Clinical Spine Surgery最新文献

{"title":"Medial Pedicle Wall Referencing Extra-pedicular (EP) Screw Insertion Technique in Narrow Dysplastic Pedicles During Posterior Spinal Fusion (PSF) in Adolescent Idiopathic Scoliosis (AIS) Patients.","authors":"Saturveithan Chandirasegaran, Chris Yin Wei Chan, Chee Kidd Chiu, Mun Keong Kwan","doi":"10.1097/BSD.0000000000002161","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002161","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To describe technique of medial pedicle wall referencing extra-pedicular (EP) screw insertion method. To compare the EP chord length of this technique with the conventional technique in adolescent idiopathic scoliosis (AIS) patients and report the accuracy of this technique based on computed tomography (CT) assessment.</p><p><strong>Summary of background data: </strong>Conventional EP screw technique has a high medial convergence angle, which increases the difficulty of entry into vertebral body, increasing the risk of anterior perforations. Lateral entry point requires more extensive dissection. A lateral starting point leads to malalignment of the screw heads when placed next to intra-pedicular screws.</p><p><strong>Methods: </strong>A total of 103 AIS patients who had undergone posterior spinal fusion (PSF) from 2018 to 2023 were recruited. A total of 2472 thoracic pedicles were analyzed on preoperative CT scans and the pedicle morphometry were classified based on the Chiu et al classification. The EP chord length of both techniques was measured for narrow dysplastic pedicles (grade C and D). Postoperative CT scans were used to assess for medial perforations (Gertzbein and Robbins classification modified by Rao et al) and anterior perforations (Hansen-Algenstaedt et al grading) .</p><p><strong>Results: </strong>The longest chord length in conventional technique was in left T8 (53.7±3.5 mm) and T9 (53.7±3.7 mm) versus medial pedicle referencing technique which recorded 38.6±3.2 mm and 38.3±3.2 mm, respectively (P<0.001). A total of 434 EP screws were inserted using this technique in narrow dysplastic pedicles. The prevalence of grade 1 medial perforations were 11.3% and for grade 1 anterior perforations were 4.1%. There were only 0.7% grade 2 (critical) perforations [medial: 0.2%, anterior: 0.5%]. None of the perforations were symptomatic and no grade 3 perforations were observed.</p><p><strong>Conclusion: </strong>The medial pedicle wall referencing EP screw technique is a safe alternative method, especially in narrow dysplastic pedicles. This technique has a shorter chord length and a less convergent trajectory with an acceptable critical perforation rate (0.7%).</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Skip Laminectomy and Laminoplasty in the Lower Cervical Spine: An Experimental Study Using a Sheep Model.","authors":"Mert Arslan, Can Şensöğüt, Taner Arslan, Buğra Hüsemoğlu, Ceren Kizmazoglu, Ahmet Karakaşlı, Murat Yılmaz","doi":"10.1097/BSD.0000000000002159","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002159","url":null,"abstract":"<p><strong>Study design: </strong>Controlled experimental biomechanical study using a sheep cervical spine model.</p><p><strong>Objective: </strong>To biomechanically evaluate and compare skip laminectomy and laminoplasty in the lower cervical spine, focusing on their influence on spinal stability.</p><p><strong>Summary of background data: </strong>Skip laminectomy and laminoplasty are 2 posterior cervical surgical techniques widely used for spinal canal decompression. Although their clinical outcomes have been compared, no previous study has biomechanically analyzed and compared these techniques in the cervical region.</p><p><strong>Methods: </strong>Twenty-eight C2-T1 cervical spine specimens obtained from merino sheep were used in this study. Seven specimens underwent preliminary fracture testing to establish nondestructive loading parameters. The remaining specimens were assigned to 3 groups: intact control, laminoplasty, and skip laminectomy (n=7 per group). Bone mineral density (BMD) was measured to ensure baseline equivalence across specimens. Biomechanical testing was performed using an electromechanical actuator to evaluate displacement during flexion, extension, lateral bending, and axial rotation under standardized loading conditions. Statistical analysis was conducted to compare biomechanical behavior among the groups.</p><p><strong>Results: </strong>No statistically significant differences were observed among the control, laminoplasty, and skip laminectomy groups with respect to displacement during flexion (P=0.755), extension (P=0.546), right lateral bending (P=0.359), left lateral bending (P=0.415), or axial rotation (P=0.690). Both surgical techniques demonstrated biomechanical behavior comparable to that of intact cervical spine specimens under the tested loading conditions.