Clinical Spine Surgery最新文献

{"title":"270-Degree Decompression, Fixation, and Realignment in a Neglected Cervical Facet Dislocation : A Case Report.","authors":"Ahmed J Zahrani, Menatalla Metwally Said ElBadawy, Amgad M Elshoeibi, Nouf Alenazi, Mohamed M Aly","doi":"10.1097/BSD.0000000000002144","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002144","url":null,"abstract":"<p><strong>Study design: </strong>Case report.</p><p><strong>Objective: </strong>To describe the surgical strategy and clinical outcome of a single-session 270-degree decompression, fixation, and realignment procedure for a neglected subaxial cervical facet dislocation.</p><p><strong>Summary of background data: </strong>Neglected cervical facet dislocations are rare but challenging injuries that often present with chronic pain, neurological deficit, and fixed kyphotic deformity. Delayed management is complicated by facet fusion, spinal cord compression, and loss of reduction potential, frequently necessitating complex circumferential reconstruction strategies.</p><p><strong>Methods: </strong>A 22-year-old male presented 1 year after a road traffic accident with persistent neck pain, radiculopathy, bilateral upper limb weakness, and gait imbalance. Computed tomography and magnetic resonance imaging demonstrated C3-C4 anterolisthesis with right-sided facet fusion, a locked facet on the left, and severe canal stenosis with cord compression and cord signal changes. Under neurophysiological monitoring, a single-session circumferential \"270 degrees\" procedure was performed: posterior partial facetectomy and unilateral lateral mass screw fixation, followed by anterior C4 corpectomy, decompression, cage insertion with plating, and completion of posterior rod fixation for definitive stabilization and realignment.</p><p><strong>Results: </strong>The patient tolerated the procedure without intraoperative complications. Postoperatively, he experienced marked improvement in radicular pain, handgrip strength, and gait stability. Follow-up radiographs confirmed restoration of cervical alignment and correction of lordosis, and he continued to demonstrate neurological recovery with a structured rehabilitation program. At 3-year follow-up, the patient remained neurologically intact with mild intermittent neck pain and stable radiographic alignment.</p><p><strong>Conclusions: </strong>A carefully planned single-stage 270-degree decompression and fusion strategy can provide effective neural decompression, correction of deformity, and restoration of mechanical stability in neglected cervical facet dislocations, enabling meaningful neurological recovery. Early recognition and careful preoperative planning of circumferential surgery are particularly important in settings where delayed presentation is common.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839346","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":"Association Between Lumbar Muscle Function and Reoperation in Patients With Recurrent Lumbar Disc Herniation After Percutaneous Endoscopic Lumbar Discectomy.","authors":"Xin-Hui Xie, Xue-Song Ren, Shi-Jie Zheng, Xiao-Zhi Sun, Cong Zhang, Su-Yang Zhuang, Zheng-Ming Shan","doi":"10.1097/BSD.0000000000002147","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002147","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective matched case-control study.</p><p><strong>Objective: </strong>To investigate whether lumbar muscle function is associated with reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH).</p><p><strong>Summary of background data: </strong>In addition to established risk factors, paraspinal muscle quality, which is measured by cross-sectional area (CSA) and fatty infiltration (FI), is related to lumbar degeneration but remains unknown as a predictor for rLDH recurrence after PELD.</p><p><strong>Methods: </strong>Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. On T2 axial preoperative magnetic resonance images (MRI) at the L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 disc levels, a transformer-based segmentation algorithm was used to contour the psoas major (PS), multifidus (MF), and erector spinae (ES) muscles. The CSA of each muscle was subsequently calculated, and the Otsu method was applied to discriminate between muscle and fat tissue, thereby enabling quantitative assessment of FI. Statistical methods were used to compare whether there were statistical differences between the case and control groups. Spearman correlation analysis was performed.</p><p><strong>Results: </strong>A total of 2603 patients were enrolled in this study. Fifty-seven patients underwent reoperation for rLDH, and 57 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Statistical analysis revealed significant differences between the case and control groups in: the CSA of PS at L3-L4 (P=0.041), L4-L5 (P=0.036), and L5-S1 (P=0.044); the CSA of ES at L1-L2 (P=0.049) and L2-L3 (P=0.026); and the FI of all muscles at all disc levels, except PS at L1-L2 (P=0.602) and ES at L1-L2 (P=0.227).</p><p><strong>Conclusion: </strong>This study showed that lumbar muscle function is associated with reoperation in rLDH patients after PELD. Smaller CSA and higher FI of core lumbar muscles were associated with an increased likelihood of rLDH after PELD.