North American Spine Society Journal最新文献

{"title":"A systematic review and meta-analysis of sagittal cervical spine parameters: Normative values, correlation with quality of life, and biomechanical modeling","authors":"Vinicius Ricieri Ferraz MD ,&nbsp;Carlos R. Goulart MD ,&nbsp;Tobias Alecio Mattei MD, FACS","doi":"10.1016/j.xnsj.2025.100819","DOIUrl":"10.1016/j.xnsj.2025.100819","url":null,"abstract":"<div><h3>Background</h3><div>The sagittal alignment of the cervical spine is pivotal for spinal biomechanics, head positioning, and overall spinal balance. This systematic review synthesizes the available evidence on sagittal cervical spine parameters, establishing normative values in asymptomatic populations, evaluating their correlation with health-related quality of life, and exploring biomechanical modeling to understand their functional implications.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in PubMed/MEDLINE (January 2010–May 2025) following PRISMA guidelines. Key cervical alignment parameters were identified, including C2–C7 Cobb angle, C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), T1 slope minus cervical lordosis (T1S–CL), C2 slope, neck tilt, cranial tilt, and spino-cranial angle (SCA). After screening 500 articles, 20 studies meeting predefined inclusion criteria were analyzed. Data on normative values, correlations with HRQoL scores and findings from biomechanical modeling were extracted. A meta-analysis was performed to establish normative values in the asymptomatic population.</div></div><div><h3>Results</h3><div>Normative values were derived from meta-analyses, and statistical correlations were used to link the cervical spine parameters under study to HRQoL metrics such as the Neck Disability Index (NDI), EuroQol 5 Dimension (EQ-5D), and Short Form-36 (SF-36). Deviations, particularly C2–C7 SVA &gt; 40 mm and T1S–CL &gt; 15–20°, were significantly associated with reduced HRQoL. Biomechanical modeling techniques, including finite element (FE) and multibody dynamics approaches, provide further insights into spinal loading and stress distribution in the setting of abnormal cervical spinal alignment.</div></div><div><h3>Conclusions</h3><div>Quantitative evidence shows that cervical alignment is prognostically decisive rather than merely descriptive. Across several clinical cohorts, a C2–7 sagittal vertical axis &gt; 40 mm or a T1-slope minus cervical-lordosis mismatch &gt; 15–20° consistently predicted clinically meaningful disability as measured by NDI, EQ-5D and SRS-22. These thresholds, supported by biomechanical modelling, define actionable targets for surgical planning, rehabilitation and long-term follow-up. Standardized measurement protocols and patient-specific reference ranges are now the critical next steps to transform these radiographic markers into personalized care pathways and prospective interventional trials.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100819"},"PeriodicalIF":2.5,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697937","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":"Higher screw-to-cage length ratios in standalone lateral interbody fusion using integrated, expandable implants provide more predictable outcomes with less variability: A 2-year follow-up study","authors":"Dean T. Biddau BBiomedSci ,&nbsp;Dean P. McKenzie BA (Hons) PhD ,&nbsp;Nigel R. Munday MBBS, MBA ,&nbsp;Gregory M. Malham BSc, MBChB, DMed, FRACS","doi":"10.1016/j.xnsj.2025.100817","DOIUrl":"10.1016/j.xnsj.2025.100817","url":null,"abstract":"<div><h3>Background Context</h3><div>Lateral Lumbar Interbody Fusion (LLIF) is widely used for degenerative spinal disorders. Standalone LLIF with expandable cages integrating plate-screw fixation (eLLIFp) has emerged to address disc degeneration and adjacent segment disease while reducing the need for posterior fixation. Biomechanical data suggest greater stability with longer screws, but the clinical impact of screw-to-cage length ratios remains unclear. This study evaluates outcomes following eLLIFp and investigates whether screw-to-cage ratios influence results.</div></div><div><h3>Methods</h3><div>Eighty-one patients (87 levels) underwent eLLIFp, mean age 63.8±10.8 years (49.4% female), BMI 27.7±4.9 kg/m². Common levels treated were L2/3 (35%) and L3/4 (29%). Mean retractor time was 30.2±5.5 min. Retrospective analysis of prospectively collected data examined integrated screw length (30–60 mm) and cage length (50–65 mm). Screw-to-cage ratios were grouped into tertiles: Low (0.46–0.75, n=36), Medium (0.76–0.82, n=18), and High (0.83–1.0, n=27). Outcomes included pain (VAS), disability (ODI), quality of life (SF-12), and fusion status on 12-month CT. Minimum follow-up was 2 years.