North American Spine Society Journal最新文献_第7页

Responsiveness of the PROMIS-10 global compared to the neck disability index in patients undergoing 1 and 2 level anterior cervical discectomy and fusion 在接受1级和2级颈椎前路椎间盘切除术和融合的患者中，与颈部残疾指数相比，promise -10全球反应性

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-08-05 DOI: 10.1016/j.xnsj.2025.100780

Matthew J. Solomito PhD , Heeren Makanji MD

Background

The reliance on patient reported outcomes (PROs) has substantially increased not only to augment current metrics of clinical success, but to capture the patient’s perspective on the benefit of their treatment. As more PROs become utilized, the time and cost of longitudinal data collection and survey fatigue must be tempered with the benefit of the data collected. Therefore, this study sought to assess the responsiveness of the Neck Disability Index (NDI) compared to the PROMIS-10 Global Health Survey physical function T-score (PFT) and mental health T-score (MHT).

Methods

A total of 264 patients that had undergone a single or two level anterior cervical discectomy and fusion (ACDF) between June 2021 and January 2024 were included. All patients completed their preoperative, 3-, and 12-month postoperative PRO assessments. A responsiveness analysis was performed and included: floor and ceiling effects, correlations among the PRO scores, and effect size indices (ESI) calculations.

Results

There were no floor or ceiling effects for the NDI and only 5.8% of the study cohort reached the floor or ceiling for the PROMIS-10 scores. The PROMIS T-scores showed weak to moderate correlations to the NDI, with the PFT having stronger correlations than the mental health T-score (MHT). The ESI demonstrated that the NDI was the most responsive tool with a maximum ESI of 0.98.

Conclusions

The PROMIS-10 is a responsive and valid tool that provides insight into both the general physical function and mental health of a patient; however, it does not display the same discretionary ability to detect small changes in neck function that the NDI demonstrated. Therefore, the PROMIS-10 may be useful to provide preoperative assessment for patients undergoing ACDF but longitudinal evaluation to assess the outcomes of this surgery may be best left to the NDI.

对患者报告结果（PROs）的依赖已经大大增加，不仅是为了增加临床成功的当前指标，而且是为了捕捉患者对其治疗益处的看法。随着越来越多的pro被利用，纵向数据收集的时间和成本以及调查疲劳必须与所收集数据的好处相协调。因此，本研究试图评估颈部残疾指数（NDI）与promise -10全球健康调查身体功能t评分（PFT）和心理健康t评分（MHT）的反应性。方法选取2021年6月至2024年1月间行单节段或双节段颈椎前路椎间盘切除术融合术（ACDF）的患者264例。所有患者均完成术前、术后3个月和12个月PRO评估。进行了响应性分析，包括：下限和上限效应、PRO评分之间的相关性和效应大小指数（ESI）计算。结果NDI没有下限或上限效应，只有5.8%的研究队列达到了promise -10分数的下限或上限。PROMIS t -评分与NDI呈弱至中度相关性，PFT比心理健康t -评分（MHT）具有更强的相关性。ESI结果表明，NDI是最具响应性的工具，最大ESI为0.98。结论：promise -10是一种反应灵敏且有效的工具，可以深入了解患者的一般身体功能和心理健康状况；然而，它并没有显示出与NDI所显示的相同的自由裁量能力来检测颈部功能的微小变化。因此，promise -10可能有助于为ACDF患者提供术前评估，但评估该手术结果的纵向评估可能最好留给NDI。

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引用次数: 0

DCM-72 (dexterity, cutaneous, and muscle-72): A composite scoring system for objective assessment of upper limb dysfunction in patients with degenerative cervical myelopathy DCM-72（灵巧性、皮肤和肌肉-72）：用于客观评估退行性颈椎病患者上肢功能障碍的综合评分系统

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-22 DOI: 10.1016/j.xnsj.2025.100775

Harshit Arora MBBS , Hassan Darabi MD , Kelsey Karnik PhD , Jared T. Wilcox MD, PhD , Jan M. Schwab MD, PhD , Francis Farhadi MD, PhD

Background Context

Degenerative cervical myelopathy (DCM) is characterized by spinal cord compression, which can present with limb weakness and numbness, loss of fine motor skills, gait disturbance, and bladder dysfunction. The modified Japanese Orthopedic Association (mJOA) and Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy (GRASSP-M) scores evaluate distinct aspects to assess the severity of upper and lower extremity dysfunction. Our study aims to develop an integrative, multidimensional Dexterity, Cutaneous, and Muscle (DCM-72) scoring system to provide a more comprehensive and objective evaluation of upper extremity functional impairment.

Methods

Within this prospective, 2 center study, a total of 123 participants, comprising of 94 subjects with confirmed DCM and 29 controls with cervical radiculopathy were enrolled. A composite DCM-72 score was developed incorporating several upper extremity functional assessments with 24 total points allocated to each of the 3 components: dexterity, sensation, and muscle strength. Descriptive statistics were used with a p≤0.05 indicating statistical significance.

Results

The mean age of the participants is 60.2±12.1 years, with a female-to-male ratio of 1:1.2. The average DCM-72 scores for the dominant and nondominant upper extremities are 28.0±6.0 and 27.3±6.5. Analysis of variance with posthoc analysis identified significant differences between mild-severe and moderate-severe cases as stratified by mJOA subclassification. The proposed composite DCM-72 severity score ranges are defined as: 68.5-72 (normal), 64.3-68.4 (mild), 56.7-62.3 (moderate), and <56.7 (severe).

