Clinical Spine Surgery最新文献

{"title":"Comparison of Reoperation Incidence After Anterior Versus Posterior Decompression and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Analysis of a Large Claims-based Database.","authors":"Soichiro Masuda, Toshiki Fukasawa, Bungo Otsuki, Koichi Murata, Takayoshi Shimizu, Takashi Sono, Shintaro Honda, Koichiro Shima, Masaki Sakamoto, Shuichi Matsuda, Koji Kawakami","doi":"10.1097/BSD.0000000000001876","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001876","url":null,"abstract":"<p><strong>Study design: </strong>Cohort study.</p><p><strong>Objective: </strong>To compare reoperation rates between anterior decompression and fusion (ADF) and posterior decompression and fusion (PDF) in patients with cervical ossification of the posterior longitudinal ligament (OPLL).</p><p><strong>Summary of background data: </strong>Reoperation after cervical OPLL surgery is a significant concern for both patients and surgeons. It is unclear which surgical approach, ADF or PDF, is superior in terms of reoperation rates for cervical OPLL.</p><p><strong>Methods: </strong>This study was conducted under a cohort design in patients who underwent ADF or PDF for cervical OPLL using claims-based data. Primary outcome was the incidence of reoperation during the follow-up period, and secondary outcome was total health care costs during hospitalization, and at 30 days and 1 year postoperatively. Confounding factors were adjusted using propensity score inverse probability of treatment weighting. Cumulative incidence of reoperation was calculated using the Kaplan-Meier method. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression models.</p><p><strong>Results: </strong>The study included 251 patients (123 patients in the ADF group and 128 in the PDF group). There was no significant difference in the incidence of reoperation between the 2 groups [weighted HR 2.00 (95% CI 0.76-5.25); P=0.16]. ADF was associated with lower mean costs than PDF during hospitalization [$6416 (95% CI $4898-$7,934); P <0.001], and at 30 days [$6449 (95% CI $4942-$7956)] and 1 year postoperatively [$10,268 ($6545-$13,992); P <0.001].</p><p><strong>Conclusions: </strong>Although reoperation rates for ADF and PDF in patients with cervical OPLL were similar, ADF was associated with lower health care costs. This study provides important information that will help surgeons make informed decisions about the choice of surgical approach for patients with cervical OPLL.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607712","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":"Robotic Cervical Traction: Cadaveric Facet Dislocation Biomechanical Testing.","authors":"Brandon A Sherrod, Ian Bales, Adam Reinsch, Andrew T Dailey, Haohan Zhang, Marcus D Mazur","doi":"10.1097/BSD.0000000000001874","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001874","url":null,"abstract":"<p><strong>Study design: </strong>Basic science.</p><p><strong>Objective: </strong>To characterize robotically controlled cervical traction applied to intact and C4-C5 facet injury cadaveric models and compare the radiographic results with those of weight-pulley traction.</p><p><strong>Summary of background data: </strong>Manual application of weight-pulley cervical traction for dislocated facet reduction or cervical deformity correction has many limitations. Robotic cervical traction has demonstrated mechanical proof of concept but has not yet demonstrated reduction of dislocated facets in multiple cadaveric specimens.</p><p><strong>Methods: </strong>Nine cephalus to T4 adult human cadaveric specimens were obtained. Intact specimens (n=4) were placed first into weight-pulley traction with Gardner-Wells tongs and then into robotic traction, and radiographs were obtained at each weight interval. Intervertebral disc heights were measured at all visualized levels. Posterior cervical dissection was performed in 5 cadaveric specimens for the iatrogenic creation of bilateral C4-C5 facet dislocation injury. These specimens were placed into weight-pulley traction, and force was applied in 5-lb increments until reduction was achieved. The injuries were then re-created, and the injured specimens were then placed into robotic traction, and force was applied in 5 lb increments until reduction was obtained. Radiographs were obtained at each force increment in the injured specimens in both traction systems.