</p><p><strong>Conclusion: </strong>This study represents, to our knowledge, the first direct biomechanical comparison of skip laminectomy and laminoplasty in the cervical spine. Both procedures preserved immediate postoperative mechanical stability in this experimental ovine model, with no significant biomechanical differences identified between the techniques. Further biomechanical and long-term clinical studies are needed to determine the clinical relevance of these findings.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Global Upper Extremity Function Before and After Decompressive Surgery in Patients With Degenerative Cervical Myelopathy (DCM).","authors":"Angie Zhang Lung, John Hong, Vicky Chan, Maya N Hatch, Jay J Han, Yu-Po Lee, Nitin N Bhatia, Michael Oh","doi":"10.1097/BSD.0000000000002151","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002151","url":null,"abstract":"<p><strong>Study design: </strong>A total of 20 patients with degenerative cervical myelopathy (DCM) and a plan for surgical decompression were recruited in this pilot study to assess a new outcome measure. Patients were evaluated preoperatively and 3 months, 6 months, and 1 year postoperatively using a 3-dimensional motion-tracking application (reachable workspace) to calculate an upper extremity (UE) relative surface area (RSA) and standard measurements [modified Japanese Orthopedic Association (mJOA), 12-Item Short Form Health Survey (SF-12), and visual analog pain (VAP) score]. Baseline demographic data were collected.</p><p><strong>Objective: </strong>To assess the validity and comparativeness of a new measurement tool in DCM.</p><p><strong>Summary of background data: </strong>Currently, no universally accepted outcome measure exists for DCM. Traditionally used assessment scales are subjective and lack sensitivity. The reachable workspace, a graphical representation of UE spatial surface area using motion-sensor technology, can be used as an objective adjuvant assessment tool in DCM.</p><p><strong>Methods: </strong>The Welch t test was performed to assess UE RSA differences between DCM patients and healthy controls (HC). Concurrent validity and effect size of the RSA were compared to the standard measurements. A P=0.05 was accepted as statistically significant.</p><p><strong>Results: </strong>DCM patients had significantly reduced RSA of all quadrants compared to controls, with the largest reductions in the upper quadrants (P<0.0001). Total RSA was significantly associated with total mJOA score (ρ=0.48, P<0.0001), upper extremity mJOA score (ρ=0.44, P<0.0002), VAP score during movement (ρ=-0.40, P<0.0007), and the SF-12 mental component (ρ=0.34, P<0.005). Patients with symptoms <1 year before surgery showed improved function via significant increases in total RSA and mJOA score. A stronger effect size was seen with RSA.</p><p><strong>Conclusion: </strong>The reachable workspace shows potential to track DCM UE function with accuracy, reliability, and sensitivity to change. Given the promise of this pilot study, a larger study to increase power and substantiate our results will be performed in the future.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Sagittal Spinopelvic Parameters and Clinical Outcomes After Minimally Invasive Versus Open Fusion in Mild Isthmic Lumbar Spondylolisthesis.","authors":"Zhongzheng Sun, Qiquan Hao, Kai Sun, Janlei Hou","doi":"10.1097/BSD.0000000000002162","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002162","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Objective: </strong>This study evaluated the radiologic and clinical outcomes of minimally invasive versus open fusion surgery using a computer-assisted image analysis tool.</p><p><strong>Background: </strong>Lumbar spondylolisthesis, isthmic in nature, tends to interfere with sagittal balance and results in chronic back pain and disability. Operationally, the primary aim is to correct sagittal imbalance and restore functional stability.</p><p><strong>Methods: </strong>Patients with single-level mild isthmic lumbar spondylolisthesis who underwent treatment with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or open posterior lumbar fusion were evaluated retrospectively. Sagittal spinopelvic parameters, such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), disc height (DH), and spondylolisthesis degree (SD), were measured preoperatively and postoperatively at 3 months with quantitative image-processing software. Functional outcomes were assessed using the Oswestry Disability Index (ODI), and the connection between radiographic and clinical changes was analyzed.</p><p><strong>Results: </strong>Both methods significantly restored PT, SS, LL, DH, and SD (all P=0.021-0.038), without changing PI (P=0.412). Greater restoration of LL and DH was associated with improved ODI scores (r=0.64 and 0.59; P=0.001 and 0.003, respectively). Clinical outcomes were comparable between groups (P=0.284); however, the minimally invasive group demonstrated shorter hospital stay and faster early recovery (P=0.018). Quantitative imaging showed high reproducibility (ICC=0.93).