North American Spine Society Journal最新文献

{"title":"Association between intraoperative hypotension and motor evoked potential change in ossification of posterior longitudinal ligament and/or ossification of ligamentum flavum surgery","authors":"Tun Liu MD, PhD ,&nbsp;Wentao Wang MD, PhD ,&nbsp;Huaguang Qi MD ,&nbsp;Jia Li MD, PhD ,&nbsp;Bin Guo MD ,&nbsp;Kuo Jiang MD, PhD ,&nbsp;Songchuan Zhao MD ,&nbsp;Ruiguo Wang MD, PhD ,&nbsp;Jitao Zhang MD ,&nbsp;Gang Wu MD, PhD ,&nbsp;Gang Wang MD, PhD","doi":"10.1016/j.xnsj.2025.100820","DOIUrl":"10.1016/j.xnsj.2025.100820","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative hypotension (IOH) is a recognized contributor to changes in motor evoked potential (MEP) during spinal surgeries. Additionally, it is essential to precisely define IOH across different surgical phases. However, there is limited data on optimal IOH thresholds for predicting MEP changes in thoracic ossification of the posterior longitudinal ligament (OPLL) and/or ossification of the ligamentum flavum (OLF) surgery. We aim to determine the IOH thresholds for predicting MEP changes during surgical treatment for OPLL and/or OLF based on different surgical phase.</div></div><div><h3>Methods</h3><div>Data collected included demographic information, surgical details, mean arterial pressure (MAP) values, and MEP signals. A receiver operating characteristic (ROC) curve was employed to determine the MAP thresholds. A comparative analysis was performed to evaluate IOH episodes occurring during predecompression versus postdecompression surgical phases, specifically in the early and later stages. Additionally, a multivariate logistic regression analysis was conducted to assess the association between surgical variables and MEP change.</div></div><div><h3>Results</h3><div>The MAP thresholds for predicting changes in MEP at the early surgical stage were determined as follows: 70 mmHg for patients with combined OPLL and OLF, 66 mmHg for OPLL patients, and 65 mmHg for OLF patients. However, it is recommended that MAP at the later surgical stage should be elevated to exceed 75 mmHg, 73 mmHg, and 71 mmHg in patients diagnosed with combined OPLL and OLF, OPLL, and OLF, respectively. A stronger correlation was observed between MAP variability ratio and MEP amplitude reduction ratio (ARR) during postdecompression surgical phase. At the early surgical stage, the administration of ephedrine bolus was identified as a risk factor for predicting MEP change (odds ratio [OR]=1.13, p&lt;.01). At the later stage, the risk-factors included ephedrine bolus (OR=1.09, p&lt;.01), estimated blood loss (per 100 mL) (OR=1.23, p=.02), and patients with combined OPLL and OLF (OR=12.12, p&lt;.01).</div></div><div><h3>Conclusions</h3><div>We determined cutoff values for MAP to predict changes in MEP in patients undergoing surgical treatment for OPLL and/or OLF based on different surgical phases. Compared to the early surgical stage, patients exhibit less tolerance to IOH at the later surgical stage. A stronger correlation was observed between the MAP variability ratio and MEP ARR at the later surgical stage. Additionally, we identified surgical factors that are associated with a higher probability of MEP change.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100820"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681368","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}

{"title":"The future is now: How AI is reshaping spine care","authors":"Eric J. Muelbauer ,&nbsp;Mohammed Ali Alvi MD, MS ,&nbsp;David J. Kennedy ,&nbsp;Michael G. Fehlings MD, PhD","doi":"10.1016/j.xnsj.2025.100825","DOIUrl":"10.1016/j.xnsj.2025.100825","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial intelligence (AI) is rapidly reshaping spinal care, transitioning from experimental algorithms to operational tools embedded in clinical workflows. This narrative review explores the evolving role of AI across the spine care continuum, including diagnostic imaging, surgical planning, intraoperative navigation, predictive analytics, and digital therapeutics.</div></div><div><h3>Methods</h3><div>Using a mixed-methods approach, we synthesized insights from peer-reviewed literature, regulatory documents, press releases, and grey sources published between 2017 and 2025.