</p><p><strong>Results: </strong>In the intact cadaveric specimens, there was no radiographic difference in intervertebral disc space height at 90 lbs of force between weight-pulley and robotic traction. In the 3 successful C4-C5 facet dislocation injury specimens, radiographic reduction was achieved at similar traction forces between robotic (mean force 31.7±11.9 lbs) and weight-pulley (mean force: 30.0±15.0 lbs) traction. Robotic traction slip-detection functions prevented unnecessary overdistraction in one injured cadaver.</p><p><strong>Conclusions: </strong>Radiographic outcomes for robotic cervical traction and weight-pulley traction were similar at identical traction forces in intact cadaveric specimens. C4-C5 facet dislocation injuries were reduced at a similar traction force when compared with weight-pulley traction and may prevent overdistraction.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599647","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":"Does Surgical Position Affect Percutaneous Transforaminal Endoscopic Discectomy Outcomes and Patient Satisfaction: A Single-Center Retrospective Study.","authors":"Wangxin Liu, Qi Zhang, Enpeng Gu, Huihui Sun, Lei Liu, Zhicheng Pan","doi":"10.1097/BSD.0000000000001875","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001875","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective, single-center study.</p><p><strong>Objective: </strong>The aim of this study is to evaluate the effects of different surgical positions on clinical outcomes and patient satisfaction of percutaneous transforaminal endoscopic discectomy (PTED).</p><p><strong>Summary of background data: </strong>The effect of lateral position (LP) versus prone position (PP) on PTED efficacy and patient satisfaction has not been entirely investigated.</p><p><strong>Methods: </strong>This study includes 85 patients who underwent PTED surgery for lumbar disc herniation from January 1, 2021, to December 31, 2023, at Binhai New District Hospital of Traditional Chinese Medicine. The patients were categorized into the LP group (n=43) and the PP group (n=42) according to the different positions when they underwent PTED surgery. The demographic data, preoperative data, intraoperative fluoroscopy times, operative duration time, length of postoperative hospital stay, VAS scores, lumbar JOA scores, complications, and patient satisfaction were all compared between the 2 groups.</p><p><strong>Results: </strong>PP in PTED reduced intraoperative fluoroscopy times and operative duration compared with LP. The mean intraoperative fluoroscopy times for the 42 patients in the PP group were 7.52 (SD: 1.79) compared with 12.26 (SD: 2.11) for 43 patients in the LP group, a statistically significant difference (95% CI: 3.88-5.59, P<0.001). The mean operative duration time was 84.16 minutes (SD: 11.67) in the PP group and 76.48 minutes (SD: 8.77) in the LP group, with a statistically significant difference (95% CI: 9.17- 18.21, P<0.001). Forty-one patients in the PP group (97.62%) and 38 patients in the PP group (88.37%) were satisfied with the surgery (P=0.027). There were no significant differences between the 2 groups in the length of postoperative hospital stay, complications, postoperative VAS scores (1 d, 1 mo, 3 mo, 6 mo) and postoperative JOA scores (1 wk, 1 mo, 3 mo, 6 mo).</p><p><strong>Conclusion: </strong>PTED performed in the PP has fewer fluoroscopy times, shorter operative duration, and higher satisfaction with postoperative rehabilitation after the surgery. No difference existed in postoperative recovery between the 2 groups. However, more studies are needed to further evaluate the effect of surgical position on surgery and clinical outcomes.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590612","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":"Design, Development, Funding, and Implementation of the CSRS Registry: A Prospective Multicenter Clinical Cervical Spine Registry.","authors":"Julie M Witham, Rick C Sasso, Praveen V Mummaneni, K Daniel Riew, Zeeshan M Sardar, Wilson Z Ray, James S Harrop, Themistocles Protopsaltis, Samuel K Cho, Ahmad Nassr, Aditya Vedentam, Addisu Mesfin, John M Rhee, Brandon D Lawrence, Steven C Ludwig, Zoher Ghogawala","doi":"10.1097/BSD.0000000000001833","DOIUrl":"https://doi.org/10.1097/BSD.0000000000001833","url":null,"abstract":"<p><strong>Study design: </strong>A national prospective cervical spine surgery registry was developed to archive radiographic studies, patient-reported outcome measures (PROMs), and surgical implant data to assess long-term safety.</p><p><strong>Objective: </strong>To describe the design, development, funding, and implementation of a cervical spine data registry for 1000 patients with myelopathy and radiculopathy.