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839302","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 Hemipelvectomy and Hip Disarticulation on Lumbar Bone and Muscle Quality.","authors":"Hannah A Levy, Caden Messer, Marisa N Ulrich, Sarah Padilla, Bradford Currier, Ahmad N Nassr, Brett A Freedman, Melvin Helgeson, Matthew Houdek, Fantley Smither, Brian A Karamian, Arjun S Sebastian","doi":"10.1097/BSD.0000000000002133","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002133","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective.</p><p><strong>Objective: </strong>To examine the long-term perioperative changes in lumbar bone quality, paraspinal muscle size and fat content, and facet degeneration after hemipelvectomy (HP) and hip disarticulation (HD).</p><p><strong>Summary of background data: </strong>Emerging evidence shows that transfemoral (TFA) and transtibial (TTA) amputations may accelerate lumbar modic changes and precipitate axial back pain. TFA and TTA amputation studies demonstrate that the severity of postamputation lower back pain is associated with the amputation type (TFA > TTA) and the degree of alteration in lumbopelvic kinematics.</p><p><strong>Methods: </strong>All patients who underwent HP or HD for malignancy or infection at an academic center between 2003 and 2022 were retrospectively identified. Preoperative to postoperative changes in multifidus, erector spinae, quadratus lumborum, and psoas cross-sectional area (CSA), and Hounsfield units (HU) were calculated on CT for the amputated and contralateral side at the level of the L3-4 disc space. Paired univariate analysis was utilized to compare preoperative and postoperative outcomes.</p><p><strong>Results: </strong>A total of 16 patients (8 HP, 8 HD) met the inclusion/exclusion criteria. The preoperative to postoperative changes in HUs in the L1, L3, and L5 vertebral bodies were -27.0 (P=0.004), -51.5 (P=0.002), and -48.1 (P=0.001), respectively. The decrease in L1 HU was greater for prosthesis nonusers (user: -16.50, nonuser: -51.32, P=0.021). L5-S1 segment facet degeneration increased postoperatively (P=0.030, n=7 progressed). There were significant preoperative to postoperative changes in psoas CSA (preop: 1063.4, postop: 586.5, P=0.005) and psoas HU (preop: 50.95, postop: 33.55, P<0.001) on the amputated but not the contralateral side.</p><p><strong>Conclusion: </strong>Hind-quarter amputations were associated with decreased lumbar bone quality, progression of facet degeneration, and loss of amputated side psoas muscle tone. Daily prosthesis use was moderately protective for lumbar bone quality following amputation. HP but not HD was associated with postoperative loss of amputated side quadratus lumborum tone.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839389","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":"Preoperative Selective Serotonin Reuptake Inhibitor (SSRI) Use Is Associated With Pseudoarthrosis and Increased Opioid Utilization Across Anterior and Posterior Cervical Spine Fusion: A Propensity-Matched Cohort Analysis.","authors":"Ahmed Manzoor, Ameera Syed, Mohammed Ali Khan, Eduardo Espiridion","doi":"10.1097/BSD.0000000000002138","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002138","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Objective: </strong>To evaluate the association between preoperative SSRI use and postoperative outcomes after anterior and posterior cervical spinal fusion.</p><p><strong>Summary of background data: </strong>Psychiatric comorbidities are common among patients with cervical spine pathology, and general antidepressant use has been associated with perioperative complications in spine surgery. However, the effect of SSRI exposure on outcomes after anterior and posterior cervical fusion has not been well defined.</p><p><strong>Methods: </strong>Patients undergoing anterior or posterior cervical fusion were identified using a large, multi-institutional database. Patients with documented SSRI use within 1 year before surgery were compared with matched controls without SSRI exposure. Propensity 1:1 score matching was performed for demographics, psychiatric diagnoses, medical comorbidities, and concurrent use of other antidepressants and gabapentinoids. Outcomes within 1 year of surgery included pseudoarthrosis, postoperative hematoma or seroma, surgical exploration, incision and drainage, infection, and postoperative opioid utilization. Risk differences and risk ratios were calculated after matching.</p><p><strong>Results: </strong>For anterior cervical fusion (N=9790 matched per group), SSRI use was associated with increased risk of pseudarthrosis (+0.9%, P=0.032) and postoperative opioid utilization (+23.9%, P<0.001), whereas risks of hematoma, exploration, incision and drainage, and infection were not significantly different. For posterior cervical fusion (N=3085 matched per group), SSRI use was associated with greater pseudoarthrosis (+2.1%, P=0.015) and strongly associated with elevated postoperative opioid use (+41.6%, P<0.001), but no significant differences were observed in the other outcome measures.