Spine最新文献

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: Systematic review and proportional meta-analysis.

Objective: To assess total and specific complication rates associated with lumbar biportal endoscopic spine surgery (BESS).

Summary of background data: In recent years, BESS has emerged as an effective minimally invasive technique for treating lumbar spine conditions, offering benefits such as reduced tissue damage and improved outcomes. However, the safety of BESS across lumbar pathologies is underexplored, with complication rates reported up to 50%.

Methods: We registered on PROSPERO (CRD42024570377) and systematically searched PubMed, Medline, Embase, and Cochrane Library (Jan 2013-Mar 2024) per PRISMA guidelines. Studies were included if they focused on lumbar BESS in cohorts of at least 10 adult patients and provided extractable complication data. We excluded conference abstracts, reviews, meta-analyses, non-English studies, and those using microendoscopic, lateral, or oblique approaches. A random-effects model was used to pool complication rates, and study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Analyses were performed in R Studio.

Results: Seventy-five studies with 4404 patients (sample sizes 10-797) were included. Most studies were retrospective and geographically concentrated in China and Korea. Patients ranged from 27.6 to 80 years old, with 51.8% being male, and follow-up durations spanned from 3 to 27.5 months. The overall pooled complication rate for lumbar BESS was 7.75% (95% CI: 5.97%, 10.01%). Specific complication rates included dural tears (2.64%), nerve palsies (1.33%), postoperative hematomas (1.80%), surgical site infections (0.20%), and surgical revisions (1.68%). Total complication rates showed significant heterogeneity (I²=82.0%, P <0.01), while specific complications exhibited low to moderate heterogeneity.

Conclusions: Lumbar BESS has a low overall complication rate of 7.75%, with dural tears and nerve palsies being the most common. Results should be interpreted with caution due to significant heterogeneity. Future research should explore risk factors of specific complication types and compare long-term outcomes with traditional methods.

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.

Study design: Retrospective cohort.

Objective: To assess the relationship between long-term gabapentinoid use and outcomes after lumbar fusion.

Summary of background data: Gabapentinoids, which include gabapentin and pregabalin, are commonly prescribed for radiculopathic pain. Basic science research has indicated that gabapentinoids may be detrimental to bone health/healing and clinical works has shown that initiating gabapentinoids at the time of spine surgery may decrease postoperative opioid requirements and increase risks of adverse outcomes. Despite these findings, no literature exists examining the impact of chronic gabapentinoid prescriptions on outcomes after lumbar fusion.

Materials and methods: Adult patients who underwent elective one/two-level lumbar fusion (2017-2022) were identified through Structured Query Language search. Patient demographic/surgical characteristics, surgical outcomes, patient-reported outcome measures (PROMs), and preoperative gabapentinoid use were collected. Perioperative opioid data were collected utilizing the Pennsylvania Prescription Drug Monitoring Program. Appropriate statistical analyses were conducted with alpha set at 0.05.

Results: Among 461 included patients, 47 (10.2%) and 61 (13.2%) were chronically prescribed pregabalin and gabapentin, respectively. All groups were similar in terms of demographics, and surgical type/complexity. There were no differences in surgical outcomes, including two-year revision rate. Patients taking pregabalin consumed more total MMEs compared with gabapentin (132±344 vs. 104±351, P =0.022) and nongabapentinoid patients (132±344 vs. 90.3±267, P =0.007). However, preoperative total MMEs were similar 60 days before surgery. Bivariate analysis demonstrated postoperative differences in back pain improvement at six months ( P =0.025) between groups; however, pairwise comparison did not show significance. Similarly, multivariate analysis did not show gabapentinoid usage as independently predictive of back pain scores. All other PROM comparisons were similar between groups.

Conclusion: Despite compelling basic science literature suggesting gabapentinoid exposure hindering bone health and healing capacity, the current investigation did not find an increase in surgical revision or other adverse outcomes, including opioid use and PROMs, associated with chronic preoperative gabapentinoid use.

Study design: Systematic review and meta-analysis of school-based AIS screening programs.

Objective: To determine the prevalence, diagnostic performance, clinical impact, and cost burden of routine school screening for adolescent idiopathic scoliosis.

Background: The rationale for routine screening is that curves detected before skeletal maturity respond to bracing, reduce progression, and avert costly fusion, yet controversy persists regarding false positives, radiation exposure, and program affordability across health care systems.

Materials and methods: Databases searched were PubMed, Embase, Scopus, Web of Science, and Cochrane Central from inception to February 2025. Inclusion criteria were asymptomatic pupils aged 10 to 16 screened at school and reporting prevalence, test accuracy, treatment, or cost. Data were pooled with random effects models, heterogeneity was assessed by I 2 , and currency was expressed as US dollars.

Results: Thirty-four studies covering 2.8 million pupils met the inclusion criteria. Prevalence was 0.66% for curves over 10°, 0.33% over 20, and 0.02% over 40. Screening tests gave sensitivity 74% to 100% and specificity 80% to 99%, negative predictive value approached 100%, and positive predictive value approached 4% to 80%. Screen-detected adolescents showed a mean Cobb 28° versus 40° in usual care, with 73% lower fusion odds. Numbers needed to screen to start bracing ranged from 448 to 2234. Costs were 0.47 to 55 dollars per pupil, and most economic models predicted net savings despite heterogeneity.

Conclusions: School-based screening reliably detects AIS at milder stages, is associated with lower surgical rates, and can be economically defensible under well-designed, multistep protocols. Nevertheless, wide variations in prevalence, screening methods, and cost frameworks highlight the need for standardized programs and contemporary economic evaluations to optimize benefit while minimizing unnecessary referrals and radiation exposure.