Pub Date : 2025-09-20DOI: 10.1016/j.xnsj.2025.100795
Cheng-Kuang Chen MD , Ming-Fu Chiang MD, PhD , Yu-Cheng Yao MD , Ming-Chau Chang MD , Axel H. Schönthal PhD , Thomas C. Chen MD, PhD
Background
Laminectomies involve removal of the lamina, usually to relieve pressure on the spinal cord. We are developing a synthetic lamina cover (SLC) that can replace the resected bone, functioning as an artificial shield, with the objective to minimize common postsurgical risks associated with laminectomies. The SLC is designed to be affixed to a common pedicle screw fixation system.
Methods
Lumbar laminectomies with posterior fusions were performed in 6 sheep and 30 human patients. Both cohorts were separated into 2 groups, where 1 group received the SLC to replace the lamina, whereas the other group did not. Otherwise, postsurgical care and medical attention were the same in both groups. After 26 weeks, the sheep were euthanized and histopathological and histomorphometrical evaluation of spine sections was performed. Human patients were followed for up to 6 months, and functional recovery was evaluated using the Oswestry Disability Index (ODI) questionnaire.
Results
In sheep, the overall host tissue response was minimal, without any signs of irritation, inflammation, or aberrant changes potentially caused by the SLC. Human patients that had received the SLC reported better and faster functional recovery (p<.05) than the group without the SLC. Neither patient group experienced complications from surgery.
Conclusions
Application of the SLC was safe and showed benefit as a shield to replace the autologous spinal lamina postlaminectomy. In its presence, functional recovery not only was faster, but also overall more pronounced.
{"title":"Safety and functional evaluation of a synthetic lamina cover that replaces lost autologous spinal bone after laminectomy, in a sheep and human study","authors":"Cheng-Kuang Chen MD , Ming-Fu Chiang MD, PhD , Yu-Cheng Yao MD , Ming-Chau Chang MD , Axel H. Schönthal PhD , Thomas C. Chen MD, PhD","doi":"10.1016/j.xnsj.2025.100795","DOIUrl":"10.1016/j.xnsj.2025.100795","url":null,"abstract":"<div><h3>Background</h3><div>Laminectomies involve removal of the lamina, usually to relieve pressure on the spinal cord. We are developing a synthetic lamina cover (SLC) that can replace the resected bone, functioning as an artificial shield, with the objective to minimize common postsurgical risks associated with laminectomies. The SLC is designed to be affixed to a common pedicle screw fixation system.</div></div><div><h3>Methods</h3><div>Lumbar laminectomies with posterior fusions were performed in 6 sheep and 30 human patients. Both cohorts were separated into 2 groups, where 1 group received the SLC to replace the lamina, whereas the other group did not. Otherwise, postsurgical care and medical attention were the same in both groups. After 26 weeks, the sheep were euthanized and histopathological and histomorphometrical evaluation of spine sections was performed. Human patients were followed for up to 6 months, and functional recovery was evaluated using the Oswestry Disability Index (ODI) questionnaire.</div></div><div><h3>Results</h3><div>In sheep, the overall host tissue response was minimal, without any signs of irritation, inflammation, or aberrant changes potentially caused by the SLC. Human patients that had received the SLC reported better and faster functional recovery (p<.05) than the group without the SLC. Neither patient group experienced complications from surgery.</div></div><div><h3>Conclusions</h3><div>Application of the SLC was safe and showed benefit as a shield to replace the autologous spinal lamina postlaminectomy. In its presence, functional recovery not only was faster, but also overall more pronounced.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100795"},"PeriodicalIF":2.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-20DOI: 10.1016/j.xnsj.2025.100798
Zvipo M. Chisango BA , Catherine B. Hurley MS , Gabriel A. Gonzalez BS , Michael J. Farias BS , Nicolas L. Carayannopoulos BS , Joseph P. Carroll BS , Manjot Singh MD , Jinseong Kim MD , Bryce A. Basques MD , Bassel G. Diebo MD , Alan H. Daniels MD
Objective
The Lumbar Pelvic Angle (L1PA) was introduced as a convenient intraoperative and postoperative measure of sagittal alignment. However, the utility of L1PA for short segment lumbar fusions remains incompletely understood. This study investigates the relationship between L1PA and segmental parameters of spinal alignment for short segment lumbar fusions.
Methods
This retrospective analysis was conducted on adult patients with degenerative conditions undergoing primary spinal fusion surgery between L4 and S1. Patients with <5° change in L1PA from pre- to postoperative measurements were stratified into 2 groups: those (1) achieving >35° of regional lordosis at L4-S1 postoperatively and (2) those with >5% change in Lumbar Distribution Index (LDI). Spinopelvic parameters were compared between preoperative and postoperative measurements.
Results
The study cohort included 539 patients, of which 360 (66.8%) had an L1PA change less than <5° pre- to postoperatively. Patients in both Group 1 and 2 had significant increases in the L5-S1 segmental angle (both p<.001) without a significant change at the L4-L5 segment. In Group 2, there was a significant increase in PI-LL mismatch (p<.001). In both groups there was a significant increase in L4-S1 lordosis, a relaxation in L1-L4 lordosis (both p<.001), and no significant change in total LL.
