North American Spine Society Journal最新文献

{"title":"Inflammatory bowel disease is associated with greater odds of complications following posterior lumbar fusion and further amplified for patients exposed to monoclonal antibody biologics","authors":"Anthony E. Seddio BS,&nbsp;Beatrice M. Katsnelson BA,&nbsp;Julian Smith-Voudouris MS,&nbsp;Michael J. Gouzoulis BS,&nbsp;Wesley Day BS,&nbsp;Sahir S. Jabbouri MD,&nbsp;Rajiv S. Vasudevan MD,&nbsp;Daniel R. Rubio MD,&nbsp;Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2024.100574","DOIUrl":"10.1016/j.xnsj.2024.100574","url":null,"abstract":"<div><h3>Background</h3><div>Posterior lumbar fusion (PLF) is a common spine surgery that may be considered in patients with underlying comorbidities, such as inflammatory bowel disease (IBD). Prior literature examining the association of this disease and PLF outcomes was done in the National Inpatient Sample (NIS), which only assessed in-hospital data and did not reveal an elevated risk of medical or surgical complications. However, characterization of PLF outcomes beyond hospital discharge is important and remains unknown for patients with IBD.</div></div><div><h3>Methods</h3><div>Patients with IBD who underwent single-level PLF ± interbody fusion were identified from the M165Ortho PearlDiver database. Exclusion criteria included: patients &lt;18 years old, those undergoing concurrent cervical, thoracic, anterior, or multi-level fusion, those with prior trauma, neoplasm, or infection diagnosed within 90-days, and &lt;90-days of follow-up. Adult patients with IBD were matched 1:4 with non-IBD patients based on age, sex, and Elixhauser Comorbidity Index (ECI). The odds of 90-day individual and aggregated any, severe, and minor adverse events (AAE, SAE, and MAE, respectively), emergency department (ED) visits, and hospital readmission were compared by multivariable logistic regression. Five-year reoperation was assessed by Kaplan-Meier survival analysis and compared by log-rank test.</div></div><div><h3>Results</h3><div>Overall, 4,392 (1.4%) of patients undergoing PLF were identified with IBD. These patients demonstrated elevated odds ratios (ORs) of aggregated MAE (OR 2.29), AAE (OR 2.27), and SAE (OR 1.84), as well as ED visits (OR 2.69) (<em>p</em>&lt;.001 for all). Conversely, 5-year reoperation rates were not different for those with vs without IBD (<em>p</em>=.70).</div></div><div><h3>Conclusions</h3><div>The current study highlights the importance of investigating post-discharge outcomes, as these findings were not detected by prior inpatient literature. Our findings reveal the odds of various complications may be significantly elevated for IBD patients within 90-days postoperatively, however, these inferior outcomes encouragingly did not translate to an elevated rate of 5-year reoperation.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100574"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The oswestry disability index in elective single level lumbar fusion: Is 3 months follow up enough?","authors":"Heeren Makanji MD ,&nbsp;Matthew J. Solomito PhD","doi":"10.1016/j.xnsj.2024.100571","DOIUrl":"10.1016/j.xnsj.2024.100571","url":null,"abstract":"<div><h3>Background</h3><div>Prospective, longitudinal collection of patients reported outcomes (PRO) has become an essential metric in orthopedics. Despite the utility of PROs, data collection presents a significant challenge to the healthcare system. There is a need to better understand if serial data collection over a 1 to 2 year postoperative period is truly warranted. The purpose of this study was to determine if continued PRO collection after 3 months postop is needed in patients that underwent lumbar fusion.</div></div><div><h3>Methods</h3><div>This retrospective study utilized 239 patients that underwent an elective single level lumbar fusion between April 1, 2020 and February 1, 2023. Changes in the Oswestry Disability Index (ODI) scores over a 1 year period were assessed for all patients. Patients were placed into 1 of 3 study groups, those that improved by 10 points, those that worsened by 10 points, and those that did not change (score change less than 10 points in either direction). Movement between study groups, the minimal clinical important difference (MCID), and patient satisfaction were analyzed for each patient.