Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100671
Dinh Thao Trinh MD , JiannHer Lin MD
BACKGROUND CONTEXT
Despite advances in surgical techniques, a portion of patients do not achieve the minimal clinically important difference (MCID) after lumbar spine surgery. Identifying factors and causes behind this is key to improving outcomes.
PURPOSE
To investigate clinical factors associated with failure to achieve MCID and potential causes.
STUDY DESIGN/SETTING
A retrospective cohort study
PATIENT SAMPLE
Patients who underwent minimally lumbar spine surgery at one hospital in Taiwan from June 2016 to June 2023.
OUTCOME MEASURES
The Oswestry Disability Index (ODI), RAND 36-item Short Form Health Survey (SF-36), and Minimal Clinically Important Difference (MCID)
METHODS
Pre-operative and post-operative one-year clinical data were collected for analysis. The MCID was determined by calculating the change in score of the SF-36 PCS with a cut-off of 4.9 or ODI with a cut-off of 12.8. Medical records and images of non-MCID achievement cases were reviewed by two spine surgeons to identify the causes.
RESULTS
Thirty-three patients (15.3%) did not reach MCID. In multivariate analysis, lower preoperative ODI scores (OR=1.09, 95%CI 1.04-1.14, p < 0.001), higher postoperative VAS for leg sng or soreness (OR=0.72, 95%CI 0.57-0.92, p=0.008), lower postoperative mental health scores (MCS) (OR=1.12, 95%CI 1.04-1.21, p=0.003) and had grade 3 lateral stenosis (OR= 14.84, 95%CI 4.34-50.74) were risk factors of non-MCID achievement. Among non-MCID achievement patients, 97% had chronic postsurgical pain. Causes of non-MCID achievement included preoperative diagnostic doubts (21.2%), recurrence/complications (21.2%), psychological disorders (3%), and idiopathic persistent pain (51.6%). The prevalence of grade 3 lateral stenosis was significantly higher in patients with idiopathic persistent leg pain than in those with idiopathic persistent back pain.
CONCLUSIONS
This study highlights that preoperative ODI, postoperative mental status, leg Sng (soreness), and especially lateral stenosis significantly impact the achievement of MCID after lumbar spine surgery. Chronic post-surgical pain is the leading cause of patient dissatisfaction, with over fifty percent experiencing idiopathic persistent pain, primarily in leg.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"P47. Lateral stenosis as a predictor of MCID achievement and chronic pain following lumbar spine surgery: a retrospective cohort study","authors":"Dinh Thao Trinh MD , JiannHer Lin MD","doi":"10.1016/j.xnsj.2025.100671","DOIUrl":"10.1016/j.xnsj.2025.100671","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Despite advances in surgical techniques, a portion of patients do not achieve the minimal clinically important difference (MCID) after lumbar spine surgery. Identifying factors and causes behind this is key to improving outcomes.</div></div><div><h3>PURPOSE</h3><div>To investigate clinical factors associated with failure to achieve MCID and potential causes.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective cohort study</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent minimally lumbar spine surgery at one hospital in Taiwan from June 2016 to June 2023.</div></div><div><h3>OUTCOME MEASURES</h3><div>The Oswestry Disability Index (ODI), RAND 36-item Short Form Health Survey (SF-36), and Minimal Clinically Important Difference (MCID)</div></div><div><h3>METHODS</h3><div>Pre-operative and post-operative one-year clinical data were collected for analysis. The MCID was determined by calculating the change in score of the SF-36 PCS with a cut-off of 4.9 or ODI with a cut-off of 12.8. Medical records and images of non-MCID achievement cases were reviewed by two spine surgeons to identify the causes.</div></div><div><h3>RESULTS</h3><div>Thirty-three patients (15.3%) did not reach MCID. In multivariate analysis, lower preoperative ODI scores (OR=1.09, 95%CI 1.04-1.14, p < 0.001), higher postoperative VAS for leg sng or soreness (OR=0.72, 95%CI 0.57-0.92, p=0.008), lower postoperative mental health scores (MCS) (OR=1.12, 95%CI 1.04-1.21, p=0.003) and had grade 3 lateral stenosis (OR= 14.84, 95%CI 4.34-50.74) were risk factors of non-MCID achievement. Among non-MCID achievement patients, 97% had chronic postsurgical pain. Causes of non-MCID achievement included preoperative diagnostic doubts (21.2%), recurrence/complications (21.2%), psychological disorders (3%), and idiopathic persistent pain (51.6%). The prevalence of grade 3 lateral stenosis was significantly higher in patients with idiopathic persistent leg pain than in those with idiopathic persistent back pain.</div></div><div><h3>CONCLUSIONS</h3><div>This study highlights that preoperative ODI, postoperative mental status, leg Sng (soreness), and especially lateral stenosis significantly impact the achievement of MCID after lumbar spine surgery. Chronic post-surgical pain is the leading cause of patient dissatisfaction, with over fifty percent experiencing idiopathic persistent pain, primarily in leg.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100671"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100726
Chao-Hung Kuo MD, PhD
BACKGROUND CONTEXT
This study investigates the clinical and radiological outcomes of skip-level cervical surgeries, comparing cervical arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) approaches in treating noncontiguous cervical degenerative disc disease. It focuses on the incidence of adjacent segment disease (ASD) and evaluates the motion-preserving efficacy of CDA in this context.
PURPOSE
N/A
STUDY DESIGN/SETTING
A retrospective analysis was conducted on 70 patients with non-contiguous cervical degenerative disc disease who underwent skip-level anterior cervical surgeries (37 ACDF and 33 CDA cases). Demographic, clinical, and radiological data were assessed over a 2-year follow-up period. Cervical lordosis, range of motion (ROM), and ASD rates were compared between the two groups. Statistical analyses were performed to determine significant differences.
PATIENT SAMPLE
A total of 70 patients with noncontiguous cervical degenerative disc disease who underwent skip-level anterior cervical surgeries (37 ACDF and 33 CDA cases) were included.
