Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100646
Ling Yi Li MD
BACKGROUND CONTEXT
Cervical ossification of the posterior longitudinal ligament (OPLL) can cause symptoms such as myelopathy and radiculopathy. Anterior decompression and fusion (ADF) and laminoplasty (LAMP) are common surgical options to decompress the spinal cord and stabilize the spine. ADF provides direct decompression but is associated with greater complexity and higher risks, whereas LAMP is less invasive but may be less effective in severe cases. Ongoing research aims to compare these approaches and guide the selection of the most appropriate treatment.
PURPOSE
N/A
STUDY DESIGN/SETTING
N/A
PATIENT SAMPLE
N/A
OUTCOME MEASURES
N/A
METHODS
Data collection included demographic characteristics, radiological findings, and the Japanese Orthopaedic Association (JOA) score for cervical myelopathy recorded between 2010 and 2024. Postoperative and last follow-up JOA scores were compared with preoperative values within and between the two groups. Postoperative complications were also assessed. Regression analysis was performed to identify factors associated with achieving a minimal clinically important improvement or difference in the JOA score.
RESULTS
The study analyzed 27 patients who underwent either ADF (n = 18) or LAMP (n = 9). Both groups had comparable demographics, although segmental involvement was more common in the ADF group. Preoperative JOA scores were higher in the ADF group, and postoperative improvements were greater, but recovery rates were similar between the two groups. Complications such as reoperation and C5 palsy occurred only in the ADF group, though these differences were not statistically significant. Surgical site infections were observed exclusively in the LAMP group. Factors such as age, BMI, and smoking history did not significantly influence the MCID, but the occupying ratio showed a potential impact (p = 0.0516), underscoring its role as a nuanced predictor of surgical success.
CONCLUSIONS
Both ADF and LAMP are effective and safe treatments for cervical OPLL. However, patients with a higher occupying ratio may have a reduced likelihood of achieving MCID success.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
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<div><h3>BACKGROUND CONTEXT</h3><div>Spinopelvic assessment (eg, SS, PT, PI, LL, TK, CL, SVA, and Cobb angle) is vital for preoperative spinal surgery planning but is often measured manually, leading to variability. Recent AI and deep learning methods improve automation and accuracy. While promising, these techniques face challenges including computational complexity, small test datasets, lack of surgeon validation, and limited robustness to varied image conditions.</div></div><div><h3>PURPOSE</h3><div>To increase accuracy, reduce complexity, and provide robust preoperative X-ray analysis, we propose a novel, physics-informed deep learning method based on mathematical spinal relations. This approach aims to automatically calculate lateral and AP spinal parameters and promptly perform Lenke classification for each patient.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>N/A</div></div><div><h3>PATIENT SAMPLE</h3><div>We collected 3500 lateral and AP spine X-rays from Grand River Hospital (GRH) in Kitchener, ON, Canada, between 2016 and 2024, encompassing hip/spine implants, varied postures, and poor-contrast or partially visible spines. Image processing filters enhanced annotation accuracy, allowing landmark detection even in incomplete images. The dataset includes conventional and EOS systems, enabling thorough performance evaluation and robust landmark detection. Data was split into 80% training, 10% validation, and 10% testing.</div></div><div><h3>OUTCOME MEASURES</h3><div>This study focuses on the automatic extraction of spinopelvic parameters and anatomical landmarks from lateral and AP X-ray images, including SS, PT, PI, LL, SVA, femur center, sacrum end plate, iliac crest, L1–L5, T12–T1, C7–C2, apex, Cobb angle, LSRS, TSM, and CSRS. These measurements enable Lenke classification, identifying curve types (1–6), lumbar modifiers (A, B, C), and thoracic modifiers (–, N, +). To evaluate performance, we use relative root mean square error (RRMSE) to compare predicted values (PR) with manual annotations (MA), while intraclass correlation coefficient (ICC) measures reliability among surgeons, MA, and PR.</div></div><div><h3>METHODS</h3><div>Using our developed physics-informed deep learning method, spinopelvic parameters were extracted from X-ray images and validated against manual annotations. Landmarks were detected as objects with geometric constraints derived from mathematical spinal relations. Performance, compared to three senior spine surgeons, demonstrated excellent correlation, with intraclass correlation coefficients exceeding 0.9, surpassing previously reported literature values. Additionally, we developed an algorithm leveraging these parameters to automate Lenke classification, identifying curve type (1–6), lumbar modifier (A,B,C), and thoracic modifier (–,N,+), significantly aiding triage and preoperative planning.</div></div><div><h3>RESULTS</h3><div>We evaluated our model on the dataset, achieving final accuracies of 93.1% (SS),