</div></div><div><h3>Results</h3><div>Improvement between preoperative and the 3 month postoperative evaluations was noted for most patients. There was limited change in scores after 3 months. Patients in the improved group continued to improve through 1 year postoperative. Patients in the worsened group continued to decline by 1 year postoperative. Patients in the no change group demonstrated the highest potential to change groups.</div></div><div><h3>Conclusions</h3><div>Patients with substantial improvement or worsening at 3 months have a low likelihood of substantial clinical change thereafter. This subset of patients may not need further evaluation with PROs, but those in the worsened group may benefit from other interventions to potentially alter their course.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100571"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of skull base and spinal chordomas: A case series with comprehensive review of the literature","authors":"Sarah Lee ,&nbsp;Nahom Teferi ,&nbsp;Juan Vivanco-Suarez ,&nbsp;Ajmain Chowdhury ,&nbsp;Stephen Glennon ,&nbsp;Kyle Kato ,&nbsp;Tyson Matern ,&nbsp;Kathryn L. Eschbacher ,&nbsp;Michael Petronek ,&nbsp;Patrick Hitchon","doi":"10.1016/j.xnsj.2024.100569","DOIUrl":"10.1016/j.xnsj.2024.100569","url":null,"abstract":"<div><h3>Background</h3><div>Chordomas are rare, slow growing, locally aggressive malignant bone tumors that arise from remnants of the embryonic notochord with variable presenting symptoms depending on tumor location.</div></div><div><h3>Methods</h3><div>All patients with craniospinal chordoma managed at our institution between 1982 and 2023 were retrospectively reviewed. Demographics, tumor characteristics, clinical course and treatment, and long-term neurological and survival outcomes were collected. Adjuvant radiotherapy (RT) was stratified into standard dose fractionated radiotherapy (standard XRT) for doses of 50 to 60 Gy at 1.8 Gy fractions or high dose hyperfractionated stereotactic radiotherapy (HD-FSRT) for doses of 60 to 81 Gy at 1.2-1.5 Gy fractions per treatment. Descriptive statistics, univariate analysis, Log-rank test, and Kaplan-Meier survival analysis were performed.</div></div><div><h3>Results</h3><div>A total of 37 patients were included in our cohort (mean age 46.0 ± 20.8 years; 22 male). Clival chordomas accounted for the majority of patients (56.8%), followed by vertebral (27%) and sacral (10.8%) chordomas. Thirty-five patients (94.6%) underwent gross total resection (GTR) or subtotal resection (STR), and 2 patients underwent excisional biopsy only. Postoperatively, functional status trended towards improvement (KPS: Preop- 80 [range 40–100] vs. Post op- 90 [60–100], p = .0911) and all patients either maintained or improved their neurological function. Median overall survival (OS) after diagnosis was 16.5 years. Age &lt; 65, clival tumor location, post-operative Frankel grade E, and administration of adjuvant RT following initial STR significantly improved OS. OS of GTR patients was not significantly affected by adjuvant RT treatment.</div></div><div><h3>Conclusions</h3><div>Our results show the best long-term survival outcomes for chordoma patients undergoing GTR of tumor tissue. Higher postoperative neurological function was significantly associated with OS, highlighting the importance of maximal but safe total tumor resection. Moreover, adjuvant RT improved long-term survival for patients that underwent STR but had no effect on survival outcomes for patients that underwent GTR.