OUTCOME MEASURES
Demographic, clinical, and radiological data were assessed over a 2-year follow-up period. Cervical lordosis, ROM, and ASD rates were compared between the two groups. Statistical analyses were performed to determine significant differences.
METHODS
N/A
RESULTS
The ASD rate was significantly lower in the CDA group (18.2%) compared to the ACDF group (40.5%, p = 0.04). Postoperative cervical ROM and skip-level ROM were significantly higher in the CDA group than in the ACDF group (p = 0.01 and p = 0.04, respectively). Both techniques restored cervical lordosis, but the fusion group exhibited a significant reduction in overall cervical ROM (p = 0.01), unlike the CDA group, which preserved motion.
CONCLUSIONS
Skip-level CDA is a motion-preserving surgical alternative with a lower ASD incidence and better cervical and skip-level ROM compared to ACDF. These findings highlight the benefits of CDA in addressing the challenges of non-contiguous cervical degenerative disc disease while maintaining cervical mobility. Future prospective studies are recommended to validate these results.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"32. Comparative outcomes of skip-level cervical arthroplasty and fusion in noncontiguous cervical degenerative disc disease","authors":"Chao-Hung Kuo MD, PhD","doi":"10.1016/j.xnsj.2025.100726","DOIUrl":"10.1016/j.xnsj.2025.100726","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>This study investigates the clinical and radiological outcomes of skip-level cervical surgeries, comparing cervical arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) approaches in treating noncontiguous cervical degenerative disc disease. It focuses on the incidence of adjacent segment disease (ASD) and evaluates the motion-preserving efficacy of CDA in this context.</div></div><div><h3>PURPOSE</h3><div>N/A</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective analysis was conducted on 70 patients with non-contiguous cervical degenerative disc disease who underwent skip-level anterior cervical surgeries (37 ACDF and 33 CDA cases). Demographic, clinical, and radiological data were assessed over a 2-year follow-up period. Cervical lordosis, range of motion (ROM), and ASD rates were compared between the two groups. Statistical analyses were performed to determine significant differences.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 70 patients with noncontiguous cervical degenerative disc disease who underwent skip-level anterior cervical surgeries (37 ACDF and 33 CDA cases) were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>Demographic, clinical, and radiological data were assessed over a 2-year follow-up period. Cervical lordosis, ROM, and ASD rates were compared between the two groups. Statistical analyses were performed to determine significant differences.</div></div><div><h3>METHODS</h3><div>N/A</div></div><div><h3>RESULTS</h3><div>The ASD rate was significantly lower in the CDA group (18.2%) compared to the ACDF group (40.5%, p = 0.04). Postoperative cervical ROM and skip-level ROM were significantly higher in the CDA group than in the ACDF group (p = 0.01 and p = 0.04, respectively). Both techniques restored cervical lordosis, but the fusion group exhibited a significant reduction in overall cervical ROM (p = 0.01), unlike the CDA group, which preserved motion.</div></div><div><h3>CONCLUSIONS</h3><div>Skip-level CDA is a motion-preserving surgical alternative with a lower ASD incidence and better cervical and skip-level ROM compared to ACDF. These findings highlight the benefits of CDA in addressing the challenges of non-contiguous cervical degenerative disc disease while maintaining cervical mobility. Future prospective studies are recommended to validate these results.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100726"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100736
Thippatai Chaichompoo MD , Woraphot Wichan MD
BACKGROUND CONTEXT
Currently, minimally invasive spine surgery is favored by surgeons because of its favorable surgical outcomes and the ability for patients to quickly resume their normal activities. Many surgeons from different institutions have stated that both uniportal and biportal approaches for endoscopic TLIF surgery are equally effective compared to micro TLIF or open TLIF surgery. TLIF endoscopic surgery necessitates advanced surgical expertise and specialized endoscopic equipment, which includes costly materials in comparison to typical open TLIF surgery with a mini-incision of 4.0 cm. Which procedure is superior?
PURPOSE
This study has conducted a comparative study between open mini-incision TLIF (4.0 cm) versus hybrid endoscopic TLIF.
STUDY DESIGN/SETTING
Retrospective study.
PATIENT SAMPLE
A total of 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023.
OUTCOME MEASURES
Visual analog scale (VAS) leg (pain) and back (pain), on the first day after surgery, the day of discharge, and 3 months after. ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Surgical data, including information on the duration of surgery surgery, blood loss, complications, pain medication, and postoperative hospitalization.
METHODS
This is a retrospective study that included 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023. The patients were categorized into two groups based on the surgical techniques used: the open TLIF group (n = 34) and the hybrid endoscopic TLIF group (n = 29). The study selected individuals with symptomatic and unstable spondylolisthesis of the lumbar spine while excluding those diagnosed with cancer or infection. By collecting general data, including gender, age, underlying disease, body mass index (BMI), and smoking status, we will collect information on symptoms before and after surgery, such as leg VAS (pain) and back VAS (pain), on the first day after surgery, the day of discharge, and 3 months after. Collection of ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Data was collected during the surgery, including information on the duration of surgery, blood loss, complications, pain medication, and postoperative hospitalization.
