Asian Spine Journal最新文献

Study design: Retrospective study.

Purpose: To compare postoperative paravertebral muscle atrophy, fat infiltration, and clinical efficacy between unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and Wiltse approach transforaminal lumbar interbody fusion (W-TLIF).

Overview of literature: The long-term effects of UBE-TLIF and W-TLIF techniques on paravertebral muscle integrity and clinical outcomes have not been directly compared.

Methods: Fifty patients who underwent UBE-TLIF and 50 patients who underwent W-TLIF, each with >2 years of follow-up, were retrospectively analyzed. Outcomes included operative parameters, time to postoperative mobilization, paravertebral muscle atrophy and fat infiltration rates, clinical scores (Visual Analog Scale [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association [JOA]), modified Macnab criteria, fusion rates, and complications.

Results: Compared with W-TLIF, the UBE-TLIF group had significantly less intraoperative blood loss, shorter operative times, and lower postoperative drainage volumes (p <0.05). The UBE-TLIF group showed faster postoperative recovery and shorter hospital stays. At 6 months, 1 year, and 2 years, W-TLIF patients had higher multifidus and erector spinae atrophy, and greater paravertebral muscle fat infiltration (p <0.05). The UBE-TLIF group also had lower VAS and ODI scores at 1 year and 2 years (p <0.05) and fewer surgical complications (6% vs. 10%). Fusion rates (94% vs. 92%) and modified Macnab outcomes (88% vs. 86%) were comparable (p >0.05).

Conclusions: UBE-TLIF is associated with reduced intraoperative trauma, quicker recovery, and fewer complications. In the long-term, it better preserves paravertebral muscle integrity and provides superior pain and functional outcomes.

Study design: Retrospective cohort study.

Purpose: This study aimed to examine outcomes in patients with adult spinal deformity (ASD) undergoing deformity correction with and without glucagon-like peptide-1 receptor agonist (GLP-1A) therapy.

Overview of literature: GLP-1As, widely used in diabetes management, have recently been linked to reduced postoperative complications. However, their role in spinal surgery remains underexplored.

Methods: This multicenter, retrospective cohort study was conducted using the TriNetX Global Collaborative Database (2005-2025) utilizing Current Procedural Terminology and International Classification of Diseases, 10th Revision, codes for patients undergoing spinal deformity correction because of ASD. Patients prescribed GLP-1As within 1 year of surgery were 1:1 propensity-score matched with those who were not using GLP-1As. The cohort was matched according to patient demographics and comorbidities. Surgical outcomes between groups were analyzed at 1- and 2-year intervals. Significance was defined as p <0.05.

Results: At 1 and 2 years following surgery, patients taking GLP-1As exhibited significantly lower odds of pseudoarthrosis, hardware failures, wound dehiscence, infections, thromboembolic events, readmissions, and mortality.

Conclusions: The findings reveal a significant reduction in the rates of pseudoarthrosis, hardware failure, readmission, and mortality in patients treated with GLP-1As. These results align with the recent literature, pointing to a potential complementary therapy in ASD management. Further studies characterizing the mechanism by which GLP-1As affect postoperative spinal physiology are warranted to assess their utility in optimizing patient outcomes.

Study design: Retrospective study.

Purpose: To investigate the diagnostic utility of anterior epidural fat (EF) for distinguishing isthmic from degenerative lumbar spondylolisthesis.

Overview of literature: Isthmic and degenerative lumbar spondylolisthesis must be distinguished accurately for appropriate clinical decision making. However, magnetic resonance imaging (MRI) often fails to detect pars defects; thus, additional imaging markers are needed.

Methods: We retrospectively analyzed lumbar spondylolisthesis in 274 patients, of whom 129 had isthmic disease and 145 had degenerative disease. We assessed the presence and structure of anterior EF on midsagittal MRI, calculated diagnostic performance metrics, and used multivariable logistic regression to identify independent predictors of isthmic spondylolisthesis.

Results: Anterior EF was observed in 95.3% of isthmic cases and 28.3% of degenerative cases (p <0.001). As a diagnostic marker, anterior EF had 95.3% sensitivity and 71.7% specificity, and the area under the receiver operating characteristic curve indicated excellent discriminative ability. Morphologically, acute triangular anterior EF was significantly more common in patients with isthmic disease (75.2%) than in those with degenerative disease (17.2%). Multivariable analysis confirmed anterior EF as a strong independent predictor (odds ratio, 38.730; p <0.001).