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective cohort analysis of alignment parameters for spinal tumor patients with instrumentation at the cervicothoracic junction","authors":"Christian B. Schroeder ScM,&nbsp;Madison J. Michles MS,&nbsp;Rahul A. Sastry MD,&nbsp;Alexander A. Chernysh BS,&nbsp;Owen P. Leary BS,&nbsp;Felicia Sun MD,&nbsp;Joaquin Q. Camara-Quintana MD,&nbsp;Adetokunbo A. Oyelese MD, PhD,&nbsp;Albert E. Telfeian MD, PhD,&nbsp;Jared S. Fridley MD,&nbsp;Ziya L. Gokaslan MD,&nbsp;Patricia Zadnik Sullivan MD,&nbsp;Tianyi Niu MD","doi":"10.1016/j.xnsj.2024.100560","DOIUrl":"10.1016/j.xnsj.2024.100560","url":null,"abstract":"<div><h3>Background</h3><div>Previous research on spinal alignment and postoperative outcomes after cervical and upper thoracic fixation has suggested that clinical and patient-reported outcomes are improved when certain anatomical parameters are maintained. These parameters include the cervical sagittal vertical axis (cSVA), C2 and T1 slopes, and cervical lordosis (CL). For patients with primary and metastatic tumors involving the subaxial cervical and/or upper thoracic spine, there is minimal guidance on how to apply these parameters. Surgeons must make critical decisions when designing the optimal construct, considering patient life expectancy, bone quality, oncology goals and deformity. This study aims to evaluate the impact of cervical spine alignment parameters on postoperative hardware failure in spine tumor patients and highlight instances of complications in patients with instrumentation crossing the cervicothoracic junction (CTJ).</div></div><div><h3>Methods</h3><div>A retrospective review of a single institutional spine tumor database identified seventeen patients who underwent spinal fusion crossing the CTJ from 2015 to 2023. All patients had postoperative neutral standing radiographs with measurable cSVA, C2 and T1 slopes, and/or CL. The primary endpoint was instrumentation failure, defined as hardware pull out or breakage, and secondary endpoints included other complications including wound infection and spinal fluid leak.</div></div><div><h3>Results</h3><div>The number of instrumented levels ranged from 3 to 15 segments with a mean of 7.47. Surgical approaches included anterior (<em>n</em>=3), posterior (<em>n</em>=12), and simultaneous anterior and posterior (<em>n</em>=2). The mean cSVA was 3.39±1.02 cm (range 1.59–4.9 cm). Fourteen patients had measurable C2 slopes with a mean of 25.03±9.16° (range 8.7 - 38.6°). Ten patients had measurable T1 slopes with a mean of 31.5±11.54° (range 18.4–59.6°). Thirteen patients had a measurable CL with a mean of 9.13±9.93° (range 0–37.5°). No cases of instrumentation failure were noted. Four patients experienced other postoperative complications (24%), but rates did not vary with increasing deviation from ideal parameters for cSVA, C2 and T1 slope, or CL.</div></div><div><h3>Conclusions</h3><div>Although there was wide variability in alignment parameters in this cohort, there were no instances of hardware failure with crossing the CTJ at a mean follow-up of 41 months. The overall complication rate was high at 24%. Despite common concerns about the impact of exaggerated slope and SVA on instrumentation failure these results suggest that cervical and upper thoracic tumor patients may still have a satisfactory result following CTJ fixation, even with unfavorable alignment parameters. Larger prospective studies are needed.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100560"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor regarding: “The utility of vertebral Hounsfield units as a prognostic indicator of adverse events following treatment of spinal epidural abscess”","authors":"Andrew J. Schoenfeld MD","doi":"10.1016/j.xnsj.2024.100572","DOIUrl":"10.1016/j.xnsj.2024.100572","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100572"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-cadaveric spine surgery simulator training in neurosurgical residency","authors":"Paul Pöser MD ,&nbsp;Robert Schenk MD ,&nbsp;Hannah Miller MD ,&nbsp;Ahmad Alghamdi MD ,&nbsp;Adrien Lavalley MD ,&nbsp;Katharina Tielking MD ,&nbsp;Nitzan Nissimov MD ,&nbsp;Anton Früh MD ,&nbsp;Denny Chakkalakal MD ,&nbsp;Victor Patsouris MD ,&nbsp;Tarik Alp Sargut MD ,&nbsp;Robert Mertens MD ,&nbsp;Ran Xu MD ,&nbsp;Peter Truckenmüller MD ,&nbsp;Kiarash Ferdowssian MD ,&nbsp;Judith Rösler MD ,&nbsp;David Wasilewski MD ,&nbsp;Claudius Jelgersma MD ,&nbsp;Anna Roethe MD ,&nbsp;Aminaa Sanchin MD ,&nbsp;Julia Sophie Onken PD, MD","doi":"10.1016/j.xnsj.2024.100573","DOIUrl":"10.1016/j.xnsj.2024.100573","url":null,"abstract":"<div><h3>Background</h3><div>Spine surgical training faces increasing challenges due to restricted working hours and greater sub specialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods.</div></div><div><h3>Methods</h3><div>Sixteen residents utilized the Realists RealSpine L4/L5 disc simulator with both microscope and exoscope. A mixed-methods analysis assessed the efficacy and acceptance of the training. Six PGY-1 residents participated in a learning curve study, divided into exoscopic and microscopic cohorts. Each group watched a tutorial in either 3D or 2D, followed by 3 surgical sessions. Endpoints included surgical progress within 30 minutes and complication rates. Microsurgical skills and mental concepts were evaluated on a numeric Likert Scale.</div></div><div><h3>Results</h3><div>Participants rated the simulator training favorably, with a median score of 8/10 across 6 categories. The learning curve study showed a 30% improvement in microsurgical performance. The completion rate of herniated disc removal increased from 50% at T2 to 100% at T3 and T4. Significant improvement in mental concept was observed (p=.035), with slightly better consolidation in the exoscope group. Self-assessments revealed significantly improved skills across all participants.</div></div><div><h3>Conclusions</h3><div>Spine simulator training was well-received and resulted in improvements in both mental concept and microsurgical performance, with enhanced outcomes in the 3D teaching/exoscope group. This study supports the integration of spine simulators into spine surgical residency, particularly for early-stage training, to improve both cognitive and practical surgical skills.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100573"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laminectomy and fusion better maintains horizontal gaze than laminoplasty in cervical spondylotic myelopathy","authors":"Bradley T. Hammoor MD, MS ,&nbsp;Lara L. Cohen MD, MPH ,&nbsp;Grace X. Xiong MD ,&nbsp;Harry M. Lightsey MD ,&nbsp;Matthew Lindsey MD ,&nbsp;Harold A. Fogel MD ,&nbsp;Daniel G. Tobert MD ,&nbsp;Stuart H. Hershman MD","doi":"10.1016/j.xnsj.2024.100575","DOIUrl":"10.1016/j.xnsj.2024.100575","url":null,"abstract":"<div><h3>Background</h3><div>Laminectomy and fusion (LF) and laminoplasty (LP) are common treatments for cervical spondylotic myelopathy and myeloradiculopathy. While both procedures show similar clinical improvement, LF requires bony fusion while LP offers motion preservation. Cervical sagittal alignment and horizontal gaze maintenance are key outcome measures, but their comparative effects between LF and LP remain unclear. This study evaluated postoperative horizontal gaze and cervical sagittal alignment in patients undergoing either procedure.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study at 2 academic centers, patients underwent either LF or LP. Pre/postoperative cervical sagittal alignment parameters were collected, including C2–7 lordosis, C2–7 SVA, Occiput-C2 angle, and T1-slope. The McGregor slope measured horizontal gaze, with 8° flexion to 13° extension as normal range. Primary outcome was horizontal gaze maintenance at minimum 1-year follow-up. Secondary outcomes included changes in cervical spine alignment parameters.</div></div><div><h3>Results</h3><div>Sixty-four patients (30 LF, 34 LP) completed minimum 1-year follow-up. Pre/postoperative sagittal alignment measures showed no significant differences between groups. Within cohorts, LP increased C2–7 sagittal vertical axis (29.1–37.6 mm, p=.04) while LF decreased C2–7 lordosis (11.5°–5.00°, p=.04). Postoperatively, LF showed significantly more optimally aligned patients (90.0%) versus LP (57.8%) (p&lt;.01). Multivariate analysis indicated LP predicted postoperative horizontal gaze malalignment (OR 13.90 [2.10–286.62], p=.022).</div></div><div><h3>Conclusions</h3><div>While both procedures yielded comparable cervical sagittal alignment outcomes, LF demonstrated superior maintenance of horizontal gaze. These findings suggest that laminectomy and fusion may preserve horizontal gaze better than laminoplasty.</div><div><strong>Level of Evidence:</strong> III.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100575"},"PeriodicalIF":0.