RESULTS
A total of 63 patients were enrolled. There were no statistically significant differences in mean ages, genders, BMI, intraoperative blood loss, painkiller usage, or length of hospital stay between the two groups (P > 0.05). Nevertheless, the mean operative time was significantly less in the open TLIF group compared to the hybrid en
{"title":"42. Comparative study between open mini-incision TLIF (4.0 cm) vs hybrid endoscopic TLIF; surgical and early clinical results report","authors":"Thippatai Chaichompoo MD , Woraphot Wichan MD","doi":"10.1016/j.xnsj.2025.100736","DOIUrl":"10.1016/j.xnsj.2025.100736","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Currently, minimally invasive spine surgery is favored by surgeons because of its favorable surgical outcomes and the ability for patients to quickly resume their normal activities. Many surgeons from different institutions have stated that both uniportal and biportal approaches for endoscopic TLIF surgery are equally effective compared to micro TLIF or open TLIF surgery. TLIF endoscopic surgery necessitates advanced surgical expertise and specialized endoscopic equipment, which includes costly materials in comparison to typical open TLIF surgery with a mini-incision of 4.0 cm. Which procedure is superior?</div></div><div><h3>PURPOSE</h3><div>This study has conducted a comparative study between open mini-incision TLIF (4.0 cm) versus hybrid endoscopic TLIF.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023.</div></div><div><h3>OUTCOME MEASURES</h3><div>Visual analog scale (VAS) leg (pain) and back (pain), on the first day after surgery, the day of discharge, and 3 months after. ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Surgical data, including information on the duration of surgery surgery, blood loss, complications, pain medication, and postoperative hospitalization.</div></div><div><h3>METHODS</h3><div>This is a retrospective study that included 63 patients who underwent single-level open TLIF and hybrid endoscopic TLIF surgery between February 1, 2023, and September 30, 2023. The patients were categorized into two groups based on the surgical techniques used: the open TLIF group (n = 34) and the hybrid endoscopic TLIF group (n = 29). The study selected individuals with symptomatic and unstable spondylolisthesis of the lumbar spine while excluding those diagnosed with cancer or infection. By collecting general data, including gender, age, underlying disease, body mass index (BMI), and smoking status, we will collect information on symptoms before and after surgery, such as leg VAS (pain) and back VAS (pain), on the first day after surgery, the day of discharge, and 3 months after. Collection of ODI data prior to surgery and again 3 months after surgery, along with the assessment of patient satisfaction. Data was collected during the surgery, including information on the duration of surgery, blood loss, complications, pain medication, and postoperative hospitalization.</div></div><div><h3>RESULTS</h3><div>A total of 63 patients were enrolled. There were no statistically significant differences in mean ages, genders, BMI, intraoperative blood loss, painkiller usage, or length of hospital stay between the two groups (P > 0.05). Nevertheless, the mean operative time was significantly less in the open TLIF group compared to the hybrid en","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100736"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical decompression with adequate timing is the standard treatment strategy for patients with degenerative cervical myelopathy (DCM). However, spine surgeons and attending physicians sometimes experience that despite significant improvement in the disease outcomes of cervical myelopathy, patients are not satisfied with surgery and/or their quality-of-life (QOL) does not improve after surgery. A previous study revealed that patients’ social functioning (SF), rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy.
PURPOSE
This study aimed to identify the effects of a multidisciplinary approach for improving SF on 1-year surgical outcomes in cervical myelopathy patients.
STUDY DESIGN/SETTING
This study compared two prospective cohorts in Japan.
PATIENT SAMPLE
Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the SF cohort.
OUTCOME MEASURES
Clinical outcomes (JOA score, JOACMEQ, EQ-5D-5L, VAS of neck pain, arm pain and surgical satisfaction) and radiographical outcomes (C7 slope, C2-7 angle, and C2-C7 SVA) at 1-year were compared between the groups.
METHODS
Patients in the control cohort were treated with standard care, and those in the SF cohort were treated with a multidisciplinary protocol that focused on SF improvement. The key to the protocol was as follows: 1) clinical psychologists identified the patient’s SF before surgery through several interviews; 2) information on SF was shared by physicians, therapists, nurses, and medical secretaries; and 3) spine surgeons, therapists, and clinical psychologists developed patient-oriented rehabilitation programs with information on the patient’s SF.
RESULTS
The control and SF cohorts comprised 140 patients (mean age, 73.5 ± 7.0 years; 62 females) and 31 patients (mean age, 72.2 ± 6.9 years; 15 females), respectively. Although there were no significant differences in the background data, the improvement in the Japanese Orthopaedic Association (JOA) score was significantly better in the SF cohort than in the control cohort (p=0.040, mixed effect model). In a detailed analysis of each JOA score domain, the improvement of upper limb function was significantly better in the SF cohort than in the control cohort (p=0.033, mixed effect model). Similarly, the SF cohort demonstrated significantly higher patient-reported outcome for upper extremity function than those in the control cohort (p< 0.001, Mann-Whitney U test). Although there was no significant difference in the total QOL score, the self-care domain in the QOL score was significantly higher in the SF gro
{"title":"12. A multidisciplinary approach to social functioning might improve the surgical outcomes of patients with cervical myelopathy: comparisons of two prospective cohorts","authors":"Koji Tamai MD , Hiroshi Taniwaki MD , Akinobu Suzuki MD, PhD , Shinji Takahashi MD, PhD , Hiromitsu Toyoda MD, PhD , Minori Kato MD , Hidetomi Terai MD, PhD","doi":"10.1016/j.xnsj.2025.100706","DOIUrl":"10.1016/j.xnsj.2025.100706","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Surgical decompression with adequate timing is the standard treatment strategy for patients with degenerative cervical myelopathy (DCM). However, spine surgeons and attending physicians sometimes experience that despite significant improvement in the disease outcomes of cervical myelopathy, patients are not satisfied with surgery and/or their quality-of-life (QOL) does not improve after surgery. A previous study revealed that patients’ social functioning (SF), rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy.</div></div><div><h3>PURPOSE</h3><div>This study aimed to identify the effects of a multidisciplinary approach for improving SF on 1-year surgical outcomes in cervical myelopathy patients.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This study compared two prospective cohorts in Japan.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the SF cohort.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes (JOA score, JOACMEQ, EQ-5D-5L, VAS of neck pain, arm pain and surgical satisfaction) and radiographical outcomes (C7 slope, C2-7 angle, and C2-C7 SVA) at 1-year were compared between the groups.</div></div><div><h3>METHODS</h3><div>Patients in the control cohort were treated with standard care, and those in the SF cohort were treated with a multidisciplinary protocol that focused on SF improvement. The key to the protocol was as follows: 1) clinical psychologists identified the patient’s SF before surgery through several interviews; 2) information on SF was shared by physicians, therapists, nurses, and medical secretaries; and 3) spine surgeons, therapists, and clinical psychologists developed patient-oriented rehabilitation programs with information on the patient’s SF.</div></div><div><h3>RESULTS</h3><div>The control and SF cohorts comprised 140 patients (mean age, 73.5 ± 7.0 years; 62 females) and 31 patients (mean age, 72.2 ± 6.9 years; 15 females), respectively. Although there were no significant differences in the background data, the improvement in the Japanese Orthopaedic Association (JOA) score was significantly better in the SF cohort than in the control cohort (p=0.040, mixed effect model). In a detailed analysis of each JOA score domain, the improvement of upper limb function was significantly better in the SF cohort than in the control cohort (p=0.033, mixed effect model). Similarly, the SF cohort demonstrated significantly higher patient-reported outcome for upper extremity function than those in the control cohort (p< 0.001, Mann-Whitney U test). Although there was no significant difference in the total QOL score, the self-care domain in the QOL score was significantly higher in the SF gro","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100706"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent studies have highlighted the impact of fatty degeneration in paraspinal muscles on quality of life (QOL), yet its role in the cervical spine remains unclear.