{"title":"3. Automated Lenke classification for preoperative spine surgery by extracting anatomical landmarks from X-ray images using a deep learning approach","authors":"AliAsghar Mohammadi Nasrabadi PhD , Gemah Moammer FRCSC , John McPhee PhD","doi":"10.1016/j.xnsj.2025.100697","DOIUrl":"10.1016/j.xnsj.2025.100697","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Spinopelvic assessment (eg, SS, PT, PI, LL, TK, CL, SVA, and Cobb angle) is vital for preoperative spinal surgery planning but is often measured manually, leading to variability. Recent AI and deep learning methods improve automation and accuracy. While promising, these techniques face challenges including computational complexity, small test datasets, lack of surgeon validation, and limited robustness to varied image conditions.</div></div><div><h3>PURPOSE</h3><div>To increase accuracy, reduce complexity, and provide robust preoperative X-ray analysis, we propose a novel, physics-informed deep learning method based on mathematical spinal relations. This approach aims to automatically calculate lateral and AP spinal parameters and promptly perform Lenke classification for each patient.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>N/A</div></div><div><h3>PATIENT SAMPLE</h3><div>We collected 3500 lateral and AP spine X-rays from Grand River Hospital (GRH) in Kitchener, ON, Canada, between 2016 and 2024, encompassing hip/spine implants, varied postures, and poor-contrast or partially visible spines. Image processing filters enhanced annotation accuracy, allowing landmark detection even in incomplete images. The dataset includes conventional and EOS systems, enabling thorough performance evaluation and robust landmark detection. Data was split into 80% training, 10% validation, and 10% testing.</div></div><div><h3>OUTCOME MEASURES</h3><div>This study focuses on the automatic extraction of spinopelvic parameters and anatomical landmarks from lateral and AP X-ray images, including SS, PT, PI, LL, SVA, femur center, sacrum end plate, iliac crest, L1–L5, T12–T1, C7–C2, apex, Cobb angle, LSRS, TSM, and CSRS. These measurements enable Lenke classification, identifying curve types (1–6), lumbar modifiers (A, B, C), and thoracic modifiers (–, N, +). To evaluate performance, we use relative root mean square error (RRMSE) to compare predicted values (PR) with manual annotations (MA), while intraclass correlation coefficient (ICC) measures reliability among surgeons, MA, and PR.</div></div><div><h3>METHODS</h3><div>Using our developed physics-informed deep learning method, spinopelvic parameters were extracted from X-ray images and validated against manual annotations. Landmarks were detected as objects with geometric constraints derived from mathematical spinal relations. Performance, compared to three senior spine surgeons, demonstrated excellent correlation, with intraclass correlation coefficients exceeding 0.9, surpassing previously reported literature values. Additionally, we developed an algorithm leveraging these parameters to automate Lenke classification, identifying curve type (1–6), lumbar modifier (A,B,C), and thoracic modifier (–,N,+), significantly aiding triage and preoperative planning.</div></div><div><h3>RESULTS</h3><div>We evaluated our model on the dataset, achieving final accuracies of 93.1% (SS), ","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100697"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672183","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 : 2025-07-01DOI: 10.1016/S2666-5484(25)00182-9
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Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100738
Yu-Cheng Yao MD , Po-Hsin Chou MD , Bruce H Lin MD , Shih-Tien Wang MD
<div><h3>BACKGROUND CONTEXT</h3><div>There are approximately 30% of patients with osteoporotic vertebral compression fracture (OVCF) who need cementoplasty for treatment. However, the occurrence of adjacent vertebral fracture (AVF) postoperatively can lead to increased pain, delayed recovery, and poorer prognosis. Current literature identifies over 30 risk factors for AVF, including patient-specific factors, preoperative and postoperative radiographical features, and surgical-related factors. There is no effective predictive model in understanding the probability of AVF occurrence preoperatively.</div></div><div><h3>PURPOSE</h3><div>This study aims to develop a robust AVF predictive model using machine learning method.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 238 patients with OVCF who underwent single level cementoplasty were included for analysis.</div></div><div><h3>OUTCOME MEASURES</h3><div>Adjacent fracture.</div></div><div><h3>METHODS</h3><div>This is a retrospective cohort analysis. Patients with OVCF who underwent single level cementoplasty between January 2016 and December 2021 were included. Exclusion criteria were pathological fractures, patients with prior cementoplasty or spinal surgeries, and follow-up less than 12 months. Total 32 preoperative clinical and radiographic features were recorded, include patient demographics, DXA, chronic diseases, vertebral height (VH), wedge angle (WA) of fracture vertebra, local kyphotic angle (LKA), presence of posterior wall fracture (PostWall), and presence of diffuse idiopathic skeletal hyperostosis (DISH), CT vertebral Hounsfield units (HU), CT psoas lumbar vertebral index (PLVI). Ten different machine learning algorithms were used to find the best model. Confusion matrix and related indicators include Accuracy, sensitivity (Se), specificity (Sp) and ROC-AUC were used to evaluate the model performance.</div></div><div><h3>RESULTS</h3><div>A total of 238 patients were included for analysis, with an average age of 77 years and 69% were female. Most fractures located at the TL junction (64%). The AVF rate was 27.3% during the follow-up and it occurred at postoperative 3.2 months. We found the random forest model had the best performance with 83% accuracy, AUC 0.92, Se: 82%, and Sp: 85%. Among the total 32 features, we found that the 11 most important features by orders were PostWall, HU_L2, DISH, L4_PLVI, WA, MVH, BMI, LKA, Age, and fracture level. Even using those 11 features alone, the model performance could reach 78% accuracy, AUC 0.88, Se: 80%, and Sp 76%.</div></div><div><h3>CONCLUSIONS</h3><div>The novel machine learning model for predicting AVF using preoperative features demonstrated excellent performance, achieving an AUC of 0.92. This model can assist clinicians and patients with OVCF in understanding the probability of AVF occurrence after cementoplasty. For patients identified as high-risk, pro