</div></div><div><h3>Results</h3><div>At 12 months, all patients showed significant improvement (p&lt;0.0001) [VAS back: 7.6→0.9; VAS leg: 6.3→0.7; ODI: 25.7→5.1; SF-12 PCS: 29.9→49.2; MCS: 37.3→55.6]. Improvements were comparable across tertiles, though the high-ratio group exhibited less variability in leg pain outcomes. Fusion was achieved in 79/81 (97.5%) patients. Complications occurred in 5 (6.2%): 3 neurological (motor radiculopathy, radicular pain, transient thigh numbness) and 2 symptomatic nonunions requiring posterior fixation, both with lower screw-to-cage ratios (0.7).</div></div><div><h3>Conclusions</h3><div>Higher screw-to-cage ratios (0.83–1.0) in standalone eLLIFp constructs may enhance consistency in leg pain relief without increasing complications. Maximizing screw length relative to cage dimensions may optimize outcomes and reduce variability in standalone LLIF.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100817"},"PeriodicalIF":2.5,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568232","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":"Predicting rehabilitation discharge after lumbar decompression: Impact of age and preoperative assistive device use","authors":"Michael Avery MD, PhD ,&nbsp;Fernando Terry MD ,&nbsp;Andrew Y. Powers MD, MBI,&nbsp;Forough Yazdanian MD,&nbsp;Chloe Lee BS,&nbsp;Punit Pandya DO,&nbsp;Martina Stippler MD,&nbsp;Efstathios Papavassiliou MD,&nbsp;Ziev B. Moses MD","doi":"10.1016/j.xnsj.2025.100815","DOIUrl":"10.1016/j.xnsj.2025.100815","url":null,"abstract":"<div><h3>Background</h3><div>Elective lumbar decompression, commonly performed via laminectomy or microdiscectomy, is a well-tolerated surgical procedure. Patients requiring discharge to inpatient rehabilitation facilities are infrequent but generate increased healthcare costs and can be burdensome to patients and families. This study aims to develop an accurate predictive model for rehabilitation discharge following elective lumbar decompression, as well as to identify associated factors.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center, cohort study. Current Procedural Terminology codes for laminectomy and microdiscectomy were used to identify patients from October 2012 to November 2024. Charts were reviewed to obtain additional demographic and clinical characteristics on which an initial univariate analysis was performed. Primary outcomes for this study included measurements of accuracy for predicting rehab discharge. Secondary outcomes included associations of variables with rehab discharge. Those with confounding diagnosis or admitted from a rehabilitation facility were excluded. Machine learning models were trained and evaluated on the data using cross-validation and classification metrics were utilized for model comparison.</div></div><div><h3>Results</h3><div>A total of 486 patients were considered for the analysis. After performing a Benjamini-Hochberg correction, the univariate analysis identified multiple statistically significant variables associated with rehabilitation discharge some of which include age, preoperative leg pain, lower extremity weakness, need for a walking assistive device, and frailty. Of the 5 machine learning models tested, the logistic regression model demonstrated superior performance, with the highest area under curve (0.81), Youden’s J statistic (0.55) and balanced accuracy (0.78). The logistic regression model demonstrated that age and the use of an ambulatory assistive device are consistently predictive of rehabilitation discharge (p&lt;.001).</div></div><div><h3>Conclusions</h3><div>When considered alongside frailty, lack of support, and other variables, age and the necessity for a walking assistive device can serve as a reliable predictors of rehabilitation discharge, thereby improving patient workflow, minimizing uncertainty and reducing healthcare costs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100815"},"PeriodicalIF":2.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466434","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":"Section on innovative spine research and novel technologies: fusion cage design, materials, and coatings: Science versus hype1","authors":"Donna D. Ohnmeiss PhD ,&nbsp;David C. Stastny II DO ,&nbsp;Zorica Buser PhD ,&nbsp;Lisa A. Ferrara PhD","doi":"10.1016/j.xnsj.2025.100814","DOIUrl":"10.1016/j.xnsj.2025.100814","url":null,"abstract":"<div><h3>Background</h3><div>Interbody fusion has been performed for many decades with evolving strategies and approaches to improve safety, fusion rates, and clinical outcomes. There have been ongoing advancements in the understanding of spinal biomechanics driving improved implant designs. The advent of 3D printing has allowed new concepts of cage designs to become a reality. The purpose of this narrative review is to provide an overview of current and developing technologies in the area of fusion cage design as well as concerns of the impact of marketing versus science in this area.