Conclusion

The DCM-72 score effectively stratifies upper extremity dysfunction in patients with DCM through a set of well-established quantitative assessments offering objective performance evaluations as compared to existing scoring systems. DCM-72 can further assist clinicians to monitor outcome trajectories to support decision-making and prognostication and further serves as a candidate tool to improve sensitivity for interventional trial testing.

背景背景退行性颈椎病（DCM）以脊髓受压为特征，可表现为肢体无力和麻木、精细运动技能丧失、步态障碍和膀胱功能障碍。改良的日本骨科协会（mJOA）和强度、敏感性和抓握性脊髓病分级重新定义评估（GRASSP-M）评分对不同方面进行评估，以评估上肢和下肢功能障碍的严重程度。我们的研究旨在开发一个综合的、多维度的灵巧性、皮肤和肌肉（DCM-72）评分系统，为上肢功能损伤提供更全面、客观的评估。方法在这项前瞻性的2中心研究中，共纳入123名参与者，包括94名确诊DCM的受试者和29名宫颈神经根病的对照组。综合DCM-72评分包括几个上肢功能评估，其中三个组成部分：灵巧性、感觉和肌肉力量，每一个都有24分。采用描述性统计，p≤0.05表示有统计学意义。结果参与者的平均年龄为60.2±12.1岁，男女比例为1:2 .2。优势肢和非优势肢DCM-72平均评分分别为28.0±6.0分和27.3±6.5分。采用事后分析进行方差分析，发现轻度-重度和中度-重度病例按mJOA亚分类分层存在显著差异。建议的DCM-72严重程度综合评分范围定义为：68.5-72（正常）、64.3-68.4（轻度）、56.7-62.3（中度）和<；56.7（严重）。结论与现有评分系统相比，DCM-72评分可通过一套完善的定量评估，对DCM患者的上肢功能障碍进行有效分层。DCM-72可以进一步帮助临床医生监测结果轨迹，以支持决策和预测，并进一步作为提高介入性试验检测敏感性的候选工具。

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引用次数: 0

Historical trends and future projections of cervical disc arthroplasty and removal cervical disc arthroplasty in the United States Medicare population 在美国医疗人口中，颈椎间盘置换术和移除颈椎间盘置换术的历史趋势和未来预测

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-20 DOI: 10.1016/j.xnsj.2025.100774

Tarun Mattikalli BS, Jeremy Steinberger MD, Konstantinos Margetis MD, PhD

Background

Cervical disc arthroplasty (CDA) has become an increasingly utilized alternative to anterior cervical discectomy and fusion (ACDF), offering potential benefits such as motion preservation and reduced incidence of adjacent segment disease. However, long-term utilization trends and future procedural burden remain unclear.

Methods

Medicare fee-for-service (FFS) cervical disc arthroplasty (CDA) volumes were extracted from the Medicare Part B National Summary between 2009 and 2022, excluding 2020, and uplifted to account for Medicare Advantage enrollment. Statistical models developed included ordinary least squares (OLS), generalized linear models (GLM), and segmented regression to detect any inflection points in utilization. Autoregressive and alternative GLMs such as Poisson and negative binomial were used for validation. For each procedure type, the model that best aligned with observed trends and statistical fit (AIC, R²) was used to generate forecasts through 2035.

Results

Primary CDA utilization demonstrated an inflection point in 2018, after which growth stabilized. Post 2018 OLS modeling estimated a 6.2% annual growth rate, reaching an estimated 9,422 procedures by 2035 (95% CI: 5,494–16,159). Removal CDA exhibited consistent exponential growth, with GLM estimated 22.9% annual increase and a projected volume of 1,773 procedures by 2035 (95% CI: 1,183–2,656).

Conclusions

Primary CDA may be entering a mature adoption phase with modest projected growth, while removal CDA is expected to grow more substantially. These projections reflect trends in an older population, which may not generalize to younger individuals undergoing CDA. Our findings reinforce the need for continued surveillance, resource planning, and better understanding of long-term CDA complications in the increasingly aging population.

背景：颈椎间盘置换术（CDA）已越来越多地成为前路颈椎间盘切除术和融合（ACDF）的替代方法，具有保留运动和减少邻近节段疾病发生率等潜在益处。但是，长期的利用趋势和今后的程序负担仍不清楚。方法从2009年至2022年（不包括2020年）的医疗保险B部分国家摘要中提取医疗保险服务收费（FFS）颈椎间盘置换术（CDA）数据，并将其提升以考虑医疗保险优惠登记。开发的统计模型包括普通最小二乘（OLS）、广义线性模型（GLM）和分段回归，以检测利用率中的任何拐点。自回归和替代glm如泊松和负二项被用于验证。对于每种程序类型，使用最符合观察趋势和统计拟合的模型（AIC, R2）来生成2035年之前的预测。结果初级CDA利用在2018年出现拐点，之后增长趋于稳定。2018年后OLS模型估计年增长率为6.2%，到2035年估计达到9,422例（95% CI: 5,494-16,159）。去除CDA表现出持续的指数增长，GLM估计每年增长22.9%，预计到2035年将有1,773例手术（95% CI: 1,183-2,656）。结论：初级CDA可能进入成熟采用阶段，预计将有适度增长，而移除CDA预计将有更大幅度的增长。这些预测反映了老年人群的趋势，这可能不适用于接受CDA的年轻人。我们的研究结果强调了持续监测、资源规划和更好地了解日益老龄化人口中长期CDA并发症的必要性。

