Clinical Spine Surgery最新文献

{"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}

{"title":"Radiologic Outcomes Following All-Pedicle Screw Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients With Lenke Type 1 and 2 Curves: A Retrospective Cohort Study With Minimum Five-Year Follow-Up.","authors":"Shun Herng Tan, Chris Yin Wei Chan, Chee Kidd Chiu, Mohd Shahnaz Hassan, Mun Keong Kwan","doi":"10.1097/BSD.0000000000002149","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002149","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To evaluate the long-term clinical and radiologic outcomes of adolescent idiopathic scoliosis (AIS) patients with Lenke 1B, 1C, 2B, and 2C curves treated with selective thoracic fusion (STF) using an all-pedicle screw construct.</p><p><strong>Summary of background data: </strong>STF has been reported in the literature to achieve better perioperative outcomes, including shorter operative duration, reduced blood loss, and lower operative risks. However, complications such as coronal decompensation (CD) and the adding-on (AO) phenomenon persist, even with strict selection criteria. Long-term data on the outcomes of STF using all-pedicle screw constructs remain limited.</p><p><strong>Methods: </strong>This retrospective study included 59 AIS patients who underwent single-staged posterior spinal fusion with an all-pedicle screw construct, with a minimum follow-up of 5 years. Radiologic outcomes and SRS-22r scores were analyzed. Complications, including AO, CD, lumbar decompensation (LD), and junctional kyphosis, were assessed.</p><p><strong>Results: </strong>At a mean follow-up of 5.8 years, the main thoracic (MT) curve correction was 60.3%. Spontaneous lumbar curve correction improved from 49.9% immediately postoperatively to 53.5% at the final follow-up (P=0.046). Coronal balance (CB) shifted significantly from 1.8±12.7 mm preoperatively to -6.9±9.9 mm at the final follow-up (P<0.001). SRS-22r scores improved significantly across all domains except pain, which remained stable. AO and CD occurred in 8.5% of cases each, and LD in 1.7%, with no instances of junctional kyphosis or revision surgery.</p><p><strong>Conclusion: </strong>This study demonstrates excellent long-term correction and clinical improvement in AIS patients treated with STF using an all-pedicle screw construct.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873380","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":"Investigating the Relationship Between Glucagon-Like Peptide-1 Receptor Agonist Use and Incidence of Vertebral Fractures in Female Patients Aged Over 50 Years With Osteoporosis: A Propensity-Matched Analysis.","authors":"Kyle Stump, Sean Kelleher, Stephan Aynaszyan, Samuel Ricci, Theresa Pazionis","doi":"10.1097/BSD.0000000000002145","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002145","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To investigate the relationship between GLP-1 receptor agonist exposure and incidence of vertebral fracture and surgical intervention for these injuries in patients with osteoporosis.</p><p><strong>Summary of background data: </strong>Vertebral fractures are relatively common in patients with osteoporosis and frequently result in substantial morbidity, such as persistent pain and functional deficit. Although primarily indicated for the management of type 2 diabetes mellitus and obesity, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated positive effects on bone mineral density (BMD) in the lumbar spine. However, it remains unknown if this effect translates to positive clinical outcomes for patients with osteoporosis.</p><p><strong>Methods: </strong>This study utilized the TriNetX database to identify female patients aged over 50 years diagnosed with osteoporosis without a current pathologic fracture within the 10-year period ended January 1, 2025. The study group included patients with a history of GLP-1 RA use after osteoporosis diagnosis compared with a control group with no GLP-1 RA exposure. Cohorts were propensity-matched based on baseline demographic characteristics, BMI, HbA1c, eGFR, medical comorbidities, osteoporotic medication use, and serum calcium, phosphate, and vitamin D levels. Primary outcomes included incidence of vertebral collapse and vertebral augmentation within the 10-year study period.</p><p><strong>Results: </strong>There were 56,142 matched pairs. The rate of vertebral fracture in the experimental group was ∼1.9% compared with 4.3% in the control group (RR: 0.434, 95% CI: 0.404-0.467, P<0.001). In addition, GLP-1 RA exposure was associated with a lower incidence of kyphoplasty or vertebroplasty (RR: 0.453, 95% CI: 0.381-0.538, P<0.001).