</div></div><div><h3>Methods</h3><div>A literature search was conducted on PubMed and OVID to identify articles related to interbody fusion cage design. The focus of the review was on current and future interbody fusion cage design.</div></div><div><h3>Results</h3><div>The area of fusion cage design has been rapidly growing. The greatest advancements have been in the area of additive manufacturing which has allowed for much more intricate implant design. Significant advancements have also been made in improving the surfaces of implants to promote osseointegration. Advancements in materials, manufacturing, and sensor technologies are paving the way for developing intelligent interbody fusion cages capable of monitoring fusion progression and potentially stimulating bone growth.</div></div><div><h3>Conclusion</h3><div>There have been many exciting developments in the area of fusion cages, primarily related to materials, design, and surface topology, much of which have been driven by the advent of 3D printing. While many of these technologies may hold promise, there is relatively little data for the particular purported benefits of these implants. Much work is needed to understand the mechanobiological function of these devices, their clinical outcomes, indications, and cost-effectiveness.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100814"},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568781","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 predictive value of the global alignment and proportion (GAP) score for mechanical complications following adult spinal deformity surgery: A systematic review and meta-analysis","authors":"Vinicius Ricieri Ferraz MD ,&nbsp;Guilherme Santos Piedade MD, PhD ,&nbsp;Carlos R. Goulart MD ,&nbsp;Maria Fernanda Ricieri Ferraz Franco de Souza MD ,&nbsp;Marcelo Ochoa Coelho de Souza Furlan MD ,&nbsp;Philippe A. Mercier ,&nbsp;Tobias A. Mattei MD","doi":"10.1016/j.xnsj.2025.100816","DOIUrl":"10.1016/j.xnsj.2025.100816","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical complications (MCs) remain a significant challenge in adult spinal deformity (ASD) surgery. The global alignment and proportion (GAP) score, a pelvic incidence-based metric, was introduced to predict the risk of postoperative MCs by assessing the proportionality of spinopelvic alignment.</div></div><div><h3>Methods</h3><div>We systematically reviewed the evidence on the predictive validity of the GAP score and its modifications with regard to postoperative MCs (eg, proximal junctional kyphosis/failure, rod fracture, or implant failure) and patient-reported outcomes in adult spinal deformity (ASD) surgery. A systematic search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was conducted for studies published from January 2017 to July 2025. A proportion meta-analysis regarding the occurrence of MCs was performed using those articles that divided the patients in the three original GAP categories.</div></div><div><h3>Results</h3><div>A total of 32 studies met the inclusion criteria, encompassing over 5,700 patients. The reported incidence of MCs varied from 17.6% to 61%. The predictive accuracy of the GAP score was inconsistent, with reported Area Under the Curve (AUC) values for predicting MCs ranging from a low of 0.53 to a moderately accurate 0.86. A meta-analysis found a significant association, with an odds ratio (OR) of 2.65 for MCs in severely disproportioned patients. However, the score's validity was diminished in specific cohorts, particularly for circumferential minimally invasive surgery (cMIS). Recent evidence demonstrates that the GAP score's predictive power is enhanced when combined with biological factors. The modified GAPB score, which incorporates Body Mass Index and Bone Mineral Density, demonstrated superior predictive accuracy (AUC=0.885 vs. 0.798). Machine learning models utilizing these multifactorial inputs achieved predictive accuracies over 73%.</div></div><div><h3>Conclusions</h3><div>The predictive value of the GAP score with regard to MCs in ASD surgery is moderate but context-dependent. Its utility as a stand-alone predictor is limited, and the current evidence in the scientific literature supports the use of multifactorial predictive models, such as the GAPB score, and the application of machine learning to integrate patient-specific biological and biomechanical factors.