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引用次数: 0

Impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusions. 经腹平面阻滞对腰椎前路椎体间融合术住院时间和术后阿片类药物使用的影响。

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-18 eCollection Date: 2025-09-01 DOI: 10.1016/j.xnsj.2025.100771

Katherine Drexelius, Steven Baltic, Kennedy Gachigi, Caleb Lifsey, Rebecca Kelso, P Bradley Segebarth

Background: Anterior lumbar interbody fusion (ALIF) is an increasingly common surgical procedure for a variety of spinal pathologies. As both opioid use and healthcare costs remain major national healthcare crises, it is crucial to understand methods of effective pain management in spine surgery, including regional anesthesia. While transversus abdominis plane (TAP) blocks are also commonly performed for anterior spinal surgery, literature evaluating outcomes after TAP blocks for ALIF patients is sparse. This retrospective cohort study aims to determine the effect of TAP blocks on perioperative opioid use and hospital length of stay.

Methods: Retrospective chart review was performed for patients 18 years or older undergoing 1- or 2-level ALIF with or without posterior percutaneous instrumented fusion. Baseline demographics, surgical details, length of stay (LOS), and data on inpatient opioid use (converted to morphine milliequivalents, MME) was collected. Total MME and MME stratified by postoperative day (POD) was collected. Bivariable and multivariable regression models were used to analyze the relationship of TAP blocks with LOS and narcotic use postoperatively.

Results: About 295 patients were included, with 102 (34.6%) undergoing TAP block and 193 (65.4%) patients without TAP block. There were no significant differences in baseline patient characteristics. Use of a TAP block had no statistically significant effect on LOS, and bivariable analysis revealed no effect when groups were analyzed by sex, age, BMI, preoperative opioid use, or number of levels fused. TAP block patients received significantly more MME on POD 0 and on combined POD 1 and 2 than those without a TAP block. Bivariable analysis did not reveal any subgroup who benefitted from a TAP block.

Conclusions: With the largest patient cohort reported to date, we found no statistically significant improvements in length of stay or short-term postoperative opioid usage when patients received TAP blocks for anterior lumbar interbody fusion.

背景：腰椎前路椎体间融合术（ALIF）是一种越来越常见的外科手术，用于治疗各种脊柱病变。由于阿片类药物的使用和医疗费用仍然是主要的国家医疗危机，了解脊柱手术中有效的疼痛管理方法，包括区域麻醉，是至关重要的。虽然腹横截面（TAP）阻滞也常用于脊柱前路手术，但评估ALIF患者TAP阻滞后疗效的文献很少。本回顾性队列研究旨在确定TAP阻滞对围手术期阿片类药物使用和住院时间的影响。方法：回顾性回顾18岁及以上接受1或2节段ALIF伴或不伴后路经皮内固定融合术的患者。收集基线人口统计、手术细节、住院时间（LOS）和住院阿片类药物使用数据（转换为吗啡毫当量，MME）。收集总MME和按术后天数（POD）分层的MME。采用双变量和多变量回归模型分析TAP阻滞与术后LOS和麻醉使用的关系。结果：共纳入295例患者，其中102例（34.6%）接受TAP阻滞，193例（65.4%）未接受TAP阻滞。两组患者的基线特征无显著差异。TAP阻滞的使用对LOS没有统计学上的显著影响，双变量分析显示，当按性别、年龄、BMI、术前阿片类药物使用或融合水平数量进行分组分析时，没有影响。与没有TAP阻断的患者相比，TAP阻断患者在POD 0和联合POD 1和2上接受了更多的MME。双变量分析未显示任何亚组受益于TAP阻断。结论：在迄今为止报道的最大的患者队列中，我们发现当患者接受前路腰椎椎体间融合术的TAP阻滞时，在住院时间或术后短期阿片类药物使用方面没有统计学上显著的改善。

{"title":"Impact of transversus abdominis plane block on length of stay and postoperative opioid use in anterior lumbar interbody fusions.","authors":"Katherine Drexelius, Steven Baltic, Kennedy Gachigi, Caleb Lifsey, Rebecca Kelso, P Bradley Segebarth","doi":"10.1016/j.xnsj.2025.100771","DOIUrl":"10.1016/j.xnsj.2025.100771","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is an increasingly common surgical procedure for a variety of spinal pathologies. As both opioid use and healthcare costs remain major national healthcare crises, it is crucial to understand methods of effective pain management in spine surgery, including regional anesthesia. While transversus abdominis plane (TAP) blocks are also commonly performed for anterior spinal surgery, literature evaluating outcomes after TAP blocks for ALIF patients is sparse. This retrospective cohort study aims to determine the effect of TAP blocks on perioperative opioid use and hospital length of stay.</p><p><strong>Methods: </strong>Retrospective chart review was performed for patients 18 years or older undergoing 1- or 2-level ALIF with or without posterior percutaneous instrumented fusion. Baseline demographics, surgical details, length of stay (LOS), and data on inpatient opioid use (converted to morphine milliequivalents, MME) was collected. Total MME and MME stratified by postoperative day (POD) was collected. Bivariable and multivariable regression models were used to analyze the relationship of TAP blocks with LOS and narcotic use postoperatively.</p><p><strong>Results: </strong>About 295 patients were included, with 102 (34.6%) undergoing TAP block and 193 (65.4%) patients without TAP block. There were no significant differences in baseline patient characteristics. Use of a TAP block had no statistically significant effect on LOS, and bivariable analysis revealed no effect when groups were analyzed by sex, age, BMI, preoperative opioid use, or number of levels fused. TAP block patients received significantly more MME on POD 0 and on combined POD 1 and 2 than those without a TAP block. Bivariable analysis did not reveal any subgroup who benefitted from a TAP block.</p><p><strong>Conclusions: </strong>With the largest patient cohort reported to date, we found no statistically significant improvements in length of stay or short-term postoperative opioid usage when patients received TAP blocks for anterior lumbar interbody fusion.</p>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"100771"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical and recreational cannabis use in patients undergoing one- or two-level lumbar spine fusion correlated with postoperative outcomes. 一节段或两节段腰椎融合患者的医用和娱乐性大麻使用与术后预后相关。