</p><p><strong>Conclusion: </strong>Glucagon-like peptide-1 receptor agonist use is associated with a lower incidence of vertebral fracture and osteoporotic fracture intervention in female patients aged 50+ with osteoporosis. These findings underscore the potential protective effects of GLP-1 receptor agonists in patients with poor bone quality.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873337","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 Outcomes Are Similar Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Systematic Review and Meta-Analysis of Studies Without Industry Influence.","authors":"Tariq Z Issa, Junho Song, Omri Maayan, Brian Cho, Yunsoo Lee, Saad B Chaudhary, Andrew C Hecht","doi":"10.1097/BSD.0000000000002141","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002141","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To compare clinical outcomes of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in studies without industry influence.</p><p><strong>Summary of background data: </strong>Both CDA and ACDF are appropriate options for cervical degenerative disc disease. However, most studies investigating this have significant industry influence due to either industry sponsorship or conflicts of interest among authors.</p><p><strong>Methods: </strong>A systematic review of all studies investigating CDA versus ACDF in the Cochrane and PubMed/EMBASE databases was performed. Studies were excluded if they were supported by industry without investigator independence, had a minimum follow-up <2 years, or were performed outside the United States or Europe. Revision rates, adjacent segment degeneration (ASD) rates, and patient-reported outcomes (PROMs), including Neck Disability Index (NDI) and visual analog scale (VAS) Neck, were extracted. Funnel plots were used to exclude biased studies for each specific outcome measure. Meta-analyses were conducted using random effects modeling and forest plot analysis.</p><p><strong>Results: </strong>Thirteen studies were included with 18,473 patients, of whom 12,270 underwent ACDF and 6203 underwent CDA. Minimum follow-up ranged from 24 to 132 months. Overall, 12/13 (92.3%) of studies were considered high quality. On random effects modeling, patients undergoing ACDF demonstrated higher rates of ASD [risk ratio (RR), 1.70; 95% CI: 1.02-2.84] but there were no differences in subsequent revision (RR, 1.29; 95% CI: 0.99-1.67), VAS Neck [(weighted mean differences (MD), 0.26; 95% CI: -0.38 to 0.90), or NDI (weighted MD, 1.81; 95% CI: -3.54 to 7.15)].</p><p><strong>Conclusions: </strong>In this first meta-analysis of all comparative studies between ACDF and CDA without industry influence, we demonstrate that despite a higher rate of ASD among patients undergoing ACDF, there are no long-term differences in revision rates or patient-reported outcomes between CDA and ACDF.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873367","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":"Role of a Novel, Fresh-Frozen Cellular Bone Allograft in Lumbar Interbody Spinal Fusion: A Retrospective, Matched-Cohort Study.","authors":"Charles P Nolte, Arjun Singh, Aaron Ishmael, Caleb Wipf, Jingdian Huang, Andriy Noshchenko, Vikas Patel","doi":"10.1097/BSD.0000000000002154","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002154","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective matched-cohort study.</p><p><strong>Objective: </strong>To evaluate the clinical efficacy, safety, and economic impact of a novel cellular bone allograft (PrimaGen Advanced Allograft; CBA-P) used in combination with recombinant human bone morphogenetic protein-2 (rhBMP-2) for short-segment lumbar interbody fusion.</p><p><strong>Summary of background data: </strong>Osteobiologic grafts are increasingly used to optimize lumbar interbody fusion outcomes. Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves fusion rates but is costly and associated with complications. Cellular bone allografts (CBAs) aim to enhance fusion by providing a bony scaffold, growth factors, and viable cells, but their clinical and economic benefit remains unclear.