcting spinopelvic parameters in focal degenerative disease remains uncertain.

Study design: Meta-Analysis.

Objective: The purpose of this meta-analysis is to appraise the evidence comparing surgical outcomes with and without preoperative embolization.

Background: Hypervascular tumors present a surgical challenge, due to their substantial intraoperative blood loss. Although preoperative embolization is often employed to mitigate intraoperative bleeding, its consistent advantage has not been conclusively demonstrated across existing studies.

Methods: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were accessed and explored until May 2025. Articles were included if they reported comparative studies evaluating perioperative outcomes of preoperative embolization (E) versus no embolization (NE) in the surgical treatment of hypervascular spinal tumors. A sub-analysis was performed based on whether studies reported no statistically significant difference in surgical invasiveness between the two groups.

Results: Fifteen studies met the inclusion criteria, including 225 patients in group NE and 340 in group E. When all studies were analyzed collectively, no significant differences were observed between the NE group and E group for any of the outcomes. However, in the subgroup of studies that reported no statistically significant differences in surgical invasiveness, there was no significant difference in blood loss (P=0.75) between the NE group and E group. In contrast, in the other subgroup of studies, the NE group showed greater blood loss (mean difference=283.08 mL; 95% CI: 2.21-563.95, P=0.05,).

Conclusion: Pre-operative embolization was not associated with consistent benefits in surgical outcomes for hypervascular spinal tumors. While some studies reported reduced blood loss with embolization, these findings were limited to analyses lacking control for specific surgical characteristics. This suggests that the perceived advantages may reflect confounding factors rather than the true effect of embolization. However, surgical equipoise remains and the decision to embolize should be individualized based on surgical and patient-related factors.

Level of evidence: III.

Study design: Retrospective analysis using the MarketScan private insurance database from 2010 to 2020.

Objective: Determine the incidence of multiple revision cervical surgeries at 5 years following primary, single-level anterior cervical discectomy and fusion (ACDF) and assess the risk of subsequent revisions after the first and second surgeries.

Background: The rate of revision surgery after ACDF is well-documented, but data on multiple revision surgeries are limited.

Materials and methods: Adult patients 65 years or younger undergoing primary, single-level ACDF were identified. Patients with infectious, traumatic, or neoplastic etiologies were excluded. The primary endpoint was any revision cervical surgery with follow-up ending at 5 years. Kaplan-Meier and Cox proportional hazards regression were used, adjusting for sex, age, Charlson Comorbidity Index, and region.

Results: A total of 42,845 patients undergoing primary, single-level ACDF (P) were included, with a mean age of 48.9 years (SD: 9.0); 52.8% were females. The "first revision" (R1) group included 2374 patients, and the "second revision" (R2) group had 195 patients. The mean revision-free follow-up was significantly different across the P, R1, and R2 groups, though with small absolute differences (P 2.2 yr, R1 2.0 yr, R2 2.0 yr; P < 0.0001). At 5 years postoperatively, the incidence of revision surgery was 10.8% after primary surgery, 24.1% after 1 revision, and 42.5% after 2 revisions. In multivariable Cox regression, the risk of subsequent revision surgery was significantly higher after one revision (HR: 1.6 vs . primary, P < 0.0001) and even more so after 2 revisions (HR: 2.6 vs . primary, P < 0.0001). Interval hazard analysis showed a significantly higher incidence of revision from 2 to 5 years with each subsequent revision (all P < 0.05).

Conclusion: After primary ACDF in patients younger than 65 years, approximately 10% underwent revision at 5 years postoperatively. The occurrence of subsequent revision surgery was higher; >20% after 1 revision, and >40% after 2 revisions, which is critical for patient decision-making.

Level of evidence: Level III.