Spine Journal最新文献

{"title":"Characteristics of upper lumbar spondylolysis in children.","authors":"Kohei Kuroshima, Shingo Miyazaki, Yoshiaki Hiranaka, Masao Ryu, Shinichi Inoue, Takashi Yurube, Kenichiro Kakutani, Ko Tadokoro","doi":"10.1016/j.spinee.2024.12.026","DOIUrl":"10.1016/j.spinee.2024.12.026","url":null,"abstract":"<p><strong>Background: </strong>Pediatric lumbar spondylolysis (LS) is common in junior and senior high school athletes. Lower LS (L4-L5 level) is more common in children, and upper LS (L1-L3 level) is relatively rare; therefore, the pathogenesis of upper LS remains unclear.</p><p><strong>Purpose: </strong>To elucidate the mechanisms of upper LS by identifying and comparing characteristics between upper and lower LS cases.</p><p><strong>Study design/setting: </strong>Retrospective cross-sectional study.</p><p><strong>Patient sample: </strong>This study included 842 pediatric patients aged ˂18 years diagnosed with single-level acute LS at a single outpatient clinic between 2015 and 2022.</p><p><strong>Outcome measures: </strong>The rate of upper LS, age, sex, participation in flexibility sports, presence of spina bifida occulta (SBO), and radiological parameters including lumber lordosis, L1-L4 lordosis, L4-S1 lordosis, and sacral slope.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of all patients with acute LS diagnosed using plain radiography, multidetector computed tomography, and magnetic resonance imaging. The upper and lower LS groups were subsequently compared using univariate and multivariate analyses to investigate factors associated with upper LS.</p><p><strong>Results: </strong>Of the included 842 patients, 88 (10.5%) had upper LS. Multivariate analysis showed that older age (odds ratio, 1.62; p<.001), flexibility sports participation (odds ratio, 2.50; p=.041), lower prevalence of SBO (odds ratio, 0.49; p=.011), increased L1-L4 lordosis (odds ratio, 1.16; p<.001), and decreased L4-S1 lordosis (odds ratio, 0.84; p<.001) were significantly associated with upper LS development.</p><p><strong>Conclusions: </strong>Patients with upper LS had clearly different characteristics from those with lower LS in terms of age, participation in flexibility sports, presence of SBO, and segmental lordosis of the lumbar spine. This study will help further research in elucidating the mechanisms of upper LS.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972896","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":"Cost-utility of lumbar interbody fusion surgery: A systematic review.","authors":"Viraj Deshpande, Evan Simpson, Jesse Caballero, Chris Haddad, Jeremy Smith, Vance Gardner","doi":"10.1016/j.spinee.2024.12.027","DOIUrl":"10.1016/j.spinee.2024.12.027","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study sample: &lt;/strong&gt;This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Direct (healthcare) and indirect (non-healthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over 1 year (0.43, IQR 0.121-0.705), while PLIF was highest over 2 years (1.33). ALIF was most favorable over 1 year ($30901/QALY) and OLIF was most favorable over 2 years ($11187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over 2 years ($44383, $45628, $48576/QALY). MIS was substantially favorable to OS at 1 year ($42635 vs. $226304), though similar at 2 years ($48576 vs. $45628/QALY). Anterior approach was favorable to posterior approach at 1 year ($30901.5 vs. $81038) and 2 years ($29","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980411","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":"Comparison of clinical and radiological outcomes of three-column lumbar osteotomies with and without interbody cages for adult spinal deformity.","authors":"Jeffrey P Mullin, Esteban Quiceno, Mohamed A R Soliman, Alan H Daniels, Justin S Smith, Michael P Kelly, Christopher P Ames, Shay Bess, Douglas Burton, Bassel Diebo, Robert K Eastlack, Richard Hostin, Khaled Kebaish, Han Jo Kim, Eric Klineberg, Virginie Lafage, Lawrence G Lenke, Stephen J Lewis, Gregory Mundis, Peter G Passias, Themistocles S Protopsaltis, Frank J Schwab, Jeffrey L Gum, Thomas J Buell, Christopher I Shaffrey, Munish C Gupta","doi":"10.1016/j.spinee.2025.01.001","DOIUrl":"10.1016/j.spinee.2025.01.