Conclusions: Anterior EF is an MRI feature that is highly sensitive and moderately specific for identifying isthmic spondylolisthesis. Its presence and characteristic acute triangular structure are valuable ancillary signs that are useful in early, noninvasive diagnosis.

Study design: Randomized controlled trial with a pretest-posttest control group design.

Purpose: To investigate the radiographic and clinical effects of core stabilization exercises (CSEs) on cervical sagittal alignment and pain in individuals with forward head posture (FHP).

Overview of literature: FHP is a common postural disorder increasingly linked to prolonged screen use. Conventional rehabilitation primarily targets cervical musculature, whereas the role of core stabilization in influencing cervical alignment remains underexplored.

Methods: Forty patients (aged 20-40 years) with FHP (craniovertebral angle ≤50°) were randomly assigned to two groups: group A received CSEs combined with postural correction exercises (PCEs), and group B received PCEs alone. Interventions were delivered 3 times per week for 6 weeks. The primary outcomes were T1 slope (T1S), spino-cranial angle (SCA), and pain intensity measured using the Pain Rating Scale (PRS).

Results: Thirty-six participants completed the intervention. A two-way mixed-design multivariate analysis of variance revealed a significant main effect of time (F =19.461, p <0.001) and a significant time×group interaction (F =9.726, p <0.001), indicating superior improvements in group A. Group A demonstrated significantly greater gains in SCA and PRS scores compared to group B (p <0.05). Both groups showed significant improvements in T1S.

Conclusions: CSEs are effective in improving cervical sagittal alignment and reducing cervical pain in individuals with FHP. These findings support the integration of core-focused interventions into clinical rehabilitation programs for postural dysfunction (ClinicalTrial.gov registration number: NCT06160245).

Study design: Retrospective study.

Purpose: To evaluate the efficacy of a surgical protocol utilizing novel anterior-only reduction and fixation techniques for acute, delayed, and old subaxial cervical facet dislocations.

Overview of literature: There is no clear consensus on the optimal surgical approach (anterior, posterior, or combined) for cervical facet dislocation.

Methods: Over a 10-year period, 87 consecutive patients with subaxial cervical facet dislocations were treated using an anterior-only approach. Patients were classified into three groups: (1) those indicated for urgent surgery; (2) those contraindicated for urgent surgery; and (3) those with old dislocations. Closed reduction was used in patients contraindicated for urgent surgery. Open reduction involved two anterior-only reduction techniques: modified Caspar pin kyphotic paramedian distraction and anterior facetectomy if required. Fixation was performed with anterior vertebral screw plates for C3/4, C4/5, and selected C5/6 cases, or pedicle screw plates for C6/7, C7/ T1, and C5/6 cases with severe vertebral or articular process fractures.

Results: Reduction success rates were 67% for closed reduction, 81% for the modified Caspar pin kyphotic paramedian distraction, and 100% for anterior facetectomy. No supplemental posterior surgery was required. At a minimum follow-up of 12 months, all patients achieved satisfactory fusion without implant failure. Neurological improvement of at least one American Spinal Injury Association grade was observed in 29 patients (43.9%), and no neurological deterioration occurred.

Conclusions: The anterior-only protocol, incorporating modified kyphotic paramedian distraction with Caspar pins, anterior facetectomy, and anterior pedicle screw plate fixation, is safe and effective for managing acute, delayed, and old subaxial cervical facet dislocations.

Study design: Mendelian randomization (MR) and gene-level analysis.

Purpose: To investigate the relationship between gut microbiota (GM) and spinal canal stenosis (SCS).

Overview of literature: To date, no studies have demonstrated the relationship between GM and SCS or explored its racial differences.

Methods: This study utilized summary data from publicly available, large-scale genome-wide association studies to investigate the causal relationship between GM and SCS in interracial, European, and East Asian populations using a bidirectional two-sample MR approach. Reverse MR analysis was conducted to estimate the effect of SCS on GM taxa with significant associations. Additionally, genelevel analyses-including Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction network analysis-were performed to elucidate key biological processes and hub genes involved in both GM and SCS.

