Clinical Spine Surgery最新文献

{"title":"The Effectiveness of Artificial Intelligence-based Pedicle Screw Trajectory Planning in Patients With Different Levels of Bone Mineral Density.","authors":"Xu Xiong, Jia-Ming Liu, William Weijia Lu, Ke-Di Yang, Huan Qi, Zhi-Li Liu, Ning Zhang, Shan-Hu Huang","doi":"10.1097/BSD.0000000000001687","DOIUrl":"10.1097/BSD.0000000000001687","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the effectiveness of pedicle screw trajectory planning based on artificial intelligence (AI) software in patients with different levels of bone mineral density (BMD).</p><p><strong>Summary of background data: </strong>AI-based pedicle screw trajectory planning has potential to improve pullout force (POF) of screws. However, there is currently no literature investigating the efficacy of AI-based pedicle screw trajectory planning in patients with different levels of BMD.</p><p><strong>Methods: </strong>The patients were divided into 5 groups (group A-E) according to their BMD. The AI software utilizes lumbar spine CT data to perform screw trajectory planning and simulate AO screw trajectories for bilateral L3-5 vertebral bodies. Both screw trajectories were subdivided into unicortical and bicortical modes. The AI software automatically calculating the POF and pullout risk of every screw trajectory. The POF and risk of screw pullout for AI-planned screw trajectories and AO standard trajectories were compared and analyzed.</p><p><strong>Results: </strong>Forty-three patients were included. For the screw sizes, AI-planned screws were greater in diameter and length than those of AO screws ( P <0.05). In groups B-E, the AI unicortical trajectories had a POF of over 200N higher than that of AO unicortical trajectories. POF was higher in all groups for the AI bicortical screw trajectories compared with the AO bicortical screw trajectories ( P <0.05). AI unicortical trajectories in groups B-E had a lower risk of screw pullout compared with that of AO unicortical trajectories ( P <0.05).</p><p><strong>Conclusions: </strong>AI unicortical screw trajectory planning for lumbar surgery in patients with BMD of 40-120 mg/cm 3 can significantly improve screw POF and reduce the risk of screw pullout.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"154-160"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119086","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":"Correction of L5 Tilt in 2-Row Vertebral Body Tethering Versus Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.","authors":"Abel De Varona-Cocero, Fares Ani, Nathan Kim, Djani Robertson, Camryn Myers, Kimberly Ashayeri, Constance Maglaras, Themistocles Protopsaltis, Juan C Rodriguez-Olaverri","doi":"10.1097/BSD.0000000000001697","DOIUrl":"10.1097/BSD.0000000000001697","url":null,"abstract":"<p><strong>Study design: </strong>Single-center retrospective cohort study.</p><p><strong>Objective: </strong>To compare the correction of fractional curve and L5 tilt in 2RVBT versus PSF with LIV in the lumbar spine.</p><p><strong>Summary of background data: </strong>Vertebral body tethering, an AIS fusion-alternative, avoids rigid constructs, allowing for lower instrumented vertebra (LIV) selection. Single-tether constructs break, but mini-open thoracoscopic assistant double-row vertebral body tethering (2RVBT) reduces this. Limited comparative studies exist with posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>Retrospective analysis of AIS correction surgeries with lumbar LIV using preoperative and minimum 2-year postoperative imaging. Patients were divided into 2RVBT or PSF groups. Data included age, Riser, UIV, LIV, instrumented levels, and revision rates. Radiographic analyses included preoperative and postoperative main curve Cobb (MCC), secondary curve Cobb (SCC), fractional curve Cobb (FCC), and L5 tilt.</p><p><strong>Results: </strong>Ninety-nine patients participated (49 in 2RVBT, 50 in PSF). Preoperatively, secondary CC differed significantly (2RVBT: 44.6±10.4 degrees vs. PSF: 39.5±11.8 degrees, P =0.026), but not L5 tilt, MCC, or FCC. Postoperatively, MCC (2RVBT: 25.7±12.3 degrees vs. PSF: 19.5±7.4 degrees, P =0.003) and SCC (2RVBT: 18.0±8.4 degrees vs. PSF: 14.5±6.6 degrees, P =0.012) varied. Preoperative to postoperative changes in MCC (2RVBT: -32.0±11.3 degrees vs. PSF: -37.2±13.3 degrees, P =0.044) and L5 tilt (-13.8±9.0 degrees vs. PSF: -8.1±6.8 degrees, P =0.001) differed. Revision rates were similar (2RVBT: 2.0%, PSF: 4.0%, P =0.57). In 2RVBT, 3 tethers broke, 1 revision occurred for a broken tether, and 1 pleural effusion needed thoracocentesis. In PSF, 1 superficial infection needed surgery, and 1 revision was for add-on phenomenon. After PSM for Lenke classification, 54 patients remained (27 in each group). At 2 years, 2RVBT showed less MCC correction (-30.8±11.8 degrees vs. -38.9±11.9 degrees, P =0.017), but greater L5 tilt correction (-14.6±10.0 degrees vs. -7.5±6.0 degrees, P =0.003).