PURPOSE
This study aimed to identify factors related to QOL improvement two years following cervical laminoplasty for degenerative cervical myelopathy (DCM), using the Minimum Clinically Important Difference (MCID) in the EuroQOL 5 Dimensions 5-Level (EQ-5D-5l) as a measure of significant change.
STUDY DESIGN/SETTING
Multicenter, retrospective study.
PATIENT SAMPLE
This study included 111 patients (mean age 72.8 years, 47 women) who underwent laminoplasty for DCM from February 2019.
OUTCOME MEASURES
Clinical outcomes were assessed using EQ-5D-5l, Japanese Orthopaedic Association (JOA) scores, and Visual Analog Scale (VAS) scores for neck pain, upper extremity pain, and numbness. Radiographic parameters, including C2-C7 sagittal vertical axis (SVA), C2-C7 kyphosis angle, and C7 slope, were evaluated preoperatively and at the two-year follow-up. MRI assessed fatty degeneration and cross-sectional area of cervical paraspinal muscles (superficial and deep) at the C3, C5, and C7 levels at 2 years postoperatively.
METHODS
The MCID cutoff for EQ-5D-5l, set at 0.0485 based on previous reports, was used to classify patients into a Poor recovery group and a Control group. Mann-Whitney U tests were used as a univariate analysis to compare the two groups. Logistic regression analysis was conducted for variables significant in univariate analysis, adjusting for age, gender, and preoperative EQ-5D-5l.
RESULTS
Comparing 34 patients in the Poor recovery group and 77 in the Control group, significant differences were observed in preoperative EQ-5D-5l (0.91 vs. 0.58, p< 0.001) and preoperative VAS for neck pain (19.2 vs. 34.6, p=0.017). Postoperatively, significant differences were noted in deep muscle fatty degeneration at the C7 level (56% vs. 49%, p=0.029) and cross-sectional areas of deep fat at C7 (2.6 vs. 2.2, p=0.006) and C3 (2.1 vs. 1.7, p=0.048). Logistic regression analysis, adjusted for age, gender, and preoperative EQ-5D-5l, identified deep muscle fatty degeneration at the C7 level as an independent factor associated with achieving MCID (adjusted odds ratio 0.97, p=0.045).
CONCLUSIONS
Our findings suggest that cervical paraspinal muscle degeneration at the C3 and C7 levels may be linked to QOL improvements following cervical laminoplasty. Deep muscle fatty degeneration particularly at the C7 level, was identified as an important factor for postoperative imaging evaluation, highlighting its potential as a predictive marker for patient-reported outcome gains.
{"title":"39. Does cervical paraspinal muscle degeneration influence quality of life after cervical spine surgery?","authors":"Hiroshi Taniwaki MD , Koji Tamai MD , Akinobu Suzuki MD, PhD , Shinji Takahashi MD, PhD , Hiromitsu Toyoda MD, PhD , Minori Kato MD , Hidetomi Terai MD, PhD","doi":"10.1016/j.xnsj.2025.100733","DOIUrl":"10.1016/j.xnsj.2025.100733","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Recent studies have highlighted the impact of fatty degeneration in paraspinal muscles on quality of life (QOL), yet its role in the cervical spine remains unclear.</div></div><div><h3>PURPOSE</h3><div>This study aimed to identify factors related to QOL improvement two years following cervical laminoplasty for degenerative cervical myelopathy (DCM), using the Minimum Clinically Important Difference (MCID) in the EuroQOL 5 Dimensions 5-Level (EQ-5D-5l) as a measure of significant change.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Multicenter, retrospective study.</div></div><div><h3>PATIENT SAMPLE</h3><div>This study included 111 patients (mean age 72.8 years, 47 women) who underwent laminoplasty for DCM from February 2019.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes were assessed using EQ-5D-5l, Japanese Orthopaedic Association (JOA) scores, and Visual Analog Scale (VAS) scores for neck pain, upper extremity pain, and numbness. Radiographic parameters, including C2-C7 sagittal vertical axis (SVA), C2-C7 kyphosis angle, and C7 slope, were evaluated preoperatively and at the two-year follow-up. MRI assessed fatty degeneration and cross-sectional area of cervical paraspinal muscles (superficial and deep) at the C3, C5, and C7 levels at 2 years postoperatively.</div></div><div><h3>METHODS</h3><div>The MCID cutoff for EQ-5D-5l, set at 0.0485 based on previous reports, was used to classify patients into a Poor recovery group and a Control group. Mann-Whitney U tests were used as a univariate analysis to compare the two groups. Logistic regression analysis was conducted for variables significant in univariate analysis, adjusting for age, gender, and preoperative EQ-5D-5l.</div></div><div><h3>RESULTS</h3><div>Comparing 34 patients in the Poor recovery group and 77 in the Control group, significant differences were observed in preoperative EQ-5D-5l (0.91 vs. 0.58, p< 0.001) and preoperative VAS for neck pain (19.2 vs. 34.6, p=0.017). Postoperatively, significant differences were noted in deep muscle fatty degeneration at the C7 level (56% vs. 49%, p=0.029) and cross-sectional areas of deep fat at C7 (2.6 vs. 2.2, p=0.006) and C3 (2.1 vs. 1.7, p=0.048). Logistic regression analysis, adjusted for age, gender, and preoperative EQ-5D-5l, identified deep muscle fatty degeneration at the C7 level as an independent factor associated with achieving MCID (adjusted odds ratio 0.97, p=0.045).</div></div><div><h3>CONCLUSIONS</h3><div>Our findings suggest that cervical paraspinal muscle degeneration at the C3 and C7 levels may be linked to QOL improvements following cervical laminoplasty. Deep muscle fatty degeneration particularly at the C7 level, was identified as an important factor for postoperative imaging evaluation, highlighting its potential as a predictive marker for patient-reported outcome gains.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include an","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100733"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100731
Ahmad Hammad MD , Arpit Sahu MBBS, MS , Bhavuk Garg MD , Mahmoud Hammad MD , Alaaeldin A. Ahmad MD
BACKGROUND CONTEXT
Active apex correction (APC) is posterior tethering technique in adjunct with guided growth for correction of early onset scoliosis. APC involves inserting tethering pedicle screws at convex side of apex proximal (A1) and distal (A3) to most wedged vertebra (A2) allowing modulation of apex according to Hueter-Volkmann law.