</div></div><div><h3>Results</h3><div>AI-enabled imaging platforms now assist in detecting spinal pathologies and extracting quantitative metrics such as disc heights and Cobb angles, improving diagnostic consistency and reducing inter-rater variability. In surgical planning, decision-support systems and robotics-integrated platforms offer personalized guidance and enhanced precision. Intraoperative tools using 2D–3D fusion and volumetric reconstruction are enabling hardware-light navigation, particularly in ambulatory settings. Predictive models for survival, reoperation risk, and patient-reported outcomes are emerging, though external validation remains limited.</div><div>Digital therapeutics and wearable technologies are expanding the reach of spine care beyond the clinic, offering scalable solutions for rehabilitation and postoperative monitoring. Meanwhile, regulatory and legal frameworks are evolving to address transparency, data governance, and intellectual property concerns. Recent FDA guidance and landmark legal cases underscore the need for disciplined collaboration and responsible deployment.</div></div><div><h3>Conclusions</h3><div>AI in spine care is no longer theoretical and is operational. Its integration promises enhanced precision, efficiency, and personalization, but also demands rigorous validation and ethical oversight. This review highlights the multifaceted impact of AI and calls for continued alignment between clinicians, developers, and regulators to ensure safe, equitable, and sustainable innovation.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100825"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736471","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}

{"title":"Anterior cement augmentation technique for correction of kyphotic deformity in the lumbar spine using an anterior-to-Psoas approach","authors":"David Shin BS ,&nbsp;David Cheng BS, MPH ,&nbsp;Debra Cheng BS ,&nbsp;Carson Cummings BS ,&nbsp;Jacob Razzouk BS ,&nbsp;Olumide Danisa MD ,&nbsp;Wayne Cheng MD","doi":"10.1016/j.xnsj.2025.100818","DOIUrl":"10.1016/j.xnsj.2025.100818","url":null,"abstract":"<div><h3>Background</h3><div>Posterior kyphotic deformity correction in patients with osteoporosis carries a significant risk of instrumentation cut-out. Anterior approaches allow direct distraction at the center of the deformity, yet reduction devices or instrumentation may telescope into vertebral endplates. This study proposes an anterior cementing augmentation technique for correction of kyphotic deformity involving a less invasive oblique lateral interbody fusion (OLIF) approach.</div></div><div><h3>Case description</h3><div>Patient 1 had a previous compression fracture at L2 above prior instrumented fusion, with kyphotic deformity, and underwent a stage-one anterior lateral L2 corpectomy via an (OLIF) approach. Cement was placed centrally at L1 and L3, followed by an expandable cage and a stage-two posterior T11-to-pelvis instrumented fusion with prophylactic cement augmentation at T10–T12. Patient 2 had a previous remote L5–S1 anterior lumbar interbody fusion and underwent a posterior C4–S1 osteotomy and instrumented fusion for kyphoscoliosis deformity. The patient developed immediate postoperative instrumentation failure with kyphosis at L4–L5 and instrumentation loosening and migration at L4–S1 within 2 weeks of surgery. They then underwent (OLIF) at L4–L5 with anterior cement augmentation at L4–L5, followed by a revision lumbar-pelvic instrumented fusion.</div></div><div><h3>Outcome</h3><div>A step-by-step technique was described for anterior corpectomy and cement augmentation via an anterior lateral approach, presenting an alternative for correction of kyphotic deformity and restoration of sagittal alignment in the lumbar spine of patients with poor-bone density.</div></div><div><h3>Conclusions</h3><div>A minimally invasive, anterior-to- psoas approach may decrease morbidity of approach related complications. Both patients demonstrated kyphotic deformity correction with follow-up records suggesting favorable outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100818"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614555","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}