</p><p><strong>Conclusion: </strong>Minimally invasive and open fusion methods both restored sagittal spinopelvic parameters and improved functional outcome in mild isthmic spondylolisthesis. Minimally invasive fusion provided similar radiographic correction at decreased perioperative morbidity. Quantitative image-based evaluation offers a consistent method for assessing spinal alignment and improving surgical planning.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Epidural Lipomatosis: Are Its Prevalence and Severity Increasing.","authors":"Jennifer A Reilly, Charles Edwards, Timothy Edwards, Michael Edwards, Brianna N Hebeka, Charles C Edwards","doi":"10.1097/BSD.0000000000002156","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002156","url":null,"abstract":"<p><strong>Study design: </strong>Nonrandomized, quantitative study.</p><p><strong>Objective: </strong>The goal of this study is to determine whether the prevalence and severity of spinal epidural lipomatosis (SEL) in patients undergoing lumbar spine decompression surgery have increased over the past decade.</p><p><strong>Summary of background data: </strong>There are no reports on whether the incidence of symptomatic spinal stenosis due to epidural lipomatosis has changed over time. This study assesses whether the prevalence and characteristics of spinal epidural lipomatosis have changed over 10 years.</p><p><strong>Methods: </strong>This retrospective cohort study assesses consecutive patients who underwent lumbar decompression surgery (laminotomy/laminectomy, with or without fusion) for treatment of degenerative stenosis in the calendar years of 2013 and 2023 by a single surgeon. Patient demographic factors, surgical details, SEL grade, body mass index, and smoking status were analyzed. Statistical analyses were conducted using the χ2 tests to compare demographic and surgical variables. Binary logistic regressions were used to model the prediction of SEL, adjusting for age, BMI, and smoking status.</p><p><strong>Results: </strong>The prevalence of SEL at multiple levels in the lumbar spine increased significantly from 2013-2023, rising from 47.5%-63% (P=0.028). Elevated Body Mass Index (BMI) was associated with an increased odds of SEL (OR=1.03, P=0.021). Cigarette smoking had a significant association with higher SEL grades, including a 3-fold increase in odds for SEL ≥60%.</p><p><strong>Conclusions: </strong>This study found a significant increase in multilevel SEL involvement from 2013-2023. Smoking and elevated BMI were associated with significantly increased odds of SEL, underscoring their impact as modifiable risk factors. These results support continued efforts to minimize smoking and obesity, while suggesting that additional, unmeasured factors may also be contributing to the increased prevalence of SEL over time.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Foraminotomy for Cervical Radiculopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"José O D Tomé, Rafael C de Souza, Wilker H de Oliveira, Bruno V Motter, Guilherme Foizer, André E M César, Luciano M R Rodrigues","doi":"10.1097/BSD.0000000000002136","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002136","url":null,"abstract":"<p><strong>Study design: </strong>Meta-analysis of randomized controlled trials.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of ACDF versus PCF for the treatment of cervical radiculopathy.</p><p><strong>Summary of background data: </strong>ACDF is widely regarded as the standard surgical treatment for cervical radiculopathy, providing reliable symptom relief but carrying risks such as adjacent segment disease, pseudoarthrosis, and implant-related complications. PCF represents a motion-preserving alternative that avoids anterior approach-related morbidity. Despite existing comparative studies, the optimal surgical approach remains controversial.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials comparing ACDF and PCF for cervical radiculopathy. The primary outcome was clinical efficacy assessed using the Odom criteria. Secondary outcomes included perioperative complications, revision surgery, and treatment satisfaction. Pooled analyses were performed using random-effects models, and heterogeneity was assessed with the I2 statistic.</p><p><strong>Results: </strong>Five randomized controlled trials involving 568 patients were included, with 284 patients (50%) undergoing ACDF. Mean follow-up ranged from 12 to 50.4 months. There was no significant difference between ACDF and PCF in the proportion of patients achieving excellent or good outcomes according to the Odom criteria (OR: 1.18; 95% CI: 0.48-2.87; P=0.72). Perioperative complication rates (OR: 0.43; 95% CI: 0.10-1.76; P=0.24), revision surgery rates (OR: 1.39; 95% CI: 0.66-2.94; P=0.39), and treatment satisfaction (OR: 0.88; 95% CI: 0.54-1.37; P=0.62) were also comparable between groups.