Spine Journal最新文献

{"title":"Patient acceptance of reoperation risk for lumbar decompression versus fusion","authors":"Alexa K. Pius MD , Yemisi D. Joseph BS , Danielle M. Mullis BS , Susmita Chatterjee MS , Jyotsna Koduri MD , Josh Levin MD , Todd F. Alamin MD","doi":"10.1016/j.spinee.2024.09.003","DOIUrl":"10.1016/j.spinee.2024.09.003","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbar decompression and lumbar fusion are effective methods of treating spinal compressive pathologies refractory to conservative management. These surgeries are typically used to treat different spinal problems, but there is a growing body of literature investigating the outcomes of either approach for patients with lumbar degenerative spondylolisthesis and stenosis. Different operations are associated with different risks and different potential needs for reoperation. Patient acceptance of reoperation rates after spinal surgery is currently not well understood.</div></div><div><h3>PURPOSE</h3><div>The purpose of this study is to identify patient tolerance for reoperation rates following lumbar decompression and lumbar fusion surgery.</div></div><div><h3>DESIGN</h3><div>A qualitative and quantitative survey intended to capture information on patient preferences was administered.</div></div><div><h3>PATIENT SAMPLE</h3><div>Written informed consent was obtained from patients presenting to 2 spinal clinics.</div></div><div><h3>OUTCOME MEASURES</h3><div>Patients were asked their threshold tolerance for reoperation rates in the context of choosing a smaller (decompression) versus larger (fusion) spinal surgery.</div></div><div><h3>METHODS</h3><div>A survey was administered to patients at 2 spinal clinics—1 surgical and 1 nonsurgical. A consecutive series of new patients over multiple clinic days who agreed to participate in the study and filled out the survey are reported on here. Patients were asked to assess, contemplating a problem that could either be treated with lumbar decompression or lumbar fusion, the level at which 1) the likelihood that needing a repeat surgery within 3 to 5 years would change their mind about choosing the decompression operation and cause them to choose the fusion operation and then 2) the likelihood of needing a repeat surgery within 3 to 5 years that would be acceptable to them after the fusion operation. The distribution of patient responses was assessed with histograms and descriptive statistics.</div></div><div><h3>RESULTS</h3><div>Ninety patients were surveyed, and of these, 73 patients (81.1%) returned fully completed questionnaires. The median reoperation acceptance rates after a decompression was <60%, while the median acceptable revision rate when contemplating the fusion surgery was 10%.</div></div><div><h3>CONCLUSIONS</h3><div>Patient acceptance for the potential need for revision surgery is higher when considering a decompression compared to a fusion operation. Reoperation risk rates along with the magnitude of the surgical intervention are important considerations in determining patients’ surgical preferences. Understanding patient preferences and risk tolerances can aid clinicians in shared decision-making, potentially improving patient satisfaction and outcomes in the several lumbar pathologies which can be ameliorated with either decompression or fusion.</div></div","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 227-236"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of anterior cervical dynamic implants: motion-sparing or a delayed fusion?","authors":"Yukai Huang MD , Dingyu Du MD , Jie Tian MD , Dean Chou MD , Longyi Chen MD , Hailong Feng MD , Jinping Liu MD","doi":"10.1016/j.spinee.2024.09.006","DOIUrl":"10.1016/j.spinee.2024.09.006","url":null,"abstract":"<div><h3>Background Context</h3><div>Use of an anterior cervical dynamic implant (ACDI) is generally considered a nonfusion technique for treating cervical degenerative disorders. However, there is limited research focused on evaluating the long-term clinical and radiographic outcomes of ACDI.</div></div><div><h3>Purpose</h3><div>To analyze the long-term clinical and radiographic outcomes of ACDI in the treatment of degenerative cervical disorders.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Patients Sample</h3><div>Patients with degenerative cervical disorders who underwent anterior cervical discectomy and dynamic cervical implant (DCI) implantation between May 2012 and August 2020 at our institution were included in this study.</div></div><div><h3>Outcome Measures</h3><div>Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) scores and patient reported satisfaction rate. Imaging assessment parameters included intervertebral height (IH), intervertebral disc height (IDH), C2-7 range of motion (ROM), segmental ROM, the degree of DCI subsidence and anterior migration, heterotopic ossification (HO) as well as adjacent segment degeneration (ASD).