{"title":"Letter to the editor regarding chemical prophylaxis and venous thromboembolism following elective spinal surgery: a systematic review and meta-analysis","authors":"Zahra Ramezani MD,&nbsp;Seyed Danial Alizadeh MD,&nbsp;Vafa Rahimi-Movaghar MD","doi":"10.1016/j.xnsj.2024.100311","DOIUrl":"10.1016/j.xnsj.2024.100311","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100311"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139639301","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}

{"title":"Development and reliability of a systematic method to evaluate lumbar paraspinal muscle size and quality in computed tomography images","authors":"Cristiane R. Carlesso PT, PhD ,&nbsp;Jaclyn M. Sions PT, DPT, PhD ,&nbsp;William J. Anderst PhD ,&nbsp;Charity G. Patterson PhD ,&nbsp;Rafaela M. Barbosa PT ,&nbsp;Luiza P. Weissmann ,&nbsp;Tom Gale MS ,&nbsp;Michael J. Schneider DC, PhD ,&nbsp;Sara R. Piva PT, PhD","doi":"10.1016/j.xnsj.2025.100822","DOIUrl":"10.1016/j.xnsj.2025.100822","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar paraspinal muscles (LPMs) are critical for spinal stability, and their morphological alterations are associated with chronic low back pain (cLBP). Computed tomography (CT) offers a feasible alternative to magnetic resonance imaging for assessing LPM morphology; however, its broader use has been hindered by inconsistent measurement methods and limited reliability data. This study aimed to describe a systematic CT-based method for evaluating LPM cross-sectional area (CSA) and attenuation (MA) in adults with cLBP and to determine its intra and inter-examiner procedural reliability.</div></div><div><h3>Methods</h3><div>High-resolution CT images were used to analyze bilateral LPMs: erector spinae (L1–L5), multifidi (L1–S1), psoas (L3), and quadratus lumborum (L3). Two trained examiners independently performed image selection and analysis, blinded to subject identity and prior results. Procedural reliability was quantified using intraclass correlation coefficients (ICC_2,1) with 95% confidence intervals (CI). Mean ICCs&lt;0.50 indicated poor, 0.50–0.74 moderate, 0.75–0.90 good, and &gt;0.90 excellent procedural reliability.</div></div><div><h3>Results</h3><div>Thirty-six participants (40% female; age 48±15 years; BMI 27.2±4.3 kg/m²) with moderate disability were included. Intraexaminer procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratus lumborum (ICC point estimates &gt;0.916, &gt;0.959, and &gt;0.962, respectively); and good to excellent for multifidi CSA (ICC point estimates: 0.770–0.916), with greater variability at L1 and L2. Inter-examiner procedural reliability was excellent for CSA of the erector spinae, psoas, and quadratum lumborum (ICC point estimates &gt;0.916, &gt;0.946, and &gt;0.941, respectively); and moderate to excellent for multifidi CSA (ICC point estimates: 0.593–0.945), with lower reliability at upper lumbar levels. Intra and inter-examiner procedural reliability for MA was excellent across all LPMs.</div></div><div><h3>Conclusions</h3><div>The presented CT-based protocol provides a standardized and reproducible method for assessing LPM CSA and MA in adults with cLBP. Demonstrated high procedural reliability—including image selection and analysis—supports its use for consistent evaluation of LPM morphology in both clinical and research contexts, particularly where muscle degeneration complicates image-based assessment.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100822"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736472","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}

{"title":"Robotic-assisted bilateral lumbar pars fracture endoscopic debridement and direct repair as treatment for lumbar radiculopathy: A case report","authors":"S. Garg BS ,&nbsp;Y. Wang MD ,&nbsp;N. Lehman MSPA ,&nbsp;M. Gallizzi MD, MS","doi":"10.1016/j.xnsj.2025.100823","DOIUrl":"10.1016/j.xnsj.2025.100823","url":null,"abstract":"<div><h3>Background</h3><div>Management of lumbar spondylolysis in the athletic population can be successful with conservative means, however surgical intervention may be required for fractures presenting with radiculopathy. Direct repair with intralaminar screws is a commonly used technique which has been described previously with various rates of success. Technological advancements now allow minimally invasive direct pars repair with robotic assistance as a viable option. Robotic assistance for instrumentation and stabilization of the fracture can also be combined with endoscopic spine techniques, to debride the fracture site, to effectively treat this issue<em>.