</p><p><strong>Summary of background data: </strong>While surgery for cervical radiculopathy and myelopathy is safe and effective, there is significant practice variation among spine surgeons. While randomized clinical trials (RCTs) can provide high-quality comparative effectiveness data, RCTs lack the ability to evaluate the safety and effectiveness of various surgical procedures and implants among heterogenous real-world patient populations. The CSRS Registry was designed to collect patient demographics, outcomes, radiographic imaging, surgical approach, and implant data for the purpose of conducting high-quality research.</p><p><strong>Methods: </strong>Patients with cervical myelopathy or radiculopathy were enrolled in the CSRS National Registry. De-identified patient data, validated PROMs, radiographic data, and implant data were collected from multiple clinical sites across the United States.</p><p><strong>Results: </strong>One thousand patients [mean age, 58 y; 456 (46%) women] were enrolled, with 31% follow-up at 1 year. Five hundred ninety-two patients were diagnosed with radiculopathy, 252 with myelopathy, and 156 with radiculopathy and myelopathy. Patients had significant improvements in their PROMs after surgery. At 1 year, the mean NDI score improved from 37.2 to 20.9 (P<0.001). The mean self-reported P-mJOA score at baseline was 14.2 and improved to 15.2 by 1 year (P<0.001). Baseline CSDI score was 23.6 and improved with a 1-year decrease to an average score of 13.6 (P<0.001). There was significant improvement in PROMIS-10 Physical Health score from 41.0 to 45.9 (n=311; P<0.001) at 1-year follow-up.</p><p><strong>Conclusions: </strong>The CSRS Registry has successfully collected clinical outcomes data that is being leveraged for comparative effectiveness research and evaluations of the long-term safety and effectiveness of spinal implants.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539264","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":"Far Lateral Tubular Microdiscectomy for Extraforaminal, Foraminal, and Lateral Recess Acute Disc Herniation: Surgical Technique.","authors":"Anthony Minh Tien Chau, Aaron Lerch, Amir Amiri, Jason McMillen","doi":"10.1097/BSD.0000000000001793","DOIUrl":"10.1097/BSD.0000000000001793","url":null,"abstract":"<p><strong>Study design: </strong>We present a 7-minute stepwise instructional video alongside a detailed technical report defining our surgical approach.</p><p><strong>Objective: </strong>We outline our technique for tubular far lateral microdiscectomy for the treatment of a soft extraforaminal, foraminal, and lateral recess disc herniation, avoiding the need for spinal fusion.</p><p><strong>Summary of background data: </strong>This technique relies on a suitable soft disc consistency.</p><p><strong>Methods: </strong>We demonstrate this with a case of a 50-year-old woman presenting with 1 month of acute onset L3 radiculopathy and weakness that is refractory to a cortisone block. Our step-by-step guide, presented in both video and written format, illustrates a specific situation where this technique may be applicable.</p><p><strong>Results: </strong>The patient presented in this case was discharged home the following day, achieved full symptom resolution, and return of normal power/mobility, with sustained clinical outcome at 6 weeks follow-up.</p><p><strong>Conclusions: </strong>The careful preoperative consideration of patients to select a suitable disc consistency allows the effective implementation of this technique to achieve excellent outcomes and avoid spinal fusion.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"278-279"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708499","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":"Constructing and Interpreting Logistic Regression Analyses in Orthopedic Clinical Research.","authors":"Teeto Ezeonu, Rajkishen Narayanan, Rachel Huang, Matthew Sherman","doi":"10.1097/BSD.0000000000001816","DOIUrl":"10.1097/BSD.0000000000001816","url":null,"abstract":"<p><p>Retrospective cohort analyses are a common study design in orthopaedic clinical research given their feasibility. Nevertheless, this study design is subject to inherent biases caused by confounding variables. Logistic regression analyses are important statistical tools that can be used to clarify relationships between independent and binary dependent variables. The purpose of this paper is to provide a broad overview of logistic regression analyses and guide the interpretation of these analyses in orthopaedic clinical research.