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-18 eCollection Date: 2025-09-01 DOI: 10.1016/j.xnsj.2025.100773

Andrea T Kwaczala, Matthew J Solomito, Caitlin McCracken, Heeren Makanji

Background: Cannabis use in the United States has become increasingly prevalent due to the legislation leading to decriminalization in several states; with increased social acceptance, patients are more willing to disclose cannabis use. Few studies have explored how cannabis may influence a patient's recovery following elective lumbar fusion. Therefore, the purpose of this study was to investigate how cannabis use was associated with patient recovery following elective lumbar fusions.

Methods: This retrospective single institution study included patients ages 35 through 80 years old who had undergone an elective single- or 2-level lumbar fusion between January 2021 and June 2024. Patients were placed into 1 of 3 study groups based on cannabis use, medical cannabis (MC), recreational cannabis (RC), and nonusers (NU). Differences in patient outcomes were assessed through univariate comparison and multivariate regression analyses.

Results: 627 patients were included, 129 (20.3%) admitted to cannabis use, 42 (32.5%) used medical cannabis and 87 (67.5%) used recreationally. Cannabis users were younger than NU (p<0.001) but reported increased pain (p=0.026) and required more opioids (p=0.017). Surgical site infections at 90 days (SSIs) were significantly greater in the MC group (p<0.001).

Conclusions: Cannabis use and type of usage had an impact on patient-reported outcomes, pain level, and measures of surgical success. The MC group had significantly higher opioid consumption and SSI rates at 90 days compared to nonusers and recreational groups. Therefore, this study suggests cannabis use may influence postoperative recovery following elective spine fusion. Additionally, medical cannabis users may be a high-risk group not previously identified in the literature.

Level of evidence: III.

背景：由于几个州的立法使大麻合法化，大麻在美国的使用变得越来越普遍；随着社会接受度的提高，患者更愿意披露大麻的使用情况。很少有研究探讨大麻如何影响患者择期腰椎融合术后的恢复。因此，本研究的目的是调查大麻使用与选择性腰椎融合术后患者康复的关系。方法：这项回顾性的单机构研究纳入了在2021年1月至2024年6月期间接受了选择性单节段或2节段腰椎融合术的年龄在35至80岁的患者。根据大麻使用、医用大麻（MC）、休闲大麻（RC）和非使用者（NU），将患者分为3个研究组中的1个。通过单因素比较和多因素回归分析评估患者预后的差异。结果：纳入627例患者，129例（20.3%）承认使用大麻，42例（32.5%）使用医用大麻，87例（67.5%）使用娱乐性大麻。大麻使用者比NU年轻（pp=0.026），需要更多的阿片类药物（p=0.017）。在90天手术部位感染（ssi）中，MC组明显更大(结论：大麻的使用和使用类型对患者报告的结果、疼痛水平和手术成功的测量有影响。与非吸毒者和娱乐组相比，MC组在90天内的阿片类药物消费量和SSI率明显更高。因此，本研究提示大麻的使用可能影响择期脊柱融合术后的恢复。此外，医用大麻使用者可能是以前文献中未确定的高危群体。证据水平：III。

{"title":"Medical and recreational cannabis use in patients undergoing one- or two-level lumbar spine fusion correlated with postoperative outcomes.","authors":"Andrea T Kwaczala, Matthew J Solomito, Caitlin McCracken, Heeren Makanji","doi":"10.1016/j.xnsj.2025.100773","DOIUrl":"10.1016/j.xnsj.2025.100773","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use in the United States has become increasingly prevalent due to the legislation leading to decriminalization in several states; with increased social acceptance, patients are more willing to disclose cannabis use. Few studies have explored how cannabis may influence a patient's recovery following elective lumbar fusion. Therefore, the purpose of this study was to investigate how cannabis use was associated with patient recovery following elective lumbar fusions.</p><p><strong>Methods: </strong>This retrospective single institution study included patients ages 35 through 80 years old who had undergone an elective single- or 2-level lumbar fusion between January 2021 and June 2024. Patients were placed into 1 of 3 study groups based on cannabis use, medical cannabis (MC), recreational cannabis (RC), and nonusers (NU). Differences in patient outcomes were assessed through univariate comparison and multivariate regression analyses.</p><p><strong>Results: </strong>627 patients were included, 129 (20.3%) admitted to cannabis use, 42 (32.5%) used medical cannabis and 87 (67.5%) used recreationally. Cannabis users were younger than NU (<i>p</i><0.001) but reported increased pain (<i>p</i>=0.026) and required more opioids (<i>p</i>=0.017). Surgical site infections at 90 days (SSIs) were significantly greater in the MC group (<i>p</i><0.001).</p><p><strong>Conclusions: </strong>Cannabis use and type of usage had an impact on patient-reported outcomes, pain level, and measures of surgical success. The MC group had significantly higher opioid consumption and SSI rates at 90 days compared to nonusers and recreational groups. Therefore, this study suggests cannabis use may influence postoperative recovery following elective spine fusion. Additionally, medical cannabis users may be a high-risk group not previously identified in the literature.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"100773"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Implant density reduction to avoid proximal junctional failure in adult spine surgery: Computer models and simulations 在成人脊柱手术中降低种植体密度以避免近端连接失败：计算机模型和模拟