</em></div></div><div><h3>Methods</h3><div>A 16-year-old giant slalom skier presented with low back pain and associated bilateral L5 radiculopathy to our facility. Using MRI and CT, they were diagnosed with bilateral L5 pars interarticularis fractures with bony edema and with subtle hypermobile retrolisthesis in combination with bilateral foraminal stenosis at the L5-S1 disc space. Due to patient’s active sports participation and continued symptoms despite rest, physical therapy, chiropractic therapy, and bracing, the patient decided to undergo elective, outpatient, bilateral robotic-assisted percutaneous endoscopic debridement of the pars fractures through 7-mm skin incisions, and bilateral percutaneous intralaminar fixation of the pars fractures with pedicle screws through 1.5-cm skin incisions.</div></div><div><h3>Results</h3><div>In the immediate postoperative period, the patient reported complete resolution of mechanical low back pain and associated bilateral radiculopathy. The patient had resolution of incisional low back pain by 6 weeks postoperatively and demonstrated stable healing with no evidence of hardware failure radiographically through their 6-month postoperative x-rays. This 16-year-old was able to return to prior level of sport and competition at 3-months postoperatively.</div></div><div><h3>Conclusions</h3><div>This novel minimally invasive robotic-assisted percutaneous approach for lumbar spondylolysis fracture debridement and direct repair is a suitable option for nonhealing pars fracture with radiculopathy in high performing active adolescent patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100823"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681369","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}

{"title":"Proton pump inhibitors are associated with increased risk of pseudoarthrosis after lumbar fusion","authors":"Melissa Romoff BA,&nbsp;Michael S. Kim MD,&nbsp;Courtney Spitzer BA,&nbsp;Andy Ton MD,&nbsp;Vivian Chen MD,&nbsp;Ryan Le MD,&nbsp;Abhinav Sharma MD,&nbsp;Emily Mills MD,&nbsp;Hao-Hua Wu MD,&nbsp;Don Young Park MD,&nbsp;Yu-Po Lee MD,&nbsp;Nitin Bhatia MD,&nbsp;Sohaib Hashmi MD","doi":"10.1016/j.xnsj.2025.100829","DOIUrl":"10.1016/j.xnsj.2025.100829","url":null,"abstract":"<div><h3>Background</h3><div>Pseudoarthrosis is a major complication following lumbar spine fusion, leading to revision surgery, increased disability, and substantial economic burden. Proton pump inhibitors (PPIs) are commonly used in the perioperative period, but their impact on fusion success remains poorly defined.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX research database to identify adult patients undergoing lumbar spine fusion. Patients were divided into 2 cohorts based on documented PPI use within 30 days postoperatively and underwent 1:1 propensity score matching based on demographic and clinical characteristics. The incidence of pseudoarthrosis was assessed using diagnostic coding, and risk was compared using risk ratios and Kaplan-Meier survival analysis. An age-stratified analysis was also performed.</div></div><div><h3>Results</h3><div>A total of 122,584 matched pairs were analyzed. Pseudoarthrosis occurred in 7.38% of PPI users compared to 3.98% of nonusers (RR: 1.88; p &lt; .0001). Kaplan-Meier survival analysis revealed early separation of pseudoarthrosis-free survival curves by postoperative day 60, persisting through 1-year follow-up. Age-stratified analysis showed consistently higher pseudoarthrosis risk among PPI users across all age groups, with the largest relative impact observed in patients under 55 years old.</div></div><div><h3>Conclusions</h3><div>Postoperative PPI use is associated with a significantly increased risk of pseudoarthrosis following lumbar spine fusion. These findings suggest careful consideration of the necessity of PPI therapy in the perioperative period, particularly in younger patients where the relative impact appears the greatest.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100829"},"PeriodicalIF":2.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840985","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}