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Different types of three-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the \"sandwich\" technique, aim to optimize alignment and fusion outcomes. The role of interbody cages in enhancing fusion and segmental correction remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to compare outcomes among these 4 3CO techniques, evaluating the impact of cage use at the osteotomy site on postoperative radiographic imaging and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This is a multicenter retrospective study utilizing data from a prospective multicenter database of patients undergoing complex ASD surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Ninety-seven patients who underwent 1 of 4 3CO techniques for thoracolumbar ASD correction with at least 2 years of follow-up were included. The sample consisted of 29 patients who underwent Schwab 3 osteotomy, 20 Schwab 4, 28 Schwab 4 with interbody cages, and 20 who underwent \"sandwich\" osteotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The Scoliosis Research Society-22 revised (SRS22r) questionnaire evaluating pain, activity, appearance, mental health, and satisfaction was used to evaluate patient reported outcomes and radiographic measures including segmental lordosis and fusion rates determined by 3 blinded reviewers were used to evaluate physiologic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study analyzed demographic data, radiographic outcomes, patient-reported outcomes, complications, and fusion rates over a 2-year follow-up period. Fusion status was determined via serial radiographs and evaluated independently by 3 blinded reviewers. Univariate and multivariate statistical analyses were performed to assess differences among the groups and the impact of interbody cage use on outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients undergoing \"sandwich\" osteotomy exhibited worse preoperative leg pain scores and lower SRS22r activity (p=.015), appearance (p=.007), and mental health domain scores (p=.0015). No differences in complications were found among groups (p&gt;.05). Patients who underwent osteotomy with a cage were more likely to have had previous spine fusion (91.7% vs. 71.4%, p=.010). Additionally, these patients had lower preoperative SRS22r mental domain (2.9±1 vs. 3.5±1, p=.009), satisfaction (2.3±1 vs. 2.7±1.2, p=.034), and SRS22r total scores (2.3±0.6 vs. 2.6±0.6, p=.0026) but demonstrated the greatest improvement in the mental health domain (0.9±0.7 vs. 0.3±0.9, p=.002). Cage use was associated with a larger mean change in segmental lordosis at the osteotomy site (32.9±9.6 vs. 28.7±9.5, p=.038). Fusion rates were significantly higher in the cage group (79.2% vs. 55.1%, p=.0012). Regression analysis identif","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972897","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":"Scoliosis progression after lung transplantation.","authors":"Takayoshi Shimizu, Satona Tanaka, Bungo Otsuki, Koki Kawasaki, Takashi Sono, Koichi Murata, Daisuke Nakajima, Shuichi Matsuda, Hiroshi Date","doi":"10.1016/j.spinee.2024.12.030","DOIUrl":"10.1016/j.spinee.2024.12.030","url":null,"abstract":"<p><strong>Background context: </strong>Scoliosis is a potential postoperative complication of various pediatric cardiothoracic conditions.</p><p><strong>Purpose: </strong>To investigate the incidence of scoliosis in pediatric lung transplant patients and explore the factors associated with its development.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Patient sample: </strong>About 330 consecutive lung transplant recipients at a single institution between April 2002 and June 2022.</p><p><strong>Outcome measures: </strong>The incidence of scoliosis.</p><p><strong>Methods: </strong>After excluding 45 patients with <1 year of follow-up, 285 patients were analyzed: 43 pediatric (≤17 years) and 242 adult (>18 years) patients. Data on baseline demographics, Cobb angle measurements pre- and posttransplant, and lung volumes at 1-year posttransplant in pediatric patients were collected. The prevalence of scoliosis was compared between pediatric and adult patients. Additionally, the impact of lung volume differences (right minus left) on scoliosis progression was assessed.