</p><p><strong>Conclusions: </strong>This study with a minimum 2-year radiographic follow-up demonstrates that 2RVBT results in greater L5 tilt correction when compared with posterior spinal fusion after PSM for Lenke classification and similar rates of revision surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E186-E192"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Table-mounted Versus Self-retaining Retraction: An Assessment of Postoperative Dysphagia Following Anterior Cervical Spine Surgery.","authors":"Athan G Zavras, Rajko S Vucicevic, Vincent P Federico, Michael T Nolte, Arash J Sayari, Nicholas A Shepard, Matthew W Colman","doi":"10.1097/BSD.0000000000001689","DOIUrl":"10.1097/BSD.0000000000001689","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To determine whether there are significant differences in postoperative dysphagia when using table-mounted versus self-retaining retractor tools.</p><p><strong>Summary of background data: </strong>Retraction of prevertebral structures during anterior cervical spine surgery (ACSS) is commonly associated with postoperative dysphagia or dysphonia. Retractors commonly used include nonfixed self-retaining retraction devices or fixed table-mounted retractor arms. However, there is a paucity of literature regarding differences in dysphagia between retractor types.</p><p><strong>Methods: </strong>Patients who underwent ACSS and adhered to a minimum of 6-month follow-up were retrospectively evaluated. Patient-reported outcomes (PROs) were compared between table-mounted and self-retaining retractor groups at the preoperative and final postoperative time points, including the SWAL-QOL survey for dysphagia. Categorical dysphagia was assessed using previously defined values for the minimum clinically important difference (MCID).</p><p><strong>Results: </strong>Overall, 117 and 75 patients received self-retaining or table-mounted retraction. Average follow-up was significantly longer in the self-retaining cohort (14.8±15.0 mo) than in the table-mounted group (9.4±7.8, P =0.005). No differences were detected in swallowing function ( P =0.918) or operative time ( P =0.436), although 3-level procedures were significantly shortened with table-mounted retraction ( P =0.005). Multivariate analysis trended toward worse swallow function with increased operative levels ( P =0.072) and increased retraction time ( P =0.054), although the retractor used did not predict swallowing function ( P =0.759). However, categorical rates of postoperative dysphagia were lower with table-mounted retraction (13.3% vs. 27.4%, P =0.033).</p><p><strong>Conclusions: </strong>There was no significant difference observed in long-term swallowing dysfunction between patients who underwent ACSS with self-retaining and table-mounted retractors, although the rate of dysphagia was lower with table-mounted retraction. In addition, the greater number of operated levels per case in the table-mounted group at a similar time suggests improved efficiency.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"141-147"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125056","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":"Community-level Socioeconomic Status Is a Poor Predictor of Outcomes Following Lumbar and Cervical Spine Surgery.","authors":"Mark J Lambrechts, Tariq Z Issa, Yunsoo Lee, Michael A McCurdy, Nicholas Siegel, Gregory R Toci, Matthew Sherman, Sydney Baker, Alexander Becsey, Alexander Christianson, Ruchir Nanavati, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1097/BSD.0000000000001676","DOIUrl":"10.1097/BSD.0000000000001676","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort study.</p><p><strong>Objective: </strong>Our objective was to compare 3 socioeconomic status (SES) indexes and evaluate associations with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion.</p><p><strong>Background data: </strong>Socioeconomic disparities affect patients' baseline health and clinical outcomes following spine surgery. It is still unclear whether community-level indexes are accurate surrogates for patients' socioeconomic status (SES) and whether they are predictive of postoperative outcomes.</p><p><strong>Methods: </strong>Adult patients undergoing ACDF (N=1189) or lumbar fusion (N=1136) from 2014 to 2020 at an urban tertiary medical center were retrospectively identified. Patient characteristics, patient-reported outcomes (PROMs), and surgical outcomes (90-day readmissions, complications, and nonhome discharge) were collected from the electronic medical record. SES was extracted from 3 indexes (Area Deprivation Index, Social Vulnerability Index, and Distressed Communities Index). Patients were classified into SES quartiles for bivariate and multivariate regression analysis. We utilized Youden's index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables.</p><p><strong>Results: </strong>Preoperatively, lumbar fusion patients in the poorest ADI community exhibited the greatest ODI ( P =0.001) and in the poorest DCI and SVI communities exhibited worse VAS back ( P <0.001 and 0.002, respectively). Preoperatively, ACDF patients in the lowest DCI community had significantly worse MCS-12, VAS neck, and NDI, and in the poorest ADI community had worse MCS-12 and NDI. There were no differences in the magnitude of improvement for any PROM. All indexes performed poorly at predicting surgical outcomes (AUC: 0.467-0.636, all P >0.05).</p><p><strong>Conclusions: </strong>Community-wide SES indexes are not accurate proxies for individual SES. While patients from poorer communities present with worse symptoms, community-level SES is not associated with overall outcomes following spine fusion. Patient-specific factors should be employed when attempting to stratify patients based on SES given the inherent limitations present with these indexes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"132-140"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799651","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 Impact of the Lowest Instrumented Vertebra on the Correction of the Minor Curve During Selective Fusion in Patients With Adolescent Idiopathic Scoliosis.","authors":"Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny","doi":"10.1097/BSD.0000000000001686","DOIUrl":"10.1097/BSD.0000000000001686","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective single-center data analysis.</p><p><strong>Objective: </strong>The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile.</p><p><strong>Summary of background data: </strong>Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate.</p><p><strong>Methods: </strong>Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed.</p><p><strong>Results: </strong>Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels ( P <0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels ( P <0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels ( P <0.01).</p><p><strong>Conclusions: </strong>Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E135-E140"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125057","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":"Endplate Degeneration and Intervertebral Vacuum Phenomenon Are Positively Correlated: A Retrospective Study in Patients Undergoing Lumbar Fusion Surgery.","authors":"Gaston Camino-Willhuber, Lukas Schönnagel, Erika Chiapparelli, Paul Kohli, Krizia Amoroso, Ali E Guven, Thomas Caffard, Gisberto Evangelisti, Bruno Verna, Jiaqi Zhu, Jennifer Shue, Gbolabo Sokunbi, William D Zelenty, Mariana Bendersky, Federico P Girardi, Andrew A Sama, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BSD.0000000000001683","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001683","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To analyze the correlation between intervertebral vacuum phenomenon (IVP) severity and total endplate damage score [total endplate score (TEPS)].</p><p><strong>Background: </strong>IVP severity and the TEPS are degenerative changes of the disc and endplate, respectively.</p><p><strong>Methods: </strong>We retrospectively analyzed a cohort of patients undergoing lumbar fusion surgery due to degenerative disease between 2013 and 2021. Computer tomography was used to classify the severity of the IVP at each lumbar level and as a combined lumbar score (Lumbar Vacuum Severity Scale). Magnetic resonance imaging was used to classify endplate degeneration by the TEPS. The correlation between the combined lumbar IVP and TEPS was analyzed through a multivariable regression model.</p><p><strong>Results: </strong>A total of 317 patients were analyzed with a median age of 63 years (interquartile range: 55-71.2), and 48.9% (n = 155) were females. In all lumbar levels, the median TEPS was 4 (interquartile range: 2-8). The severity of the TEPS was significantly associated with an increased odds ratio (OR) of having more severe IVP (OR: 1.78, 95% CI: 1.62-1.95, P < 0.001). After adjusting for multiple confounders, this relationship remained significant (OR: 1.32, 95% CI: 1.17-1.49, P < 0.001). Other independent significant influences were age (OR: 1.07, 95% CI: 1.04-1.10, P < 0.001) and the Pfirrmann grade (OR: 7.44, 95% CI: 4.40-12.58, P < 0.001). The analysis of the relationship between the combined lumbar vacuum score and lumbar endplate score was significant, with a beta-coefficient (β) of 0.24 (95% CI: 0.20-0.28, P < 0.001).</p><p><strong>Conclusion: </strong>We found a significant correlation between IVP and TEPS in patients undergoing spine fusion surgery. These results support the theory that endplate damage could play a role in the pathogenesis of IVP.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751502","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 Utility of Magnetic Resonance Imaging-based Vertebral Bone Quality Scores as a Predictor of Cage Subsidence Following Transforaminal and Posterior Lumbar Interbody Fusion.","authors":"Ara Khoylyan, Mina Y Girgis, Alex Tang, Frank Vazquez, Tan Chen","doi":"10.1097/BSD.0000000000001682","DOIUrl":"10.1097/BSD.0000000000001682","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objectives: </strong>The objectives were to determine whether vertebral bone quality (VBQ) scores are associated with interbody cage subsidence following transforaminal (TLIF) and posterior (PLIF) lumbar interbody fusions and whether there is a clinically sensitive threshold for subsidence.