{"title":"Extraforaminal lumbar interbody fusion: A systematic review of clinical outcomes, fusion rates, and safety profile","authors":"Michael K. Coffin BS,&nbsp;Kyle A. McGrath DO,&nbsp;Rebecca M. Garner MD,&nbsp;Christiana M. Cornea MD,&nbsp;Joseph S. Cheng MD,&nbsp;Justin N. Virojanapa DO","doi":"10.1016/j.xnsj.2025.100830","DOIUrl":"10.1016/j.xnsj.2025.100830","url":null,"abstract":"<div><h3>Background</h3><div>Extraforaminal lumbar interbody fusion (ELIF) accesses the disc through a posterolateral extraforaminal corridor that preserves the posterior ligamentous complex and avoids abdominal exposure. The objective of this systematic review is to synthesize the clinical outcomes, fusion rates, complications, and surgical indications for ELIF.</div></div><div><h3>Methods</h3><div>PRISMA 2020–conformant review registered in PROSPERO (ID: 1111090). Eligible studies reported clinical or radiographic outcomes of ELIF performed via the posterolateral extraforaminal approach. Extracted variables included indications, operative time, patient-reported outcomes, fusion, and complications. Risk of bias was assessed with the Newcastle–Ottawa Scale (NOS).</div></div><div><h3>Results</h3><div>Thirteen retrospective studies (n=518) met inclusion. The quality of studies included was generally fair, as graded by Newcastle–Ottawa Scale (NOS). The most common indication was degenerative disc disease. Mean operative time was 168.7 minutes. Fusion by technique: open pooled mean 98%, minimally invasive pooled mean 84%, and endoscopic 100% in a single series. Pooled VAS back improved as follows: open 6.27 to 2.80 (Δ 3.47; mean follow-up 12.8 months), minimally invasive 8.16 to 3.52 (Δ 4.64; 18.8 months), endoscopic 6.49 to 1.66 (Δ 4.83; 13.2 months). Pooled VAS leg improved: open 6.66 to 2.35 (Δ 4.31, 13.3 months), minimally invasive 8.66 to 2.17 (Δ 6.49; 15.5 months), endoscopic 6.60 to 1.50 (Δ 5.10; 14.2 months). Pooled Oswestry disability index (ODI) improved: open 60.17 to 26.25 (Δ 33.92; 9.5 months), minimally invasive 56.02 to 21.46 (Δ 34.56; 18.8 months), endoscopic 34.59 to 12.19 (Δ 22.40; 13.2 months). Transient radiculopathy was reported at 9.5% and dural tear at 0.5%.</div></div><div><h3>Conclusions</h3><div>As the first systematic review on ELIF, findings indicate it is a safe, effective alternative for lumbar fusion in select patients. Success necessitates favorable extraforaminal anatomy and intraoperative nerve monitoring to minimize complications. Future prospective trials are essential to validate these outcomes and standardize patient selection criteria.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100830"},"PeriodicalIF":2.5,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840986","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}

{"title":"Artificial intelligence in spine care: A scoping review of treatment applications","authors":"Victoria A. Bensel DC, MS, MPH ,&nbsp;Anne Habeck MPH ,&nbsp;Marcda Hilaire Brunot DC, MPH ,&nbsp;Eleni-James Becton DC ,&nbsp;Monika Ray PhD ,&nbsp;Alexandria L. Brackett ,&nbsp;Anthony J. Lisi DC","doi":"10.1016/j.xnsj.2025.100827","DOIUrl":"10.1016/j.xnsj.2025.100827","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly applied in healthcare to support decision-making, personalize treatment, and improve outcomes. In spine care, AI has been used for both operative and nonoperative interventions, including surgical planning, outcome prediction, and digital tools for chronic low back pain (cLBP). However, evidence remains fragmented and variable in quality, limiting its utility for clinicians and researchers. This review maps the current literature on AI in spinal disorder treatment and highlights gaps for future research.