European Spine Journal最新文献

{"title":"MRI Radiomics based on paraspinal muscle for prediction postoperative outcomes in lumbar degenerative spondylolisthesis.","authors":"Yongze Yu, Wen Xu, Xin Li, Xuejiao Zeng, Zehua Su, Qing Wang, Shun Li, Chunzheng Liu, Zetian Wang, Shanjin Wang, Lijun Liao, Jinyuan Zhang","doi":"10.1007/s00586-025-08959-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08959-x","url":null,"abstract":"<p><strong>Object: </strong>This study aims to develop an paraspinal muscle-based radiomics model using a machine learning approach and assess its utility in predicting postoperative outcomes among patients with lumbar degenerative spondylolisthesis (LDS).</p><p><strong>Methods: </strong>This retrospective study included a total of 155 patients diagnosed with LDS who underwent single-level posterior lumbar interbody fusion (PLIF) surgery between January 2021 and October 2023. The patients were divided into train and test cohorts in a ratio of 8:2.Radiomics features were extracted from axial T2-weighted lumbar MRI, and seven machine learning models were developed after selecting the most relevant radiomic features using T-test, Pearson correlation, and Lasso. A combined model was then created by integrating both clinical and radiomics features. The performance of the models was evaluated through ROC, sensitivity, and specificity, while their clinical utility was assessed using AUC and Decision Curve Analysis (DCA).</p><p><strong>Results: </strong>The LR model demonstrated robust predictive performance compared to the other machine learning models evaluated in the study. The combined model, integrating both clinical and radiomic features, exhibited an AUC of 0.822 (95% CI, 0.761-0.883) in the training cohorts and 0.826 (95% CI, 0.766-0.886) in the test cohorts, indicating substantial predictive capability. Moreover, the combined model showed superior clinical benefit and increased classification accuracy when compared to the radiomics model alone.</p><p><strong>Conclusion: </strong>The findings suggest that the combined model holds promise for accurately predicting postoperative outcomes in patients with LDS and could be valuable in guiding treatment strategies and assisting clinicians in making informed clinical decisions for LDS patients.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with immediate post-operative complications in pediatric patients in intensive care after spinal deformity surgical repair.","authors":"Reut Kassif Lerner, Amiad Levi Baltzan, Nissim Ackshota, Evyatar Hubara, Tal Sadeh, Marina Rubinstein, Gidi Paret, Itai M Pessach","doi":"10.1007/s00586-025-08974-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08974-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical repair is a widely used and effective treatment for pediatric scoliosis, significantly improving patients' quality of life. However, despite the overall safety of these procedures, postoperative complications can occur, presenting notable challenges. To ensure optimal monitoring and management, pediatric scoliosis patients are frequently admitted to the pediatric intensive care unit (PICU) during the immediate postoperative period. This study aimed to identify patient characteristics associated with immediate postoperative complications within the first 48 h following spinal deformity surgery. Furthermore, it sought to evaluate the types, prevalence, and severity of these complications, as well as the risk factors contributing to their development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted, encompassing all children aged 8 to 18 years who underwent spinal deformity surgery and were admitted to the largest tertiary pediatric intensive care unit (PICU) in Israel between 2010 and 2021. Clinical and laboratory data were extracted from electronic medical records and systematically analyzed. Statistical analyses were performed to identify risk factors associated with immediate postoperative complications occurring within the first 48 h after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 81 pediatric patients who underwent spinal deformity surgery. Of these, 41 (50%) experienced complications within the first 48 h post-surgery. Patients with comorbidities demonstrated a higher prevalence of complications (RR = 1.8; 95% CI = 1.12-2.91). A significantly increased risk of hemodynamic complications was observed in patients with serum lactate levels above 2 mmol/L upon PICU admission (RR = 7.3; 95% CI = 2.45-21.79) and in those with a significant decrease in hemoglobin levels (RR = 4.56; 95% CI = 1.76-11.83). Additionally, patients with CRP levels above 20 mg/dL or albumin levels below 3 mg/dL upon admission had significantly higher relative risks of general complications (RR = 1.71; 95% CI = 1.12-2.63 and RR = 1.57; 95% CI = 1.06-2.32, respectively). A predictive model for significant complications in pediatric patients following spinal deformity surgery was developed based on these factors. The model was able to predict possible immediate complications with an AUC of 0.74 and with scores above 4 points demonstrated 100% specificity and 100% positive predictive value in identifying complications at the time of PICU admission. Using this model, we effectively stratified patients into low-risk and high-risk groups for postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We identified several factors associated with an increased risk of complications within 48 h following pediatric spinal deformity surgery. A simple and easy to use predictive model developed using these factors demonstrated good performance allowing stratification