</div></div><div><h3>Methods</h3><div>JOA and VAS scores were obtained through questionnaire. The patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied at the final follow-up. The position of the implants, IDH and IH were evaluated on lateral radiographs. ROM at C2-7, ROM at operated level were measured on dynamic radiographs. Cervical 3-dimensional computer tomography (CT) and magnetic resonance image (MRI) images were used to assess the presence of HO and ASD. The clinical and radiologic variables between the preoperative period and different follow-up time point were statistically analyzed by unpaired <em>t</em>-tests or chi-square tests. Statistical significance was defined as p<.05.</div></div><div><h3>Results</h3><div>A total of 92 patients (51 males and 41 females) were included in this study. Among them, there were 36 cases of cervical spondylotic myelopathy, 26 cases of cervical radiculopathy, and 30 cases of myeloradiculopathy. The mean age was 55.1±12.6 years. The number of operated levels was single level in 57 patients, 2 levels in 31 patients, and 3 levels in 4 patients. The average follow-up period was 81.3 months (range: 35-135 months). The mean JOA scores showed a gradual increase at 1 month, 1 year, and the final follow-up (12.0±0.7,13.5±0.8, and14.4±1.1 respectively) compared to the preoperative score (9.1±0.9, p<.01). VAS scores significantly decreased at 1 month, 1 year, and the final follow-up (4.1±0.7, 2.3±0.9, and 2.0±0.8 respectively) compared to the preoperative score (7.2±l .2, p<.01). At the final follow-up, the patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied (79","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 244-254"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postoperative mechanical complications with the ethnicity-adjusted global alignment and proportion score in degenerative scoliosis: does paraspinal muscle degeneration matter?","authors":"Peiyu Li PhD , Jie Li PhD , Abdukahar Kiram PhD , Zhen Tian PhD , Xing Sun PhD , Xiaodong Qin PhD , Benlong Shi PhD , Yong Qiu PhD , Zhen Liu MD , Zezhang Zhu MD","doi":"10.1016/j.spinee.2024.09.029","DOIUrl":"10.1016/j.spinee.2024.09.029","url":null,"abstract":"<div><h3>Background</h3><div>The global alignment and proportion (GAP) score was developed to predict mechanical complications (MCs) after adult spinal deformity surgery but showed limited sensitivity in the Asian population. Considering variations in sagittal parameters among different ethnic groups, our team developed the ethnicity-adjusted GAP score according to the spinopelvic parameters of 566 asymptomatic Chinese volunteers (C-GAP score). Notably, degenerative scoliosis (DS) patients with MCs following corrective surgery have more severe paraspinal muscle degeneration. For DS patients with various sagittal alignments, the unevenly distributed degeneration of paraspinal muscle may exert different influences on MC occurrence and largely affect the accuracy of the C-GAP score in clinical assessment. Therefore, incorporating paraspinal muscle degeneration indices within the C-GAP score may improve its accuracy in predicting MC occurrence.</div></div><div><h3>Purpose</h3><div>We aimed to clarify the influence of paraspinal muscle degeneration on the C-GAP score predicting MC occurrence following DS surgery and modify the C-GAP score with paraspinal muscle degeneration parameters.</div></div><div><h3>Study Design</h3><div>A retrospective case-control study.</div></div><div><h3>Sample Size</h3><div>A total of 107 adult degenerative scoliosis patients.</div></div><div><h3>Outcome Measures</h3><div>Demographic information, postoperative sagittal spinopelvic parameters, the GAP score, the C-GAP score, and paraspinal muscle degeneration parameters.</div></div><div><h3>Methods</h3><div>A total of 107 DS patients undergoing posterior spinal fusion surgery (≥4 vertebrae) with a minimum of 2 years follow-up (or experiencing MCs within 2 years) were retrospectively reviewed. Their C-GAP score was calculated based on our previous study and patients were divided into 3 C-GAP categories, “proportioned” (P), “moderately disproportioned” (MD), and “severely disproportioned” (SD). Relative cross-sectional area (cross-sectional area of muscle–disc ratio×100, rCSA) and fat infiltration rate, FI% at L1/2, L2/3, L3/4, and L4/5 discs were quantitatively evaluated using magnetic resonance imaging (MRI). In each C-GAP category, patients were additionally divided into the MC group and the non-MC group to analyze their paraspinal muscle degeneration. A multivariable logistic regression model consisting of the CSA-weighted average FI% (total FI%) and the C-GAP score, C-GAPM was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was used to evaluate the predictability of the GAP score, the C-GAP score, FI%, and C-GAPM. This project was supported by the National Natural Science Foundation of China (No.82272545) and Special Fund of Science and Technology Plan of Jiangsu Province (No.BE2023658).