Clinical Spine Surgery最新文献

{"title":"Prevalence and Risk Factors of Perceived Stress in Elderly Patients With Osteoporotic Fractures of Spine.","authors":"Huang Fang, Rui He","doi":"10.1097/BSD.0000000000001817","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001817","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the point prevalence and risk factors of perceived stress in elderly patients with osteoporotic spinal fractures.</p><p><strong>Summary of background data: </strong>Osteoporotic fractures, common in the elderly, are often complicated by stress-related psychological factors, which can affect recovery outcomes. However, the specific impact of perceived stress on these fractures remains underexplored.</p><p><strong>Methods: </strong>This study included 190 elderly patients with osteoporotic spinal fractures, of whom 43 (22.6%) were diagnosed with perceived stress and 147 (77.4%) were in the nonperceived stress group at The First Affiliated Hospital of the University of Science and Technology of China between January 1, 2020 and September 20, 2021. Patients were assessed for perceived stress using the Chinese 14-item Perceived Stress Scale (PSS). Sociodemographic and disease characteristics were evaluated, and the incidence of refracture and kyphosis was compared between patients with and without perceived stress. Statistical analyses included χ2 tests and binary logistic regression.</p><p><strong>Results: </strong>Univariate analysis identified pain, gender, living alone, personality type, monthly family income, and prognosis expectations as significant factors associated with perceived stress (P<0.05). Multivariate analysis indicated that living alone (OR=321.176, 95% CI: 41.489-2486.319), low monthly family income (OR=291.667, 95% CI: 28.645-2969.798), introversion (OR=356.188, 95% CI: 72.770-1743.438), poor prognosis expectations (OR=2.791, 95% CI: 0.745-10.457), traumatic history (OR=194.750, 95% CI: 42.492-892.579), and intense pain (OR=6.857, 95% CI: 3.458-13.598) were significant risk factors (OR>1) for perceived stress. Patients with perceived stress had a higher incidence of refracture and kyphosis (P<0.05).</p><p><strong>Conclusions: </strong>Female gender, living alone, low family income, introversion, intense pain, and poor prognosis expectations are significant risk factors for perceived stress in elderly patients with osteoporotic fractures. Perceived stress is also linked to a higher incidence of local kyphosis and refractures. Individualized treatment plans integrating psychosocial care are essential for optimizing recovery in this patient population.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955664","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":"Clinical Efficacy of Posterior and Combined Posterior-Anterior Surgical Approaches for Intractable Tuberculous Thoracolumbar Kyphosis: A Retrospective Analysis.","authors":"Maierdanjiang Maihemuti, Junshen Wu, Zhibing Dai, Aierpati Maimaiti, Renbing Jiang","doi":"10.1097/BSD.0000000000001829","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001829","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective, single-center study.</p><p><strong>Objective: </strong>To evaluate the effectiveness of posterior and combined posterior-anterior surgical approaches for treating intractable tuberculous thoracolumbar kyphosis.</p><p><strong>Summary of background data: </strong>Intractable spinal tuberculosis, though rare, poses significant therapeutic challenges. Its management is complex and remains a subject of debate.</p><p><strong>Methods: </strong>We analyzed 63 cases of intractable tuberculous thoracolumbar kyphosis retrospectively. The evaluation criteria included clinical symptoms, kyphotic angle correction rate, sagittal vertebral axis (SVA), operative time, intraoperative bleeding, and surgical complications. Functional assessments were conducted using the American Spinal Injury Association (ASIA) spinal cord injury classification, the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Kirkaldy-Willis functional score. Fusion success was determined by the Eck fusion grading scale.</p><p><strong>Results: </strong>All patients with bone grafting achieved grade I fusion. The preoperative kyphotic angles were 59.4±12.6 degrees and 102.9±16.6 degrees, and the improved postoperative kyphotic angles were 19.9±6.2 degrees and 28.5±9.6 degrees, with correction rates of 65.5%±12.0% and 72.0%±9.5%, respectively. The preoperative SVA were 27.6±10.7 and 39.1±18.6 mm, which postoperatively improved to 20.6±9.0 and 26.4±12.1 mm. The Kirkaldy-Willis functional scores were 89.7% and 85.3%. No tuberculosis recurrence, internal fixation loosening, and obvious loss of correction were found during the follow-up period.</p><p><strong>Conclusions: </strong>Posterior surgery is effective for mild cases, while combined posterior-anterior surgery is necessary for severe cases, offering a safe and reliable treatment approach.