{"title":"44. Development of a novel machine learning model for prediction of adjacent fracture after cementoplasty in treating osteoporotic vertebral compression fracture","authors":"Yu-Cheng Yao MD , Po-Hsin Chou MD , Bruce H Lin MD , Shih-Tien Wang MD","doi":"10.1016/j.xnsj.2025.100738","DOIUrl":"10.1016/j.xnsj.2025.100738","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>There are approximately 30% of patients with osteoporotic vertebral compression fracture (OVCF) who need cementoplasty for treatment. However, the occurrence of adjacent vertebral fracture (AVF) postoperatively can lead to increased pain, delayed recovery, and poorer prognosis. Current literature identifies over 30 risk factors for AVF, including patient-specific factors, preoperative and postoperative radiographical features, and surgical-related factors. There is no effective predictive model in understanding the probability of AVF occurrence preoperatively.</div></div><div><h3>PURPOSE</h3><div>This study aims to develop a robust AVF predictive model using machine learning method.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 238 patients with OVCF who underwent single level cementoplasty were included for analysis.</div></div><div><h3>OUTCOME MEASURES</h3><div>Adjacent fracture.</div></div><div><h3>METHODS</h3><div>This is a retrospective cohort analysis. Patients with OVCF who underwent single level cementoplasty between January 2016 and December 2021 were included. Exclusion criteria were pathological fractures, patients with prior cementoplasty or spinal surgeries, and follow-up less than 12 months. Total 32 preoperative clinical and radiographic features were recorded, include patient demographics, DXA, chronic diseases, vertebral height (VH), wedge angle (WA) of fracture vertebra, local kyphotic angle (LKA), presence of posterior wall fracture (PostWall), and presence of diffuse idiopathic skeletal hyperostosis (DISH), CT vertebral Hounsfield units (HU), CT psoas lumbar vertebral index (PLVI). Ten different machine learning algorithms were used to find the best model. Confusion matrix and related indicators include Accuracy, sensitivity (Se), specificity (Sp) and ROC-AUC were used to evaluate the model performance.</div></div><div><h3>RESULTS</h3><div>A total of 238 patients were included for analysis, with an average age of 77 years and 69% were female. Most fractures located at the TL junction (64%). The AVF rate was 27.3% during the follow-up and it occurred at postoperative 3.2 months. We found the random forest model had the best performance with 83% accuracy, AUC 0.92, Se: 82%, and Sp: 85%. Among the total 32 features, we found that the 11 most important features by orders were PostWall, HU_L2, DISH, L4_PLVI, WA, MVH, BMI, LKA, Age, and fracture level. Even using those 11 features alone, the model performance could reach 78% accuracy, AUC 0.88, Se: 80%, and Sp 76%.</div></div><div><h3>CONCLUSIONS</h3><div>The novel machine learning model for predicting AVF using preoperative features demonstrated excellent performance, achieving an AUC of 0.92. This model can assist clinicians and patients with OVCF in understanding the probability of AVF occurrence after cementoplasty. For patients identified as high-risk, pro","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100738"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672416","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 : 2025-07-01DOI: 10.1016/j.xnsj.2025.100635
Jun Rui Don Koh MBChB, BS
BACKGROUND CONTEXT
Adult degenerative scoliosis is a spinal deformity resulting in an unbalanced spine, the further progression of which results in associated conditions such as disc herniation, ligament hypertrophy and facet ossification. Patients with scoliosis therefore frequently suffer from both axial back pain as well as radicular pain.
PURPOSE
N/A
STUDY DESIGN/SETTING
Case Series
PATIENT SAMPLE
N/A
OUTCOME MEASURES
N/A
METHODS
We report a case series of two middle aged patients with severe scoliosis who presented to our department complaining of both back and radicular pain.
RESULTS
These patients subsequently underwent minimally invasive endoscopic decompression of the affected levels following a failure of conservative management, with no fusion to address the scoliosis. The patients report good relief of their radicular pain post-operatively, although the axial back pain remained.
CONCLUSIONS
Endoscopic decompression is a potential surgical option which should be considered for the management of radicular pain in patients with scoliosis.
FDA Device/Drug Status
This abstract does not discuss or include any applicable devices or drugs.
{"title":"P11. Endoscopic decompression for radiculopathy in scoliosis","authors":"Jun Rui Don Koh MBChB, BS","doi":"10.1016/j.xnsj.2025.100635","DOIUrl":"10.1016/j.xnsj.2025.100635","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Adult degenerative scoliosis is a spinal deformity resulting in an unbalanced spine, the further progression of which results in associated conditions such as disc herniation, ligament hypertrophy and facet ossification. Patients with scoliosis therefore frequently suffer from both axial back pain as well as radicular pain.</div></div><div><h3>PURPOSE</h3><div>N/A</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>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 report a case series of two middle aged patients with severe scoliosis who presented to our department complaining of both back and radicular pain.</div></div><div><h3>RESULTS</h3><div>These patients subsequently underwent minimally invasive endoscopic decompression of the affected levels following a failure of conservative management, with no fusion to address the scoliosis. The patients report good relief of their radicular pain post-operatively, although the axial back pain remained.</div></div><div><h3>CONCLUSIONS</h3><div>Endoscopic decompression is a potential surgical option which should be considered for the management of radicular pain in patients with scoliosis.</div></div><div><h3>FDA Device/Drug Status</h3><div>This abstract does not discuss or include any applicable devices or drugs.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672424","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 : 2025-07-01DOI: 10.1016/j.xnsj.2025.100721
Sunjoon Yoo MD
