Background context: Surgical correction of severe rigid kyphoscoliosis remains technically challenging and is associated with high complication rates. Posterior vertebral column resection (pVCR) is often required for satisfactory correction but entails substantial surgical risks. Halo-pelvic traction (HPT) has been proposed as a safer alternative that may reduce the need for high-grade osteotomy by partially correcting the deformity preoperatively.
Purpose: To compare the clinical outcomes of HPT combined with posterior spinal fusion (HPT+PSF) versus pVCR for severe rigid kyphoscoliosis, focusing on deformity correction, surgical morbidity, pulmonary function, and complication profiles.
Study design/setting: Retrospective comparative effectiveness study conducted at 2 public tertiary referral hospitals in Beijing, China.
Patient sample: A total of 82 patients (41 per group) with severe rigid kyphoscoliosis (defined as coronal and/or sagittal Cobb angle >90° and flexibility <30%) treated between March 2016 and April 2023, with a minimum follow-up of 2 years.
Outcome measures: Primary outcomes included deformity correction, intraoperative variables, pulmonary function, and surgery-related complications. Secondary outcomes for the HPT+PSF group included traction duration, traction efficacy, and traction-related complications.
Methods: Patients received either HPT+PSF or pVCR based on surgical decision-making. Radiographic measurements were performed independently by 2 blinded observers. Comparative analyses of radiological and clinical outcomes were performed between groups.
Results: The mean duration of HPT was 4.7±1.4 weeks. The traction correction rates in the coronal and sagittal planes were 43%±10% and 39%±14%, respectively. 34% (14/41) of the patients experienced traction-related complications. The total correction rates in the coronal and sagittal planes were comparable between the HPT+PSF and pVCR groups. No significant difference between the groups at baseline or at the latest follow-up in terms of the pulmonary function indices. Compared to the pVCR group, the HPT+PSF group demonstrated significantly shorter surgical time, reduced estimated blood loss, lower incidence of intraoperative neurological monitoring alerts, and fewer surgery-related complications.
Conclusion: HPT+PSF provides deformity correction comparable to that of pVCR while significantly reducing surgical morbidity. It represents a viable and potentially safer alternative for patients with severe rigid kyphoscoliosis. However, the risk of traction-related complications and psychological stress necessitates further refinement of HPT protocols.
Background context: Postoperative outcomes in degenerative cervical myelopathy (DCM) vary considerably, yet few studies have characterized the heterogeneous recovery trajectories using longitudinal data.
Purpose: To identify distinct postoperative quality of life (QOL) trajectories in DCM patients and determine baseline predictors of recovery patterns.
Study design/setting: Prospective multicenter observational study.
Patient sample: 977 patients undergoing surgery for DCM across 10 high-volume spine centers in Japan.
Outcome measures: The QOL outcome measure comprised the Short Form-36 physical component summary (PCS) score. Functional outcomes were specifically captured through Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Outcomes were measured at baseline, 6, 12, and 24 months postoperatively.
Methods: Latent growth mixture modeling was employed to classify patients into distinct postoperative recovery trajectories based on PCS trends. To identify independent predictors of trajectory membership, multinomial logistic regression was performed, with variable selection refined through least absolute shrinkage and selection operator regression (LASSO) regression. Model performance was assessed using area under the receiver operating characteristic curve (AUC) for discrimination and decile-based calibration plots with bootstrap validation.
Results: Four distinct PCS recovery trajectories were identified: Low-to-High (L-H, 7.3%), High-to-High (H-H, 44.9%), Low-to-Low (L-L, 37.7%), and Initial-Decline (I-D, 10.1%). Preoperative lower extremity function emerged as the strongest predictor of trajectory class, reflecting the baseline QOL. Additional significant predictors included age, smoking history, symptom duration, and cervical spine function. Particularly, reduced cervical function at baseline was found to be a significant predictor of unfavorable QOL at 24 months. The prediction model demonstrated good discriminatory performance following least absolute shrinkage and selection operator (LASSO) regression for common classes (AUCs: H-H=0.86, L-L=0.80) and moderate performance for L-H class (AUC 0.74). However, accuracy was limited for the I-D class (AUC = 0.63), and calibration was compressed in rarer classes due to class imbalance.
Conclusions: Distinct patterns of postoperative recovery exist among DCM patients, with baseline physical function and patient characteristics significantly influencing QOL trajectory. While predictive models reliably distinguished major recovery patterns, less frequent trajectories, particularly those involving deterioration, were difficult to forecast. These findings support the utility of trajectory modeling and patient-reported outcome measures to enhance individualized surgical prognostication in DCM.