Conclusions
This investigation assessed L1PA in over 500 patients undergoing lumbar fusion between L4 and S1 and found that despite value to the measure, important changes to spinal shape and segmental alignment may occur even in the face of Δ L1PA <5°. As such, L1PA serves as a potentially useful adjunct to clinical assessment and radiographic measurement in lumbar degenerative fusion but should not serve as a stand-alone measurement.
{"title":"Utility of the L1 pelvic angle (L1PA) for assessment of sagittal alignment of the lumbar spine following short segment fusion: Comparison to segmental measures","authors":"Zvipo M. Chisango BA , Catherine B. Hurley MS , Gabriel A. Gonzalez BS , Michael J. Farias BS , Nicolas L. Carayannopoulos BS , Joseph P. Carroll BS , Manjot Singh MD , Jinseong Kim MD , Bryce A. Basques MD , Bassel G. Diebo MD , Alan H. Daniels MD","doi":"10.1016/j.xnsj.2025.100798","DOIUrl":"10.1016/j.xnsj.2025.100798","url":null,"abstract":"<div><h3>Objective</h3><div>The Lumbar Pelvic Angle (L1PA) was introduced as a convenient intraoperative and postoperative measure of sagittal alignment. However, the utility of L1PA for short segment lumbar fusions remains incompletely understood. This study investigates the relationship between L1PA and segmental parameters of spinal alignment for short segment lumbar fusions.</div></div><div><h3>Methods</h3><div>This retrospective analysis was conducted on adult patients with degenerative conditions undergoing primary spinal fusion surgery between L4 and S1. Patients with <5° change in L1PA from pre- to postoperative measurements were stratified into 2 groups: those (1) achieving >35° of regional lordosis at L4-S1 postoperatively and (2) those with >5% change in Lumbar Distribution Index (LDI). Spinopelvic parameters were compared between preoperative and postoperative measurements.</div></div><div><h3>Results</h3><div>The study cohort included 539 patients, of which 360 (66.8%) had an L1PA change less than <5° pre- to postoperatively. Patients in both Group 1 and 2 had significant increases in the L5-S1 segmental angle (both p<.001) without a significant change at the L4-L5 segment. In Group 2, there was a significant increase in PI-LL mismatch (p<.001). In both groups there was a significant increase in L4-S1 lordosis, a relaxation in L1-L4 lordosis (both p<.001), and no significant change in total LL.</div></div><div><h3>Conclusions</h3><div>This investigation assessed L1PA in over 500 patients undergoing lumbar fusion between L4 and S1 and found that despite value to the measure, important changes to spinal shape and segmental alignment may occur even in the face of Δ L1PA <5°. As such, L1PA serves as a potentially useful adjunct to clinical assessment and radiographic measurement in lumbar degenerative fusion but should not serve as a stand-alone measurement.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100798"},"PeriodicalIF":2.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.xnsj.2025.100796
Andrew B. Rees MD , Katherine Drexelius MD , Rebecca DeCarlo MD , Austin J. Allen MD , Samuel J. Chewning MD , Michael A. Bohl MD
Background
Anterior cervical discectomy and fusion (ACDF) hardware failure can have serious complications for patients. Various advances in screw and plate design have increased the pullout strength of ACDF constructs, yet failure with screw pullout still occurs. One previously unexplored factor influencing pullout strength is the method of screw pilot hole creation. We aimed to compare pullout strength, stiffness, and strain of ACDF constructs in 3D-printed cervical spine vertebral bodies based on pilot hole creation with a drill versus an awl.
Methods
Spine models were 3D-printed into uniform testing blocks to mimic cervical vertebrae, according to previously validated methods. Four pilot holes per block for eventual screw placement were made with a 3 mm drill (n = 20) or a 3mm awl (n = 20). Using a biomimetic model, a plate and four 3.5 mm screws were affixed to each testing block. Pullout strength, stiffness, and strain of the final construct were collected. Maximum axial pullout forces and forces over distance curves were recorded for statistical analysis.
Results
Pullout strength of the construct was significantly greater in the awl group compared to the drill group (mean force during load-to-failure 810.8 N vs. 765.6 N, respectively; p = .002). No significant difference was observed in the stiffness (p = .434) or strain (p = .526) of the constructs based on method of pilot hole creation.
Conclusions
This study aimed to evaluate the influence of pilot hole creation technique on biomechanical characteristics of ACDF constructs in a high fidelity 3D-printed biomimetic model. The results—favoring creation of pilot holes with an awl—highlight a biomechanical benefit of a previously unexplored surgical technique for the placement of ACDF screws. This may guide surgeons in choosing the optimal surgical technique to improve the strength of an ACDF construct, potentially minimizing complications and improving fusion rates.