</p><p><strong>Conclusions: </strong>Preoperative SSRI use is associated with an increased risk of pseudoarthrosis and significantly higher postoperative opioid use after both anterior and posterior cervical fusion. These risks appear consistent across surgical approaches and should be considered during preoperative counseling and postoperative pain management.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839441","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":"Delayed Cerebrospinal Fluid Leakage With Central Nervous System Infection Following Posterior Cervical Laminectomy: A Case Report and Review of Literature.","authors":"Dapeng Bi, Jianbang Han, Jiang Jiang, Yingfeng Wang","doi":"10.1097/BSD.0000000000002148","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002148","url":null,"abstract":"<p><strong>Study design: </strong>Case report and literature review.</p><p><strong>Objective: </strong>To report a rare case of delayed cerebrospinal fluid leakage complicated by central nervous system infection following posterior cervical laminectomy, and to elucidate the associated diagnostic and management challenges.</p><p><strong>Background: </strong>Acute cerebrospinal fluid (CSF) leakage is a recognized complication of posterior cervical spine surgery, whereas delayed CSF leakage remains exceedingly rare. When delayed CSF leakage coincides with central nervous system infection, delayed diagnosis may lead to catastrophic outcomes. We describe an unusual case of this complication following a cervical laminectomy.</p><p><strong>Methods: </strong>A 60-year-old male underwent a posterior cervical C3-5 laminectomy and decompression with lateral mass screw-rod fixation for traumatic cervical spinal cord injury and multilevel cervical spinal stenosis. Postoperatively, he developed fever, cervicodorsal pain, and headache. The diagnostic workup consisted of magnetic resonance imaging, cerebrospinal fluid analysis, and microbial culture.</p><p><strong>Results: </strong>Magnetic resonance imaging revealed a fluid collection at the surgical site, and cerebrospinal fluid analysis confirmed bacterial meningitis caused by Enterobacter aerogenes. The patient achieved complete neurological recovery following combined antimicrobial therapy and lumbar cistern drainage.</p><p><strong>Conclusion: </strong>This case highlights that nonspecific symptoms such as orthostatic headache and fever, emerging more than 48 hours postoperatively-even in the absence of an intraoperative dural tear-should raise suspicion for delayed cerebrospinal fluid (CSF) leakage with central nervous system infection. Definitive diagnosis requires prompt magnetic resonance imaging and CSF analysis. Early intervention with targeted antibiotics and lumbar cistern drainage is essential for optimal outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839396","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":"Comparison of Posterior Instrumentation With and Without Interbody Fusion for Degenerative Spinal Stenosis.","authors":"Çağrı Özcan, Ömer Polat, Halid Şafak, Elif R Cadircibasi, Bahattin Kemah, Serdar K Çepni","doi":"10.1097/BSD.0000000000002150","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002150","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective comparative cohort study.</p><p><strong>Objectives: </strong>The aim of this study was to compare the radiologic and functional outcomes of patients undergoing short-segment instrumentation for lumbar spinal stenosis, specifically those treated with posterior instrumentation and decompression alone versus those treated with posterior instrumentation, decompression, and transforaminal lumbar interbody fusion (TLIF).</p><p><strong>Summary of background data: </strong>TLIF is often added to improve stability and fusion in lumbar spinal stenosis surgery. However, the additional clinical benefit of TLIF in short-segment degenerative lumbar stenosis remains controversial due to its association with increased operating time and perioperative morbidity.</p><p><strong>Methods: </strong>Twenty-four underwent TLIF in combination with posterior spinal instrumentation (PSI), whereas 26 received only PSI and decompression. Surgical duration, postoperative complications, symptom duration, intrahospital blood transfusion requirements, complications, radiologic images and fusion levels were retrospectively analyzed. The ODI and VAS scores were evaluated preoperatively and at the final follow-up.</p><p><strong>Results: </strong>There were no statistically significant differences between the groups in terms of age, symptom duration, follow-up, preoperative or postoperative VAS and ODI scores, ASA scores, complication, number of fusions, or length of hospital stay. However, the operative duration was significantly longer and blood transfusion rates were significantly higher in the TLIF group than in the control group (P<0.05).</p><p><strong>Conclusion: </strong>PSI with TLIF provides superior radiologic fusion outcomes in short-segment spinal stenosis surgery but does not offer a clear clinical advantage over PSI with decompression. Furthermore, it may result in longer operative duration, greater intraoperative blood loss, and may contribute to higher hospital costs.