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100816"},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520080","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":"Long-term outcomes of total lumbar disc prosthesis: Sustained pain relief","authors":"Vicente Vanaclocha PhD MD ,&nbsp;Pablo Jordá-Gómez PhD MD ,&nbsp;Nieves Saiz-Sapena PhD MD ,&nbsp;Juan Martínez-Leon PhD MD ,&nbsp;Leyre Vanaclocha MD","doi":"10.1016/j.xnsj.2025.100813","DOIUrl":"10.1016/j.xnsj.2025.100813","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar degenerative disc disease (DDD) is a leading cause of chronic low back pain and work-related disability. Total lumbar disc prosthesis offers motion preservation and may reduce adjacent segment degeneration compared to fusion. However, long-term functional and occupational outcomes remain underreported.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 130 patients (mean age 37.3±7.9 years; 71.54% male) who underwent total lumbar disc replacement between 2008 and 2020. Patients were assessed preoperatively and at a mean follow-up of 13.88 years using Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and occupational status. Statistical analyses included ANOVA, regression modeling, and correlation analysis.</div></div><div><h3>Results</h3><div>VAS scores improved significantly (back: 8.6±1.7 to 1.6±2.4; leg: 7.3±2.9 to 1.1±0.9; p&lt;.001). ODI decreased from 46.12±7.3 to 27±9.3. At final follow-up, 73.84% of patients returned to their original job, 13.84% transitioned to alternative roles, and 3.07% were pensioned. Patient satisfaction was high (77.69% rated outcome as 10/10). Complication and reoperation rates were low (3.08% and 12.31%, respectively), with no prosthesis revisions.</div></div><div><h3>Conclusions</h3><div>Total lumbar disc prosthesis provides durable pain relief, functional improvement, and high rates of occupational reintegration. These findings support its use as a motion-preserving alternative to fusion in appropriately selected patients.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100813"},"PeriodicalIF":2.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466435","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 prediabetes on postoperative outcomes following short-segment transforaminal lumbar interbody fusions","authors":"Syed I. Khalid MD ,&nbsp;Ryan Wang BS ,&nbsp;Jakov Tiefenbach MD ,&nbsp;Tatiana Abou-Mrad MD ,&nbsp;Elie Massaad MD, MSc ,&nbsp;Aladine Elsamadicy MD ,&nbsp;Ankit I. Mehta MD ,&nbsp;John H. Shin MD, MBA","doi":"10.1016/j.xnsj.2025.100811","DOIUrl":"10.1016/j.xnsj.2025.100811","url":null,"abstract":"<div><h3>Objectives</h3><div>Type 2 diabetes mellitus (T2DM) is a well-established risk factor for adverse surgical outcomes, but the impact of prediabetes on spine surgery remains unexplored. This study evaluated the influence of prediabetes on postoperative complications in patients undergoing short-segment (≤3 levels) transforaminal lumbar interbody fusion (TLIF).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing 1-3 level TLIF in a national administrative database. Patients were categorized into 3 groups: no diabetes, prediabetes, and T2DM. Patients with type 1 diabetes were excluded. A 1:1:1 exact match was performed to balance demographics, comorbidities, and the number of spinal levels fused. Thirty-day postoperative medical and surgical complications were analyzed.</div></div><div><h3>Results</h3><div>A total of 17,796 patients (5,932 per group) were included. Patients with T2DM demonstrated a significantly higher incidence of urinary tract infection (OR, 1.49; 97.5% CI, 1.19–1.86), pneumonia (OR, 1.59; 97.5% CI, 1.10–2.31), acute kidney injury (OR, 2.32; 97.5% CI, 1.70–3.18), surgical site infection (OR, 1.34; 97.5% CI, 1.04–1.74), overall medical complications (OR, 1.50; 97.5% CI, 1.28–1.75), and surgical complications (OR, 1.29; 97.5% CI, 1.05–1.58). In contrast, patients with prediabetes did not demonstrate a statistically significant increase in postoperative complications.</div></div><div><h3>Conclusions</h3><div>T2DM is associated with a higher risk of medical and surgical complications following short-segment TLIF. However, prediabetes does not appear to affect postoperative complication rates. These findings suggest enhanced perioperative management is warranted for patients with T2DM, while standard protocols may be sufficient for patients with prediabetes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100811"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416314","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":"Not all Parkinsons patients with thoracolumbar spinal fusion are created equal: Highlighting the difference between long and short fusions","authors":"Matthew Lindsey MD ,&nbsp;Hannah Levy MD ,&nbsp;Tyler Allen MD ,&nbsp;Andrew Pumford BA ,&nbsp;Abdelrahman Hamouda BS ,&nbsp;Brian Kelley BS ,&nbsp;Brian Goh MD, PhD ,&nbsp;Brett Freedman MD ,&nbsp;Arjun Sebastian MD ,&nbsp;Ahmad Nassr MD","doi":"10.1016/j.xnsj.2025.100808","DOIUrl":"10.1016/j.xnsj.2025.100808","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Parkinsons disease (PD) is a devastating neuromuscular disease that has several distinct spinal syndromes in addition to common degenerative spinal disorders. Multiple studies have concluded that patients with Parkinson's disease are at increased risk for perioperative medical complications and poor surgical outcomes such as failure of hardware and reoperation. PD patients exist in a spectrum of spinal disease with presentations, indications and surgical paradigms varying widely, yet the literature tends to treat them as a homogenous group. A more nuanced investigation and comparison of PD patients undergoing TL fusion will yield important differences in presentation, indication and outcomes. There is scant evidence on the most appropriate fusion paradigm for treating Parkinson's patients. We set out to compare patients who had short or long (&gt;3 levels) thoracolumbar fusions to contrast the rate of surgical failure, and complications between each surgical approach and identify any patient, surgical, or disease risk factors for poor outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective cohort study of a single center experience with spinal fusion patients with concomitant Parkinson's disease at the time of spinal surgery. We included adult patients who underwent thoracolumbar spinal fusion and had a concomitant diagnosis of PD at an academic center between 2017 and 2022. Revision, oncologic and infection cases were excluded. Primary outcome measures were radiographic (stenosis, listhesis, hardware, fracture) evidence of failure, and morbidity. Secondarily, a multivariate regression was performed to identify patient risk factors for failure. We extracted and analyzed demographic information, Parkinson's specific metrics, in and out of hospital complications, surgical data, and radiologic outcomes and compared patients who underwent either short or long fusion constructs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;92 patients were identified after inclusion and exclusion. 63 (68%) underwent short fusion and 29 (32%) had long fusion constructs. Short fusion constructs were more strongly indicated for radiculopathy 51% vs. 21% p=.01) while extended fusions had a higher indication of spinal deformity (41%vs. 10% p=.001) or fracture (34%vs. 8% p=.004) and were more likely to have decreased mobility prior to surgery (79.7%vs. 53.9%; P&lt;.001). Short constructs had a higher rate of listhesis (20%vs. 0% p=.01) or stenosis (34.5%vs. 4% p=.008) at the level above the upper instrumented level, proximal screw loosening (13%vs. 0% p=.009), proximal junctional complications (53%vs. 12% p=.001) and proximal junctional failures (37%vs. 8% p=.02). In hospital complications, 90 day and 1 year mortality, reoperation rate, infection rate, progressive neurologic decline, and fusion rates were statistically similar between groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;How to approach surgical treatment of PD patients remains a c","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100808"},"PeriodicalIF":2.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466438","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 enhanced hospital infection prevention measures during-COVID-19 pandemic on the incidence of surgical site infections following spinal instrumentation surgery for lumbar spinal stenosis: A nationwide database study","authors":"Daiyang Yu MD ,&nbsp;Yuri Miyakoshi MD ,&nbsp;Tomoyuki Tanaka MD, PhD ,&nbsp;Kunihiko Takahashi PhD ,&nbsp;Tetsuya Jinno MD, PhD ,&nbsp;Toshitaka Yoshii MD, PhD ,&nbsp;Kiyohide Fushimi MD, PhD ,&nbsp;Hiroyuki Inose MD, PhD","doi":"10.1016/j.xnsj.2025.100810","DOIUrl":"10.1016/j.xnsj.2025.100810","url":null,"abstract":"<div><h3>Background context</h3><div>Despite the implementation of stringent infection control measures during the COVID-19 pandemic, the impact of these interventions on surgical site infection (SSI) rates in spinal instrumentation surgery remains unclear. This study aimed to compare the incidence of SSIs after spinal instrumentation surgeries for lumbar spinal canal stenosis (LCS) before and during the COVID-19 pandemic and to assess the impact of the COVID-19 pandemic, including enhanced hospital infection prevention measures implemented during-pandemic, on the incidence of SSIs following spinal instrumented surgery for LCS.