背景：前路颈椎椎间盘切除术融合术（ACDF）内固定失败会导致严重的并发症。螺钉和钢板设计的各种进步提高了ACDF结构的拉出强度，但螺钉拉出的故障仍然发生。影响拉拔强度的一个先前未被发现的因素是螺旋导孔的形成方法。我们的目的是比较ACDF结构在3d打印颈椎椎体中的拉出强度、刚度和应变，这是基于用钻头和锥子制造先导孔。方法根据先前验证的方法，将脊柱模型3d打印到均匀的测试块中以模拟颈椎。每个块用3mm钻头（n = 20）或3mm锥子（n = 20）打四个导孔，用于最终的螺钉放置。使用仿生模型，在每个测试块上固定一个板和4个3.5 mm螺钉。收集了最终结构的拉出强度、刚度和应变。最大轴向拉拔力和距离曲线上的力被记录下来进行统计分析。结果与钻头组相比，锥子组构造体的抗拔强度显著更高（加载至失效期间的平均力分别为810.8 N和765.6 N, p = 0.002）。基于导孔创建方法的构建体在刚度（p = .434）或应变（p = .526）方面没有观察到显著差异。结论本研究旨在通过高保真度3d打印仿生模型，评估导孔制造技术对ACDF构建体生物力学特性的影响。结果表明，使用锥子制造导孔是一种以前未开发的ACDF螺钉植入手术技术的生物力学优势。这可以指导外科医生选择最佳的手术技术来提高ACDF结构的强度，潜在地减少并发症并提高融合率。
{"title":"Use of awl for screw pilot hole creation increases strength of anterior cervical discectomy and fusion plate constructs in biomimetic model","authors":"Andrew B. Rees MD , Katherine Drexelius MD , Rebecca DeCarlo MD , Austin J. Allen MD , Samuel J. Chewning MD , Michael A. Bohl MD","doi":"10.1016/j.xnsj.2025.100796","DOIUrl":"10.1016/j.xnsj.2025.100796","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cervical discectomy and fusion (ACDF) hardware failure can have serious complications for patients. Various advances in screw and plate design have increased the pullout strength of ACDF constructs, yet failure with screw pullout still occurs. One previously unexplored factor influencing pullout strength is the method of screw pilot hole creation. We aimed to compare pullout strength, stiffness, and strain of ACDF constructs in 3D-printed cervical spine vertebral bodies based on pilot hole creation with a drill versus an awl.</div></div><div><h3>Methods</h3><div>Spine models were 3D-printed into uniform testing blocks to mimic cervical vertebrae, according to previously validated methods. Four pilot holes per block for eventual screw placement were made with a 3 mm drill (n = 20) or a 3mm awl (n = 20). Using a biomimetic model, a plate and four 3.5 mm screws were affixed to each testing block. Pullout strength, stiffness, and strain of the final construct were collected. Maximum axial pullout forces and forces over distance curves were recorded for statistical analysis.</div></div><div><h3>Results</h3><div>Pullout strength of the construct was significantly greater in the awl group compared to the drill group (mean force during load-to-failure 810.8 N vs. 765.6 N, respectively; p = .002). No significant difference was observed in the stiffness (p = .434) or strain (p = .526) of the constructs based on method of pilot hole creation.</div></div><div><h3>Conclusions</h3><div>This study aimed to evaluate the influence of pilot hole creation technique on biomechanical characteristics of ACDF constructs in a high fidelity 3D-printed biomimetic model. The results—favoring creation of pilot holes with an awl—highlight a biomechanical benefit of a previously unexplored surgical technique for the placement of ACDF screws. This may guide surgeons in choosing the optimal surgical technique to improve the strength of an ACDF construct, potentially minimizing complications and improving fusion rates.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100796"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268456","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}
Pedicle screws are essential in spinal arthrodesis surgeries but pose potential risks due to their proximity to neural and vascular structures. Traditionally, tEMG has been used to assess screw placement, though its invasiveness, low specificity, and cost limit its applicability. MMG may offer a promising alternative for routine clinical use. Our study compares the relative accuracy of triggered electromyography (tEMG) versus mechanomyography (MMG) in detecting intraoperative cortical bony breaches.
Methods
Using an equivalence trial design, consecutive patients undergoing posterior lumbosacral spinal arthrodesis were prospectively enrolled at a single institution. Pedicle screw trajectories were queried in real-time using combined tEMG and MMG-based evaluations at pretap, tap, post-tap and postscrew placement stages. Intraoperative computed tomography (CT) scans were performed to evaluate pedicle screw trajectories according to the Gertzbein-Robbins (GR) classification. Receiver operating characteristic curve analysis were performed to evaluate the relative accuracy of tEMG and MMG threshold potentials to detect cortical breaches. Pain and quality-of-life outcomes were evaluated up to 3 months postoperatively.
Results
A total of 303 consecutive lumbar pedicle screw trajectories were included (61 participants; mean age: 61.3 ± 9.7 years; male-to-female ratio: 32:29). 7 grade C-E GR cortical breaches were identified in a total of 5 subjects, with 5 (71.4%) classified as Grade C and 2 (28.6%) as Grade E. Baseline demographics were comparable between the breach and nonbreach groups. The tEMG and MMG AUC values determining predictive ability for breach detection were comparable for the pretap (AUC 0.82 vs. 0.80, p = .442) and post-tap stages (AUC 0.71 vs. 0.79, p = .380). Follow-up pain and functional assessments revealed significant improvements at last follow-up.
Conclusion
tEMG and MMG demonstrate high and equivalent accuracy to detect cortical breaches intraoperatively. Adequate utilization of either technique may enhance pedicle screw placement accuracy, reducing intraoperative complications and improving surgical outcomes.