<div><h3>BACKGROUND CONTEXT</h3><div>Cervical ossification of the posterior longitudinal ligament (OPLL) is a common cause of cervical myelopathy, often requiring surgical intervention. Laminoplasty, with two main approaches—open-door (OD) and double-door (DD)—is widely performed. However, while previous studies have reported on the clinical and radiological outcomes of these techniques, none have examined a 10-year follow-up with a significant number of patients.</div></div><div><h3>PURPOSE</h3><div>This study aims to compare the long-term outcomes of open-door and double-door laminoplasties in patients with cervical OPLL over a 10-year follow-up period.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A 10-year retrospective cohort analysis conducted at a single institution.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 109 patients with cervical OPLL, comprising 63 patients in the open-door laminoplasty group and 46 patients in the double-door laminoplasty group.</div></div><div><h3>OUTCOME MEASURES</h3><div>The clinical outcomes assessed in this study included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and recovery rates. Radiological outcomes evaluated were the C2-7 Cobb angle, range of motion (ROM), occupying ratio, and K-line type.</div></div><div><h3>METHODS</h3><div>For cervical myelopathy caused by OPLL, we performed OD and double-door DD laminopasties at a single institution. A total of 63 patients in the OD group and 46 patients in the DD group were evaluated for 10 years’ follow-up. The following criteria were evaluated: demographic information, range of operation, occupying ratio, K-line, type of OPLL, Cobb angle of C2-C7, and range of motion. Clinical outcomes were assessed using the VAS, JOA score and recovery rate.</div></div><div><h3>RESULTS</h3><div>Age, sex, symptom duration, and comorbidities were not significantly different between the groups. No significant differences in K-line type, canal occupying ratio were found. There were 6 patients in each group who underwent reoperation. Between the two groups, there was no difference in the change in the C2-7 cobb angle preoperative, immediate after surgery, and 2 years after surgery. However, at 10 years after surgery, the angle during extension decreased in the DD group, and the ROM also decreased statistically significantly (12.61 vs 8.4, p=0.02; 18.87 vs 13.62, p=0.016). However, the ROM decreased in both groups from before surgery to the last follow-up, with no significant difference (-14.43 vs -18.07, p=0.221). The VAS scores for neck and arm were significantly lower in the DD group immediately after surgery (p=0.044, 0.022), but no difference was observed between the groups 10 years post-surgery. JOA scores showed a similar improvement 10 years postoperatively.</div></div><div><h3>CONCLUSIONS</h3><div>Both laminoplasty methods are effective for treating cervical OPLL over a 10-year period. However, the ROM decreased significant
背景背景后纵韧带颈椎骨化（OPLL）是颈椎病的常见病因，通常需要手术干预。椎板成形术有两种主要的方法-开门（OD）和双门(DD) -被广泛应用。然而，尽管先前的研究报道了这些技术的临床和放射学结果，但没有一项研究对大量患者进行了10年的随访。目的：本研究旨在比较开放门和双门椎板成形术在10年随访期间对颈椎OPLL患者的长期疗效。研究设计/设置在单一机构进行的10年回顾性队列分析。患者共109例颈椎OPLL患者，其中开门椎板成形术组63例，双门椎板成形术组46例。本研究评估的临床结果包括视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分和康复率。影像学结果评估为C2-7 Cobb角、活动范围（ROM）、占位率和k线类型。方法：对于OPLL所致的颈椎病，我们在同一家机构进行了OD和双门DD椎板手术。OD组共63例，DD组46例，随访10年。评估标准如下：人口统计学信息、操作范围、占位率、k线、OPLL类型、C2-C7 Cobb角和活动范围。采用VAS评分、JOA评分和康复率评估临床结果。结果两组患者年龄、性别、症状持续时间、合并症无显著差异。k线型、管占比差异无统计学意义。两组再手术6例。两组患者术前、术后即刻、术后2年的C2-7 cobb角变化无差异。然而，在手术后10年，DD组伸展时的角度减小，ROM也有统计学意义(12.61 vs 8.4, p=0.02；18.87 vs 13.62, p=0.016)。然而，从术前到最后一次随访，两组的ROM均下降，差异无统计学意义（-14.43 vs -18.07, p=0.221）。DD组术后即刻颈部和手臂VAS评分明显降低（p=0.044, 0.022），但术后10年各组间无差异。术后10年JOA评分也有类似的改善。结论两种椎板成形术均可有效治疗10年以上的颈椎上睑下垂。然而，在DD组中，ROM明显下降得更多。尽管如此，两组在JOA评分方面表现出相似的长期临床结果和改善。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。
{"title":"27. Open door versus double door laminoplasty in the treatment of cervical OPLL: a 10-year retrospective analysis","authors":"Sunjoon Yoo MD","doi":"10.1016/j.xnsj.2025.100721","DOIUrl":"10.1016/j.xnsj.2025.100721","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Cervical ossification of the posterior longitudinal ligament (OPLL) is a common cause of cervical myelopathy, often requiring surgical intervention. Laminoplasty, with two main approaches—open-door (OD) and double-door (DD)—is widely performed. However, while previous studies have reported on the clinical and radiological outcomes of these techniques, none have examined a 10-year follow-up with a significant number of patients.</div></div><div><h3>PURPOSE</h3><div>This study aims to compare the long-term outcomes of open-door and double-door laminoplasties in patients with cervical OPLL over a 10-year follow-up period.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A 10-year retrospective cohort analysis conducted at a single institution.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 109 patients with cervical OPLL, comprising 63 patients in the open-door laminoplasty group and 46 patients in the double-door laminoplasty group.</div></div><div><h3>OUTCOME MEASURES</h3><div>The clinical outcomes assessed in this study included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and recovery rates. Radiological outcomes evaluated were the C2-7 Cobb angle, range of motion (ROM), occupying ratio, and K-line type.</div></div><div><h3>METHODS</h3><div>For cervical myelopathy caused by OPLL, we performed OD and double-door DD laminopasties at a single institution. A total of 63 patients in the OD group and 46 patients in the DD group were evaluated for 10 years’ follow-up. The following criteria were evaluated: demographic information, range of operation, occupying ratio, K-line, type of OPLL, Cobb angle of C2-C7, and range of motion. Clinical outcomes were assessed using the VAS, JOA score and recovery rate.