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839381","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":"Human Versus Machine: Concordance and Conflict in Spinal Metastasis Management.","authors":"Elie Najjar, Rawan Masarwa, Ahmed A Hassan, Sotiris Karatzoglou, Rodrigo Muscogliati, Khalid Salem, Nasir A Quraishi","doi":"10.1097/BSD.0000000000002135","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002135","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective concordance analysis.</p><p><strong>Objective: </strong>To evaluate the concordance between ChatGPT-4 and a spinal multidisciplinary team (MDT) in management decisions for metastatic spinal disease and to explore the potential role of large language models (LLMs) as decision-support tools in oncologic spine care.</p><p><strong>Summary of background data: </strong>Management of metastatic spinal disease requires multidisciplinary input balancing neurological preservation, mechanical stability, and systemic prognosis. Frameworks such as the Spine Instability Neoplastic Score (SINS) and the NOMS model guide decisions, but variability persists. Artificial intelligence tools like ChatGPT may standardize reasoning, yet their concordance with expert MDTs remains unexplored in this context.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 100 anonymized adult cases referred to a spinal MDT for spinal metastases with suspected instability or metastatic spinal cord compression (MSCC). Ten additional cases were used to calibrate the model input. Each case summary, including demographics, tumor histology, SINS, Karnofsky Performance Scale, and Tokuhashi estimates, was presented identically to ChatGPT-4 (OpenAI, March 2025 snapshot) and the MDT. Management recommendations: surgical versus palliative (noncurative therapy including radiotherapy, systemic treatment, or best supportive care) were compared using Cohen κ, and discordant cases underwent qualitative analysis.</p><p><strong>Results: </strong>ChatGPT and the MDT were concordant in 86% of cases (κ=0.66, P<0.001), indicating substantial agreement. Concordant recommendations included surgery in 26% and palliative care in 60%. Discordance occurred in 14% of cases, typically involving younger patients or rare tumor histologies. ChatGPT emphasized mechanical instability and high SINS scores, whereas the MDT weighted systemic prognosis more heavily.</p><p><strong>Conclusions: </strong>ChatGPT-4 achieved substantial concordance with expert MDT decision-making in metastatic spinal disease. While it aligned well in structurally clear-cut cases, discordance in prognostically complex scenarios underscores the need for prognosis-aware, dynamically validated AI models. These findings support AI as an adjunct-not a replacement-for multidisciplinary clinical workflows.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Cervical Discectomy and Fusion Achieves Outcomes Comparable to Laminoplasty in Patients With Spinal Cord-Canal Mismatch.","authors":"Dong-Ho Lee, Sehan Park, Myeong G Song, Chang J Hwang, Jae H Cho","doi":"10.1097/BSD.0000000000002139","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002139","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To compare the clinical and radiographic outcomes of anterior cervical discectomy and fusion (ACDF) and laminoplasty in patients with cervical myelopathy complicated by spinal cord-canal mismatch (SCCM).</p><p><strong>Summary of background data: </strong>SCCM, defined by a high spinal cord occupation ratio (SCOR), represents a congenital or developmental stenosis that may complicate surgical decision-making. Although laminoplasty provides indirect posterior decompression, ACDF offers direct ventral decompression and correction of local alignment. Comparative evidence in patients with SCCM-related myelopathy remains limited.</p><p><strong>Methods: </strong>A retrospective review was conducted of 323 patients who underwent ACDF and 244 who underwent laminoplasty between 2014 and 2020. Patients with SCOR ≥0.7 on magnetic resonance imaging and a minimum 2-year follow-up were included. Clinical outcomes included the Japanese Orthopaedic Association (JOA) score, recovery rate, and Visual Analog Scale (VAS) for neck and arm pain. Radiographic parameters (C2-C7 sagittal vertical axis, cervical lordosis) and incidence of adjacent segment degeneration (ASD) were analyzed.</p><p><strong>Results: </strong>Thirty-nine ACDF and 22 laminoplasty patients met the inclusion criteria. Baseline demographics were comparable, except for a higher prevalence of hypertension and more operated levels in the laminoplasty group. Both procedures significantly improved JOA scores with no difference in recovery rate (P=0.901). Neck and arm pain improved significantly after ACDF but not after laminoplasty, although between-group differences were not significant. Radiographic parameters were similar at follow-up. Symptomatic ASD occurred in 20.5% of patients with ACDF and in none after laminoplasty (P=0.079). Neither SCOR nor surgical approach independently predicted neurological recovery.