椎弓根螺钉在脊柱融合术中是必不可少的，但由于其靠近神经和血管结构而存在潜在风险。传统上，tEMG已被用于评估螺钉放置，尽管其侵入性、低特异性和成本限制了其适用性。MMG可能为常规临床应用提供一个有希望的替代方案。我们的研究比较了触发肌电图（tEMG）和肌力图（MMG）在检测术中皮质骨断裂方面的相对准确性。方法采用等效试验设计，在单一机构前瞻性地招募了连续接受腰骶后路腰椎融合术的患者。在攻丝前、攻丝后、攻丝后和钉后置入阶段，使用基于tEMG和mmg的联合评估实时查询椎弓根螺钉轨迹。术中计算机断层扫描（CT）根据Gertzbein-Robbins （GR）分类评估椎弓根螺钉轨迹。通过受试者工作特征曲线分析，评价tEMG和MMG阈值电位检测皮层损伤的相对准确性。术后3个月评估疼痛和生活质量。结果共纳入303例连续腰椎椎弓根螺钉运动轨迹（61例，平均年龄：61.3±9.7岁，男女比：32:29）。5名受试者共发现7个C- e级GR皮质裂口，其中5个（71.4%）为C级，2个（28.6%）为e级。裂口组和非裂口组的基线人口统计学具有可比性。确定泄漏检测预测能力的tEMG和MMG AUC值在泄漏前（AUC 0.82 vs. 0.80, p = .442）和泄漏后阶段（AUC 0.71 vs. 0.79, p = .380）具有可比性。最后一次随访时疼痛和功能评估显示有显著改善。结论术中mri和MMG对皮质损伤的检测具有较高的准确度。充分利用任何一种技术都可以提高椎弓根螺钉放置的准确性，减少术中并发症，改善手术效果。
{"title":"Prospective evaluation of mechanomyography versus triggered electromyography for intraoperative assessment of cortical breaches during instrumented lumbar surgery","authors":"Harshit Arora MBBS , Hassan Darabi MD , Francis Farhadi MD, PhD","doi":"10.1016/j.xnsj.2025.100797","DOIUrl":"10.1016/j.xnsj.2025.100797","url":null,"abstract":"<div><h3>Introduction</h3><div>Pedicle screws are essential in spinal arthrodesis surgeries but pose potential risks due to their proximity to neural and vascular structures. Traditionally, tEMG has been used to assess screw placement, though its invasiveness, low specificity, and cost limit its applicability. MMG may offer a promising alternative for routine clinical use. Our study compares the relative accuracy of triggered electromyography (tEMG) versus mechanomyography (MMG) in detecting intraoperative cortical bony breaches.</div></div><div><h3>Methods</h3><div>Using an equivalence trial design, consecutive patients undergoing posterior lumbosacral spinal arthrodesis were prospectively enrolled at a single institution. Pedicle screw trajectories were queried in real-time using combined tEMG and MMG-based evaluations at pretap, tap, post-tap and postscrew placement stages. Intraoperative computed tomography (CT) scans were performed to evaluate pedicle screw trajectories according to the Gertzbein-Robbins (GR) classification. Receiver operating characteristic curve analysis were performed to evaluate the relative accuracy of tEMG and MMG threshold potentials to detect cortical breaches. Pain and quality-of-life outcomes were evaluated up to 3 months postoperatively.</div></div><div><h3>Results</h3><div>A total of 303 consecutive lumbar pedicle screw trajectories were included (61 participants; mean age: 61.3 ± 9.7 years; male-to-female ratio: 32:29). 7 grade C-E GR cortical breaches were identified in a total of 5 subjects, with 5 (71.4%) classified as Grade C and 2 (28.6%) as Grade E. Baseline demographics were comparable between the breach and nonbreach groups. The tEMG and MMG AUC values determining predictive ability for breach detection were comparable for the pretap (AUC 0.82 vs. 0.80, p = .442) and post-tap stages (AUC 0.71 vs. 0.79, p = .380). Follow-up pain and functional assessments revealed significant improvements at last follow-up.</div></div><div><h3>Conclusion</h3><div>tEMG and MMG demonstrate high and equivalent accuracy to detect cortical breaches intraoperatively. Adequate utilization of either technique may enhance pedicle screw placement accuracy, reducing intraoperative complications and improving surgical outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100797"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.xnsj.2025.100794
Ali Haider Bangash MBBS , Rose Fluss MD , Sertac Kirnaz MD , Jason D. Nosrati MD , Byung-Han Rhieu MD , Justin Tang MD, MS , Madhur K. Garg MBA, MD , Saikiran G. Murthy DO , Yaroslav Gelfand MD , Reza Yassari MD , Rafael De la Garza Ramos MD
Background
Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance.
Methods
We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications.
Results
Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions.
Conclusions
Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.
{"title":"A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance","authors":"Ali Haider Bangash MBBS , Rose Fluss MD , Sertac Kirnaz MD , Jason D. Nosrati MD , Byung-Han Rhieu MD , Justin Tang MD, MS , Madhur K. Garg MBA, MD , Saikiran G. Murthy DO , Yaroslav Gelfand MD , Reza Yassari MD , Rafael De la Garza Ramos MD","doi":"10.1016/j.xnsj.2025.100794","DOIUrl":"10.1016/j.xnsj.2025.100794","url":null,"abstract":"<div><h3>Background</h3><div>Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications.</div></div><div><h3>Results</h3><div>Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions.</div></div><div><h3>Conclusions</h3><div>Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100794"},"PeriodicalIF":2.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.xnsj.2025.100793
Philip P. Ratnasamy BS, Gwyneth C. Maloy BA, John Slevin BS, Arya G. Varthi MD, Jonathan N. Grauer MD
Background
Lumbar discectomy may be considered for lumbar radicular symptoms. There have been recent pushes to reduce opioid use and promote multimodal pain management. This large administrative database study evaluated trends in pain management prescriptions following lumbar discectomy.