</p><p><strong>Conclusion: </strong>This meta-analysis of randomized controlled trials demonstrates no significant differences between ACDF and PCF in terms of clinical efficacy, safety, revision surgery, or patient satisfaction for cervical radiculopathy. Given its motion-preserving nature and avoidance of anterior approach-related complications, PCF remains a valid surgical alternative in selected patients.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Adding a Cross-Link During Single-Level Lumbar Interbody Fusion for Degenerative Lumbar Spine Diseases: A Computed Tomography-Based Analysis.","authors":"Koichiro Shima, Bungo Otsuki, Koichi Murata, Takayoshi Shimizu, Takashi Sono, Shintaro Honda, Masaki Sakamoto, Takaki Yoshiyama, Ryohei Saito, Shuichi Matsuda","doi":"10.1097/BSD.0000000000002157","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002157","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>To evaluate whether adding cross-links during single-level lumbar interbody fusion (LIF) improves fusion rates, segmental alignment, and clinical outcomes.</p><p><strong>Summary of background data: </strong>Biomechanical studies suggest cross-links enhance rotational stability in single-level posterior lumbar interbody fusion, but clinical evidence for their benefit in degenerative lumbar spine diseases remains limited. No previous clinical study has investigated how cross-link addition affects LIF outcomes.</p><p><strong>Methods: </strong>One hundred thirty-one patients underwent single-level LIF for degenerative lumbar spine diseases (2012-2022) and were categorized into cross-link (CL, n=64) and non-cross-link (NCL, n=67) groups. Researchers assessed CT-based fusion parameters (interbody and facet fusion rates), segmental alignment measurements (segmental lordosis, disk height, and coronal tilt), and clinical outcomes (JOA and VAS scores) over a minimum 1-year follow-up. Propensity score matching minimized selection bias.</p><p><strong>Results: </strong>One-year interbody fusion rates were comparable between groups (CL: 72.1% vs. NCL: 69.1%, P=0.839). No significant differences were found in facet fusion rates (CL: 37.7% vs. NCL: 30.9%, P=0.558), pedicle screw loosening (CL: 8.2% vs. NCL: 16.4%, P=0.254), or cage subsidence (CL: 9.8% vs. NCL: 9.1%, P=1.000). Clinical outcomes improved similarly in both groups based on final JOA scores (CL: 26.0±6.8 vs. NCL: 25.3±4.3, P=0.47) and VAS back pain scores (CL: 21.8±20.8 vs. NCL: 22.9±22.7, P=0.79). Propensity score-matched analysis of 32 patients per group confirmed these findings.</p><p><strong>Conclusions: </strong>Routine use of cross-link in single-level LIF does not improve radiographic or clinical outcomes after 1 year. A selective approach could reduce costs while maintaining excellent patient outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biportal Endoscopic Cervical Laminectomy for Cervical Myelopathy: Clinical and Radiographic Short-Term Analysis.","authors":"Jueun Kim, Maximillian Y Lee, Daniel K Park","doi":"10.1097/BSD.0000000000002158","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002158","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>To analyze the clinical and radiologic outcomes of biportal endoscopic cervical laminectomy (BECL) for cervical myelopathy.</p><p><strong>Summary of background: </strong>Cervical myelopathy is a progressive disease caused by spinal cord compression that significantly impacts quality of life. While open posterior surgeries have been utilized, they carry risks such as postoperative instability, kyphosis, and muscle damage. BECL has emerged as a minimally invasive technique designed to minimize damage.</p><p><strong>Methods: </strong>Fifteen patients without cervical kyphosis or segmental instability underwent BECL for myelopathy. The endoscopic approach was designed to preserve the multifidus muscle. Clinical outcomes were measured using the Neck Disability Index (NDI) and Visual Analog Scale (VAS) preoperatively and at least 1-year postoperatively. Radiologic outcomes were assessed to evaluate changes in alignment.</p><p><strong>Results: </strong>The mean follow-up period was 18.9±4.4 months. All clinical outcomes showed statistically significant improvement (P<0.05). VAS Neck, VAS Arm, and NDI all demonstrated clinical improvement. Radiologically, there were no statistically significant changes in sagittal alignment.</p><p><strong>Conclusion: </strong>In appropriately selected patients, BECL is a safe and effective alternative treatment for myelopathy. It provides excellent clinical outcomes for pain relief and functional recovery while preserving preoperative cervical sagittal alignment in the short term.