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using the Diagnosis Procedure Combination database, a Japanese national database. We analyzed 42,890 patients who underwent instrumentation surgery for LCS during the prepandemic (2017–2018) and during-pandemic (2020–2021) periods. The primary outcome was the occurrence of postoperative SSIs during hospitalization. We used propensity score (PS) matching to compare SSI rates and conducted multivariate logistic regression analysis to assess the pandemic’s impact after adjusting for confounding variables</div></div><div><h3>Results</h3><div>Results showed a significant increase in SSI rates during-pandemic, from 1.83% to 2.53% (p&lt;.01). After PS matching, the during-pandemic group continued to show a higher SSI rate (2.44%) compared to the prepandemic group (1.84%, p=.01). Multiple logistic regression analysis demonstrated that the association between the COVID-19 period (prepandemic versus during-pandemic) and SSI incidence remained statistically significant after adjusting for potential confounding variables (p=.01, OR=1.26).</div></div><div><h3>Conclusions</h3><div>These findings suggest that SSIs following instrumented spinal surgeries for LCS in Japan increased during-pandemic, even with matched patient characteristics. Future research should focus on identifying specific elements of perioperative care that may have been compromised during the pandemic and developing targeted interventions to address these gaps in surgical infection prevention.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100810"},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466437","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":"Factors associated with transforaminal epidural steroid injection efficacy and prognosis for symptomatic treatment of lumbar stenosis associated with degenerative scoliosis","authors":"Tyler MacNeil BA ,&nbsp;Owen Karsmarski MD ,&nbsp;Amanda Spraggs-Hughes PhD ,&nbsp;Isaac L. Moss MD ,&nbsp;Durgadas P. Sakalkale MD","doi":"10.1016/j.xnsj.2025.100807","DOIUrl":"10.1016/j.xnsj.2025.100807","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Although transforaminal epidural steroid injections (TFESIs) have been very commonly used for symptomatic treatment in patients with lumbar spinal stenosis, there is a paucity of literature on their use in patients with stenosis associated with degenerative lumbar scoliosis. There have been various published studies on parameters affecting the outcome of TFESIs, however there are no studies focusing on the effects of anatomical parameters associated with lumbar scoliosis on the outcome of these injections. The primary goal of this study is to assess anatomical and structural factors affecting efficacy of TFESI in the treatment of patients with lumbar degenerative scoliosis. A secondary goal of this study is to assess whether positive response with TFESI could predict better outcomes of subsequent lumbar surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This is a retrospective cohort study involving patients who were treated at an academic medical center. The patient sample is made of 149 patients with degenerative lumbar scoliosis who underwent TFESI during the time period of 2018 to 2023 for symptoms of axial and radicular pain. 19 of these patients underwent subsequent lumbar surgery. Scoliosis was defined as having a Cobb’s angle of at least 20 degrees. The primary outcome measure is TFESI efficacy, assessed by the difference in pain on the numerical rating scale (NRS, score 0–10) for patients between score before TFESI and score at minimum 2 weeks after the injection. A minimal clinically important difference (MCID) was defined as net change in NRS ≥2.0 to identify the patients with a clinically significant reduction in pain level. A secondary outcome measure is subjective clinical improvement or lack thereof for patients after lumbar surgery. Variables analyzed to assess TFESI efficacy include laterality of injections with respect to the primary lumbar curve, distance of an injection to the apex of the primary lumbar curve, severity of Cobb’s angle, severity of stenosis, and degree of spinal lateral listhesis. Lumbar surgery success was compared between patients who had either previously achieved or had not achieved MCID with TFESI. Statistical analyses included Chi-Square tests, Fisher exact tests, and a linear regression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We found an improvement in TFESI efficacy for injections completed on the convex-side of the primary scoliosis curve over concave-side when patients had radicular pain at the L5-S1 spinal level (likelihood ratio with convex-side injection 0.21, likelihood with concave-side injection 0.80; p = .037). Trends were also observed for convex-side injections overall and for lower levels of lateral listhesis over higher levels to be associated with improved efficacy, and there was a 100% positive predictive value for prior successful TFESI to predict lumbar surgery success. No significant impact of severity of Cobb’s angle nor severity of stenosis were noted on the out","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100807"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416313","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}