Methods
Lumbar discectomy patients were identified from the 2010-2021 PearlDiver M165Ortho database. Patients with prior history of substance abuse, neoplasm, or any concomitant anterior or posterior lumbar surgical intervention were excluded. Prescriptions of pain management drugs were evaluated in the 90-days following surgery and manually grouped as opioids and/or other categories of pain management drugs. Prescriptions and morphine milligram equivalents (MMEs) per 1,000 lumbar discectomy surgeries were determined and trended. Multivariable analysis was performed to determine clinical and nonclinical factors independently associated with opioid prescription use.
Results
From a total of 93,252 lumbar discectomies meeting inclusion criteria, opioid prescriptions decreased from 531.7 per 1,000 lumbar discectomy surgeries in 2010 to 97.1 in 2021 (-81.7%). Prescriptions of other pain management drugs on aggregate decreased from 527.9 in 2010 to 174.9 in 2021 (-66.9%). The proportion of all analgesics prescribed postoperatively that were opioids decreased from 50.2% in 2010 to 35.7% in 2021. Among patients who received opioids in the 90-days postoperatively, MMEs prescribed per lumbar discectomy case decreased from 262.8 in 2010 to 24.6 in 2021 (-90.7%). Predictors of postoperative opioid prescriptions by multivariate analysis included clinical factors (younger age [OR 1.20 per decade decrease], male sex [OR 1.40], lower ECI [OR 1.16]) and the nonclinical factor of geographic variation (relative to South, Northeast OR 1.08, Midwest OR 1.09) (p<.05 for each).
Conclusions
Opioid prescriptions following lumbar discectomy have markedly decreased over the past decade. Notably, nonopioid prescriptions have also decreased, likely in favor of nonprescription multimodal pain management medications and strategies.
{"title":"Decreasing utilization of opioids and prescription nonopioids following lumbar discectomy","authors":"Philip P. Ratnasamy BS, Gwyneth C. Maloy BA, John Slevin BS, Arya G. Varthi MD, Jonathan N. Grauer MD","doi":"10.1016/j.xnsj.2025.100793","DOIUrl":"10.1016/j.xnsj.2025.100793","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar discectomy may be considered for lumbar radicular symptoms. There have been recent pushes to reduce opioid use and promote multimodal pain management. This large administrative database study evaluated trends in pain management prescriptions following lumbar discectomy.</div></div><div><h3>Methods</h3><div>Lumbar discectomy patients were identified from the 2010-2021 PearlDiver M165Ortho database. Patients with prior history of substance abuse, neoplasm, or any concomitant anterior or posterior lumbar surgical intervention were excluded. Prescriptions of pain management drugs were evaluated in the 90-days following surgery and manually grouped as opioids and/or other categories of pain management drugs. Prescriptions and morphine milligram equivalents (MMEs) per 1,000 lumbar discectomy surgeries were determined and trended. Multivariable analysis was performed to determine clinical and nonclinical factors independently associated with opioid prescription use.</div></div><div><h3>Results</h3><div>From a total of 93,252 lumbar discectomies meeting inclusion criteria, opioid prescriptions decreased from 531.7 per 1,000 lumbar discectomy surgeries in 2010 to 97.1 in 2021 (-81.7%). Prescriptions of other pain management drugs on aggregate decreased from 527.9 in 2010 to 174.9 in 2021 (-66.9%). The proportion of all analgesics prescribed postoperatively that were opioids decreased from 50.2% in 2010 to 35.7% in 2021. Among patients who received opioids in the 90-days postoperatively, MMEs prescribed per lumbar discectomy case decreased from 262.8 in 2010 to 24.6 in 2021 (-90.7%). Predictors of postoperative opioid prescriptions by multivariate analysis included clinical factors (younger age [OR 1.20 per decade decrease], male sex [OR 1.40], lower ECI [OR 1.16]) and the nonclinical factor of geographic variation (relative to South, Northeast OR 1.08, Midwest OR 1.09) (p<.05 for each).</div></div><div><h3>Conclusions</h3><div>Opioid prescriptions following lumbar discectomy have markedly decreased over the past decade. Notably, nonopioid prescriptions have also decreased, likely in favor of nonprescription multimodal pain management medications and strategies.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100793"},"PeriodicalIF":2.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.xnsj.2025.100789
Catherine R. Olinger MD , Pei-fu Chen MD, PhD , Sarah J. Lee BS , Daniel F. Waldschmidt BSN , Reagan A. Grieser-Yoder BS , Lauren G. Havertape BA , Debra J. O’Connell-Moore MBA , Lanchi B. Nguyen BS , Jill D. Corlette MS , Bradley J. Hindman MD , Matthew A. Howard III MD
Background
Cervical spine surgery is often performed to alleviate symptoms of cervical spondylotic myelopathy (CSM) and/or cervical radiculopathy (CR). Although postoperative delirium (POD) is common after cervical spine surgery, it is not known if CSM, CSM symptom severity, and/or surgical approach (anterior vs. posterior) affect POD incidence or severity. The purpose of this study was to determine 1) If the preoperative diagnosis of CSM was an independent risk factor for POD incidence or severity; 2) Among patients who had CSM, which patient and intraoperative characteristics, including CSM symptom severity, were independently associated with POD incidence or severity.