</div></div><div><h3>RESULTS</h3><div>Age, sex, symptom duration, and comorbidities were not significantly different between the groups. No significant differences in K-line type, canal occupying ratio were found. There were 6 patients in each group who underwent reoperation. Between the two groups, there was no difference in the change in the C2-7 cobb angle preoperative, immediate after surgery, and 2 years after surgery. However, at 10 years after surgery, the angle during extension decreased in the DD group, and the ROM also decreased statistically significantly (12.61 vs 8.4, p=0.02; 18.87 vs 13.62, p=0.016). However, the ROM decreased in both groups from before surgery to the last follow-up, with no significant difference (-14.43 vs -18.07, p=0.221). The VAS scores for neck and arm were significantly lower in the DD group immediately after surgery (p=0.044, 0.022), but no difference was observed between the groups 10 years post-surgery. JOA scores showed a similar improvement 10 years postoperatively.</div></div><div><h3>CONCLUSIONS</h3><div>Both laminoplasty methods are effective for treating cervical OPLL over a 10-year period. However, the ROM decreased significant","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100721"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672448","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 : 2025-07-01DOI: 10.1016/j.xnsj.2025.100626
Shao Lun Chen MD
<div><h3>BACKGROUND CONTEXT</h3><div>Intramedullary spinal cord abscess (ISCA) and intraventricular empyema are both rare, severe infections that can result in significant neurological impairment or death if not managed promptly. Although each condition alone poses diagnostic and therapeutic challenges, the simultaneous occurrence of ISCA and intraventricular empyema is exceedingly uncommon. Recognizing these pathologies early and initiating aggressive treatment is essential to prevent irreversible CNS damage.</div></div><div><h3>PURPOSE</h3><div>To present a rare case of concurrent cervical intramedullary spinal cord abscess and intraventricular empyema, highlighting the diagnostic difficulties, the necessity of early surgical intervention, and the importance of comprehensive antibiotic coverage in managing complex central nervous system infections.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a single-patient case report treated at a tertiary neurosurgical center, coupled with a review of the pertinent literature to contextualize the rarity and management of such concurrent CNS infections.</div></div><div><h3>PATIENT SAMPLE</h3><div>A 43-year-old female patient, with a history of cervical spine surgery (for ossification of the posterior longitudinal ligament), presented with a two-week history of fever, acute left upper limb weakness, numbness, and neck pain.</div></div><div><h3>OUTCOME MEASURES</h3><div>Key measures included neurological status (motor strength, level of consciousness), radiological evolution of the spinal and intraventricular infections (MRI findings), and response to antimicrobial therapy and surgical interventions (abscess drainage, external ventricular drainage, and shunt placement).</div></div><div><h3>METHODS</h3><div>An urgent surgical decompression and drainage of the intramedullary abscess at the C3–4 level was performed via a posterior approach. Antibiotics were initially broad-spectrum, then tailored to culture results identifying oral flora (Prevotella species and Fusobacterium nucleatum). When the patient’s mental status worsened, follow-up brain imaging revealed intraventricular empyema, requiring external ventricular drainage. After infection control was achieved, ventriculoperitoneal shunts were placed to address persistent hydrocephalus.</div></div><div><h3>RESULTS</h3><div>Despite initial deterioration in motor strength post-surgery, the patient demonstrated gradual neurological improvement with appropriate antibiotic therapy and serial interventions for both the spinal cord abscess and the intraventricular empyema. Final discharge status showed partial but meaningful recovery of left-sided strength, normal alertness, and resolution of severe headaches attributed to hydrocephalus.</div></div><div><h3>CONCLUSIONS</h3><div>Concurrent spinal cord abscess and intraventricular empyema demand high clinical suspicion and a coordinated, multidisciplinary approach. Early recognition, comprehensive antibiot
{"title":"P2. Concurrent intramedullary cervical spine abscess and intraventricular empyema","authors":"Shao Lun Chen MD","doi":"10.1016/j.xnsj.2025.100626","DOIUrl":"10.1016/j.xnsj.2025.100626","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Intramedullary spinal cord abscess (ISCA) and intraventricular empyema are both rare, severe infections that can result in significant neurological impairment or death if not managed promptly. Although each condition alone poses diagnostic and therapeutic challenges, the simultaneous occurrence of ISCA and intraventricular empyema is exceedingly uncommon. Recognizing these pathologies early and initiating aggressive treatment is essential to prevent irreversible CNS damage.</div></div><div><h3>PURPOSE</h3><div>To present a rare case of concurrent cervical intramedullary spinal cord abscess and intraventricular empyema, highlighting the diagnostic difficulties, the necessity of early surgical intervention, and the importance of comprehensive antibiotic coverage in managing complex central nervous system infections.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is a single-patient case report treated at a tertiary neurosurgical center, coupled with a review of the pertinent literature to contextualize the rarity and management of such concurrent CNS infections.</div></div><div><h3>PATIENT SAMPLE</h3><div>A 43-year-old female patient, with a history of cervical spine surgery (for ossification of the posterior longitudinal ligament), presented with a two-week history of fever, acute left upper limb weakness, numbness, and neck pain.</div></div><div><h3>OUTCOME MEASURES</h3><div>Key measures included neurological status (motor strength, level of consciousness), radiological evolution of the spinal and intraventricular infections (MRI findings), and response to antimicrobial therapy and surgical interventions (abscess drainage, external ventricular drainage, and shunt placement).