</div></div><div><h3>Results</h3><div>For all 107 patients, FI% at L1/2, L2/3, L3/4, and L4/5 discs and the total FI% of the MC group (n=","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 347-358"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who gets better after surgery for degenerative cervical myelopathy? A responder analysis from the multicenter Canadian Spine Outcomes and Research Network","authors":"Husain Shakil MD, MSc , Nicolas Dea MD, MSc , Armaan K. Malhotra MD , Ahmad Essa MD, MPH , W. Bradley Jacobs MD , David W. Cadotte MD, PhD , Jérôme Paquet MD, PhD , Michael H. Weber MD, MSc, PhD , Philippe Phan MD, PhD , Christopher S. Bailey MD, MSc , Sean D. Christie MD , Najmedden Attabib MD, MBBCH , Neil Manson MD , Jay Toor MD, MBA , Andrew Nataraj MD , Hamilton Hall MD , Greg McIntosh MSc , Charles G. Fisher MD, MHSC , Y. Raja Rampersaud MD , Nathan Evaniew MD, PhD , Jefferson R. Wilson MD, PhD","doi":"10.1016/j.spinee.2024.09.033","DOIUrl":"10.1016/j.spinee.2024.09.033","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Degenerative cervical myelopathy (DCM) is the most common cause of acquired nontraumatic spinal cord injury worldwide. Surgery is a common treatment for DCM; however, outcomes often vary across patients.</div></div><div><h3>PURPOSE</h3><div>To inform preoperative education and counseling, we performed a responder analysis to identify factors associated with treatment response.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>An observational cohort study was conducted utilizing prospectively collected data from the Canadian Spine Outcomes Research Network (CSORN) registry collected between 2015–2022.</div></div><div><h3>PATIENT SAMPLE</h3><div>We included all surgically treated DCM patients with complete 12-month follow-up and patient-reported outcomes (PROs) available at 1-year.</div></div><div><h3>OUTCOME MEASURES</h3><div>Treatment response was measured using the minimal clinically important difference (MCID) in PROs including the Neck Disability Index (NDI) and EuroQol-5D (EQ-5D) at 12 months postsurgery.</div></div><div><h3>METHODS</h3><div>A Least Absolute Shrinkage and Selection Operator (LASSO) machine learning model was used to identify significant associations between 14 preoperative patient factors and likelihood of treatment response measured by achievement of the MCID in NDI, and EQ-5D. Variable importance was measured using standardized coefficients. To test robustness of findings we trained a separate XGBOOST model, with variable importance measured using SHAP values.</div></div><div><h3>RESULTS</h3><div>Among the 554 DCM patients included, 229 (41.3%) and 330 (59.6%) patients responded to treatment by meeting or surpassing MCID thresholds for NDI and EQ-5D at 1-year, respectively. LASSO regression for likelihood of treatment response measured through NDI found the variable importance rank order to be baseline NDI (OR 1.06 per 1 point increase; 95% CI 1.04–1.07), then symptom duration (OR 0.65; 95% CI 0.44–0.97). For EQ-5D, the variable importance rank order was baseline EQ-5D (OR 0.16 per 0.1-point increase; 95% CI 0.03–0.78), living independently (OR 2.17; 95% CI 1.22–3.85), symptom duration (OR 0.62; 95% CI 0.40–0.97), then number of levels affected (OR 0.80 per additional level; 95% CI 0.67–0.96). A separate XGBoost model of treatment response measured through NDI, corroborated findings that patients with higher baseline NDI, and shorter symptom duration were more likely to respond to treatment, and additionally found older patients, and those with kyphosis on baseline upright X-ray were less likely to respond. Similarly, an XGBoost model for treatment response measured through EQ-5D corroborated findings that patients with higher baseline EQ-5D, shorter symptom duration, living independently, with fewer affected levels were more likely to respond to treatment, and additionally found older patients were less likely to respond.