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-16 DOI: 10.1016/j.xnsj.2025.100770

Morteza Rasouligandomani PhD , Alex del Arco MD-PhD , Tomaso Villa PhD , Luigi La Barbera PhD , Miguel A. González Ballester PhD , Fabio Galbusera PhD , Jérôme Noailly PhD

Background

Proximal Junctional Failure (PJF) is a common complication in Adult Spine Deformity (ASD) surgeries, often leading to reoperations. While revision surgeries with osteotomies carry high complication rate of 34.8%, alternatives such as hardware proximal extension may increase PJF risk in patients with severe Global Alignment and Proportion (GAP) scores. Implant Density Reduction (IDR) has emerged to mitigate PJF risk. This study assessed the impact of IDR on PJF risk and explored sub-optimal strategies.

Methods

Two patient-personalized Finite Element (FE) models were used and expanded into a virtual cohort. Implant Density (ID), rod material, bone quality, and GAP were systematically varied. Thoracolumbar FE models were developed using structured Statistical Shape Modeling (SSM). Biomechanical metrics of Intervertebral Disk (IVD) fiber strain, Screw Pull-out Force (SPF), and rod stress, were evaluated. Trade-off analyses could determine sub-optimal configurations avoiding PJF.

Results

IDR significantly decreased IVD strain (up to −70%) and improved screw stability (up to +142%), for patients with titanium (Ti) rods and normal bone. However, IDR effectiveness was limited for cases with GAP ≥12, osteoporotic bone, and Cobalt-Chromium (Cr-Co) rods. No IDR strategy could prevent PJF for cases with GAP 12 or 13, regardless of rod type. For cases with GAP 11 and Upper Instrumented Vertebra (UIV) at T10, IDR was effective with only Ti rods. For cases with GAP 13 and UIV at T3, none of IDRs, independent of rod material, offered benefit. Notably, Ti rods may support IDR-based risk reduction in borderline cases, such as GAP 12, UIV at T3.

Conclusions

IDR is a promising strategy to lower PJF risk in high-risk spine revision cases, though its effectiveness depends on surgical and anatomical factors. This study provides an in-silico tool to support personalized surgical planning and guide future clinical trials aimed at reducing reoperations and healthcare costs.

近端连接功能衰竭（PJF）是成人脊柱畸形（ASD）手术的常见并发症，经常导致再手术。虽然骨截骨翻修手术的并发症发生率高达34.8%，但对于具有严重Global Alignment and Proportion （GAP）评分的患者，其他选择如硬体近端延伸可能会增加PJF的风险。种植体密度降低（IDR）已经出现，以减轻PJF的风险。本研究评估了IDR对PJF风险的影响，并探讨了次优策略。方法采用两种患者个性化有限元模型，并将其扩展为虚拟队列。种植体密度（ID）、棒材料、骨质量和GAP系统变化。采用结构化统计形状建模（SSM）建立胸腰椎有限元模型。评估椎间盘（IVD）纤维应变、螺钉拔出力（SPF）和棒应力的生物力学指标。权衡分析可以确定避免PJF的次优配置。结果对于钛（Ti）棒和正常骨患者，sidr可显著降低IVD应变（高达- 70%），提高螺钉稳定性（高达+142%）。然而，对于GAP≥12、骨质疏松和钴铬（Cr-Co）棒的病例，IDR的有效性有限。对于GAP为12或13的患者，无论棒子类型如何，IDR策略都不能预防PJF。对于GAP 11和上固定椎体（UIV）在T10时的病例，IDR仅使用Ti棒有效。对于GAP 13和UIV在T3的病例，与棒材料无关的idr均未提供益处。值得注意的是，钛棒可能支持基于idr的边缘病例的风险降低，例如GAP 12， T3时的UIV。结论sidr是降低高危脊柱翻修病例PJF风险的有效策略，但其效果取决于手术和解剖因素。该研究提供了一种支持个性化手术计划的计算机工具，并指导未来旨在减少再手术和医疗费用的临床试验。

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引用次数: 0

The symbiosis of robotics, enabling technology and minimally invasive surgery1 机器人、赋能技术与微创手术的共生

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-08 DOI: 10.1016/j.xnsj.2025.100769

Katherine M. Bunch MD, MS , Garret P. Greeneway MD , Darius S. Ansari MD , Chetan Patel MD , Eric W. Nottmeier MD , Karthik H.S. Madhavan MD , Stephen M. Pirris MD , Andrew A. Sama MD , Nathaniel P. Brooks MD

Background

Procedural and technical advances in spinal surgery, such as the utilization of minimally-invasive techniques, have evolved alongside the development and distribution of tools such as navigation, robotics, augmented reality (AR), dynamic visualization, and preoperative planning modules. Each innovative advancement in a surgeon’s ability to see, measure, and manipulate human tissue entails an improvement or novel application of existing tools. Similarly, given the enormous economic and opportunity costs associated with the research and development of novel technologies, these efforts must be refined to address existing needs and infrastructure gaps. The successful application of enabling technologies such as robotics, navigation, and minimally-invasive techniques, is therefore dependent upon the expansion of new surgical tools and techniques.