</p><p><strong>Results: </strong>Pediatric (n=43) and adult (n=242) patients had a mean age of 10.3 and 44.9 years, respectively. Scoliosis was significantly more prevalent in pediatric patients, with 30.2% having a Cobb angle >10° and 13.9% having a Cobb angle >20°, compared to 11.5% and 1.6% in adults, respectively. Pediatric patients with Cobb angles >20° exhibited significant lung volume differences 1-year posttransplant. Lung volume disparities increased the risk of scoliosis progression, particularly in patients with unilateral lung collapse.</p><p><strong>Conclusions: </strong>Pediatric lung transplant recipients have a higher incidence of significant scoliosis than adult recipients. Posttransplant lung volume disparities, especially in cases of unilateral lung collapse, may contribute to scoliosis progression. Routine spinal assessments are necessary for managing scoliosis in pediatric lung transplant patients to prevent curvature progression and ensure long-term musculoskeletal health.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972898","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":"The predictive value of multifidus degeneration in osteoporotic vertebral compression fracture patients with kyphosis deformity.","authors":"Junyu Li, Zimo Wang, Gengyu Han, Zhuoran Sun, Yongqiang Wang, Miao Yu, Weishi Li, Lin Zeng, Yan Zeng","doi":"10.1016/j.spinee.2024.12.031","DOIUrl":"10.1016/j.spinee.2024.12.031","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Osteoporotic vertebral compression fracture (OVCF) causes pain, kyphosis and neurological damage, which significantly affect patients' quality of life. Patients with OVCF are often elderly and have severe osteoporosis, which makes preoperative symptom more serious, postoperative recovery worse and the incidence of postoperative complications high. The paraspinal muscles have been well studied in adult spinal deformities, but there is no conclusive evidence that their findings can be applied to OVCF. The purpose of this study was to evaluate the associations between multifidus (MF) parameters including fat infiltration (FI), relative functional sectional area (rFCSA), relative gross cross-sectional area (rGCSA) and the sagittal parameters, symptom score, and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To figure out the potential associations between multifidus muscle (MF) degeneration and patients' quality of life (QoL), sagittal parameters and mechanical complications in osteoporotic vertebral compression fracture (OVCF) patients with kyphosis deformity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study PATIENT SAMPLE: OVCF patients with kyphosis deformity who underwent corrective surgery between 2008 to 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measurements: &lt;/strong&gt;MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), MF relative gross cross-sectional area (MFrGCSA), VAS, ODI, JOA, SRS-22, preoperative, postoperative and last-follow up spine sagittal parameters, postoperative mechanical complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study included 108 OVCF patients with kyphosis deformity who underwent corrective surgery and were followed for 2 years. MRI were performed preoperatively to evaluate the paraspinal muscle morphology, including MF fat infiltration (MFFI), relative functional cross-sectional area (MFrFCSA), and MF relative gross cross-sectional area (MFrGCSA). VAS, ODI, JOA, and SRS-22 were conducted preoperatively. Preoperative, postoperative and last-follow up spine sagittal parameters were recorded, as well as sagittal balance, loss of correction results and improvement and deterioration of sagittal parameters. The occurrence of postoperative mechanical complications, including adjacent segment disease, screw loosening, proximal junctional kyphosis, and distal junctional problem were recorded. We analyzed the relationship between MF degeneration and the above parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Strong correlation was observed in VAS and MFFI (rr=0.597, p=.000),MF rFCSA (rr=-0.520, p=.001) and MF rGCSA (rr=-0.461, p=.005), as well as ODI and MF rFCSA (rr=-0.336, p=.042). Preoperatively, strong correlations