</div></div><div><h3>CONCLUSIONS</h3><div>Our findings suggest pa","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 276-289"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expandable interbody cages for lumbar spinal fusion: a systematic review.","authors":"Daniel Orr, Ron Anderson, Anna Jensen, Tyler Peterson, John Edwards, Anton E Bowden","doi":"10.1016/j.spinee.2025.01.013","DOIUrl":"10.1016/j.spinee.2025.01.013","url":null,"abstract":"<p><strong>Background context: </strong>Since the early 2000s, various expandable spinal fusion cages have been developed to facilitate less invasive procedures, however, expandable cages have often been evaluated as a homogeneous group, neglecting differences in shape, size, material, expandability and lordotic adjustability. This systematic review aimed to comprehensively survey the literature on expandable spinal fusion cages, discuss their differentiating factors, and identify gaps in the literature regarding these devices.</p><p><strong>Purpose: </strong>To demonstrate the range of design features included in expandable interbody devices and identify which of these features are associated with improved surgical outcomes.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic search of MEDLINE and Embase using the search terms \"lumbar\" AND \"fusion\" AND (\"expandable cage\" OR \"expandable interbody\") including only English language articles that contained sufficient detail to correlate a specific expandable cage design to patient outcomes. Relevant elements, including device design parameters, patient population information, details of the intervention, comparison data, outcome variables, and the timeframe were extracted. Statistical analysis was conducted to correlate patient outcomes with different device features.</p><p><strong>Results: </strong>While 387 different articles were initially identified, 49 met all the criteria for inclusion. Design differences contributed to disparate outcomes, with rectangular titanium cages featuring medial-lateral and vertical expansion and continuous lordotic adjustability being correlated with significantly improved patient-reported outcomes. The surgical approach and location were also found to be correlated with patient outcomes, indicating that confounding factors are present.</p><p><strong>Conclusions: </strong>We recommend that expandable cage technologies not be considered a homogenous group, as long-term outcomes likely are dependent upon specific design characteristics. Categorizing devices based on design features such as material composition, shape, vertical expandability, horizontal expandability, and restoration of segmental lordosis may allow for more rapid identification of device characteristics associated with better outcomes.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of medially and laterally malpositioned screws: a biomechanical study on cadavers","authors":"Christos Tsagkaris MD, MPA ,&nbsp;Marie-Rosa Fasser PhD ,&nbsp;Mazda Farshad MD, MPH ,&nbsp;Caroline Passaplan MD ,&nbsp;Frederic Cornaz MD, MSc ,&nbsp;Jonas Widmer PhD ,&nbsp;José Miguel Spirig MD","doi":"10.1016/j.spinee.2024.09.008","DOIUrl":"10.1016/j.spinee.2024.09.008","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Pedicle screw instrumentation is widely used in spine surgery. Axial screw misplacement is a common complication. In addition to the recognized neurovascular risks associated with screw misplacement, the biomechanical stability of misplaced screws remains a subject of debate.</div></div><div><h3>PURPOSE</h3><div>The present study investigates whether screw misplacement in the lumbar spine reduces mechanical screw hold.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Cadaveric biomechanical study.</div></div><div><h3>METHODS</h3><div>Pedicle screw (mis)placement was planned for 12 fresh frozen cadaveric spines between the T12 and the L5 levels. The screws were then implanted into the vertebrae with the help of 3D-printed template guides. Pre- and postinstrumentation computed tomography (CT) scans were acquired for instrumentation planning and quantification of the misplacement. The instrumented vertebrae were potted into CT transparent boxes using Polymethyl methacrylate and mounted on a standardized biomechanical setup for pull-out (PO) testing with uniaxial tensile load.</div></div><div><h3>RESULTS</h3><div>The bone density of all the specimens as per HU was comparable. The predicted pull-out force (POF) for screws medially misplaced by 2 , 4, and 6 mm was respectively 985 N (SD 474), 968 N (SD 476) and 822 N (SD 478). For screws laterally misplaced by 2 , 4, and 6 mm the POF was respectively 605 N (SD 473), 411 N (SD 475), and 334 N (SD 477). Screws that did not perforate the pedicle (control) resisted pull-out forces of 837 N (SD 471).</div></div><div><h3>CONCLUSIONS</h3><div>Medial misplacement is associated with increased axial screw hold against static loads compared to correctly placed screws and laterally placed screws.