Results: In the interracial population, five bacterial taxa were identified as risk factors and four as protective factors for SCS. Among Europeans, three bacterial taxa were associated with increased risk and three with reduced risk. In the East Asian population, seven bacterial taxa demonstrated protective effects, while one taxon was associated with increased risk. Sensitivity analyses revealed no evidence of heterogeneity or horizontal pleiotropy. Cross-comparisons indicated significant differences in GM profiles between European and East Asian populations. Gene-level analysis identified key GO terms, enriched KEGG pathways, and hub genes potentially mediating the relationship between GM and SCS.

Conclusion: This study identified a potential causal relationship between GM and SCS, highlighting distinct microbial and genetic mechanisms in European and East Asian populations. The findings provide novel insights into the pathogenesis, prevention, and treatment of SCS. Gene-level analyses suggest potential molecular pathways underlying the GM-SCS association, providing a foundation for future mechanistic research.

Study design: Retrospective cohort study.

Purpose: To evaluate whether intraoperative changes in T1 tilt can predict the development of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).

Overview of literature: Multiple factors have been associated with PSI, but few studies have specifically investigated intraoperative radiographic predictors, such as changes in T1 tilt, in patients with Lenke type 2 AIS.

Methods: Fifty patients (45 females, five males) who underwent posterior corrective fusion surgery for Lenke type 2 AIS with at least 2 years of follow-up were included. Radiographic parameters and health-related quality of life were evaluated preoperatively, 1 week postoperatively, and at final follow-up. Intraoperative T1 tilt and upper instrumented vertebra (UIV) tilt were measured in the prone position before and after correction. PSI was defined as radiographic shoulder height (RSH) greater than 15 mm at 1 week postoperatively. Patients were classified into PSI and non-PSI groups. Intergroup comparisons were conducted using the Mann-Whitney U test or chisquare test. Correlations of intraoperative changes in T1 tilt (ΔT1) and UIV tilt (ΔUIV) with changes in RSH (ΔRSH) and clavicle angle (ΔCA) were analyzed.

Results: Twelve patients (24.0%) had PSI at 1 week postoperatively, which persisted in five patients (10.0%) at final follow-up. Intraoperative ΔT1 and ΔUIV were significantly correlated with ΔRSH (R =0.613, p <0.001; R =0.435, p =0.002) and ΔCA (R =0.453, p =0.002; R =0.383, p =0.007). In the PSI group, ΔRSH was strongly correlated with ΔT1 (R =0.678, p =0.015).

Conclusions: Minimizing intraoperative changes in T1 tilt may help reduce the risk of PSI in Lenke type 2 AIS.

Study design: retrospective study.

Purpose: This study aimed to develop an indicator of the compensatory capacity of hip joints in response to spinopelvic mismatch using standard radiographs.

Overview of literature: EOS imaging has enabled detailed analysis of hip and lower extremity compensation in sagittal malalignment. However, its high cost and limited availability hinder widespread clinical use. Currently, there are no established indicators to assess hip compensation for spinopelvic mismatch using standard radiographs.

Methods: A total of 209 patients with osteoporosis and 54 with adult spinal deformities were included. Patients were divided into two groups based on pelvic incidence-lumbar lordosis (PI-LL): <20° and ≥20° groups. The sagittal vertical axis (SVA), thoracic kyphosis, PI, pelvic tilt (PT), LL, sacral slope, and pelvic femoral angle (PFA) were measured. Health-related quality of life (HRQOL) was assessed in 86 patients using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A new index, PFA-(PI-LL), was defined as spinopelvic-hip mismatch. Correlation coefficients were calculated for each radiographic parameter, and the coefficient of determination (R2) for the relationship of each parameter with SVA was evaluated in both groups. The correlations between SVA, PT, PI-LL, PFA-(PI-LL), and JOABPEQ domain scores were also analyzed.

Results: PI-LL correlated with PFA in the PI-LL <20° group (r=0.56, p<0.001) but not in the PI-LL ≥20° group. Among all parameters, PFA-(PI-LL) demonstrated the strongest association with SVA, indicating its superior ability to explain variations in sagittal alignment in both groups and across all patients (all patients, R2=0.77). Significant correlations were observed between the radiographic parameters and JOABPEQ scores across all domains.

Conclusions: PFA-(PI-LL), which represented spinopelvic-hip mismatch, was a reliable indicator of hip compensatory function in terms of anterior trunk inclination and HRQOL.