</div></div><div><h3>METHODS</h3><div>An urgent surgical decompression and drainage of the intramedullary abscess at the C3–4 level was performed via a posterior approach. Antibiotics were initially broad-spectrum, then tailored to culture results identifying oral flora (Prevotella species and Fusobacterium nucleatum). When the patient’s mental status worsened, follow-up brain imaging revealed intraventricular empyema, requiring external ventricular drainage. After infection control was achieved, ventriculoperitoneal shunts were placed to address persistent hydrocephalus.</div></div><div><h3>RESULTS</h3><div>Despite initial deterioration in motor strength post-surgery, the patient demonstrated gradual neurological improvement with appropriate antibiotic therapy and serial interventions for both the spinal cord abscess and the intraventricular empyema. Final discharge status showed partial but meaningful recovery of left-sided strength, normal alertness, and resolution of severe headaches attributed to hydrocephalus.</div></div><div><h3>CONCLUSIONS</h3><div>Concurrent spinal cord abscess and intraventricular empyema demand high clinical suspicion and a coordinated, multidisciplinary approach. Early recognition, comprehensive antibiot","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100626"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672512","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 : 2025-07-01DOI: 10.1016/j.xnsj.2025.100631
Katrina Ysabel Naraval MD , Mikhail Lew Perez Ver MD
<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar spinal fusion relieves pain in degenerative spondylolisthesis (DLS) but carries postoperative risks, including pseudoarthrosis and adjacent segment degeneration and disease, which may eventually lead to reoperation. Dynamic stabilizers, like Coflex® interlaminar device, preserve motion while ensuring stability, providing symptom relief with fewer complications and a reduced risk profile. Though research varies, recent studies highlight their benefits in low-grade DLS.</div></div><div><h3>PURPOSE</h3><div>This study evaluated the radiologic and clinical effectiveness of Coflex® after decompression for low-grade DLS, with follow-ups at 1 to up to 6 years to assess outcomes and complications.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is an analytical retrospective cohort study from a single tertiary center including patients who had low-grade spondylolisthesis (Meyerding Gr I) and was treated with lumbar decompression with consequent interlaminar device (Coflex®) application performed by two fellowship-trained spine surgeons between January 1, 2017 and June 31, 2023. Ethical clearance was obtained (SL-23278).</div></div><div><h3>PATIENT SAMPLE</h3><div>Forty-seven patients who had low-grade spondylolisthesis (Meyerding Gr I) and treated with lumbar decompression with consequent interlaminar device (Coflex®) application were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>Radiographic parameters – lumbar lordosis (LL), lower lumbar lordosis (LLL), intervertebral disc height (IDH), intervertebral foramen height (IFH), and vertebral translation (VT) – were obtained. Clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability Index (ODI).</div></div><div><h3>METHODS</h3><div>Primary outcomes were categorized as radiographic and clinical. Radiographic parameters and functional outcomes included were assessed preoperatively, postoperatively, at 1-year follow-up, and at =1-year follow-up. Descriptive statistics (mean, range, SD, frequency, percentage) were calculated. A paired Student*s t-test assessed differences in radiographic parameters and clinical outcomes. Comparisons were made across preoperative, immediate postoperative, 12-month follow-up, and latest follow-up (=1 year). Linear mixed model analysis with compound symmetry evaluated significant changes over time. Statistical significance was set at p< 0.05.</div></div><div><h3>RESULTS</h3><div>A total of 47 patients (mean age 57 years, range 30-92) with 50 implanted levels were included in the study. Following surgical decompression and interlaminar device placement, LL showed a slight but non-significant decrease [42.89° ± 10.08 to 40.33° ± 8.30 (p = 0.059)] and remained stable, while LLL remained unchanged. VT improved significantly from 3.82 mm ± 3.66 mm to 1.53 mm ± 1.84 mm (p < 0.001) and remained stable until the final follow-up (p = 0.922). IDH increased significantly from 10.23 mm ± 2.33 to 12
{"title":"P7. Clinical and radiologic outcomes of the use of interlaminar device (Coflex®) among patients with low-grade lumbar spondylolisthesis: a single center study","authors":"Katrina Ysabel Naraval MD , Mikhail Lew Perez Ver MD","doi":"10.1016/j.xnsj.2025.100631","DOIUrl":"10.1016/j.xnsj.2025.100631","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar spinal fusion relieves pain in degenerative spondylolisthesis (DLS) but carries postoperative risks, including pseudoarthrosis and adjacent segment degeneration and disease, which may eventually lead to reoperation. Dynamic stabilizers, like Coflex® interlaminar device, preserve motion while ensuring stability, providing symptom relief with fewer complications and a reduced risk profile. Though research varies, recent studies highlight their benefits in low-grade DLS.</div></div><div><h3>PURPOSE</h3><div>This study evaluated the radiologic and clinical effectiveness of Coflex® after decompression for low-grade DLS, with follow-ups at 1 to up to 6 years to assess outcomes and complications.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>This is an analytical retrospective cohort study from a single tertiary center including patients who had low-grade spondylolisthesis (Meyerding Gr I) and was treated with lumbar decompression with consequent interlaminar device (Coflex®) application performed by two fellowship-trained spine surgeons between January 1, 2017 and June 31, 2023. Ethical clearance was obtained (SL-23278).</div></div><div><h3>PATIENT SAMPLE</h3><div>Forty-seven patients who had low-grade spondylolisthesis (Meyerding Gr I) and treated with lumbar decompression with consequent interlaminar device (Coflex®) application were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>Radiographic parameters – lumbar lordosis (LL), lower lumbar lordosis (LLL), intervertebral disc height (IDH), intervertebral foramen height (IFH), and vertebral translation (VT) – were obtained. Clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability Index (ODI).