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"304-307"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981652","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":"Intraoperative Methadone in Spine Surgery ERAS Protocols: A Systematic Review of the Literature.","authors":"Christian Rajkovic, Sima Vazquez, Zach Thomas, Eris Spirollari, Bridget Nolan, Cameron Marshall, Nitin Sekhri, Ammar Siddiqui, Merritt D Kinon, John V Wainwright","doi":"10.1097/BSD.0000000000001726","DOIUrl":"10.1097/BSD.0000000000001726","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>To systematically review the use of intraoperative methadone in spine surgery and examine its effects on postoperative opioid use, pain, length of stay, and operative time.</p><p><strong>Summary of background data: </strong>Spine surgery patients commonly have a history of chronic pain and opioid use, and as a result, they are at an increased risk of severe postoperative pain. While pure mu opioids remain the standard for acute surgical pain management, they are associated with significant short-term and long-term adverse events. Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery.</p><p><strong>Results: </strong>Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. However, one study observed that intraoperative methadone used in a multimodal analgesia regimen strategy with ketamine resulted in a shortened LOS compared with the use of intraoperative methadone alone. Differences in operating time between cases that used intraoperative methadone and cases that used comparator analgesics were not statistically significant among included studies.</p><p><strong>Conclusion: </strong>Methadone may present an alternative option for both intraoperative and postoperative analgesia in spine surgery recovery protocols and may reduce postoperative pain, opioid use, and LOS while maintaining consistent operating time and reduced side effects of pure mu opioids.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"280-293"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Full Endoscopic Interlaminar Lumbar Discectomy and Lumbar Microdiscectomy.","authors":"Luay Şerifoğlu, Mustafa Umut Etli, Selçuk Özdoğan","doi":"10.1097/BSD.0000000000001733","DOIUrl":"10.1097/BSD.0000000000001733","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical study.</p><p><strong>Objectives: </strong>The aim is to assess and contrast the results of full endoscopic lumbar discectomy (FELD) and lumbar microdiscectomy (LMD) for L5-S1 disc herniation, with a specific emphasis on postoperative pain reduction and surgical effectiveness.</p><p><strong>Background: </strong>Although minimally invasive spine operations are becoming more popular, there is still little research on the comparative effectiveness of FELD and LMD.</p><p><strong>Materials and methods: </strong>The research had a total of 50 patients who received surgical intervention for L5-S1 disc herniation, with 25 patients getting full endoscopic interlaminar discectomy and the other 25 patients undergoing LMD. Clinical outcomes were assessed using the Visual Analog Scale for low back and leg pain, collected preoperatively and at the end of 1 week, 3 months, and 6 months postsurgery. Patient satisfaction was evaluated using Odoms criteria at the same intervals.</p><p><strong>Results: </strong>The study included 50 patients (26 men, 24 women), with a mean age of 51.11 ± 13.76 years. The groups had no significant differences in demographic data. Back and leg pain Visual Analog Scale scores decreased more significantly in the FELD group after 1 week of surgery ( P < 0.001), although the declines at 3 months and 6 months were not significantly different between the two groups. According to Odoms criteria, patient satisfaction was favorable in both groups and significantly better in the FELD group than in the LMD group at 1 week postoperatively [excellent in 20 patients (80%) in the FELD group vs 9 patients (36%) in the LMD group ( P = 0.025)]. However, patient satisfaction at 3 months and 6 months did not differ between the groups.</p><p><strong>Conclusion: </strong>This study demonstrates that FELD offers significant early postoperative advantages over LMD at the L5-S1 level when compared with pain and satisfaction scales.