Methods

We review numerous technological advances (Navigation, Intraoperative Imaging, Robotics, Augmented Reality, Computational Planning and Visualization) within the field of spine surgery and demonstrate their mutually beneficial, yet dependent, relationship with one another in advancing spine surgery technology through both expert opinion and published literature.

Results

We provide an overview of several different domains of enabling technology as they pertain to novel applications in spinal surgery and review current uses, limitations, and areas of potential improvement.

Conclusions

The integration of augmented reality, robotics, visualization and navigational technologies, minimally invasive techniques, and other advanced tools have enabled the surgeon to perform both standard and novel procedures in unique ways.

脊柱外科手术的程序和技术进步，如微创技术的使用，随着导航、机器人、增强现实（AR）、动态可视化和术前规划模块等工具的发展和普及而不断发展。外科医生在观察、测量和操作人体组织方面的每一个创新进步都需要对现有工具的改进或新应用。同样，鉴于与新技术的研究和开发有关的巨大经济和机会成本，必须改进这些努力，以解决现有的需求和基础设施差距。因此，诸如机器人技术、导航技术和微创技术等技术的成功应用取决于新手术工具和技术的扩展。方法我们回顾了脊柱外科领域的众多技术进步（导航、术中成像、机器人、增强现实、计算规划和可视化），并通过专家意见和已发表的文献展示了它们在推进脊柱外科技术方面的互利，但相互依赖的关系。我们概述了几个不同领域的使能技术，因为它们与脊柱外科的新应用有关，并回顾了当前的用途、局限性和潜在的改进领域。增强现实、机器人技术、可视化和导航技术、微创技术和其他先进工具的集成，使外科医生能够以独特的方式执行标准和新颖的手术。

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引用次数: 0

Qualitative and quantitative retrieval analysis of a ball-and-socket cervical disc replacement 球窝式颈椎间盘置换术的定性和定量检索分析

IF 2.5 Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-05 DOI: 10.1016/j.xnsj.2025.100768

Jenna M. Wahbeh MS , Sophia N. Sangiorgio PhD , Sang-Hyun Park PhD , G. Bryan Cornwall PhD , Neha V. Kulkarni BS , Roberto Chiesa PhD , Edward Ebramzadeh PhD

Background

The Porous Coated Motion (PCM) is a ball-and-socket cervical disc replacement with excellent reported short-term clinical outcome. However, longer-term studies identified migration as a common cause of implant removal and the device was withdrawn from the market. Given these discrepancies, retrieval analyses are crucial to assess whether preclinical testing accurately predicts clinical performance. This study aimed to quantitatively and qualitatively analyze retrieved PCM devices to identify primary reasons for removal and assess the impact of observed damage on overall device fixation.

Methods

Thirty-seven PCM devices were received for postmarket surveillance. Nondestructive analysis included visual examination, photographic documentation, and radiographic review. Analytical measurements were performed using a coordinate measuring machine to assess articulating surfaces or a digital microscope for endplate surface feature characterization. Oxidation analysis was performed on all devices with adequate handling and storage conditions, and histopathology was performed when tissue samples were available.

Results

Twenty-five devices met the inclusion criteria for this study. The mean patient age at retrieval was 45.3±13.5 years, with an average time-in-vivo of 121±15.6 days. Anterior migration was the most common reason for removal, reported in 17 cases, with the inferior convex polyethylene component predominately migrating. Additionally, 17 devices had a focalized deviation on the posterior quadrant of the articulating polyethylene ball, 11 of which had evidence of radiographic clinical migration. Histopathology and metrology findings indicated that wear debris did not contribute to clinical failure.

Conclusions

The findings of the present study, specifically the minimal bony ongrowth, lack of extraction damage, and radiographic imaging, indicated that most devices were removed due to migration. Metrology analysis revealed a depression on the posterior edge of the inferior endplate polyethylene ball, which correlated with anterior slippage. This may be a distinctive feature of the PCM’s relatively large ball-and-socket design that led to increased stress during extension, causing anterior migration.

多孔包覆运动（PCM）是一种球窝型颈椎间盘置换术，近期临床疗效良好。然而，长期研究发现移植物迁移是导致植入物移除的常见原因，因此该设备被从市场上撤出。鉴于这些差异，检索分析对于评估临床前测试是否准确预测临床表现至关重要。本研究旨在定量和定性地分析取出的PCM装置，以确定移除的主要原因，并评估观察到的损伤对整体装置固定的影响。方法收集37个PCM器械进行上市后监测。无损分析包括目视检查、照片记录和射线检查。分析测量使用坐标测量机评估关节面或数码显微镜进行端板表面特征表征。在适当的处理和储存条件下对所有设备进行氧化分析，并在组织样本可用时进行组织病理学检查。结果25台器械符合本研究的纳入标准。患者平均年龄为45.3±13.5岁，平均在体时间为121±15.6天。前移是最常见的切除原因，报告了17例，下凸聚乙烯组件主要迁移。此外，17个器械在关节聚乙烯球的后象限有聚焦偏差，其中11个有影像学临床偏移的证据。组织病理学和计量学结果表明，磨损碎片不会导致临床失败。结论本研究的结果，特别是最小的骨生长，缺乏拔牙损伤和x线影像，表明大多数装置是由于迁移而被移除的。计量分析显示下终板聚乙烯球后缘凹陷，与前滑脱相关。这可能是PCM相对较大的球窝设计的一个显著特征，导致伸展时应力增加，导致前移。