</p><p><strong>Methods: </strong>We retrospectively assessed 100 adults who underwent 1- or 2-level posterior or transforaminal lumbar interbody fusion between 2017 and 2023. Fifty patients received CBA-P with rhBMP-2 (experimental cohort), and 50 matched controls received rhBMP-2 with standard-of-care demineralized bone matrix and/or allograft bone powder. Matching was based on age decade, sex, and fusion level. The primary outcome was interbody fusion at 12 and 24 months, assessed using a validated radiograph measurement platform. Secondary outcomes included revision surgery, complications, pain scores, and per-case osteobiologic cost.</p><p><strong>Results: </strong>Fusion rates were similar between cohorts at 12 months (95.7% vs. 89.1%, P=0.27) and 24 months (100% vs. 89.5%, P=0.49), with comparable revision and complication rates. Estimated blood loss (364.4 vs. 232.9 mL, P<0.001) and 6-month pain scores (P=0.03) were higher in the experimental cohort. CBA-P use significantly increased per-case osteobiologic cost ($9478 vs. $5252, P<0.0001).</p><p><strong>Conclusions: </strong>Use of CBA-P with rhBMP-2 did not improve fusion rates, reduce complications, or enhance pain outcomes, yet markedly increased surgical cost. These findings do not clearly support the routine use of CBA-P alongside rhBMP-2 in short-segment lumbar interbody fusion and highlight the need for well-designed prospective studies to define its standalone clinical value.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873365","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":"Future Trends in Cervical Spinal Fusion Surgery Through 2035 Among the US Medicare Population.","authors":"Tarun Mattikalli, Matthew T Carr, Jeremy Steinberger, Konstantinos Margetis","doi":"10.1097/BSD.0000000000002152","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002152","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to forecast national trends in anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) through 2035 in the US Medicare population using comprehensive, procedure-specific modeling approaches.</p><p><strong>Summary of background data: </strong>Cervical spinal fusion is widely performed for degenerative cervical spine disease. ACDF remains the most common procedure, while PCF is indicated for multilevel disease, deformity, and revision cases. Despite the high-utilization, up-to-date, procedure-specific forecasts for the Medicare population are lacking. Updated forecasts are required to guide workforce planning, policy development, and resource allocation for an aging population.</p><p><strong>Methods: </strong>National Medicare Part B data were analyzed from 2005 to 2022 to identify ACDF and PCF procedures using Current Procedural Terminology (CPT) codes. Procedure volumes were adjusted for Medicare Advantage enrollment. Ordinary least squares (OLS) regression models were developed to project volumes through 2035, excluding data from 2020 and 2021 to minimize bias from COVID-19-related disruptions. Model performance was assessed using R2, slope estimates, and 5-fold cross-validation.</p><p><strong>Results: </strong>Estimated ACDF volumes increased from 57,765 in 2011 to 101,019 in 2022. ACDF volumes are projected to increase to about 170,102 procedures by 2035 (95% CI: 139,912-200,291). Estimated PCF volumes increased from 9659 in 2005 to 42,400 in 2022 and are projected to reach 68,901 procedures by 2035 (95% CI: 66,108-71,693). The models demonstrated strong fit for both procedures (ACDF R2=0.8382, PCF R2=0.9892).</p><p><strong>Conclusions: </strong>National volumes of cervical spinal fusion are expected to continue rising through 2035 among Medicare beneficiaries. These trends likely reflect an aging population, broader surgical indications, and the continued shift toward outpatient spine surgery. Our findings have important implications for surgical workforce needs, reimbursement policy, and resource allocation across inpatient and ambulatory care settings.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873413","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":"Revisiting the Incidence and Risk Factors for Cervical Postlaminectomy Kyphosis: A Systematic Review.","authors":"Takashi Hirase, Colten Rowan, Thomas Jacob, Max Sadlowski, Sree M Vemu, Austin Nguyen, Gregory S Kazarian, Kevin J DiSilvestro, Rex A W Marco, Todd J Albert, Han J Kim","doi":"10.1097/BSD.0000000000002146","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002146","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To perform a systematic review that investigates the incidence and risk factors for cervical postlaminectomy kyphosis.</p><p><strong>Summary of background data: </strong>There is a wide range of incidences and risk factors for cervical postlaminectomy kyphosis reported within the literature. Definitive recommendations on indications and technical considerations to minimize this complication remain elusive.