were observed between MF rFCSA and LL (rr=-0.320, p=.010), TLK (rr=-0.271, p=.026), TK (rr=-0.251,p=.048). MF rGCSA and LL (rr=-0.259, p=.039), TLK (rr=-0.247, p=.043), TK (rr=-0.273, p=.030), GK (rr=-0.381, p=.002) were also strongly ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972899","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":"A retrospective analysis of spinal teratomas and spinal lipomas: overlaps and differences in presentation, surgical treatments, and outcomes","authors":"Hongmei Song,&nbsp;Mingxin Yu,&nbsp;Yang Song,&nbsp;Shuanglin Deng","doi":"10.1016/j.spinee.2024.08.026","DOIUrl":"10.1016/j.spinee.2024.08.026","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Spinal teratomas and lipomas, both adult and pediatric cases, are rare diseases with many similarities, but have yet to be systematically compared.</div></div><div><h3>PURPOSE</h3><div>To systematically compare spinal teratomas and lipomas to optimize management.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective.</div></div><div><h3>PATIENT SAMPLE</h3><div>Symptomatic spinal teratoma and lipoma patients surgically treated at our center.</div></div><div><h3>OUTCOME MEASURES</h3><div>Anatomical distribution, clinical manifestations, resection status, and outcomes.</div></div><div><h3>METHODS</h3><div>Spinal teratoma and lipoma patients with complete data treated during 2008 to 2023 in our center were enrolled. Electrophysiological monitoring was routinely performed after 2012. Patient characteristics, anatomical distribution, clinical manifestations, surgical resection, and outcomes were analyzed.</div></div><div><h3>RESULTS</h3><div>We enrolled 86 teratoma patients (71 adults) and 51 lipoma patients (39 adults). Most tumors were lumbosacral lesions; cervical/thoracic involvement was more common with lipomas. Pain, the most frequent manifestation, was more common in teratomas. Gross total resection (GTR) was achieved in 51.1% and 49% of teratomas and lipomas, respectively. Electrophysiological monitoring increased the GTR rate from 38.8% to 48.6%. Age independently predicted (OR: 1.040, 95% CI: 1.008–1.078) GTR/near-total resection (NTR). Symptom relief occurred in 81.4% teratoma patients and 64.7% lipoma patients. Recurrence/symptomatic progression occurred in 19 teratomas and 7 lipomas after a median of 95 and 115 months, respectively. Adult lipoma patients without spinal dysraphism had lower recurrence rates. GTR (HR: 0.172, 95% CI: 0.02557–0.7028) and lesion length (HR: 1.351, 95% CI: 1.138–1.607) independently predicted recurrence/progression.</div></div><div><h3>CONCLUSIONS</h3><div>GTR should be pursued for adult/pediatric spinal teratomas and pediatric spinal lipomas. For adult spinal lipoma patients without dysraphism, conservative surgery could be considered.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 111-126"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180816","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":"Comparative analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study","authors":"Zhuosong Bai MD ,&nbsp;Haoran Zhang MD ,&nbsp;Yuechuan Zhang MD ,&nbsp;Tongyin Zhang MD ,&nbsp;Xiangjie Yin MD ,&nbsp;Yunze Han MD ,&nbsp;Yiqiao Zhang MD ,&nbsp;Qianyu Zhuang MD ,&nbsp;Jianguo Zhang MD","doi":"10.1016/j.spinee.2024.09.005","DOIUrl":"10.1016/j.spinee.2024.09.005","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Lumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups.</div></div><div><h3>PURPOSE</h3><div>To evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective analysis.</div></div><div><h3>PATIENT SAMPLE</h3><div>We retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years.</div></div><div><h3>OUTCOME MEASURE</h3><div>The following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters.</div></div><div><h3>METHODS</h3><div>From 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (&gt;6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected.</div></div><div><h3>RESULTS</h3><div>Compared to Group L, Group E exhibited a lower intraoperative blood loss (p&lt;.001), higher final main curve correction rate (p=.037), smaller postop compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate postop (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006).