Background context: Previous research has shown the positive effect of 1- and 2-level anterior cervical spine surgery on driving disability; however, the impact of posterior cervical spine surgery, which is usually performed for three or more level pathologies, remains unexplored.
Purpose: To investigate the impact of posterior cervical spine surgery on neck pain-related driving disability and identify the risk factors for poor driving outcomes.
Study design: A retrospective review of a multicenter prospective database.
Patient sample: Patients undergoing posterior cervical spine surgery for degenerative cervical myelopathy.
Outcome measures: Data were collected on patient and surgical characteristics and patient-reported outcome measurements (PROMs), including the Neck Disability Index (NDI), Numeric Rating Scale for neck/arm pain, EuroQol 5 Dimension, Japanese Orthopedic Association scores, and postoperative satisfaction.
Methods: The NDI driving subscale (0-5) was used to evaluate neck pain-related driving disability at baseline and 24 months postoperatively. Driving severity was categorized as "non-to-mild" (score 0, 1, or 2) and "moderate-to-severe" (score 3, 4, or 5) and used to determine whether patients experienced postoperative improvement, worsening, or rest. Multivariate analysis was performed to identify clinical and surgical risk factors for deteriorating or persistent driving disability. We analyzed the association between driving outcomes and PROMs.
Results: Of the 1,067 patients included, 277 (26.0%) reported moderate-to-severe driving disability at baseline. At 24 months, 70.8% of these patients experienced substantial improvement, whereas 29.2% did not. Among the 790 patients with baseline non-to-mild driving disability, 69 (8.7%) experienced significant postoperative deterioration. Multivariate analysis identified older age (odds ratio [OR] 2.6), female sex (OR 2.2), and ≥4-level fusion (OR 2.4) as significant risk factors for postoperative worsening, whereas older age (OR 2.1) was the significant risk factor for poor postoperative improvement. Patients with poor outcomes were less likely to achieve clinically significant improvements in all PROMs.
Conclusions: Posterior cervical spine surgery can improve driving disability associated with neck pain. Nevertheless, the potential risk of postoperative deterioration or poor improvement should be considered, particularly among patients who are older, female, or have undergone ≥4-level fusion surgery.
Background context: Postoperative burden following lumbar spine surgery plays a crucial role in determining surgical indication. Efforts to minimize surgical impact have been emphasized to improve patient selection and reduce unnecessary invasiveness. Although recent advances in spine surgery have led to improved outcomes at discrete time points, few studies have quantified the continuous and time-dependent burden experienced by patients throughout recovery.
Purpose: To quantify cumulative postoperative disability using a continuously modeled recovery trajectory and to compare this metric across common lumbar procedures.
Study design/setting: A retrospective analysis of a prospectively collected registry.
Patient sample: Patients undergoing primary 1- to 4-level lumbar surgery between April 2017 and April 2024 in a single academic institution.
Outcome measures: Cumulative postoperative disability quantified with the modified Integrated Health State (mIHS), a novel continuous metric calculated as the area under the modeled Oswestry Disability Index recovery curve per week.
Methods: Recovery trajectories were modeled with multivariable mixed-effects regression using restricted cubic splines for postoperative day and an interaction term for surgical grades based on previously reported grading system (Grade 1=decompression only; Grade 2=single-approach fusion, 1 to 2 levels; Grade 3=dual-approach fusion, 1 level; Grade 4=dual-approach fusion, 2 levels; Grade 5=dual-approach fusion, ≥3 levels). Differences in mIHS among grades were tested with one-way ANOVA followed by adjusted pairwise comparisons. Effect sizes were reported as eta squared (η²; small ≥0.01, medium ≥0.06, large ≥0.14) and Cohen's d (d; small ≥0.20, medium ≥0.50, large ≥0.80) to aid interpretation of differences among surgical grades.
Results: The multivariable model demonstrated a significant interaction between surgical grade and time (p<.001), indicating that recovery trajectories of ODI differed across surgical grades. The mIHS differed significantly among surgical grades at 10 weeks (Grade 1: 4.79 vs. Grade 2: 6.27 vs. Grade 3: 6.86 vs. Grade 4: 7.31 vs. Grade 5: 7.77; η2=0.38; p<.001), 20 weeks (η2=0.20, p<.001), 30 weeks (η2=0.11, p<.001), and 1 year (η2=0.03, p<.001). At 10 weeks, post hoc comparisons indicated stepwise increases in mIHS with higher surgical grades, with significant differences observed between Grade 1 vs. 2 (mean difference=1.48 [95%CI 1.37 to 1.59]; d=1.38; p<.001), Grade 2 vs. 3 (0.59 [95% CI 0.33-0.85]; d=0.55; p<.001), and Grade 3 vs. 4 (0.45 [95% CI 0.02-0.87]; d=0.42; p=.044). Significant differences persisted after 1 year between Grades 1 and 2 (mean difference=0.40; p<.001; d=0.25) and between Grades 2 and 4 (0.92; p=.003; d=0.57).