</div></div><div><h3>Methods</h3><div>This scoping review followed Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. Ovid MEDLINE, AMED, Embase, Cochrane CENTRAL, Web of Science, and Scopus were searched from January 2019 to December 2024. Eligible studies were English-language, peer-reviewed, involved AI applied to treatment interventions in human participants, included a comparison group, and provided sufficient methodological detail. No geographic restrictions were applied. Studies were evaluated by AI technology, treatment modality, outcomes, and quality. Methodological quality was assessed using a 19-point scoring system covering study design, reporting clarity, data validation, and feature selection.</div></div><div><h3>Results</h3><div>The search yielded 1,782 manuscripts; 16 met inclusion criteria. Of these, 3 originated from the United States, 8 were single-country studies, and 5 were international collaborations. Fourteen studies focused on nonoperative management of musculoskeletal pain, particularly cLBP, using chatbots, AI-driven exercise platforms, and decision-support systems. These demonstrated modest improvements in pain, disability, and quality of life, with high adherence and satisfaction. Two studies investigated operative applications, reporting favorable results. Methodological scores ranged from 8.5 to 17/19, with common limitations in data validation and feature selection.</div></div><div><h3>Conclusions</h3><div>Current literature demonstrates AI applications in nonoperative management of cLBP and in operative contexts such as surgical planning and outcome prediction. Most studies addressed cLBP, with limited exploration of neck pain, highlighting an area for future investigation.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100827"},"PeriodicalIF":2.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798463","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}

{"title":"Impact of sarcopenia and multifidus atrophy on outcomes from minimally invasive decompression surgery for lumbar spinal stenosis","authors":"Gilad J. Regev MD ,&nbsp;Uri Hochberg MD ,&nbsp;Dror Ofir MD ,&nbsp;Khalil Salame MD ,&nbsp;Zvi Lidar MD ,&nbsp;Morsi Khashan MD","doi":"10.1016/j.xnsj.2025.100828","DOIUrl":"10.1016/j.xnsj.2025.100828","url":null,"abstract":"<div><h3>Background</h3><div>In order to improve outcomes for patients with lumbar spinal stenosis, identification of better prognostic factors is necessary to guide patient selection for surgery. The purpose of this study was to investigate the prognostic value of multifidus atrophy and sarcopenia on postoperative pain and disability following minimally invasive decompression for lumbar spinal stenosis.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed medical records and imaging studies for patients with lumbar spinal stenosis who underwent minimally invasive tubular decompression. Multifidus total cross sectional area (tCSA), multifidus functional cross sectional area (fnCSA), multifidus fatty infiltration (FI), psoas tCSA, and psoas relative cross sectional area (rCSA) were evaluated by univariable and multivariable regression to identify predictors of postoperative improvement in visual analogue scores for back pain (VASB) and leg pain (VASL) and Oswestry disability index (ODI) scores for disability.</div></div><div><h3>Results</h3><div>Minimally invasive decompression was performed at 75 spinal levels in 64 patients with an average age of 70.1±10.0 years. In multivariable analysis, lower multifidus FI was significantly associated with 5 point improvement in ODI (p=.002), 10 point improvement in ODI (p=.017), and 17 point improvement in ODI (p=.044). Only male gender (p=.030), lower preoperative VASB (p=.001), and lower preoperative VASL (p=.015) were independently predictive of postoperative deterioration in ODI, VASB, and VASL, respectively.</div></div><div><h3>Conclusions</h3><div>Multifidus FI predicts postoperative improvement in disability following minimally invasive decompression for lumbar spinal stenosis with high accuracy. Minimally invasive decompression surgery is effective for elderly patients and sarcopenic patients, who are not at risk for poorer postoperative outcomes. Male gender and lower preoperative pain or disability are risk factors for postoperative deterioration in patient-reported outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100828"},"PeriodicalIF":2.5,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798543","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}