PURPOSE
To assess whether APC allows modulation of apical vertebrae of scoliotic curvature.
STUDY DESIGN/SETTING
Prospective study.
PATIENT SAMPLE
Eleven patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights.
OUTCOME MEASURES
Curve characteristics including Cobb angle, apical vertebral translation (AVT), spinal length T1-T12 and T1-L5, convex and concave height of apical vertebrae measurements.
METHODS
Prospective study including 11 patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights. Excluded patients with follow-up < 2years, missing data on apex modulation, and APC was not primary surgical intervention.
RESULTS
Mean age 8.18 ± 2.27 years, 90% congenital scoliosis and mean follow-up post-surgery 2.36 ± 0.51 years. Compared to preoperatively, concave/convex height ratio at the final follow up increased for A1 (from 0.75 to 0.85, P=0.04), A2 (from 0.71 to 0.78, P=0.04), A3 (from 0.78 to 0.82, P=0.16) but decreased for the untethered vertebra (from 1.00 to 0.97, P=0.06). The statistically significant change at A1 and A2 compared to untethered vertebrae indicates persistent growth in both convex and concave sides with a difference in growth rate following APC and thus modulation of the segment of tethered apical vertebrae, and not solely the most wedged vertebra. Compared to preoperatively, there was significant change in Cobb angle, apical vertebral translation, spinal length T1-T12 and T1-L5 at immediate and was maintained at final follow-up.
CONCLUSIONS
APC as a surgical technique for treatment of early onset scoliosis allowing modulation of the most wedged and adjacent vertebrae at the apex of the curvature, while preserving whole spine correction through growth guidance.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"37. A prospective study on modulation of the apical vertebrae by active apex correction technique for early onset scoliosis","authors":"Ahmad Hammad MD , Arpit Sahu MBBS, MS , Bhavuk Garg MD , Mahmoud Hammad MD , Alaaeldin A. Ahmad MD","doi":"10.1016/j.xnsj.2025.100731","DOIUrl":"10.1016/j.xnsj.2025.100731","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Active apex correction (APC) is posterior tethering technique in adjunct with guided growth for correction of early onset scoliosis. APC involves inserting tethering pedicle screws at convex side of apex proximal (A1) and distal (A3) to most wedged vertebra (A2) allowing modulation of apex according to Hueter-Volkmann law.</div></div><div><h3>PURPOSE</h3><div>To assess whether APC allows modulation of apical vertebrae of scoliotic curvature.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Prospective study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Eleven patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights.</div></div><div><h3>OUTCOME MEASURES</h3><div>Curve characteristics including Cobb angle, apical vertebral translation (AVT), spinal length T1-T12 and T1-L5, convex and concave height of apical vertebrae measurements.</div></div><div><h3>METHODS</h3><div>Prospective study including 11 patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights. Excluded patients with follow-up < 2years, missing data on apex modulation, and APC was not primary surgical intervention.</div></div><div><h3>RESULTS</h3><div>Mean age 8.18 ± 2.27 years, 90% congenital scoliosis and mean follow-up post-surgery 2.36 ± 0.51 years. Compared to preoperatively, concave/convex height ratio at the final follow up increased for A1 (from 0.75 to 0.85, P=0.04), A2 (from 0.71 to 0.78, P=0.04), A3 (from 0.78 to 0.82, P=0.16) but decreased for the untethered vertebra (from 1.00 to 0.97, P=0.06). The statistically significant change at A1 and A2 compared to untethered vertebrae indicates persistent growth in both convex and concave sides with a difference in growth rate following APC and thus modulation of the segment of tethered apical vertebrae, and not solely the most wedged vertebra. Compared to preoperatively, there was significant change in Cobb angle, apical vertebral translation, spinal length T1-T12 and T1-L5 at immediate and was maintained at final follow-up.</div></div><div><h3>CONCLUSIONS</h3><div>APC as a surgical technique for treatment of early onset scoliosis allowing modulation of the most wedged and adjacent vertebrae at the apex of the curvature, while preserving whole spine correction through growth guidance.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100731"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100653
Hae-Dong Jang PhD, MD , Jae Chul Lee MD, PhD , Byung-Joon Shin PhD
BACKGROUND CONTEXT
There are various approach techniques for the interbody fusion of the lumbosacral region (L5-S1), and each method has its own advantages, disadvantages, and clinical features. The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases.
PURPOSE
To introduce the “lateral corridor” as an optional surgical approach for MI-OLIF L5-S1 and report the details of the surgical technique with a clinical case series.
STUDY DESIGN/SETTING
A clinical series and technical note.
PATIENT SAMPLE
Patients who underwent MI-OLIF L5-S1 at our hospital between July 2015 and October 2022 for degenerative lumbar disease were included. Patients with confirmed spinal surgery history within 1 year and those with an infection, tumor, or trauma were excluded. Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the “lateral corridor” technique were included.
OUTCOME MEASURES
The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated.