</p><p><strong>Background: </strong>Interbody cage subsidence following lumbar fusion is a complication that can generate poor surgical outcomes. Prior research has correlated cage subsidence with bone mineral density. VBQ scores derived from magnetic resonance imaging (MRI) have been proposed as a tool for measuring bone mineral density, offering a potential new and convenient preoperative risk assessment tool for subsidence.</p><p><strong>Methods: </strong>The study involved patients undergoing single-level PLIF or TLIF between 2007 and 2022. Exclusions were for nondegenerative diagnoses, multilevel/revision surgeries, inadequate radiographs, missing immediate postoperative radiographs, and preoperative MRI studies older than 1 year. VBQ was calculated at L1-L4 from preoperative T1-weighted MRI images. Subsidence was assessed by changes in disc height (DH; >2 mm difference) and segmental lordosis (SL; >5 degrees difference) between immediate weight-bearing postoperative and latest postoperative lateral radiographs. Statistical analysis included descriptive and inferential statistics.</p><p><strong>Results: </strong>Subsidence was observed in 27% (SL parameter) and 47% (DH parameter) of 51 total patients. VBQ scores were significantly associated with cage subsidence based on both SL (odds ratio = 7.750, P = 0.012; correlation coefficient = 0.382, P = 0.006) and DH (odds ratio = 4.074, P = 0.026; correlation coefficient = 0.258, P = 0.057) in the combined TLIF/PLIF cohorts. In the cohort of 36 patients undergoing TLIF, a VBQ of 2.70 yielded 100.0% sensitivity and 46.2% specificity in detecting subsidence with SL measurement (area under the curve = 0.812, P < 0.001) and 86.7% sensitivity and 47.6% specificity with the DH measurement (area under the curve = 0.692, P = 0.033).</p><p><strong>Conclusions: </strong>We found that MRI-based VBQ scores are effective predictors of cage subsidence following TLIF surgery. A VBQ score of 2.70 demonstrated a reliable model and high sensitivity for doing so, identifying a potential clinical threshold for preoperative subsidence risk assessment.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E145-E151"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281440","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":"Container Plasty in Advanced Painful Osteolytic Vertebral Metastases With Posterior Wall Defect: A Retrospective Observational Study.","authors":"Qingshan Liu, Yuanliang He, Xi Lei, Jun Yan, Wei Feng, Chengchui He, Xuemei Huang, Dan Cao, Yingchun Dong, Dingding Li","doi":"10.1097/BSD.0000000000001700","DOIUrl":"10.1097/BSD.0000000000001700","url":null,"abstract":"<p><strong>Study design: </strong>Review of mesh-container plasty (MCP) in osteolytic vertebral metastases.</p><p><strong>Objective: </strong>This study aims to assess the efficacy and safety of MCP in treating advanced vertebral metastases with posterior wall defects.</p><p><strong>Background: </strong>Diagnosis of vertebral metastases typically relies on the patient's tumor history, bone scans, or vertebral MRI. Surgical intervention often involves sampling vertebral body tissue for pathologic diagnosis. The revised Tokuhashi score is commonly used to predict survival time in patients with bone metastases. Outcome evaluation frequently employs the visual analog scale (VAS) and the Oswestry disability index (ODI) in assessing spinal surgery outcomes.</p><p><strong>Methods: </strong>A retrospective analysis included 111 patients treated between January 2014 and January 2018 in our hospital. Patients were categorized into 2 groups: MCP group (n=51) and PVP group (n=60). Grades based on the percentage of posterior wall defect area were established: grade I (≤25%), grade II (26% to 50%), grade III (51% to 75%), and grade IV (76% to 100%). Efficacy was assessed using VAS and ODI.</p><p><strong>Results: </strong>Both MCP and PVP groups exhibited significant pain relief and improved motor function. No significant differences were observed in VAS and ODI scores at any follow-up point ( P >0.05). In the MCP group, bone cement leakage occurred in 13 cases, with a leakage rate of 25.49%. However, none of the patients experienced clinical or neurological symptoms. In the PVP group, bone cement leakage occurred in 50% of patients, with 6 patients developing neurological symptoms. Significant differences between the groups were observed in major complications related to bone cement leakage ( P =0.03).</p><p><strong>Conclusion: </strong>MCP demonstrates efficacy in pain relief and safety in treating vertebral metastases with deficient posterior walls. It represents a promising option for spinal surgeons managing vertebral metastases with posterior wall deficiencies.