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977526","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":"Postoperative Footdrop Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications.","authors":"Manjot Singh, Ashley Knebel, Negin Fani, Michael Farias, Joseph Nassar, Jeremy Heard, Eren O Kuris, Bryce A Basques, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BSD.0000000000001831","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001831","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess the epidemiology, procedural risk factors, and associated complications of postoperative footdrop following posterior lumbar fusion.</p><p><strong>Summary of background data: </strong>Footdrop is an uncommon complication following spine surgery that is associated with functional impairments. Understanding the epidemiology and risk factors of postoperative footdrop may allow for early implementation of preventive measures before and during surgery.</p><p><strong>Methods: </strong>Adults who underwent posterior lumbar fusion were identified using PearlDiver. Eligible patients were stratified by the development of footdrop within 90 days of surgery. Epidemiological trends in footdrop were evaluated by age groups and year between 2010 and 2022. Patient demographics, comorbidities, procedural characteristics, hospital outcomes, and occurrence of intraoperative and postoperative complications were compared.</p><p><strong>Results: </strong>In total, 2988 (0.6%) footdrop and 473,129 (99.4%) no footdrop patients were included, with a mean age of 60.9 years and 57.6% female sex. Postoperative footdrop rates increased from 0.4% to 0.8% between 2010 to 2022 and increased with age. Preoperatively, footdrop patients more frequently reported prior posterior spine surgery and medical comorbidities (all P<0.05). Intraoperatively, they had higher rates of 2 or more level fusion, osteotomy, dural tear, and nerve injury (all P<0.01). Postoperatively, they had higher rates of acute kidney injury, deep venous thrombosis, urinary tract infection, wound-related, hematoma, transfusion, and site-related complications, as well as higher rates of 90-day readmissions (all P<0.001).</p><p><strong>Conclusion: </strong>Patients developing footdrop following lumbar spinal fusion were older, had more comorbidities, and frequently underwent complex multilevel procedures. They also had other postoperative complications, higher hospital readmissions, and increased health care expenditures. This data provides valuable insights into the risk factors and associated adverse outcomes for postoperative footdrop after lumbar spinal fusion.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984793","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":"Type 2 Odontoid Fractures: Atlantodental Arthrosis as a Novel Risk Factor for Failure of Conservative Management.","authors":"Ashley W Zheng, Pratheek Makineni, Taylor Paziuk, Tyler W Henry, Terence L Thomas, Alec M Giakas, Jonathan Belding, Michael Kelly, Timothy Moore","doi":"10.1097/BSD.0000000000001827","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001827","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Objective: </strong>The purpose of this study is to assess how the presence and grade of atlantodental arthrosis impact outcomes of nonoperatively managed type 2 odontoid fractures.</p><p><strong>Summary of background data: </strong>The nonoperative management of geriatric type 2 odontoid fractures requires consideration of all potential variables that may influence outcomes. The presence of underlying atlantodental arthrosis can create a more rigid lever arm adjacent to the fracture site inducing greater biomechanical strain on an already tenuous healing environment.</p><p><strong>Methods: </strong>Eighty-one patients with traumatic type 2 odontoid fractures managed nonoperatively were included, with an average follow-up of 180 days after injury. Radiographic evaluation was performed to identify the presence and severity of atlantodental arthrosis on computed tomography (CT) imaging at the time of injury. Electronic medical records were reviewed to report patient demographics, fracture characteristics, and treatment outcomes. The relationship between atlantodental arthrosis and failure of conservative management was primarily assessed.</p><p><strong>Results: </strong>Patients who failed conservative treatment were more likely to have an atlantodental arthrosis grade >2 (P<0.001) and increased posterior displacement on index imaging (P=0.008). Following multivariable regression, grade 3 (OR: 4.4, 95% CI: 1.6-11.9, P=0.004) and grade 4 arthrosis (OR: 13.9, 95% CI: 1.5-127.9, P=0.02) were independently associated with an increased risk for failing conservative management.</p><p><strong>Conclusions: </strong>The present findings identify the presence of atlantodental arthrosis as a risk factor for treatment failure in conservatively managed geriatric type 2 odontoid fractures. Future prospective studies are necessary to further elucidate the prognostic value of arthrosis severity in determining optimal treatment strategies.