{"title":"Qualitative and quantitative retrieval analysis of a ball-and-socket cervical disc replacement","authors":"Jenna M. Wahbeh MS , Sophia N. Sangiorgio PhD , Sang-Hyun Park PhD , G. Bryan Cornwall PhD , Neha V. Kulkarni BS , Roberto Chiesa PhD , Edward Ebramzadeh PhD","doi":"10.1016/j.xnsj.2025.100768","DOIUrl":"10.1016/j.xnsj.2025.100768","url":null,"abstract":"<div><h3>Background</h3><div>The Porous Coated Motion (PCM) is a ball-and-socket cervical disc replacement with excellent reported short-term clinical outcome. However, longer-term studies identified migration as a common cause of implant removal and the device was withdrawn from the market. Given these discrepancies, retrieval analyses are crucial to assess whether preclinical testing accurately predicts clinical performance. This study aimed to quantitatively and qualitatively analyze retrieved PCM devices to identify primary reasons for removal and assess the impact of observed damage on overall device fixation.</div></div><div><h3>Methods</h3><div>Thirty-seven PCM devices were received for postmarket surveillance. Nondestructive analysis included visual examination, photographic documentation, and radiographic review. Analytical measurements were performed using a coordinate measuring machine to assess articulating surfaces or a digital microscope for endplate surface feature characterization. Oxidation analysis was performed on all devices with adequate handling and storage conditions, and histopathology was performed when tissue samples were available.</div></div><div><h3>Results</h3><div>Twenty-five devices met the inclusion criteria for this study. The mean patient age at retrieval was 45.3±13.5 years, with an average time-in-vivo of 121±15.6 days. Anterior migration was the most common reason for removal, reported in 17 cases, with the inferior convex polyethylene component predominately migrating. Additionally, 17 devices had a focalized deviation on the posterior quadrant of the articulating polyethylene ball, 11 of which had evidence of radiographic clinical migration. Histopathology and metrology findings indicated that wear debris did not contribute to clinical failure.</div></div><div><h3>Conclusions</h3><div>The findings of the present study, specifically the minimal bony ongrowth, lack of extraction damage, and radiographic imaging, indicated that most devices were removed due to migration. Metrology analysis revealed a depression on the posterior edge of the inferior endplate polyethylene ball, which correlated with anterior slippage. This may be a distinctive feature of the PCM’s relatively large ball-and-socket design that led to increased stress during extension, causing anterior migration.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"23 ","pages":"Article 100768"},"PeriodicalIF":2.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748873","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}

引用次数: 0

Preclinical evaluation of lateral interbody fusions using 3D printed PEEK or 3D printed titanium cages 使用3D打印PEEK或3D打印钛笼进行侧体间融合的临床前评估

Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-03 DOI: 10.1016/j.xnsj.2025.100756

William Robert Walsh PhD , Matthew Pelletier PhD , Dan Wills PhD, BScVet , Tian Wang PhD , Max Lloyd BScVet , Michael Veldman BS , Nick Cordaro BS , Mark Brady PhD

Background

PEEK interbody cages are well established. 3D porous PEEK designs can now be produced with additive manufacturing. This study compared the in-vivo response of additive manufactured porous PEEK (3D PEEK) and titanium alloy (3D Ti) cages.

Methods

Interbody fusion was performed in 11 adult sheep at 2 levels (L2-3 and L4-5) using 3D PEEK and 3D Ti cages filled with autograft with posterior bilateral pedicle screw fixation. Fusions were evaluated at 8 and 16 weeks via manual palpation, microcomputed tomography (microCT), histology, and histomorphometry.

Results

All animals recovered well following surgery with no adverse events. The radiolucent nature of PEEK allowed the fusions to be evaluated using radiographs and microCT. The 3D Ti cages however appeared solid rather than porous in the radiographs and presented artifacts in the microCT scans which precluded definitive determination of the fusions. Range of motion results improved with time for 3D PEEK and 3D Ti while no differences between designs were detected. Histology and histomorphometry confirmed 3D PEEK and 3D Ti supported fusion in this model using autograft.

Conclusions

Range of motion and histology results were similar for 3D PEEK and 3D Ti. Radiographs and microCT could be used to assess the fusions with 3D PEEK due to the radiolucent nature. 3D Ti appeared solid in the radiographs and had image artifact in microCT which precluded definitive evaluation of the fusions. 3D PEEK and 3D Ti cages both support interbody fusion in this preclinical model.

peek体间固定架已经很成熟。3D多孔PEEK设计现在可以用增材制造生产。本研究比较了添加剂制造的多孔PEEK （3D PEEK）和钛合金（3D Ti）笼的体内响应。方法采用3D PEEK和3D Ti笼填充自体移植物，双侧后路椎弓根螺钉固定，对11只成年羊进行L2-3和L4-5两个节段的椎体融合。在8周和16周时通过手触诊、显微计算机断层扫描（microcomputer tomography, microCT）、组织学和组织形态计量学评估融合情况。结果所有动物术后均恢复良好，无不良反应发生。聚醚醚酮的放射透光性允许使用x线片和微ct评估融合。然而，三维钛笼在x光片上表现为固体而不是多孔，并且在微ct扫描中呈现伪影，这妨碍了对融合的明确确定。3D PEEK和3D Ti的运动范围结果随着时间的推移而改善，而设计之间没有发现差异。组织学和组织形态学证实3D PEEK和3D Ti支持融合在该模型中使用自体移植物。结论3D PEEK和3D Ti的运动范围和组织学结果相似。由于三维聚醚醚酮的放射性，x线片和微ct可用于评估融合。三维钛在x线片上呈固体状，在微ct上有图像伪影，这妨碍了对融合的明确评估。在这个临床前模型中，3D PEEK和3D Ti笼都支持椎间融合。