</div></div><div><h3>CONCLUSIONS</h3><div>This study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 145-153"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331027","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":"The association of lumbar intervertebral disc degeneration with low back pain is modified by underlying genetic propensity to pain","authors":"Pradeep Suri MD, MS ,&nbsp;Maryam Kazemi Naeini PhD ,&nbsp;Patrick J. Heagerty PhD ,&nbsp;Maxim B. Freidin PhD ,&nbsp;Isabelle Granville Smith MS ,&nbsp;Elizaveta E. Elgaeva MS ,&nbsp;Roger Compte MS ,&nbsp;Yakov A. Tsepilov PhD ,&nbsp;Frances M.K. Williams PhD, FRCP(E)","doi":"10.1016/j.spinee.2024.05.018","DOIUrl":"10.1016/j.spinee.2024.05.018","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Associations between magnetic resonance imaging (MRI)-detected lumbar intervertebral disc degeneration (LDD) and LBP are often of modest magnitude. This association may be larger in specific patient subgroups.</div></div><div><h3>PURPOSE</h3><div>To examine whether the association between LDD and LBP is modified by underlying genetic predispositions to pain.</div></div><div><h3>STUDY DESIGN</h3><div>Cross-sectional study in UK Biobank (UKB) and Twins UK.</div></div><div><h3>PATIENT SAMPLES</h3><div>A genome-wide association study (GWAS) of the number of anatomical chronic pain locations was conducted in 347,538 UKB participants. The GWAS was used to develop a genome-wide polygenic risk score (PRS) in a holdout sample of 30,000 UKB participants. The PRS model was then used in analyses of 645 TwinsUK participants with standardized LDD MRI assessments.</div></div><div><h3>OUTCOME MEASURES</h3><div>Ever having had LBP associated with disability lasting ≥1 month (LBP1).</div></div><div><h3>METHODS</h3><div>Using the PRS as a proxy for “genetically-predicted propensity to pain”, we stratified TwinsUK participants into PRS quartiles. A “basic” model examined the association between an LDD summary score (LSUM) and LBP1, adjusting for covariates. A “fully-adjusted” model also adjusted for PRS quartile and LSUM x PRS quartile interaction terms.</div></div><div><h3>RESULTS</h3><div>In the basic model, the odds ratio (OR) of LBP1 was 1.8 per standard deviation of LSUM (95% confidence interval [CI] 1.4–2.3). In the fully-adjusted model, there was a statistically significant LSUM-LBP1 association in quartile 4, the highest PRS quartile (OR=2.5 [95% CI 1.7–3.7], p=2.6×10⁻⁶), and in quartile 3 (OR=2.0, [95% CI 1.3–3.0]; p=.002), with small-magnitude and/or nonsignificant associations in the lowest 2 PRS quartiles. PRS quartile was a significant effect modifier of the LSUM-LBP1 association (interaction p≤.05).</div></div><div><h3>CONCLUSIONS</h3><div>Genetically-predicted propensity to pain modifies the LDD-LBP association, with the strongest association present in people with the highest genetic propensity to pain. Lumbar MRI findings may have stronger connections to LBP in specific subgroups of people.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 8-17"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471967","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":"The spinopelvic alignment in patients with prior knee or hip arthroplasty undergoing elective lumbar surgery","authors":"Jan Hambrecht MD ,&nbsp;Paul Köhli MD ,&nbsp;Erika Chiapparelli MD ,&nbsp;Jiaqi Zhu MS ,&nbsp;Ali E. Guven MD ,&nbsp;Gisberto Evangelisti MD ,&nbsp;Marco D. Burkhard MD ,&nbsp;Koki Tsuchiya MD ,&nbsp;Roland Duculan MD ,&nbsp;Franziska C.S. Altorfer MD ,&nbsp;Jennifer Shue MS ,&nbsp;Andrew A. Sama MD ,&nbsp;Frank P. Cammisa MD ,&nbsp;Federico P. Girardi MD ,&nbsp;Carol A. Mancuso MD ,&nbsp;Alexander P. Hughes MD","doi":"10.1016/j.spinee.2024.08.025","DOIUrl":"10.1016/j.spinee.2024.08.025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Concurrent degeneration of the lumbar spine, hip, and knee can cause significant disability and lower quality of life. Osteoarthritis in the lower extremities can lead to movement limitations, possibly requiring total knee arthroplasty (TKA) or total hip arthroplasty (THA). These procedures often impact spinal posture, causing alterations in spinopelvic alignment and lumbar spine degeneration. It is unclear if patients with a history of prior total joint arthroplasty (TJA) have different spinopelvic alignment compared to patients without.