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987583","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":"Radiation Exposure and Dose Estimates of Robot-Guided Versus Fluoroscopy-Guided Spinal Fusion: A Meta-Analysis of Randomized Controlled Trials.","authors":"Jordan J Levett, Abdulrhman Alnasser, Uri Barak, Lior M Elkaim, Thien Sa Hoang, Naif M Alotaibi, Daipayan Guha, Isaac L Moss, Alexander G Weil, Michael H Weber","doi":"10.1097/BSD.0000000000001820","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001820","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Summary of background data: </strong>Robot-guided (RG) pedicle screw placement offers several advantages over fluoroscopy-guided (FG) surgery to patients undergoing spinal fusion. Radiation exposure and detrimental risks associated with RG surgery are poorly described in the literature.</p><p><strong>Objectives: </strong>We perform a systematic review and meta-analysis of randomized controlled trials comparing RG to FG spinal fusion to assess radiation exposure to patients and clinicians.</p><p><strong>Methods: </strong>MEDLINE, Embase, Web of Science, and Cochrane Central were systematically queried. Inclusion was restricted to RCTs in adults. Version 2 of the Cochrane risk-of-bias tool for RCTs (RoB 2) was used to evaluate risk of bias and quality was appraised using the GRADE assessment tool. Continuous data were pooled across trials with inverse variance weighting to mean difference (MD) and dichotomous data were pooled with Mantel-Haenszel weighting to odds ratio (OR) with corresponding 95% CI.</p><p><strong>Results: </strong>A total of 1042 patients (RG: 651; FG: 391) from 8 RCTs were included. Radiation time was reduced in the RG group by 39.6% (MD: -25.65 seconds, 95% CI: -51.07 to -0.22) with an estimated anteroposterior and lateral dose-area product in the RG group measuring 123.85±73.12 and 241.08±142.33 cGycm2, respectively. Estimated cancer risk and detrimental hereditary disorder risk were reduced by 40.2% in the RG group (3.60×10-5±2.12×10-5 and 1.31×10-6±7.72×10-7, respectively). Intraoperative bleeding volume was reduced in the RG group (MD: -61.52 mL, 95% CI: -100.16 to -22.87, P=0.002, I2=48%). However, surgical duration was significantly higher in the RG group (MD: 12.01 min, 95% CI: 1.63-22.39). Pedicle screw accuracy and length of hospital stay differences were not significant.</p><p><strong>Conclusions: </strong>Radiation exposure to patients undergoing spinal fusion is lower in RG surgery compared with FG surgery. These findings can be supported with long-term studies that better characterize radiation dosages associated with these procedures.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993392","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":"Assessment of Bilateral Pedicle Root Puncture Vertebral Fissure Expansion Percutaneous Kyphoplasty for the Treatment of Kümmell Disease.","authors":"Sheng Chang, Yu Wang, Shuai Cheng, Yong-Bin Wang, Yong Liu, Jian-Wei Guo","doi":"10.1097/BSD.0000000000001813","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001813","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of clinical efficacy.</p><p><strong>Objective: </strong>To assess the clinical efficacy of bilateral pedicle root puncture vertebral fissure expansion percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease (KD).</p><p><strong>Summary of background data: </strong>KD is a challenging condition characterized by delayed healing of a vertebral compression fracture, often leading to chronic pain and disability. Traditional treatments may not provide optimal outcomes, necessitating new interventional approaches.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 56 patients, each with a single vertebra affected by KD. The bilateral pedicle root puncture vertebral fissure expansion PKP technique was used to treat these patients. In this procedure, a balloon was used to expand the vertebral fissure at the interface between the fissure within the vertebral body and the adjacent cancellous bone, facilitating the anchoring of bone cement at this junction. This allowed for the diffusion of cement into the fissure cavity and surrounding areas. Surgical outcomes were systematically observed and documented, including assessments of pain levels, quality of life, and vertebral recovery both preoperatively and postoperatively at intervals of 1 day, 3 months, 6 months, and 12 months.</p><p><strong>Results: </strong>All patients exhibited significant improvement in clinical status and imaging outcomes, with no indications of cement loosening or displacement. Significant alleviation of back pain symptoms was observed, as demonstrated by reductions in scores on the visual analog scale (VAS) and Oswestry disability index (ODI), along with improved anterior vertebral body height, wedging angle, hyperextension segmental angle, and Cobb angle at both postoperative and final follow-up assessments (P<0.05).</p><p><strong>Conclusion: </strong>The application of bilateral pedicle root puncture vertebral fissure expansion PKP in treating KD reduces the risks associated with cement leakage, displacement, and loosening. This technique achieves an extensive and 3-dimensional distribution of cement, thereby enhancing the stability of the fractured vertebrae.