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引用次数: 0

P19. Infection following cervical artificial disc replacement P19。颈椎人工椎间盘置换术后感染

Q3 Medicine

North American Spine Society Journal

Pub Date : 2025-07-01 DOI: 10.1016/j.xnsj.2025.100643

Adeesya Gausper BA , Justin K. Scheer MD , Suhas K Etigunta BS , Andy M Liu BS , Alexander Tuchman MD

<div><h3>BACKGROUND CONTEXT</h3><div>Cervical artificial disc replacement (ADR) is a procedure performed for patients with cervical disc degeneration or herniation in the setting of radiculopathy or myelopathy, with a primary advantage of motion preservation compared to fusion procedures. Infection following cervical ADR is poorly understood, with no established guidelines for prevention or management.</div></div><div><h3>PURPOSE</h3><div>This case series aims to characterize the clinical presentation, microbiological findings, and outcomes of patients who develop cervical ADR infections.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective case series.</div></div><div><h3>PATIENT SAMPLE</h3><div>N/A</div></div><div><h3>OUTCOME MEASURES</h3><div>N/A</div></div><div><h3>METHODS</h3><div>We conducted a retrospective review of patients treated at our institution who developed infection following cervical ADR and underwent subsequent revision surgery. Data collected included patient demographics, clinical presentation, infective organism, and type of disc implanted. Infections were identified based on clinical symptoms and radiographical findings and confirmed with microbiological cultures. Infection management, including antibiotic therapy and revision surgery, was recorded.</div></div><div><h3>RESULTS</h3><div>A total of 23 cases involving 18 patients were included in this study. Five patients (27.8%) required two revision surgeries. Intractable neck pain and cervical radiculopathy were reported in nearly all patients. Upper extremity weakness, muscular spasms, balance issues, and dysphagia were also reported. Head and neck trauma preceded symptom onset in 3 patients. Time from symptom onset to diagnosis ranged from 4 days to 98 weeks (mean 32.7 weeks). Species most commonly isolated from OR cultures were Cutibacterium acnes in 14 cases (60.9%) and Staphylococcus epidermidis in 7 cases (30.4%). Polymicrobial cultures were isolated in 9 cases, and cultures were negative in 3 cases. Intraoperative vancomycin powder was not used in any initial ADR surgery, and vancomycin powder was utilized in 4 revisions. Notably, of the 17 patients who underwent revision of hardware, 100% were eventually converted to fusion.</div></div><div><h3>CONCLUSIONS</h3><div>Infection following cervical ADR is rare but poses significant clinical challenges and most often requires conversion to fusion. Early identification and appropriate management are critical to optimizing patient outcomes. Variability in clinical presentation and time to diagnosis highlights the need to refine perioperative protocols to reduce infection risk and improve success of subsequent procedures. This study reports the largest cohort of patients with infected cervical ADRs to date and provides valuable insights to inform future guidelines for prevention and management.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or d

背景背景颈椎人工椎间盘置换术（ADR）是一种治疗神经根病或脊髓病的颈椎椎间盘退变或突出患者的手术，与融合手术相比，其主要优点是保持运动。人们对宫颈不良反应引起的感染了解甚少，没有既定的预防或管理指南。目的：本病例系列旨在描述宫颈不良反应感染患者的临床表现、微生物学结果和预后。研究设计/设置回顾性病例系列。患者样本/结果测量/方法我们对在我院治疗的宫颈不良反应后发生感染并随后进行翻修手术的患者进行了回顾性研究。收集的数据包括患者人口统计学、临床表现、感染菌和植入椎间盘的类型。根据临床症状和x线检查结果确定感染，并通过微生物培养确诊。记录感染管理，包括抗生素治疗和翻修手术。结果本研究共纳入23例患者18例。5例（27.8%）患者需要两次翻修手术。几乎所有的患者都报告了顽固性颈部疼痛和颈椎神经根病。上肢无力、肌肉痉挛、平衡问题和吞咽困难也有报道。3例患者出现症状前有头颈部外伤。从症状出现到诊断的时间从4天到98周不等（平均32.7周）。OR培养中最常见的菌种是痤疮角质杆菌14例（60.9%）和表皮葡萄球菌7例（30.4%）。多菌培养9例，培养阴性3例。术中未使用万古霉素粉剂进行首次不良反应手术，4次改版均使用万古霉素粉剂。值得注意的是，在17例接受内固定翻修的患者中，100%最终转化为融合。结论宫颈不良反应引起的感染是罕见的，但对临床有很大的挑战，通常需要转化为融合。早期识别和适当管理对于优化患者预后至关重要。临床表现和诊断时间的差异突出了改进围手术期方案以降低感染风险和提高后续手术成功率的必要性。本研究报告了迄今为止最大的宫颈感染不良反应患者队列，并为未来的预防和管理指南提供了有价值的见解。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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引用次数: 0