</p><p><strong>Conclusions: </strong>ACDF and laminoplasty achieved comparable neurological recovery in SCCM-related myelopathy. Laminoplasty may reduce ASD risk, whereas ACDF yields comparable outcomes when decompression is sufficient. SCCM alone should not contraindicate anterior surgery; approach selection should consider alignment, pathology, and symptoms.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817303","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":"Randomized Controlled Trials on Thoracolumbar Burst Fracture Management Are Statistically Fragile: A Systematic Review.","authors":"Junho Song, Julian V Javier, Ramone M Brown, Reginald M Brewster, Avanish Yendluri, Nikan K Namiri, John J Corvi, Samuel K Cho, Saad Chaudhary, Andrew C Hecht","doi":"10.1097/BSD.0000000000002140","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002140","url":null,"abstract":"<p><strong>Study design: </strong>Statistical fragility analysis.</p><p><strong>Objective: </strong>The management of thoracolumbar burst fractures (TLBFs) is challenging, and many surgeons rely on randomized controlled trials (RCTs) to inform decision-making. RCTs often report P-values, which may not fully reflect statistical robustness. This study utilizes fragility statistics to assess the reliability of RCTs evaluating TLBF outcomes.</p><p><strong>Summary of background data: </strong>Thoracolumbar burst fracture management remains controversial. Surgeons often rely on RCTs, though P-values alone may not reflect the reliability of the results. Fragility analysis offers deeper insight into the robustness of reported outcomes, yet its use in TLBF research remains limited.</p><p><strong>Methods: </strong>RCTs assessing TLBF management outcomes (2014-2024) were identified through PubMed, Embase, and Medline. Fragility index (FI) and reverse FI (rFI) were calculated as the number of events required to reverse the significance for significant and nonsignificant outcomes, respectively. Fragility quotient (FQ) was derived by dividing FI by the sample size. Subgroup analyses included pain, function, complications, perioperative metrics, and radiographic outcomes.</p><p><strong>Results: </strong>Of the 1073 studies screened, 22 RCTs were included, yielding 179 outcomes (114 continuous and 65 dichotomous). The median FI was 6 [Interquartile Range (IQR) 3-15], indicating that a median of 6 patient reversals changes statistical significance. The median FQ was 0.13 (IQR=0.08-0.24). Subgroup analyses demonstrated median FQs of 6 for pain (IQR=3-12), 6 for function (IQR=3-9), 4 for postoperative complications (IQR=2.75-6), 7 for intraoperative complications (IQR=7-7), 16 for perioperative metrics (IQR=10-20), and 5 for radiographic outcomes (IQR=2-8).</p><p><strong>Conclusions: </strong>Outcomes reported in RCTs evaluating TLBF management are statistically fragile, with an overall fragility quotient of 0.13. The significance of radiographic outcomes can be altered by as few as 6 event reversals. Reporting fragility metrics alongside P-values is recommended to improve the interpretation of RCT results and enable better-informed surgical decisions.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817445","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":"Quantitative Paraspinal Muscle Morphology and Risk of 90-Day Complications After Lumbar Instrumentation Surgery.","authors":"Mustafa Bulut, Muhammed Furkan Darılmaz, Serkan Güler","doi":"10.1097/BSD.0000000000002143","DOIUrl":"https://doi.org/10.1097/BSD.0000000000002143","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the association between paraspinal muscle morphology and postoperative complications after lumbar instrumentation surgery for degenerative lumbar spine disease.</p><p><strong>Summary of background data: </strong>Paraspinal muscle degeneration may influence outcomes after lumbar spine surgery; however, quantitative imaging-based predictors of postoperative complications remain limited.</p><p><strong>Methods: </strong>In this retrospective cohort study, 89 patients who underwent lumbar instrumentation surgery were analyzed. Paraspinal muscle cross-sectional areas of the multifidus and erector spinae at the L4-L5 level were measured using a region-of-interest technique on preoperative MRI. Muscle ratios, a composite Paraspinal Muscle Index (SMI), and asymmetry indices were calculated. Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate associations with 90-day postoperative complications.</p><p><strong>Results: </strong>Postoperative complications occurred in 19 patients (21.3%). Patients with complications demonstrated lower mean multifidus ratio (P=0.005), erector spinae ratio (P=0.010), and SMI (P=0.004), whereas multifidus asymmetry was significantly higher (P=0.012). In multivariable analysis, diabetes mellitus and operative time remained independent predictors. The addition of muscle parameters increased model discrimination from AUC 0.771-0.820; however, this improvement did not reach statistical significance (P=0.150).</p><p><strong>Conclusions: </strong>Reduced paraspinal muscle ratios and increased muscle asymmetry were associated with postoperative complications. Quantitative evaluation of paraspinal muscles on routine MRI may contribute to perioperative risk stratification.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817439","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}