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>In clinical settings, the reinsertion of medially misplaced screws should primarily aim to prevent neurological complications while the reinsertion of lateral misplaced screws should aim to prevent screw loosening.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 380-388"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bodily growth and the intervertebral disc: a longitudinal MRI study in healthy adolescents","authors":"Teija Lund MD, PhD ,&nbsp;Leena Ristolainen DSc ,&nbsp;Hannu Kautiainen PhD ,&nbsp;Martina Lohman MD, PhD ,&nbsp;Dietrich Schlenzka MD, PhD","doi":"10.1016/j.spinee.2024.09.013","DOIUrl":"10.1016/j.spinee.2024.09.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Low back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This study was a prospective longitudinal cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The morphology of the lumbar discs was evaluated on T2-weighted midsagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;In the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02–1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60–68.7) and 7.92 (1.19–52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12–2.04) and for BMI 1.05 (1.01–1.09).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;More relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 317-323"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term mechanical failure in well aligned adult spinal deformity patients","authors":"Sleiman Haddad MD, PhD ,&nbsp;Caglar Yilgor MD ,&nbsp;Eva Jacobs MD, PhD ,&nbsp;Lluis Vila MD ,&nbsp;Susana Nuñez-Pereira MD, PhD ,&nbsp;Manuel Ramirez Valencia MD ,&nbsp;Anika Pupak PhD ,&nbsp;Maggie Barcheni BS ,&nbsp;Javier Pizones MD, Phd ,&nbsp;Ahmet Alanay MD ,&nbsp;Frank Kleinstuck MD ,&nbsp;Ibrahim Obeid MD ,&nbsp;Ferran Pellisé MD, PhD ,&nbsp;European Spine Study Group","doi":"10.1016/j.spinee.2024.09.019","DOIUrl":"10.1016/j.spinee.2024.09.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Mechanical complications (MC) are frequently linked to suboptimal postoperative alignment and represent a primary driver of revision surgery in the context of adult spinal deformity (ASD). However, it's worth noting that even among those deemed \"well aligned,\" the risk of experiencing MCs persists, hinting at the potential influence of factors beyond alignment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;The aim was to assess the incidence of MCs among well-aligned patients and delving into the relevant risk factors and surgical outcomes that come into play within this specific subgroup.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;A retrospective analysis was conducted using data from a prospective multicenter database dedicated to ASD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The study focused on patients aged 55 years or older, who had a minimum follow-up period of 2 years, and exhibited a Global Alignment and Proportion (GAP) score of 2 points or less (excluding age) within 6 weeks of their index surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Mechanical complications such as rod fractures, pseudarthrosis, or junctional kyphosis or failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Patients who developed mechanical complications were identified. Comparative analyses were performed, encompassing both continuous and categorical variables. Furthermore, binary logistic regression tests were employed to pinpoint risk factors, and ROC curves were used to determine the optimal threshold values for these variables.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 83 patients met the inclusion criteria for this study, with a mean age of 66 years. On average, they had 10 instrumented levels, and 77% of them had fusion extending to the pelvis. Additionally, 27% of the patients had undergone 3-column osteotomies (3-CO). Among them, 33 patients (40%) experienced at least 1 MC during an average follow-up period of 4 years, which included 14 cases of proximal junctional kyphosis (PJK) and 20 cases of nonunion or rod breakage. 