</p><p><strong>Methods: </strong>A systematic review was registered with PROSPERO and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All level I-III evidence studies investigating radiologic outcomes after cervical laminectomy for compressive pathology of the cervical spine were included.</p><p><strong>Results: </strong>Twenty studies with 1538 patients (1007 males, 531 females) were included. Extensive laminectomy (≥4 laminae) was performed in 746 patients (48.5%), selective laminectomy (<4 laminae) in 275 patients (17.9%), and skip laminectomy in 43 patients (2.8%). A non-muscle-sparing technique was performed in 726 patients (47.2%) and a partial or complete interspinales and/or semispinalis cervicis muscle-sparing technique was performed in 338 patients (22.0%). Postoperative radiologic follow-up was available in 1198 patients (77.9%). Patients undergoing extensive laminectomy had a significantly higher rate of postlaminectomy kyphosis compared with selective or skip laminectomy (15.3% vs. 3.5%, P<0.001). Patients undergoing non-muscle-sparing laminectomy also had a higher rate of postlaminectomy kyphosis at final follow-up compared with partial or complete muscle-sparing laminectomy (13.8% vs. 5.3%, P<0.001).</p><p><strong>Conclusions: </strong>The incidence of cervical postlaminectomy kyphosis varies widely, and the risk factors are multifactorial. Performing selective laminectomies and maximally preserving the attachments of the interspinales and/or semispinalis cervicis may be important considerations for preventing this complication.</p><p><strong>Levels of evidence: </strong>Level III-systematic review of level I-III studies.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839379","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":"Implications of Trauma in Patients With Cervical Ossification of the Posterior Longitudinal Ligament (OPLL).","authors":"Madhusudhan Nagesh, Rakesh K Mishra, Abhijit Goyal-Honavar, Nishanth Sadashiva, Andiperumal R Prabhuraj, Manish Beniwal, Gyani J S Birua, Nupur Pruthi","doi":"10.1097/BSD.0000000000002153","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002153","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Cervical ossification of the posterior longitudinal ligament (OPLL) is a well-established cause of degenerative myelopathy. The objective of this study was to compare the clinical outcomes of patients with cervical OPLL who underwent surgery, with and without a history of trauma.</p><p><strong>Summary of background data: </strong>Literature on the impact of OPLL on neurological recovery following cervical spine injury is conflicting. While some suggest an association between the presence of OPLL and neurological deterioration following trivial trauma, others have argued that OPLL does not affect neurological outcomes initially or at discharge. The correlation of clinical outcomes with preoperative radiologic features is also unclear.</p><p><strong>Methods: </strong>A retrospective analysis was performed of 61 patients who underwent posterior cervical approach and decompressive cervical laminectomy (without fusion) for cervical OPLL between January 2015 and December 2018 in a tertiary neurosurgical referral center. Seventeen patients had a history of antecedent trauma, while 44 did not. Patient demographics, clinical outcomes [modified Japanese Orthopedic Association score (mJOA) and Nurick grade], radiologic features, and parameters associated with recovery were analyzed and compared among the groups.</p><p><strong>Results: </strong>Male patients were predominant in both groups, and the mean age of presentation was slightly lower in the trauma group. The trauma group had lower pre- and postoperative mJOA scores. The length of high signal intensity (HIS) observed in T2-weighted sagittal MRI was longer in the trauma group. Significant recovery (defined as a recovery rate >50%) was significantly more frequent in the nontrauma group (35 patients, 79.5%) compared with the trauma group (2 patients, 11.76%) (P=0.007).</p><p><strong>Conclusion: </strong>Patients with OPLL with a history of trauma more frequently harbor radiologic changes associated with myelopathy, with lower preoperative mJOA scores, and have a lower rate of significant recovery following surgery than those without a history of trauma.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817364","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}