METHODS
We propose a novel surgical approach using the “lateral corridor” to access the lateral window to the left common iliac vein (LCIV) in this study as an alternative to the standard technique using the central corridor. The LCIV is manipulated in significantly different ways between the two approaches. The central corridor method uses the medial window of the LCIV and retracts the LCIV and the left common iliac artery laterally. In contrast, the “lateral corridor” method uses the lateral window of the LCIV and retracts all vasculature medially. It is the space between the lateral margin of the LCIV and the medial margin of the left psoas muscle.
RESULTS
We introduced surgical technique using the "lateral corridor" in the following steps: 1) patient position, localization, and skin incision, 2) soft tissue dissection, 3) vascular dissection, 4) intervertebral disc and endplate preparation, 5) cage insertion and orientation, and 6) closure and posterior procedure. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of the ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries.
CONCLUSIONS
We introduced the "lateral corridor" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular compli
{"title":"P29. A novel surgical approach using the “lateral corridor” for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note","authors":"Hae-Dong Jang PhD, MD , Jae Chul Lee MD, PhD , Byung-Joon Shin PhD","doi":"10.1016/j.xnsj.2025.100653","DOIUrl":"10.1016/j.xnsj.2025.100653","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>There are various approach techniques for the interbody fusion of the lumbosacral region (L5-S1), and each method has its own advantages, disadvantages, and clinical features. The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases.</div></div><div><h3>PURPOSE</h3><div>To introduce the “lateral corridor” as an optional surgical approach for MI-OLIF L5-S1 and report the details of the surgical technique with a clinical case series.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A clinical series and technical note.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent MI-OLIF L5-S1 at our hospital between July 2015 and October 2022 for degenerative lumbar disease were included. Patients with confirmed spinal surgery history within 1 year and those with an infection, tumor, or trauma were excluded. Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the “lateral corridor” technique were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated.</div></div><div><h3>METHODS</h3><div>We propose a novel surgical approach using the “lateral corridor” to access the lateral window to the left common iliac vein (LCIV) in this study as an alternative to the standard technique using the central corridor. The LCIV is manipulated in significantly different ways between the two approaches. The central corridor method uses the medial window of the LCIV and retracts the LCIV and the left common iliac artery laterally. In contrast, the “lateral corridor” method uses the lateral window of the LCIV and retracts all vasculature medially. It is the space between the lateral margin of the LCIV and the medial margin of the left psoas muscle.</div></div><div><h3>RESULTS</h3><div>We introduced surgical technique using the \"lateral corridor\" in the following steps: 1) patient position, localization, and skin incision, 2) soft tissue dissection, 3) vascular dissection, 4) intervertebral disc and endplate preparation, 5) cage insertion and orientation, and 6) closure and posterior procedure. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of the ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries.</div></div><div><h3>CONCLUSIONS</h3><div>We introduced the \"lateral corridor\" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular compli","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100653"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100665
Shrey Binyala MS, DNB
BACKGROUND CONTEXT
Vertebral body fractures with non-union and associated neurological deficits pose significant challenges, especially in high-risk, morbid patients. Traditional surgical interventions may not be feasible due to elevated perioperative risks.
PURPOSE
This prospective study evaluates safety, efficacy, and outcomes of vertebroplasty combined with percutaneous screw fixation in treating vertebral body fracture non-unions with neurological deficits in high-risk patients.
STUDY DESIGN/SETTING
This is a prospective, single-center study conducted to evaluate the clinical and radiological outcomes of vertebroplasty combined with O-arm-guided, navigation-assisted percutaneous screw fixation for the treatment of vertebral body fracture non-unions with neurological deficits in high-risk, morbid patients.
PATIENT SAMPLE
A total of 32 high-risk patients with vertebral body fracture non-unions and associated neurological deficits were included in this study.
OUTCOME MEASURES
Pain Relief: Assessed using the Visual Analog Scale (VAS) preoperatively and at 1, 3, 6 months, and 2–4 years postoperatively. Neurological Recovery: Evaluated through improvements in motor and sensory function based on clinical examination. Functional Improvement: Measured using the Oswestry Disability Index (ODI) at the same time points as VAS assessments. Fracture Stability: Confirmed through radiological imaging (X-ray/CT scans) to verify proper screw placement and fusion. Complications: Documented intraoperative and postoperative adverse events, including infection, screw malposition, or procedure-related morbidity.
METHODS
This prospective study included high-risk patients with vertebral body fracture non-unions and associated neurological deficits. Patients were classified as high surgical risk based on comorbid conditions and perioperative risk factors. All patients underwent vertebroplasty and O-arm-guided, navigation-assisted percutaneous screw fixation. Vertebroplasty was performed to provide immediate pain relief and augment the structural integrity of the fractured vertebral body. Percutaneous screws were placed under real-time navigation to stabilize the fracture and prevent further displacement. Data collection included: Operative Parameters: operative time and intraoperative blood loss. Clinical Outcomes: pain relief assessed via the Visual Analog Scale (VAS), neurological recovery via clinical examination, and functional improvement using the Oswestry Disability Index (ODI). Radiological Outcomes: stability and accuracy of screw placement confirmed through postoperative imaging. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively, and then annually for 2–4 years. Statistical analyses were performed to compare preoperative and postoperative outcomes, with significance defined