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980506","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":"Implant Migration After Anterior Cervical Spine Surgery: A Systematic Literature Review.","authors":"Darlington Nwaudo, Audrey Litvak, Mostafa El Dafrawy","doi":"10.1097/BSD.0000000000001826","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001826","url":null,"abstract":"<p><strong>Study design: </strong>Systematic literature review.</p><p><strong>Objective: </strong>To summarize the demographics, diagnosis, clinical course, management, and outcomes for implant migration after anterior cervical spine surgery.</p><p><strong>Summary of background data: </strong>Implant migration following anterior cervical spine surgery is a rare event that may predispose patients to high morbidity due to the proximity of cervical implants to critical structures. Due to the infrequency of this complication, most of the literature on this topic is described in case reports or series.</p><p><strong>Methods: </strong>We screened the PubMed database for relevant publications from January 1975 to December 2023 using the terms: (screw OR hardware OR plate OR implant OR instrumentation) AND (pull-out OR migration OR displacement OR erosion OR perforation) AND (anterior cervical OR ACDF OR ACCF). The PRISMA systematic review template guided the identification and screening of full-text articles in English.</p><p><strong>Results: </strong>Fifty-five studies with 76 patients were included. The median age was 50.0 (32.0, 60.0) years, with a median time-to-diagnosis of 15 months (2.0, 60.8). Seventy-five percent were symptomatic, while 20% were asymptomatic. Common symptoms included dysphagia (54%), neck pain (22%), and fever or cervical abscess (13%). Treatments included complete implant removal (59%), partial removal (20%), spontaneous gastrointestinal elimination (11%), and retention of all instrumentation (5%). In addition, 25% underwent revision spinal fusion. Sixty-one percent experienced major complications (eg, perforation, fistula, abscess). However, 84% had resolution of symptoms without further treatment at the most recent follow-up.</p><p><strong>Conclusions: </strong>Implant migration after anterior cervical spine surgery is rare yet may occur many years after a patient's initial surgery without heralding symptoms. For this reason, surgeons should consider extended routine follow-up with radiographic imaging in these patients, for the first 5 years postoperatively since this complication transpired most frequently within this time frame. We recommend an individualized, patient-centered approach for radiographic follow-up to balance the risk of unnecessary radiation exposure in addition to practical risks like travel-related accidents. Extended routine follow-up may be most beneficial for patients with identified risk factors for late complications or early migration, that is, complex deformity or poor bone quality.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984500","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":"Odontoid Parameters in Adolescent Idiopathic Scoliosis Patients.","authors":"Qiong-Run Xiao, Long-Ao Huang, Ke-Lin Li, Yu-Wang Du, Xiao Liang, Chong-Yang Wang, Hua Jiang","doi":"10.1097/BSD.0000000000001823","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001823","url":null,"abstract":"<p><strong>Study design: </strong>This was a retrospective study.</p><p><strong>Objective: </strong>The purposes of this study were to compare the characteristics of odontoid parameters between subjects with and without adolescent idiopathic scoliosis (AIS) and to investigate the correlation between odontoid parameters and other cervical sagittal parameters.</p><p><strong>Summary of background data: </strong>Previous studies have shown that odontoid parameters are important parameters related to cervical sagittal alignment. However, there are few reports on odontoid parameters in patients with AIS.</p><p><strong>Materials and methods: </strong>Between November 2022 and November 2023, 42 AIS patients (AIS group) underwent standing erect whole-spine posteroanterior and lateral full-spine digital radiography. Correspondingly, 28 sex- and age-matched normal adolescents (control group) were enrolled. Odontoid parameters and other cervical sagittal parameters, including odontoid incidence (OI), odontoid tilt (OT), C2 slope (C2S), T1 slope (T1S), C0-2 angle, C2-7 angle (CL), and T1S-CL, were measured via standing plain radiographs. Pearson correlation and linear regression were used to compare the sagittal parameters between the 2 groups.</p><p><strong>Results: </strong>There were no significant differences between the 2 groups in terms of cervical sagittal parameters, including OI, OT, C2S, C0-2 angle, or T1S-CL. After Bonferroni correction, in the AIS group, OI was significantly correlated with C2S (r=0.37, P<0.05) and T1S-CL (r=0.34, P<0.05). OI matched with the C0-2 angle (r2=0.081), and T1S-CL (r2=0.093). In the control group, after Bonferroni correction, OI was significantly correlated with C2S (r=0.49, P<0.01) and T1S-CL (r=0.40, P<0.05). OI matched with T1S-CL (r2=0.130).