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Paraspinal Muscle Atrophy Is Associated With Internal Carotid Artery Stenosis.","authors":"Bruno Verna, Ali E Guven, Marco D Burkhard, Erika Chiapparelli, Anna-Maria Mielke, Vidushi Tripathi, Thomas Caffard, Artine Arzani, Jiaqi Zhu, Jennifer Shue, John A Carrino, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BSD.0000000000002155","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002155","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Objective: </strong>The objective of our study is to assess the relationship between carotid artery stenosis (CAS) and muscle morphology.</p><p><strong>Summary of background data: </strong>Paraspinal muscle degeneration, marked by fatty infiltration (FI) and reduced functional cross-sectional area (fCSA), contributes to spine instability, chronic pain, and disc degeneration. While abdominal aortic calcification is linked to lumbar muscle atrophy, cervical vascular-muscle associations remain underexplored.</p><p><strong>Methods: </strong>Sixty-five patients undergoing primary cervical spine surgery between 2009 and 2018 with preoperative cervical MRI and CTA exams (≤12 mo apart) were included. T2-weighted axial MRIs at C3 were used to measure FI and fCSA in 5 bilateral muscle groups: sternocleidomastoid (SCM), anterior, posteromedial (PM), posterolateral (PL), and trapezius (TP). Carotid stenosis was measured on CTA using semiautomated software. Correlations between muscle parameters and stenosis were analyzed with Spearman correlation and multivariable regression, adjusted for age, BMI, and sex.</p><p><strong>Results: </strong>Mean stenosis was significantly associated with FI in all muscle groups, including SCM (P=0.001), anterior (P=0.022), PL (P=0.031), PM (P=0.003), and TP (P=0.001). Maximum stenosis was associated with reduced fCSA in SCM (P=0.032) and anterior (P=0.032), as well as FI in SCM (P=0.005), TP (P=0.006), and PM (P=0.001).</p><p><strong>Conclusions: </strong>This is the first study linking CAS with cervical muscle atrophy, pointing toward vascular health's potential role in muscle degeneration and the need for further research into vascular and musculoskeletal health interplay.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Clinical Implications of Vitamin D Deficiency in Spine Surgery Patients: A Large-Scale Clinical Study.","authors":"Guoping Xu, Huanting Hu, Lihong Lai, Jiajiang Jiang, Li Li, Ying Ren, Zhan Wang","doi":"10.1097/BSD.0000000000002163","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002163","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To determine the prevalence of vitamin D deficiency in patients undergoing spine surgery and to evaluate its distribution across demographic characteristics, bone mineral density (BMD), and spine disease categories. A secondary objective was to examine the associations between serum 25-hydroxyvitamin D (25(OH)D) levels and bone turnover markers (BTMs).</p><p><strong>Summary of background data: </strong>Vitamin D is essential for musculoskeletal health. Although previous studies have reported a high prevalence of vitamin D deficiency among patients undergoing spinal surgery, most have been limited by small sample sizes, and large-scale investigations remain scarce.</p><p><strong>Methods: </strong>Patients aged ≥40 years who underwent spine surgery between January 2021 and March 2024 were retrospectively reviewed. Preoperative evaluation included BMD measured by dual-energy X-ray absorptiometry and serum measurements of 25(OH)D and BTMs, including β-cross-linked C-telopeptide of type I collagen (β-CTX), procollagen type I N-terminal propeptide (PINP), and osteocalcin. Patients were stratified by age, sex, BMD status, and spine disease category. The correlation between serum 25(OH)D and BTMs was evaluated.</p><p><strong>Results: </strong>A total of 1388 patients were included. Vitamin D deficiency was present in 43.4% of patients, and 39.2% had insufficient levels. Deficiency was more common in females (50.1%) than males (29.9%) and was most prevalent among patients aged 40-59 years. Patients with osteoporosis had the lowest mean 25(OH)D levels and the highest β-CTX, PINP, and osteocalcin levels. Among disease categories, patients with osteoporotic vertebral fractures showed the lowest vitamin D levels and the highest β-CTX and PINP levels. Serum 25(OH)D levels were negatively correlated with β-CTX and PINP.</p><p><strong>Conclusions: </strong>Vitamin D deficiency remains highly prevalent among patients undergoing spine surgery, particularly in females and younger individuals. Lower vitamin D levels are associated with increased bone turnover activity, suggesting that routine assessment and management of vitamin D status may help optimize bone health.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}