Methods
A retrospective search of the electronic medical record of a tertiary academic medical center identified patients undergoing cervical spine surgery. Patients who had: 1) POD assessments within the first 7 days of surgery (Delirium Observation Screening Scale [DOSS]; and 2) preoperative clinical diagnoses of CSM or CR were selected for analysis. Patient and surgical characteristics were extracted from the medical record, including CSM symptom severity (modified Japanese Orthopedic Association [mJOA] scores). Characteristics that were univariately associated with POD were included in multivariable models to determine characteristics that were independently associated with POD incidence and severity.
Results
In the entire cohort (755 patients), POD incidence was (139/755) 18.4%, and 4 characteristics were independently associated with greater POD incidence: posterior-based surgical approach (adjusted odds ratio [aOR]=2.27, p=.0005), greater American Society of Anesthesiologists (ASA) class (aOR=1.66, p=.0432), obstructive sleep apnea (OSA) (aOR=1.76, p=.0280), and depression (aOR = 2.20, p=.0138). In this cohort, POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.4346, p=.0000) greater ASA class (Beta coefficient=0.1648, p=.0326), and lower preoperative hemoglobin (Beta coefficient=-0.0663, p=.0014). In the CSM subgroup (n = 629), POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.5527, p=.0002), OSA (Beta coefficient=0.4650, p=.0100), lower body mass index (BMI) (Beta coefficient = -0.0246, p=.0194) and lower (more severe) mJOA scores (Beta coefficient = -0.0465, p=.0197).
Conclusions
For patients who have CSM, more severe symptoms (lower mJOA scores) and lower BMI were independently associated with greater POD severity. In addition, posterior-based surgical procedures were independently associated with greater POD incidence and severity.
{"title":"Cervical myelopathy symptom severity, posterior-based cervical surgical approach, and lower body mass index are associated with postoperative delirium: A retrospective observational study","authors":"Catherine R. Olinger MD , Pei-fu Chen MD, PhD , Sarah J. Lee BS , Daniel F. Waldschmidt BSN , Reagan A. Grieser-Yoder BS , Lauren G. Havertape BA , Debra J. O’Connell-Moore MBA , Lanchi B. Nguyen BS , Jill D. Corlette MS , Bradley J. Hindman MD , Matthew A. Howard III MD","doi":"10.1016/j.xnsj.2025.100789","DOIUrl":"10.1016/j.xnsj.2025.100789","url":null,"abstract":"<div><h3>Background</h3><div>Cervical spine surgery is often performed to alleviate symptoms of cervical spondylotic myelopathy (CSM) and/or cervical radiculopathy (CR). Although postoperative delirium (POD) is common after cervical spine surgery, it is not known if CSM, CSM symptom severity, and/or surgical approach (anterior vs. posterior) affect POD incidence or severity. The purpose of this study was to determine 1) If the preoperative diagnosis of CSM was an independent risk factor for POD incidence or severity; 2) Among patients who had CSM, which patient and intraoperative characteristics, including CSM symptom severity, were independently associated with POD incidence or severity.</div></div><div><h3>Methods</h3><div>A retrospective search of the electronic medical record of a tertiary academic medical center identified patients undergoing cervical spine surgery. Patients who had: 1) POD assessments within the first 7 days of surgery (Delirium Observation Screening Scale [DOSS]; and 2) preoperative clinical diagnoses of CSM or CR were selected for analysis. Patient and surgical characteristics were extracted from the medical record, including CSM symptom severity (modified Japanese Orthopedic Association [mJOA] scores). Characteristics that were univariately associated with POD were included in multivariable models to determine characteristics that were independently associated with POD incidence and severity.</div></div><div><h3>Results</h3><div>In the entire cohort (755 patients), POD incidence was (139/755) 18.4%, and 4 characteristics were independently associated with greater POD incidence: posterior-based surgical approach (adjusted odds ratio [aOR]=2.27, p=.0005), greater American Society of Anesthesiologists (ASA) class (aOR=1.66, p=.0432), obstructive sleep apnea (OSA) (aOR=1.76, p=.0280), and depression (aOR = 2.20, p=.0138). In this cohort, POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.4346, p=.0000) greater ASA class (Beta coefficient=0.1648, p=.0326), and lower preoperative hemoglobin (Beta coefficient=-0.0663, p=.0014). In the CSM subgroup (<em>n</em> = 629), POD severity was independently associated with posterior-based surgical approach (Beta coefficient=0.5527, p=.0002), OSA (Beta coefficient=0.4650, p=.0100), lower body mass index (BMI) (Beta coefficient = -0.0246, p=.0194) and lower (more severe) mJOA scores (Beta coefficient = -0.0465, p=.0197).</div></div><div><h3>Conclusions</h3><div>For patients who have CSM, more severe symptoms (lower mJOA scores) and lower BMI were independently associated with greater POD severity. In addition, posterior-based surgical procedures were independently associated with greater POD incidence and severity.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100789"},"PeriodicalIF":2.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-08DOI: 10.1016/j.xnsj.2025.100788
Reza Ehsanian MD, PhD , Jordan A. Buttner BS , Byron Schneider MD , Zachary L. McCormick MD
Background
Chronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP.