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E193-E199"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of Retro-Corporeal Compressive Pathology Using Guttering Osteotomy During Anterior Cervical Discectomy and Fusion.","authors":"Dong-Ho Lee, Chang Ju Hwang, Jae Hwan Cho, Sehan Park","doi":"10.1097/BSD.0000000000001679","DOIUrl":"10.1097/BSD.0000000000001679","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>Guttering is a technique that creates a tunnel through the vertebral body adjacent to the endplate to remove compressive pathologies behind the vertebral body during anterior cervical discectomy and fusion (ACDF). In this study, we investigated cases of patients who underwent gutter-shaped osteotomy (guttering) to decompress retro-corporeal compressive lesions.</p><p><strong>Summary of background data: </strong>Retro-corporeal pathologies causing cord compression cannot be removed using conventional ACDF.</p><p><strong>Materials and methods: </strong>A total of 217 patients who underwent ACDF to treat cervical myelopathy and were followed up for ≥1 year were retrospectively reviewed. The fusion rate, subsidence, neck pain visual analog scale (VAS), arm pain VAS, and neck disability index (NDI) were assessed. Results were compared between the guttering (patients for whom guttering was performed) and nonguttering (patients for whom guttering was not performed) groups.</p><p><strong>Results: </strong>Thirty-five patients (16.1%) were included in the guttering group, while 182 patients (83.8%) were included in the nonguttering group. Fusion rates assessed by interspinous motion ( P =0.559) and bone bridging on computed tomography (CT) ( P =0.541 and 0.715, respectively) were not significantly different between the 2 groups at 1 year after surgery. Furthermore, neck pain VAS ( P =0.492), arm pain VAS ( P =0.099), and NDI ( P =1.000) 1 year after surgery did not demonstrate significant intergroup differences. All patients in the guttering group exhibited healed guttering on 1-year postsurgery CT.</p><p><strong>Conclusions: </strong>Guttering as an adjunct to ACDF could provide a more expansive workspace for complete decompression when compressive pathology extends retrocorporeal. This additional bone resection is not associated with increased pseudarthrosis or subsidence or related to aggravation of patient symptoms.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E160-E167"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361235","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 Column Support With Anterior Lumbar Interbody Fusion Cage Through Posterior Approach Maneuver: A Technical Note and Preliminary Radiologic Report.","authors":"Dae-Jean Jo, Sungsoo Bae, Jae-Hyun Park, Ho Yong Choi","doi":"10.1097/BSD.0000000000001720","DOIUrl":"10.1097/BSD.0000000000001720","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate the feasibility of anterior column support through a posterior approach using an anterior lumbar interbody fusion (ALIF) cage.</p><p><strong>Summary of background data: </strong>Anterior fusion is an effective way to maintain spinal lordosis; however, it may be technically difficult in some cases.</p><p><strong>Methods: </strong>Conventional lumbar fusion and spinal deformity correction surgeries were performed using a conventional ALIF cage with a modified extratransforaminal lumbar interbody fusion (ExTLIF). Patients with 1 or 2 fusion levels were classified into group 1, and those with spinal deformity correction were classified into group 2. Radiologic parameters were evaluated during the follow-up periods.</p><p><strong>Results: </strong>A total of 51 patients underwent this procedure. Thirty-five patients (19 male and 16 female, 69.4±9.6 y old) with 37 fusion sites were in group 1, and 16 patients (3 male and 13 female, 71.4±5.7 y old) were in group 2. The mean follow-up periods of groups 1 and 2 were 12.3±3.4 and 10.7±4.7 months, respectively. In group 1, the mean lumbar lordosis and segmental lumbar lordosis increased significantly during the last follow-up (39.9±13.0 and 20.6±6.0 degrees, respectively, both P <0.001), and the mean disc space also increased at the last follow-up ( P <0.001). The same was observed in group 2 with significant increases in the mean lumbar lordosis and segmental lumbar lordosis at the last of the follow-up period (46.8±9.3 and 16.9±8.9 degrees, respectively, both P <0.001). The disc space also increased significantly ( P <0.001). Fusion rates were 94.2% and 87.5% in groups 1 and 2, respectively, and the corresponding subsidence rates were 85.4% and 68.8%. In group 1, there was a significant correlation between subsidence and cage height ( P =0.046).</p><p><strong>Conclusion: </strong>This procedure (ExTLIF) can be applied in cases where an anterior approach is contraindicated as well as for deformity correction.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E206-E211"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675173","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}