15 patients (18%) required revision surgery specifically for MC. In univariable analyses, patients who developed MC were characterized by higher body weight, poorer baseline general health (as indicated by worse SF-36 scores), and less favorable preoperative coronal and sagittal alignment. They also had longer hospital stays, a greater number of instrumented levels, and achieved less favorable postoperative coronal and sagittal alignment. Interestingly, factors such as 3-column osteotomies, postoperative bracing, and the addition of an anterior approach did not significantly alter the risk of MC in well-aligned ASD patients. Binary regression models revealed that independent risk factors for MC included the residual coronal lumbosacral curve, the number of instrumented levels, and relative spinopelvic alignment (RSA). ROC curves identified an optimal threshold of a residual lumbosacral curve of ≤4","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 337-346"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically","authors":"Shiming Xie MD ,&nbsp;Liqiang Cui MD ,&nbsp;Chenglong Wang MD ,&nbsp;Hongjun Liu MD ,&nbsp;Yu Ye MD ,&nbsp;Shuangquan Gong MD ,&nbsp;Jingchi Li PhD","doi":"10.1016/j.spinee.2024.09.021","DOIUrl":"10.1016/j.spinee.2024.09.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty in patients with osteoporotic vertebral compressive fracture (OVCF). Studies have demonstrated that intervertebral cement leakage (ICL) can increase the incidence of AVF, but others have reached opposite conclusions. The stress concentration initially increases the risk of AVF, and dispersive concentrated stress is the main biomechanical function of the intervertebral disc (IVD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study was designed to validate the hypothesis that direct contact between the leaked cement and adjacent bony endplate (BEP) can inhibit this biomechanical function, trigger adjacent vertebral stress concentration and increase the risk of AVF.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective study and corresponding numerical mechanical simulations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;Clinical data from 97 OVCF patients treated by bone cement augmentation operations were reviewed in this study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Clinical assessments involved measuring ICL and cement-BEP contact status in patients with and without AVF. Numerical simulations were conducted to compute stress values in adjacent vertebral body's BEP and cancellous bone under various body positions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;MATERIALS AND METHODS&lt;/h3&gt;&lt;div&gt;Radiographic and demographic data of 97 OVCF patients (with an average follow-up period of 11.5 months) treated using bone cement augmentation operation were reviewed in the present study. The patients were divided into 2 groups: those with AVF and those without AVF. Bone cement leakage status was judged via 2 different methods: with or without IVD cement leakage and with and without adjacent vertebral endplate contact. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. Patients without IVD cement leakage, with IVD cement leakage but without adjacent vertebral endplate cement contact, and with direct adjacent vertebral endplate cement contact were simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to the AVF were computed and recorded in these surgical models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Radiographic analysis revealed that the incidence of AVF was numerically higher, but was not significantly higher in patients with IVD cement leakage. In contrast, patients with direct adjacent vertebral endplate cement contact had a significantly greater incidence of AVF, which has also been proven to be an independent risk factor for AVF. In addition, numerical mechanical simulations revealed an obvious stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral body in the model with endplate cement contact.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 324-336"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach","authors":"Francesco Petri MD ,&nbsp;Omar K. Mahmoud MD ,&nbsp;Said El Zein MD ,&nbsp;Seyed Mohammad Amin Alavi MD ,&nbsp;Matteo Passerini MD ,&nbsp;Felix E. Diehn MD ,&nbsp;Jared T. Verdoorn MD ,&nbsp;Aaron J. Tande MD ,&nbsp;Ahmad Nassr MD ,&nbsp;Brett A. Freedman MD ,&nbsp;M. Hassan Murad MD ,&nbsp;Elie F. Berbari MD, MBA","doi":"10.1016/j.spinee.2024.09.018","DOIUrl":"10.1016/j.spinee.2024.09.018","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome.</div></div><div><h3>PURPOSE</h3><div>To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Meta-epidemiological study with a systematic review of definitions.</div></div><div><h3>PATIENTS SAMPLE</h3><div>An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms.</div></div><div><h3>OUTCOME MEASURES</h3><div>Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria.</div></div><div><h3>METHODS</h3><div>We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams.</div></div><div><h3>RESULTS</h3><div>The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology.</div></div><div><h3>CONCLUSIONS</h3><div>Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 2","pages":"Pages 359-368"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}