{"title":"P41. Evaluating the efficacy of vertebroplasty and percutaneous screw fixation in high-risk patients with vertebral fracture non-union and neurological deficit","authors":"Shrey Binyala MS, DNB","doi":"10.1016/j.xnsj.2025.100665","DOIUrl":"10.1016/j.xnsj.2025.100665","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Vertebral body fractures with non-union and associated neurological deficits pose significant challenges, especially in high-risk, morbid patients. Traditional surgical interventions may not be feasible due to elevated perioperative risks.</div></div><div><h3>PURPOSE</h3><div>This prospective study evaluates safety, efficacy, and outcomes of vertebroplasty combined with percutaneous screw fixation in treating vertebral body fracture non-unions with neurological deficits in high-risk patients.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a prospective, single-center study conducted to evaluate the clinical and radiological outcomes of vertebroplasty combined with O-arm-guided, navigation-assisted percutaneous screw fixation for the treatment of vertebral body fracture non-unions with neurological deficits in high-risk, morbid patients.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 32 high-risk patients with vertebral body fracture non-unions and associated neurological deficits were included in this study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Pain Relief: Assessed using the Visual Analog Scale (VAS) preoperatively and at 1, 3, 6 months, and 2–4 years postoperatively. Neurological Recovery: Evaluated through improvements in motor and sensory function based on clinical examination. Functional Improvement: Measured using the Oswestry Disability Index (ODI) at the same time points as VAS assessments. Fracture Stability: Confirmed through radiological imaging (X-ray/CT scans) to verify proper screw placement and fusion. Complications: Documented intraoperative and postoperative adverse events, including infection, screw malposition, or procedure-related morbidity.</div></div><div><h3>METHODS</h3><div>This prospective study included high-risk patients with vertebral body fracture non-unions and associated neurological deficits. Patients were classified as high surgical risk based on comorbid conditions and perioperative risk factors. All patients underwent vertebroplasty and O-arm-guided, navigation-assisted percutaneous screw fixation. Vertebroplasty was performed to provide immediate pain relief and augment the structural integrity of the fractured vertebral body. Percutaneous screws were placed under real-time navigation to stabilize the fracture and prevent further displacement. Data collection included: Operative Parameters: operative time and intraoperative blood loss. Clinical Outcomes: pain relief assessed via the Visual Analog Scale (VAS), neurological recovery via clinical examination, and functional improvement using the Oswestry Disability Index (ODI). Radiological Outcomes: stability and accuracy of screw placement confirmed through postoperative imaging. Follow-up assessments were conducted at 1, 3, and 6 months postoperatively, and then annually for 2–4 years. Statistical analyses were performed to compare preoperative and postoperative outcomes, with significance defined","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100665"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100651
Mohammad Khalil Al-Barbarawi MD, MBBS
BACKGROUND CONTEXT
Vertebral body replacement (VBR) is a crucial intervention for addressing fractures and tumors that compromise spinal stability. Traditional methods often involve extensive muscle dissection and the assistance of access surgeons, leading to longer recovery times. The eXtreme Lateral Interbody Fusion (XLIF) approach, performed exclusively by neurosurgeons without the need for access surgeons, offers a minimally invasive alternative, potentially improving patient outcomes and reducing complications.
PURPOSE
To evaluate the clinical and radiological outcomes of vertebral body replacement (VBR) using the eXtreme Lateral Interbody Fusion (XLIF) technique performed exclusively by neurosurgeons, assessing its efficacy in reducing pain, improving neurological function, and restoring spinal stability in patients with fractures or tumors.
STUDY DESIGN/SETTING
This is a retrospective clinical study conducted in a single neurosurgical center, analyzing outcomes of single-level vertebral body replacement (VBR) performed exclusively by neurosurgeons using the eXtreme Lateral Interbody Fusion (XLIF) technique between 2018 and 2023.
PATIENT SAMPLE
The study included 23 consecutive patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. The sample consisted of patients with vertebral fractures or tumors requiring anterior column reconstruction.
OUTCOME MEASURES
Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the American Spinal Injury Association (ASIA) classification for neurological status. Radiological outcomes included preoperative and postoperative CT measurements of regional angulation and spinal stability. Complications were also recorded and analyzed.
METHODS
A retrospective analysis was conducted on 23 patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. Clinical outcomes were evaluated using Visual Analog Scale (VAS) scores for pain and the American Spinal Injury Association (ASIA) classification for neurological function. Radiological assessments included preoperative and postoperative CT scans to measure regional angulation and spinal stability. Data were analyzed for pain reduction, neurological improvement, and complication rates.
RESULTS
Patients demonstrated significant clinical improvements, with a median reduction in VAS pain scores from 8 to 2 and neurological improvement in 82.6% of cases (ASIA E classification). Radiological outcomes showed a median kyphotic angle correction of 5° post-dorsal stabilization and 9° post-ventral stabilization. Complications were noted in 8.7% of cases, including pleural injuries and hypoesthesia, primarily in thoracic VBR and osteoporotic patients. O
{"title":"P27. A multicenter retrospective study on single-level thoracolumbar corpectomy and vertebral body replacement done by neurosurgeons","authors":"Mohammad Khalil Al-Barbarawi MD, MBBS","doi":"10.1016/j.xnsj.2025.100651","DOIUrl":"10.1016/j.xnsj.2025.100651","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Vertebral body replacement (VBR) is a crucial intervention for addressing fractures and tumors that compromise spinal stability. Traditional methods often involve extensive muscle dissection and the assistance of access surgeons, leading to longer recovery times. The eXtreme Lateral Interbody Fusion (XLIF) approach, performed exclusively by neurosurgeons without the need for access surgeons, offers a minimally invasive alternative, potentially improving patient outcomes and reducing complications.</div></div><div><h3>PURPOSE</h3><div>To evaluate the clinical and radiological outcomes of vertebral body replacement (VBR) using the eXtreme Lateral Interbody Fusion (XLIF) technique performed exclusively by neurosurgeons, assessing its efficacy in reducing pain, improving neurological function, and restoring spinal stability in patients with fractures or tumors.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a retrospective clinical study conducted in a single neurosurgical center, analyzing outcomes of single-level vertebral body replacement (VBR) performed exclusively by neurosurgeons using the eXtreme Lateral Interbody Fusion (XLIF) technique between 2018 and 2023.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study included 23 consecutive patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. The sample consisted of patients with vertebral fractures or tumors requiring anterior column reconstruction.</div></div><div><h3>OUTCOME MEASURES</h3><div>Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the American Spinal Injury Association (ASIA) classification for neurological status. Radiological outcomes included preoperative and postoperative CT measurements of regional angulation and spinal stability. Complications were also recorded and analyzed.