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To assess the relationship between a history of previous THA or TKA, as well as combined THA and TKA, and the spinopelvic alignment in patients undergoing elective lumbar surgery for degenerative conditions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective analysis was conducted on patients who underwent lumbar surgery for degenerative conditions. The patients were stratified based on a history of TKA, THA, or both TKA and THA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 632 patients (63% female) with an average age of 64±11 years and an average BMI of 30±6 kg/m&lt;sup&gt;2&lt;/sup&gt; were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Patients were stratified based on a history of THA, TKA, or combined THA and TKA. Spinopelvic parameters (lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were assessed. The relationship between spinopelvic alignment and prior TKA, THA or TKA and THA was analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The data was tested for normal distribution using the Shapiro-Wilk test. We analyzed the relationship between the spinopelvic parameters and the different arthroplasty groups. Differences in scores between groups were examined using ANOVA. Tukey's Honestly Significant Difference test was used for pairwise comparison for significant ANOVA test results. Multivariable linear regression was applied, adjusted for age, sex and BMI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 632 patients (63% female) were included in the study. Of these patients, 74 (12%) had a history of isolated TKA, 40 (6%) had prior isolated THA, and 15 (2%) had TKA and THA prior to lumbar surgery. Patients with prior arthroplasty were predominantly female (59%) and significantly older (68±7 years vs 63±12 years, p&lt;.001) with a significantly higher BMI (31±6 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 29±6 kg/m&lt;sup&gt;2&lt;/sup&gt;, p&lt;.001). The LL was significantly lower (45.0°±13 vs 50.9°±14 p=.011) in the arthroplasty group compared to the nonarthroplasty group. A history of isolated TKA was significantly associated with lower LL (Est=−3.8, 95% CI −7.3 to −0.3, p=.031) and SS (Est=−2.6, 95% CI −5.0 to −0.2, p=.012) compared to patients without TJA. Prior combined THA and TKA was found to be significantly associated with a higher PT compared to the nonarthroplasty group (Est=5.1, 95% CI 0.4–9.8, p=.034).&lt;/div&gt;&lt;/di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 45-54"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299507","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":"Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites","authors":"Tomasz Klepinowski MD, PhD ,&nbsp;Natalia Żyłka ,&nbsp;Samuel D. Pettersson ,&nbsp;Jagoda Hanaya ,&nbsp;Bartłomiej Pala ,&nbsp;Kajetan Łątka MD ,&nbsp;Dominik Taterra MD ,&nbsp;Wojciech Poncyljusz MD ,&nbsp;Christopher S. Ogilvy MD ,&nbsp;Leszek Sagan MD","doi":"10.1016/j.spinee.2024.08.021","DOIUrl":"10.1016/j.spinee.2024.08.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Our recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Three types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;HRVA was defined as C2IsH of ≤5 mm and/or C2InH of ≤2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Prevalence of at least 1 HRVA was 24.9% (n=113 subjects) and 16.2% of PSIS (n=147 sites). Based on the measurements and K-means clustering, the following 3 types of HRVA have been distinguished: type 1—isthmic with only C2IsH being reduced and normal C2InH; type 2—internal with only C2InH being reduced and C2IsH within normal limits; type 3—isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted posthoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;We present the first classification system for the high-riding vertebral artery distinguishing 3 types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this clas","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 59-68"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180818","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}