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for metastatic disease at presentation with chordoma and its prognostic value","authors":"Ari R. Berg MD, MBA,&nbsp;Gabriel Hanna MD,&nbsp;Dhruv Mendiratta BS,&nbsp;Ashok Para MD,&nbsp;Matthew Michel MD,&nbsp;Kathleen Beebe MD,&nbsp;Michael J. Vives MD","doi":"10.1016/j.xnsj.2024.100566","DOIUrl":"10.1016/j.xnsj.2024.100566","url":null,"abstract":"<div><h3>Background</h3><div>Chordoma is a rare bone cancer arising from the embryonic notochord with special predilection to the axial skeleton. The locally destructive nature and metastatic potential of chordomas can lead to devastating outcomes in terms of survival. The purpose of this study was to examine potential risk factors predictive of metastatic disease at presentation and prognostic factors in patients with metastasis.</div></div><div><h3>Methods</h3><div>SEER was used to classify each patient as having metastatic or localized disease at the time of diagnosis. Patient-specific and tumor characteristics were analyzed to determine which factors were predictive of an increased rate of metastatic disease at presentation. These factors were analyzed using univariate as well as a multivariate logistic regression model. Prognostic factors for survival were analyzed using the Kaplan–Meier estimates with log-rank tests, and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>We identified 1,241 cases of chordoma affecting the axial skeleton, and 117 (9.4%) of the patients presented with metastatic disease. The most common locations for metastasis at presentation were lung (6.0%), followed by bone (5.1%) and liver (3.4%). Based on the unadjusted logistic regression analysis, patients had the highest odds of metastatic disease at presentation if they had a tumor located in the sacrococcygeal area (OR = 1.72; 95% CI, 1.11–2.68; p = .015), a tumor with a dedifferentiated histological subtype (OR = 7.42; 95% CI, 2.31–23.79; p = .001) and a tumor size greater than 10 cm (OR = 4.57; 95% CI, 2.52–8.28; p = .009). Only the histological subtype remained significant when combined in a multivariate model controlling for age, sex, race, tumor location, histology, and size. For patients with recorded tumor size information (n = 858), the odds of metastasis at presentation increased by 12.2% with each additional centimeter of tumor size (OR = 1.122; 95% CI, 1.072–1.175; p &lt; .0001). However, this lost significance in the multivariate model. Advanced age (hazard ratio, 2.06; 95% confidence interval, (1.18–3.60); p = .011) and dedifferentiated subtype (hazard ratio, 4.7; 95% confidence interval, (1.33–16.8); p = .02) were significant prognostic factors for survival in patients with metastatic chordoma.</div></div><div><h3>Conclusions</h3><div>Chordoma patients with dedifferentiated histological subtype were more likely to have metastatic disease at presentation. Advanced age and dedifferentiated histological subtype were independent predictors of increased mortality in patients with metastatic chordoma. Identification of this high-risk group may help providers in counseling their patients regarding the likelihood of discovering metastatic disease at the time of diagnosis of chordoma and predicting long term prognosis.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100566"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of SpineNetV2 on a comprehensive set of radiological features for grading lumbosacral disc pathologies","authors":"Alemu Sisay Nigru MSc ,&nbsp;Sergio Benini PhD ,&nbsp;Matteo Bonetti MD ,&nbsp;Graziella Bragaglio MSc ,&nbsp;Michele Frigerio MD ,&nbsp;Federico Maffezzoni MSc ,&nbsp;Riccardo Leonardi PhD","doi":"10.1016/j.xnsj.2024.100564","DOIUrl":"10.1016/j.xnsj.2024.100564","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the integration of Artificial Intelligence (AI) models has revolutionized the diagnosis of Low Back Pain (LBP) and associated disc pathologies. Among these, SpineNetV2 stands out as a state-of-the-art, open-access model for detecting and grading various intervertebral disc pathologies. However, ensuring the reliability and applicability of AI models like SpineNetV2 is paramount. Rigorous validation is essential to guarantee their robustness and generalizability across diverse patient cohorts and imaging protocols.