</div></div><div><h3>METHODS</h3><div>A retrospective analysis was conducted on 23 patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. Clinical outcomes were evaluated using Visual Analog Scale (VAS) scores for pain and the American Spinal Injury Association (ASIA) classification for neurological function. Radiological assessments included preoperative and postoperative CT scans to measure regional angulation and spinal stability. Data were analyzed for pain reduction, neurological improvement, and complication rates.</div></div><div><h3>RESULTS</h3><div>Patients demonstrated significant clinical improvements, with a median reduction in VAS pain scores from 8 to 2 and neurological improvement in 82.6% of cases (ASIA E classification). Radiological outcomes showed a median kyphotic angle correction of 5° post-dorsal stabilization and 9° post-ventral stabilization. Complications were noted in 8.7% of cases, including pleural injuries and hypoesthesia, primarily in thoracic VBR and osteoporotic patients. O","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100651"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>BACKGROUND CONTEXT</h3><div>Thoracolumbar fractures, particularly those accompanied by incomplete neurological deficits, present significant challenges in spine surgery. These fractures, predominantly located at the thoracolumbar junction (T10-L2), are prone to instability due to the biomechanical transition from a rigid thoracic to a mobile lumbar spine. Approximately 25%-32% of such fractures result in neurological deficits, necessitating surgical intervention. Traditionally, open approaches for fixation and decompression have been standard, but they are associated with higher morbidity. Minimally invasive surgery (MIS), including posterior fixation and biportal endoscopic decompression, offers a promising alternative with reduced tissue disruption, improved visualization, and faster recovery. However, the optimal approach for managing thoracolumbar fractures with incomplete neurological deficits remains inconclusive. This study aims to evaluate the efficacy of MIS posterior fixation combined with biportal endoscopic decompression in addressing mechanical stabilization and neural decompression in such cases.</div></div><div><h3>PURPOSE</h3><div>To assess the clinical and radiological outcomes of minimally invasive posterior fixation and biportal endoscopic decompression in thoracolumbar fractures with incomplete neurological deficits. Primary objective: Evaluate the adequacy of decompression using postoperative MRI, defined by a clear subarachnoid space around neural structures. Secondary objectives: Assess neurological recovery using ASIA motor and sensory scores. Analyze radiological outcomes, including correction and maintenance of sagittal Cobb’s angle. Investigate the incidence of complications such as iatrogenic dural injury and surgical site infections. Measure postoperative pain (VAS scores) and compare them at each follow-up interval. Assess hospital stay duration and clinical outcomes compared to patients undergoing open surgery.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a prospective observational study conducted at the Department of Orthopedics and Trauma, All India Institute of Medical Sciences (AIIMS), Rishikesh. The study spans 18 months, with patient enrollment over 12 months and follow-ups extending to 6 months. The research adheres to Level III evidence and involves comprehensive clinical and radiological evaluations.</div></div><div><h3>PATIENT SAMPLE</h3><div>Inclusion criteria: thoracolumbar fractures (T11-L5, AO type A/B) with incomplete neurological deficits (ASIA Grades B, C, D). Less than 50% canal compromise. Bony injury to the posterior ligamentous complex (PLC). McCormack score < 4 and patients presenting within 3 weeks of injury. Exclusion criteria: AO type C injuries, comminuted fractures, pathological fractures, or ligamentous injuries to the PLC. Patients unfit for surgery or unwilling to provide consent. The final sample size includes all eligible patients admitted to the trauma and o
{"title":"P38. Efficacy of minimal invasive posterior fixation and biportal endoscopic decompression in patients with thoracolumbar fractures with incomplete neurological deficit: a prospective observational study","authors":"Manish Kumar Shah MBBS , Shivam Malaviya MBBS, DO, DNB , Bhaskar Sarkar MS, DNB, MBBS","doi":"10.1016/j.xnsj.2025.100662","DOIUrl":"10.1016/j.xnsj.2025.100662","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Thoracolumbar fractures, particularly those accompanied by incomplete neurological deficits, present significant challenges in spine surgery. These fractures, predominantly located at the thoracolumbar junction (T10-L2), are prone to instability due to the biomechanical transition from a rigid thoracic to a mobile lumbar spine. Approximately 25%-32% of such fractures result in neurological deficits, necessitating surgical intervention. Traditionally, open approaches for fixation and decompression have been standard, but they are associated with higher morbidity. Minimally invasive surgery (MIS), including posterior fixation and biportal endoscopic decompression, offers a promising alternative with reduced tissue disruption, improved visualization, and faster recovery. However, the optimal approach for managing thoracolumbar fractures with incomplete neurological deficits remains inconclusive. This study aims to evaluate the efficacy of MIS posterior fixation combined with biportal endoscopic decompression in addressing mechanical stabilization and neural decompression in such cases.</div></div><div><h3>PURPOSE</h3><div>To assess the clinical and radiological outcomes of minimally invasive posterior fixation and biportal endoscopic decompression in thoracolumbar fractures with incomplete neurological deficits. Primary objective: Evaluate the adequacy of decompression using postoperative MRI, defined by a clear subarachnoid space around neural structures. Secondary objectives: Assess neurological recovery using ASIA motor and sensory scores. Analyze radiological outcomes, including correction and maintenance of sagittal Cobb’s angle. Investigate the incidence of complications such as iatrogenic dural injury and surgical site infections. Measure postoperative pain (VAS scores) and compare them at each follow-up interval. Assess hospital stay duration and clinical outcomes compared to patients undergoing open surgery.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a prospective observational study conducted at the Department of Orthopedics and Trauma, All India Institute of Medical Sciences (AIIMS), Rishikesh. The study spans 18 months, with patient enrollment over 12 months and follow-ups extending to 6 months. The research adheres to Level III evidence and involves comprehensive clinical and radiological evaluations.</div></div><div><h3>PATIENT SAMPLE</h3><div>Inclusion criteria: thoracolumbar fractures (T11-L5, AO type A/B) with incomplete neurological deficits (ASIA Grades B, C, D). Less than 50% canal compromise. Bony injury to the posterior ligamentous complex (PLC). McCormack score < 4 and patients presenting within 3 weeks of injury. Exclusion criteria: AO type C injuries, comminuted fractures, pathological fractures, or ligamentous injuries to the PLC. Patients unfit for surgery or unwilling to provide consent. The final sample size includes all eligible patients admitted to the trauma and o","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100662"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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