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E312-E315"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766938","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":"Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle Screw Placement With Advanced Imaging?","authors":"Jordan Lebovic, Maxwell Trudeau, Lefko T Charalambous, Nitya Venkat, Jason Gallina, Jeffrey A Goldstein","doi":"10.1097/BSD.0000000000001724","DOIUrl":"10.1097/BSD.0000000000001724","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to determine the utility of advanced imaging to confirm the placement of robotic pedicle screws.</p><p><strong>Summary of background data: </strong>With increasing robotic adoption, certain institutions and surgeons have developed protocols for obtaining 3D intraoperative imaging after robotic pedicle screw placement to ensure proper hardware placement. No studies have assessed the utility of these protocols relative to the potential risks of increased radiation exposure and operative time. The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws.</p><p><strong>Methods: </strong>This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B.</p><p><strong>Results: </strong>Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. All pedicle screws were placed in either a GRS type A or type B position. Three hundred fifty-one were placed in a GRS A classification (99.2%, 351/354), and 3 were placed in a GRS B classification (0.08% 3/354). No patients had screw-related complications. The average radiation dosage of 3D imaging was 289.7±164.6 mGy.</p><p><strong>Conclusion: </strong>The robotic system places pedicle screws accurately without 3D intraoperative imaging. Given the increased radiation and operative time associated with 3D imaging protocols 3D imaging scans should only be obtained in cases with heightened clinical concern.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"E295-E299"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544132","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":"Changes in Segmental and Lumbar Lordosis Following Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis.","authors":"Elizabeth A Lechtholz-Zey, Mina Ayad, Brandon S Gettleman, Emily S Mills, Hannah Shelby, Andy Ton, William J Karakash, Ishan Shah, Jeffrey C Wang, Ram K Alluri, Raymond J Hah","doi":"10.1097/BSD.0000000000001728","DOIUrl":"10.1097/BSD.0000000000001728","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration.</p><p><strong>Summary of background data: </strong>LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity. Common approaches include posterior LIF (PLIF), transforaminal LIF (TLIF), anterior LIF (ALIF), oblique LIF (OLIF), and lateral LIF (LLIF).</p><p><strong>Methods: </strong>A systematic review and meta-analysis were carried out using PRISMA guidelines with appropriate MeSH terms. Papers were included based on relevance, number of patients, and a minimum of 1-year radiographic follow-up. Radiographic outcomes included segmental lordosis (SL) and lumbar lordosis (LL). Only papers directly comparing SL restoration between two or more LIF techniques were utilized in the systematic review, while all articles meeting the aforementioned criteria were used in the meta-analysis.</p><p><strong>Results: </strong>Nineteen studies were included in the final systematic review, and 88 papers were included in the meta-analysis. Seven studies in the systematic review showed a significantly higher increase in SL with ALIF versus TLIF, and two showed significantly higher SL gain with ALIF compared with LLIF. When comparing ALIF versus OLIF, one study favored ALIF, while another favored OLIF for SL restoration. OLIF likewise demonstrated superior restoration of SL compared with TLIF. LLIF demonstrated improved SL restoration compared with TLIF in 2 of the 3 studies comparing the 2 procedures. Furthermore, both ALIF and OLIF demonstrated superior LL restoration compared with TLIF in 4 and 3 studies, respectively. The meta-analysis results demonstrated that ALIF provided significantly better restoration of SL than TLIF, LLIF, and OLIF, while TLIF conferred significantly lower SL restoration than ALIF and OLIF. Similarly, LL restoration was significantly reduced with TLIF relative to OLIF and LLIF (all P <0.05).</p><p><strong>Conclusions: </strong>The included studies demonstrated superior SL and LL restoration with ALIF, OLIF, and LLIF compared with TLIF. ALIF improved SL to a greater extent when directly compared with all other interbody techniques.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":"294-303"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686269","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}