</div></div><div><h3>METHODS</h3><div>Primary outcomes were categorized as radiographic and clinical. Radiographic parameters and functional outcomes included were assessed preoperatively, postoperatively, at 1-year follow-up, and at =1-year follow-up. Descriptive statistics (mean, range, SD, frequency, percentage) were calculated. A paired Student*s t-test assessed differences in radiographic parameters and clinical outcomes. Comparisons were made across preoperative, immediate postoperative, 12-month follow-up, and latest follow-up (=1 year). Linear mixed model analysis with compound symmetry evaluated significant changes over time. Statistical significance was set at p< 0.05.</div></div><div><h3>RESULTS</h3><div>A total of 47 patients (mean age 57 years, range 30-92) with 50 implanted levels were included in the study. Following surgical decompression and interlaminar device placement, LL showed a slight but non-significant decrease [42.89° ± 10.08 to 40.33° ± 8.30 (p = 0.059)] and remained stable, while LLL remained unchanged. VT improved significantly from 3.82 mm ± 3.66 mm to 1.53 mm ± 1.84 mm (p < 0.001) and remained stable until the final follow-up (p = 0.922). IDH increased significantly from 10.23 mm ± 2.33 to 12","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100631"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672553","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 : 2025-07-01DOI: 10.1016/j.xnsj.2025.100707
Taha Khalilullah BS, Ripul R. Panchal DO, FACS
<div><h3>BACKGROUND CONTEXT</h3><div>Degenerative spondylolisthesis at the L4-5 level is a prevalent spinal condition often requiring surgery. Chronic low back pain has been strongly associated with paraspinal muscle deterioration, including multifidus atrophy, and poorer muscle health has been linked to decreased quality of life. However, the connection between muscle degeneration and lumbar spine instability remains unclear, with contributing factors likely including age, altered biomechanics, and activity levels. Degenerative spondylolisthesis at L4-5 often requires surgery and is linked to paraspinal muscle atrophy and reduced quality of life. However, the impact of instability and alignment changes on muscle health remains unclear, particularly in severe cases. This study aims to address these gaps by investigating muscle health using advanced metrics to better understand its relationship with spondylolisthesis.</div></div><div><h3>PURPOSE</h3><div>This study aims to investigate the association between dynamic instability and muscle health changes in patients with Grade 1 L4-5 degenerative spondylolisthesis and operative spinal stenosis, enhancing our understanding of the pathophysiology of spondylolisthesis.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Single-center retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study cohort consisted of patients diagnosed with L4-5 spinal stenosis who underwent surgical intervention at the L4-5 level. The cohort was further stratified into two groups: those with L4-5 grade 1 spondylolisthesis and those without spondylolisthesis.</div></div><div><h3>OUTCOME MEASURES</h3><div>Difference in lumbar lordosis, L4-5 Cobb angle, anterior disc height, posterior disc height between flexion and extension, Goutallier classification, lumbar indentation value, BMI, and L4-5 paraspinal and psoas cross sectional area.</div></div><div><h3>METHODS</h3><div>Descriptive statistics were employed to determine L4-5 grade 1 spondylolisthesis, L4-5 spinal stenosis, and surgery involving the L4-5 intervertebral level. Patients were subdivided based on the presence of spondylolisthesis. Cross-sectional area normalized by body mass index (CSA/BMI) was quantified using ImageJ software. Measurement of lumbar lordosis, Cobb angle, and lumbar indentation value were recorded by radiographs. Statistical analysis was conducted using independent Student's t-test and bivariate analysis to compare the groups.</div></div><div><h3>RESULTS</h3><div>There were 101 patients included in our analysis. Fifty-two patients had Grade 1 degenerative spondylolisthesis. The spondylolisthesis group presented with significantly greater L4-5 lordosis in extension compared to the group without spondylolisthesis (23.69 ± 10.62 vs 20.22 ± 7.92, p = .044). However, the spondylolisthesis group also presented with significantly worse anterolisthesis in flexion (7.21 ± 3.66 vs 10.14 ± 23.53, p = .0002). There was no significant diffe
背景：L4-5节段退行性椎体滑脱是一种常见的脊柱疾病，通常需要手术治疗。慢性腰痛与脊柱旁肌肉退化密切相关，包括多裂肌萎缩，而肌肉健康状况较差与生活质量下降有关。然而，肌肉退变与腰椎不稳定之间的关系尚不清楚，可能的影响因素包括年龄、生物力学改变和活动水平。L4-5退行性椎体滑脱通常需要手术，并与棘旁肌萎缩和生活质量下降有关。然而，不稳定和排列变化对肌肉健康的影响尚不清楚，特别是在严重的情况下。本研究旨在通过使用先进的指标来研究肌肉健康，以更好地了解其与脊柱滑脱的关系，从而解决这些差距。目的本研究旨在探讨L4-5级退行性椎体滑脱伴椎管狭窄患者的动力不稳定性与肌肉健康变化的关系，提高我们对椎体滑脱病理生理的认识。研究设计/设置：单中心回顾性队列研究。患者样本：研究队列包括诊断为L4-5椎管狭窄并在L4-5水平行手术干预的患者。该队列进一步分为两组：L4-5级脊柱滑脱组和无脊柱滑脱组。结果测量：腰椎前凸、L4-5 Cobb角、前盘高度、后盘屈伸高度、Goutallier分类、腰椎压痕值、BMI、L4-5棘旁和腰肌横截面积的差异。方法采用描述性统计方法对L4-5级1级椎体滑脱、L4-5级椎管狭窄以及涉及L4-5椎间节段的手术进行统计。根据有无脊柱滑脱对患者进行细分。采用ImageJ软件对体重指数归一化横截面积（CSA/BMI）进行量化。通过x线片测量腰椎前凸、Cobb角和腰椎压痕值。统计学分析采用独立的Student’st检验和双变量分析进行组间比较。结果101例患者纳入我们的分析。52例患者为1级退行性椎体滑脱。与无滑脱组相比，滑脱组L4-5前凸明显增大（23.69±10.62 vs 20.22±7.92,p = .044）。然而，脊柱滑脱组屈曲前滑脱也明显更差（7.21±3.66 vs 10.14±23.53,p = .0002）。两组患者前凸和L4-5节段屈伸角度的绝对差异无统计学意义。通过双变量分析，结果显示腰肌CSA/BMI与腰椎前凸差异呈显著负相关（p = ）。0038, r = - 0.578)、Goutallier评分、前凸度和L4-5 Cobb角（p = ）。00017, r = .798)。在非脊柱滑脱组中，类似的结果并不显著。结论本研究强调了L4-5退行性椎体滑脱和椎管狭窄患者的动力不稳定性与肌肉健康之间的重要联系。腰椎滑脱患者在伸展时表现出更大的L4-5前凸，在屈曲时表现出更严重的前滑脱，腰肌健康状况与不稳定性指标呈负相关。这些发现表明，肌肉退化可能有助于脊柱滑脱的病理生理，需要进一步的研究来指导靶向治疗。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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Pub Date : 2025-07-01DOI: 10.1016/j.xnsj.2025.100728
Shrey Binyala MS, DNB