</p><p><strong>Conclusions: </strong>OI is a constant cervical anatomic parameter closely related to other cervical sagittal parameters and was not affected by adolescent idiopathic scoliosis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962395","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":"Adaptation of the Lumbar Spine From Orthostasis to Supine.","authors":"Eduardo Sávio de Oliveira Mariúba, Lidia Raquel de Carvalho, Mauro Dos Santos Volpi, Rui Seabra Ferreira Junior, Marcone Lima Sobreira","doi":"10.1097/BSD.0000000000001808","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001808","url":null,"abstract":"<p><strong>Study design: </strong>Observational-ecologic study.</p><p><strong>Introduction: </strong>Spine and pelvis undergo modifications in alignment so that the individual can maintain an orthostatic position, but to date there is no evidence as to the contribution of each lumbar segment and the change that occurs in them when moving from orthostasis to supine position.</p><p><strong>Objective: </strong>To identify the difference in the contribution of the lumbar segments and pelvis to the formation of lumbar lordosis in both positions (orthostasis and supine) and how each one alters in this change.</p><p><strong>Summary of background data: </strong>lumbar lordosis adapts to the individual's body position and can be physiological or pathologic.</p><p><strong>Materials and methods: </strong>Retrospective cohort study that included 174 patients: the segments total lumbar lordosis (LL), L1-L4, L4-S1, L4-L5, L5-S1, and sacral slope were measured on x-rays (orthostasis) and MRI (supine). We obtained the mean values, correlations and models proposed for the relationship between the values found.</p><p><strong>Results: </strong>The SS, LL, L1-L4, L4-S1, and L4-L5 had their angular value reduced, and L5-S1 had its contribution to lordosis significantly increased when lying down. Moderate and strong correlations were obtained between SS × LL, L1-L4 and L4-S1, and between LL versus L1-L4 and L4-S1 in both positions. When using linear regression, proposed models were obtained with a high coefficient of determination between LL versus SS, L1-L4 and L4-S1 in orthostasis, for the same measurements and SS versus L4-S1 in supine, as well as for lordosis when comparing the 2 positions.</p><p><strong>Conclusions: </strong>The L5-S1 segment has no change in angular value when lying in supine and is thus the largest contributor to lordosis in supine. L1-L4 increases its angular value when standing in orthostasis, the position in which it is the greatest contributor to lordosis.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981649","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":"The Influence of Paraspinal Sarcopenia on Patient-Reported Outcomes Following Lumbar Fusion.","authors":"Robert J Oris, Jacob R Staub, Rushmin Khazanchi, Anitesh Bajaj, Jeremy Marx, Tyler Compton, Jae Jang, Shyam Chandrasekar, Abhinav Balu, Alpesh A Patel, Wellington K Hsu, Srikanth N Divi","doi":"10.1097/BSD.0000000000001815","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001815","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To analyze the ability of various quantitative, MRI-based measures of spine-specific sarcopenia to predict patient-reported outcomes following lumbar fusion surgery.</p><p><strong>Summary of background data: </strong>Sarcopenia is an established risk factor for poor outcomes and complications in spine surgery. However, a lack of consensus exists on how to optimally quantify paraspinal sarcopenia for outcome prediction. Furthermore, few studies have investigated the ability of MRI-based measures of sarcopenia to predict Patient-Reported Outcome Measure Information System (PROMIS), physical function (PF), and pain interference (PI) scores after lumbar fusion surgery.</p><p><strong>Methods: </strong>Included patients underwent lumbar fusion surgery at a single, tertiary academic center and had a lumbar MRI within 1 year before surgery. Demographic factors were collected, and lumbar paraspinal muscle (ie, multifidus, psoas, and erector spinae) cross-sectional area (CSA) and fatty infiltration (FI) were measured by 2 reviewers. All variables were compared on bivariable and multivariable analyses between patients who did versus did not meet a minimum clinically important difference (MCID) of 8 on PROMIS-PF and PROMIS-PI scores.</p><p><strong>Results: </strong>Of the 87 patients who met inclusion criteria, 59 patients met MCID for physical function (PF) while 57 patients met MCID for pain interference (PI). Bivariable analysis revealed no differences in demographic variables or CSA between MCID and non-MCID groups. Psoas FI demonstrated a trend towards significance for PROMIS-PF [MCID: 8.37 (±5.45) vs. non-MCID: 10.9 (±6.03), P=0.055], and baseline PROMIS-PI scores were higher in patients that met MCID for PROMIS-PI [67.2 (±4.79) vs. 62.9 (±7.78), P=0.005]. With multivariable analysis controlling for confounders, increasing psoas FI lowered the odds of meeting PROMIS-PF MCID (OR=0.90, P=0.033, 95% CI=0.82-0.99).</p><p><strong>Conclusions: </strong>Patients with increased psoas FI were less likely to see improvements in physical function after controlling for comorbidity burden and frailty. However, the effect size was relatively small.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967969","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}