Methods
PubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence.
Results
Patient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP.
Conclusions
In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.
{"title":"Patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of basivertebral nerve ablation for the treatment of vertebrogenic low back pain: A narrative review1","authors":"Reza Ehsanian MD, PhD , Jordan A. Buttner BS , Byron Schneider MD , Zachary L. McCormick MD","doi":"10.1016/j.xnsj.2025.100788","DOIUrl":"10.1016/j.xnsj.2025.100788","url":null,"abstract":"<div><h3>Background</h3><div>Chronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence.</div></div><div><h3>Results</h3><div>Patient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP.</div></div><div><h3>Conclusions</h3><div>In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100788"},"PeriodicalIF":2.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-07DOI: 10.1016/j.xnsj.2025.100790
Courtney Spitzer BA, Melissa Romoff BA, Madison Brunette BA, Melanie K Peterson MD, Andy Ton MD, Ryan Le MD, Abhinav Sharma MD, Justin P Chan MD, Hao-Hua Wu MD, Sohaib Hashmi MD, Michael S Kim MD
Background
Non-tobacco nicotine products (eg, e-cigarettes, nicotine pouches) are increasingly used by cigarette smokers and prior nonsmokers. While the detrimental effects of cigarette dependence (CD) on healing and surgical recovery are well documented, the impact of non-tobacco nicotine dependence (NTND) on outcomes after lumbar spine surgery remains poorly characterized.
Methods
We conducted a retrospective cohort study using the TriNetX database. Patients undergoing lumbar spine decompression and fusion were divided into 3 cohorts: NTND, CD, and controls (no documented nicotine dependence). Propensity score matching was performed 1:1 based on demographic and clinical characteristics. Complication rates were assessed at 90 days and 3 years postoperatively. Outcomes included anemia, deep vein thrombosis (DVT), myocardial infarction (MI), pneumonia, renal failure, pulmonary embolism (PE), sepsis, stroke, opioid abuse, pseudoarthrosis, and lumbar fracture.
Results
A total of 39,195 matched NTND and control patients were analyzed. NTND was associated with increased 90-day risks of anemia, DVT, MI, pneumonia, renal failure, sepsis, stroke, and opioid abuse, as well as higher 3-year risks of pseudoarthrosis and lumbar fracture (p < .05). In a comparison of 36, 877 matched NTND and CD patients, NTND showed higher anemia risk but lower risks of MI, PE, renal failure, sepsis, stroke, and opioid abuse at 90 days. At 3 years, NTND carried a higher pseudoarthrosis risk but lower lumbar fracture risk relative to CD (p < .0001). When NTND and CD patients were combined (n = 102,720 total), both groups demonstrated significantly higher complications risks compared with controls at both 90 days and 3 years (p < .0001).
Conclusions
NTND is associated with increased perioperative and long-term complications following lumbar spine surgery, including higher rates of infection, opioid abuse, pseudoarthrosis, and lumbar fracture. NTND demonstrates a distinct complication profile compared to CD, underscoring the need for further research on the impact of non-tobacco nicotine exposure on spinal fusion outcomes.
{"title":"Non-tobacco nicotine dependence increases risk of complications following lumbar spine decompression and fusion","authors":"Courtney Spitzer BA, Melissa Romoff BA, Madison Brunette BA, Melanie K Peterson MD, Andy Ton MD, Ryan Le MD, Abhinav Sharma MD, Justin P Chan MD, Hao-Hua Wu MD, Sohaib Hashmi MD, Michael S Kim MD","doi":"10.1016/j.xnsj.2025.100790","DOIUrl":"10.1016/j.xnsj.2025.100790","url":null,"abstract":"<div><h3>Background</h3><div>Non-tobacco nicotine products (eg, e-cigarettes, nicotine pouches) are increasingly used by cigarette smokers and prior nonsmokers. While the detrimental effects of cigarette dependence (CD) on healing and surgical recovery are well documented, the impact of non-tobacco nicotine dependence (NTND) on outcomes after lumbar spine surgery remains poorly characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX database. Patients undergoing lumbar spine decompression and fusion were divided into 3 cohorts: NTND, CD, and controls (no documented nicotine dependence). Propensity score matching was performed 1:1 based on demographic and clinical characteristics. Complication rates were assessed at 90 days and 3 years postoperatively. Outcomes included anemia, deep vein thrombosis (DVT), myocardial infarction (MI), pneumonia, renal failure, pulmonary embolism (PE), sepsis, stroke, opioid abuse, pseudoarthrosis, and lumbar fracture.</div></div><div><h3>Results</h3><div>A total of 39,195 matched NTND and control patients were analyzed. NTND was associated with increased 90-day risks of anemia, DVT, MI, pneumonia, renal failure, sepsis, stroke, and opioid abuse, as well as higher 3-year risks of pseudoarthrosis and lumbar fracture (p < .05). In a comparison of 36, 877 matched NTND and CD patients, NTND showed higher anemia risk but lower risks of MI, PE, renal failure, sepsis, stroke, and opioid abuse at 90 days. At 3 years, NTND carried a higher pseudoarthrosis risk but lower lumbar fracture risk relative to CD (p < .0001). When NTND and CD patients were combined (<em>n</em> = 102,720 total), both groups demonstrated significantly higher complications risks compared with controls at both 90 days and 3 years (p < .0001).</div></div><div><h3>Conclusions</h3><div>NTND is associated with increased perioperative and long-term complications following lumbar spine surgery, including higher rates of infection, opioid abuse, pseudoarthrosis, and lumbar fracture. NTND demonstrates a distinct complication profile compared to CD, underscoring the need for further research on the impact of non-tobacco nicotine exposure on spinal fusion outcomes.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"24 ","pages":"Article 100790"},"PeriodicalIF":2.5,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.xnsj.2025.100779