<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar spondylolisthesis often results in pelvic imbalance, contributing to chronic pain and disability. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has emerged as an effective surgical option, offering stabilization and correction of spinal alignment with reduced tissue disruption.</div></div><div><h3>PURPOSE</h3><div>This retrospective study evaluates postoperative improvements in pelvic indices, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), in patients with lumbar spondylolisthesis treated with MIS-TLIF.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>The study design is retrospective. It involves reviewing and analyzing the medical records and radiographic data of patients who underwent MIS-TLIF for lumbar spondylolisthesis between 2018 and 2024. The study examines preoperative and postoperative changes in pelvic indices and their correlation with clinical outcomes.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 354 patients were included in this retrospective study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Pelvic Indices: PI, PT, SS, LL. Preoperative and postoperative changes in these parameters were assessed through radiographic imaging. Clinical Outcomes: pain levels, assessed using a visual analog scale (VAS) preoperatively and postoperatively. Functional improvements, measured using the Oswestry Disability Index (ODI) or a similar functional assessment tool. Sagittal Alignment: improvement in overall spinal sagittal balance, evaluated through radiographic measurements and clinical examination. Correlation between radiographic and clinical outcomes: The relationship between improvements in pelvic indices and clinical improvements in pain and function was analyzed. Complications: any intraoperative or postoperative complications, such as infection or hardware failure, were documented.</div></div><div><h3>METHODS</h3><div>This is a retrospective study involving patients who underwent MIS-TLIF for lumbar spondylolisthesis between 2018 and 2024. The following steps were involved: Patient Selection: inclusion criteria: patients diagnosed with lumbar spondylolisthesis who underwent MIS-TLIF surgery. Exclusion criteria: patients with incomplete clinical or radiographic data or those who had additional spine surgeries outside the MIS-TLIF approach. Radiographic Analysis: Preoperative and postoperative radiographs (x-rays or CT scans) were reviewed to measure key pelvic parameters, including: PI, PT, SS, LL. Changes in these pelvic indices were analyzed to evaluate improvements in sagittal alignment. Clinical Outcome Assessment: Pain Assessment: pain levels were measured using the VAS preoperatively and at follow-up intervals. Functional Outcome: Functional improvements were assessed using the ODI or other relevant clinical scoring tools. Follow-up: Patients were followed up at regular intervals (eg, 1, 3, and 6 months; 1,
{"title":"34. Postoperative changes in pelvic indices after MIS-TLIF for lumbar spondylolisthesis: retrospective analysis","authors":"Shrey Binyala MS, DNB","doi":"10.1016/j.xnsj.2025.100728","DOIUrl":"10.1016/j.xnsj.2025.100728","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar spondylolisthesis often results in pelvic imbalance, contributing to chronic pain and disability. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has emerged as an effective surgical option, offering stabilization and correction of spinal alignment with reduced tissue disruption.</div></div><div><h3>PURPOSE</h3><div>This retrospective study evaluates postoperative improvements in pelvic indices, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), in patients with lumbar spondylolisthesis treated with MIS-TLIF.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>The study design is retrospective. It involves reviewing and analyzing the medical records and radiographic data of patients who underwent MIS-TLIF for lumbar spondylolisthesis between 2018 and 2024. The study examines preoperative and postoperative changes in pelvic indices and their correlation with clinical outcomes.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 354 patients were included in this retrospective study.</div></div><div><h3>OUTCOME MEASURES</h3><div>Pelvic Indices: PI, PT, SS, LL. Preoperative and postoperative changes in these parameters were assessed through radiographic imaging. Clinical Outcomes: pain levels, assessed using a visual analog scale (VAS) preoperatively and postoperatively. Functional improvements, measured using the Oswestry Disability Index (ODI) or a similar functional assessment tool. Sagittal Alignment: improvement in overall spinal sagittal balance, evaluated through radiographic measurements and clinical examination. Correlation between radiographic and clinical outcomes: The relationship between improvements in pelvic indices and clinical improvements in pain and function was analyzed. Complications: any intraoperative or postoperative complications, such as infection or hardware failure, were documented.</div></div><div><h3>METHODS</h3><div>This is a retrospective study involving patients who underwent MIS-TLIF for lumbar spondylolisthesis between 2018 and 2024. The following steps were involved: Patient Selection: inclusion criteria: patients diagnosed with lumbar spondylolisthesis who underwent MIS-TLIF surgery. Exclusion criteria: patients with incomplete clinical or radiographic data or those who had additional spine surgeries outside the MIS-TLIF approach. Radiographic Analysis: Preoperative and postoperative radiographs (x-rays or CT scans) were reviewed to measure key pelvic parameters, including: PI, PT, SS, LL. Changes in these pelvic indices were analyzed to evaluate improvements in sagittal alignment. Clinical Outcome Assessment: Pain Assessment: pain levels were measured using the VAS preoperatively and at follow-up intervals. Functional Outcome: Functional improvements were assessed using the ODI or other relevant clinical scoring tools. Follow-up: Patients were followed up at regular intervals (eg, 1, 3, and 6 months; 1,","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"22 ","pages":"Article 100728"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672411","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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