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of MRI images of 1747 lumbosacral intervertebral discs (IVDs) from 353 patients (mean age, 54 ± 15.4 years, 44.5% female) with various spinal disorders, collected between September 2021 and February 2023 at X-Ray Service s.r.l. The SpineNetV2 system was used to grade 11 distinct lumbosacral disc pathologies, including Pfirrmann grading, disc narrowing, central canal stenosis, spondylolisthesis, (upper and lower) endplate defects, (upper and lower) marrow changes, (right and left) foraminal stenosis, and disc herniation, using T2-weighted sagittal MR images. Performance metrics included accuracy, balanced accuracy, precision, F1 score, Matthew's Correlation Coefficient, Brier Score Loss, Lin's concordance correlation coefficients, and Cohen's kappa coefficients. Two expert radiologists provide annotations for these discs. The evaluation of SpineNetV2′s grading is compared against expert radiologists' assessments.</div></div><div><h3>Results</h3><div>SpineNetV2 demonstrated strong performance across various metrics, with high agreement scores (Cohen's Kappa, Lin's Concordance, and Matthew's Correlation Coefficient exceeding 0.7) for most pathologies. However, lower agreement was found for foraminal stenosis and disc herniation, underscoring the limitations of sagittal MR images for evaluating these conditions.</div></div><div><h3>Conclusions</h3><div>This study highlights the importance of external validation, emphasizing the need for comprehensive assessments of deep learning models. SpineNetV2 exhibits promising results in predicting disc pathologies, with findings guiding further improvements. The open-source release of SpineNetV2 enables researchers to independently validate and extend the model's capabilities. This collaborative approach promotes innovation and accelerates the development of more reliable and comprehensive deep learning tools for the assessment of spine pathology.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100564"},"PeriodicalIF":0.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth-friendly spinal surgery: Review of the effect on truncal growth","authors":"Dalton J. Ennis BS,&nbsp;Dustin K. Baker MD,&nbsp;Howard M. Place MD","doi":"10.1016/j.xnsj.2024.100563","DOIUrl":"10.1016/j.xnsj.2024.100563","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric spinal deformity surgery affects ultimate spinal height in the growing child. This effect on ultimate spinal height has also been shown to affect pulmonary development and ultimately pulmonary function. There has been an increasing trend toward growth-friendly spinal surgery in early onset scoliosis to minimize the negative consequences of early spinal fusion surgery. Such growth-friendly techniques include VEPTR, MCGR, and Shilla. Which technique allows for the most growth after initial implantation is still not clear.</div></div><div><h3>Methods</h3><div>An extensive literature review on the topic of pediatric spinal growth was undertaken. Topics reviewed include: normal growth, growth after intervention by various methods, and the effect on pulmonary function. We have summarized the literature for the techniques identified and compared these with normal population data..</div></div><div><h3>Results</h3><div>The data for various surgical techniques were reviewed. These included VEPTR, standard growing rods, and MCGR. The measurement techniques for determining ultimate spinal growth varied based upon the technique for measurement and the timing of initial and final measurements. The results of attained spinal growth were not directly correlated to pulmonary function values.</div></div><div><h3>Conclusions</h3><div>There is still no standardized ideal time or technique for assessing the best results in this area. We suggest that some of what is called growth from growth-friendly techniques is lengthening from the initial deformity correction. This nomenclature needs to be clarified. In addition, how and when to determine ultimate spinal growth from each surgical technique and by which radiographic technique needs to be standardized.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"20 ","pages":"Article 100563"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}