Zach Pennington MD , Joseph H Schwab MD , Sheng-fu Larry Lo MD MHS , C. Rory Goodwin MD PhD , Matthew L Goodwin MD PhD , Matthew Colman MD , Raphaële Charest-Morin MD , Nicolas Dea MD , Daniel Lubelski MD , Ali Ozturk MD , Jacob M. Buchowski MD MS , Wende Gibbs MD , Wesley Hsu MD , Ajit Krishnaney MD , Ilya Laufer MD , Mohamed Macki MD , Addisu Mesfin MD , Ganesh Shankar MD PhD , Dan Tobert MD , John Shin MD MBA , Daniel M Sciubba MD MBA
Background
With advances in surgical techniques, radiation, and systemic therapy, prognoses and quality of life have improved amongst patients with primary and metastatic vertebral column tumors. Sagittal deformity is known to have an adverse impact on patient quality of life but has been largely ignored in this study population.
Methods
A comprehensive literature review was conducted, focusing on articles germane to the study of spinal deformity in the context of oncologic disease. Articles included those focusing on bone health, the association of spinal deformity with oncologic spine disease, and both pelvic and anterior column reconstruction in patients treated for primary tumors.
Results
Little to date has focused specifically on the management of spinal deformity in the context of spinal tumors. However, it is known that tumor involvement of the vertebral column is associated with poorer screw purchase, which can be further worsened by radiotherapy. Instrumentation techniques that seek to address underlying deformity must also balance the need for radiographic follow-up, which is improved with novel carbon fiber-reinforced polyetheretherketone implants, and the need for intraoperative contouring. Last, residual deformity is associated with poorer patient reported outcomes and increased mechanical complications in adult spinal deformity, but better study within the spinal oncology population is merited.
Conclusion
The potential negative impact of spinal deformity on patient quality of life in the spinal oncology population is now better appreciated amongst spinal oncologists, but studies have been limited to date. Further investigation is merited as survival outcomes continue to improve.
{"title":"Application of deformity principles in the management of spinal neoplasms: A Primer","authors":"Zach Pennington MD , Joseph H Schwab MD , Sheng-fu Larry Lo MD MHS , C. Rory Goodwin MD PhD , Matthew L Goodwin MD PhD , Matthew Colman MD , Raphaële Charest-Morin MD , Nicolas Dea MD , Daniel Lubelski MD , Ali Ozturk MD , Jacob M. Buchowski MD MS , Wende Gibbs MD , Wesley Hsu MD , Ajit Krishnaney MD , Ilya Laufer MD , Mohamed Macki MD , Addisu Mesfin MD , Ganesh Shankar MD PhD , Dan Tobert MD , John Shin MD MBA , Daniel M Sciubba MD MBA","doi":"10.1016/j.xnsj.2025.100779","DOIUrl":"10.1016/j.xnsj.2025.100779","url":null,"abstract":"<div><h3>Background</h3><div>With advances in surgical techniques, radiation, and systemic therapy, prognoses and quality of life have improved amongst patients with primary and metastatic vertebral column tumors. Sagittal deformity is known to have an adverse impact on patient quality of life but has been largely ignored in this study population.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted, focusing on articles germane to the study of spinal deformity in the context of oncologic disease. Articles included those focusing on bone health, the association of spinal deformity with oncologic spine disease, and both pelvic and anterior column reconstruction in patients treated for primary tumors.</div></div><div><h3>Results</h3><div>Little to date has focused specifically on the management of spinal deformity in the context of spinal tumors. However, it is known that tumor involvement of the vertebral column is associated with poorer screw purchase, which can be further worsened by radiotherapy. Instrumentation techniques that seek to address underlying deformity must also balance the need for radiographic follow-up, which is improved with novel carbon fiber-reinforced polyetheretherketone implants, and the need for intraoperative contouring. Last, residual deformity is associated with poorer patient reported outcomes and increased mechanical complications in adult spinal deformity, but better study within the spinal oncology population is merited.</div></div><div><h3>Conclusion</h3><div>The potential negative impact of spinal deformity on patient quality of life in the spinal oncology population is now better appreciated amongst spinal oncologists, but studies have been limited to date. Further investigation is merited as survival outcomes continue to improve.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100779"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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