Conclusi
Background context: Liquid electronic cigarettes (LECs), heat-not-burn electronic cigarettes (HECs), and combustible cigarettes (CCs) pose varying disc disease risks.
Purpose: To assess disc disease risk among LEC, HEC, combined LEC/HEC, and CC users and nonsmokers, including those transitioning from CCs to LECs or HECs STUDY DESIGN/SETTING: This was an observational, nationwide, population-based retrospective cohort study using data from the Korean National Health Insurance Service.
Patient sample: Data from 3,265,293 adults in the Korean National Health Insurance Service database were analyzed.
Outcome measures: The primary study outcome was spinal disc disease hazard ratios.
Methods: Participants were categorized as LEC, HEC, combined LEC/HEC or CC users or never-smokers. Propensity score matching and multivariable Cox proportional hazards regression estimated adjusted hazard ratios (aHRs) for disc disease risk. Smoking status was self-reported, and detailed quantitative exposure data were unavailable, which may limit interpretation of hazard ratios.
Results: Increased disc disease risk was found in smokers than in nonsmokers: CC (aHR=1.174 [95% confidence interval (CI), 1.158-1.191]), LEC (aHR=1.153 [95% CI, 1.079-1.232]), HEC (aHR=1.132 [95% CI, 1.063-1.204]), and combined LEC/HEC (aHR=1.174 [95% CI, 1.01-1.366]). Switching from CC to HEC reduced the risk compared to that after continuous CC use (aHR=0.89 [95% CI, 0.838-0.944]). However, the risk remained higher than that in nonsmokers (aHR=1.092 [95% CI, 1.026-1.163]). Switching from CC to LEC showed risk similar to that with continuous CC use (aHR=1.01 [95% CI, 0.902-1.132]) and higher risk than that in nonsmokers (aHR=1.339 [95% CI, 1.185-1.513]).
Conclusions: CC smokers present the highest risk of spinal disc disease. LEC and HEC smokers have lower risks than CC smokers but higher risks than nonsmokers. Transitioning from CCs to HECs reduces disc disease risk, but switching to LECs does not, compared to continuous CC use.
Background context: Current clinical guidelines lack clear, quantitative recommendations on intensity-specific physical activity (PA) levels for preventing back pain. Moreover, accelerometer-based evidence regarding dose-response relationships and interactions between PA and genetic susceptibility remains limited.
Purpose: To determine the relationships between accelerometer-measured total and intensity-specific PA and incident back pain, and to assess potential effect modification by polygenic risk scores (PRS).
Study design: Prospective, large-scale, population-based study using UK Biobank data.
Patient sample: UK Biobank participants who wore wrist accelerometers for 7 days (N=71,601).
Outcome measures: Incident back pain, defined as the first recorded ICD-10 dorsalgia code (M54).
Methods: Total PA, light PA (LPA), and moderate-to-vigorous PA (MVPA) were derived using validated machine-learning algorithms from raw accelerometer data. Dose-response relationships were modeled using restricted cubic splines within Cox proportional hazards models, with adjustment for and stratification by a polygenic risk score (PRS). Point estimates for the population attributable fraction (PAF) were then calculated. Body mass index (BMI) mediation was assessed.
Results: Over a median follow-up of 7.0 years, total PA and MVPA exhibited nonlinear inverse associations with incident back pain, independent of genetic risk, with thresholds at approximately 35 milli-g (total PA) and 60 min/day (MVPA). The adjusted PAF was 15.9% for low MVPA and 9.9% for low total PA. Associations were strongest for MVPA, followed by total PA; no significant association was observed for LPA. Within both PRS strata, risk declined monotonically across PA quartiles, with similar effect sizes and no PA × PRS interaction. Notably, participants with high PRS and high PA had lower risk than those with low PRS and low PA. BMI mediated 26.2% of the total PA association and 15.5% of the MVPA association.
Conclusions: Accelerometer-measured MVPA robustly reduces back-pain risk, independent of genetic predisposition. Future guidelines should provide clear, intensity-specific recommendations and account for the observed nonlinear dose-response to optimize prevention.
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