of patients upon admission to th","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor concerning \"pulmonary function does not improve after 10 years of posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis\" by Burgos, Jesús et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-08831-y).","authors":"Ziyu Guo, Yuchen Li, Nan Ning","doi":"10.1007/s00586-025-08986-8","DOIUrl":"https://doi.org/10.1007/s00586-025-08986-8","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxford spinal sarcoma service: excellent oncological outcomes with a centralised multidisciplinary approach to primary spinal tumour care.","authors":"Jonathan Jiong Hao Tan, Euan Stirling, Radek Kaiser, Gerard Mawhinney, Dominique Rothenfluh, Yiong Huak Chan, Shilin Wang, Ruxandra Mihai, Stana Bojanic, Jeremy Reynolds","doi":"10.1007/s00586-025-08893-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08893-y","url":null,"abstract":"<p><strong>Purpose: </strong>The Oxford Spinal Sarcoma Service is a designated primary spinal tumour referral centre in the United Kingdom serving over ten million residents. We report the outcomes of this centralised approach to primary spinal tumour care.</p><p><strong>Methods: </strong>This is a retrospective review of surgically treated primary spinal tumour patients during 2008-2022. Patients were classified based on tumour resection margins - Enneking Appropriate (EA) or Enneking Inappropriate (EI). Outcomes studied include local recurrence and overall survival.</p><p><strong>Results: </strong>119 patients were included. 86/119(72%) cases involved the mobile spine; 33/119(28%), the sacrum. 96/119(81%) patients were virgin cases. EA margins were achieved in 68%(81/119) of cases. There were 38/119(32%) EI patients; 23/38(61%) were non-virgin cases which precluded EA resection. EA resection was achieved 90%(81/90) of the time when attempted. In EA patients with mobile spine tumours, local recurrence rate was 2%(1/51), vs. 18%(5/28) in EA patients with sacral tumours, 20%(7/35) in EI patients with mobile spine tumours, and 80%(4/5) in EI patients with sacral tumours. Mean local recurrence-free survival was 5.2(range 1-13.5) years; local recurrence rate, 18.5%(22/119). Mortality rate was 21.0%(25/119); mean overall survival was 5.63(range 1-13.5) years post-surgery. On multivariate analysis, EI margins and post-operative systemic treatment were significant predictors for local recurrence; presence of metastases and pre-operative systemic therapy, significant predictors for mortality.</p><p><strong>Conclusion: </strong>Centralisation of primary spinal tumour care has led to excellent oncological results comparable to most large spinal tumour centres. In mobile spine primary tumours where EA margins were achieved, our local recurrence rate (2.0%) is one of the lowest reported in literature.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining ultrasound and surface topography on curve assessment versus radiographic measurements for children with adolescent idiopathic scoliosis- a pilot study.","authors":"Thi N N Nguyen, Thanh-Tu Pham, Lawrence H Le, Derek J Emery, Kyle Stampe, Sarah Southon Hryniuk, Edmond Lou","doi":"10.1007/s00586-025-08921-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08921-x","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the correlation in combining ultrasound (US) and surface topography (ST) parameters to assess curve severity for children with adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>Seventy participants (56 F & 14 M, aged 14.2 ± 1.8 years old), all having (1) radiographs (XR), (2) US scans, and (3) 3D ST on the back were recruited. The reliability of ST measurements was evaluated on the first 30 participants. Two raters (R1, R2) with no prior experience measured ST data twice with one week apart. Then, all the US, ST, and XR images were measured once by R1, who had 10 years of experience in clinical radiology with two years of experience in scoliosis research. The correlations between parameters and stepwise linear regression were used to estimate XR measurements from US and ST. The main statistical measures were mean absolute difference (MAD), intraclass correlation coefficient (ICC [2, 1]), and Pearson correlation r.</p><p><strong>Results: </strong>All ST parameters showed excellent intra-rater reliability (ICCs [2, 1] ≥ 0.95), and good to excellent inter-rater reliability (ICC [2, 1] ≥ 0.79). Compared with XR measurements, US parameters showed a good to strong correlation with r ranging from 0.67 to 0.97, while ST parameters showed a weak to good correlation with r ranging from 0.28 to 0.73. Two ST parameters (scapular angle and coronal balance) combined with US measurements improve accuracy in assessing the right thoracic curve and axial vertebral rotation.</p><p><strong>Conclusion: </strong>Combining US and ST parameters had merit in providing a more accurate assessment than using the US or ST only to estimate the Cobb angle and axial vertebral rotation on right thoracic curves.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tubular versus unilateral biportal endoscopy: MRI analysis after unilateral laminectomy for bilateral decompression in lumbar spinal stenosis.","authors":"Nicolas Ross, Carlos Aleman, Alexandre Dhenin, Matthieu Vassal, Guillaume Lonjon","doi":"10.1007/s00586-025-08953-3","DOIUrl":"https://doi.org/10.1007/s00586-025-08953-3","url":null,"abstract":"<p><strong>Introduction: </strong>Degenerative lumbar spinal stenosis frequently requires surgical intervention when conservative treatments fail. Minimally invasive techniques such as unilateral laminectomy for bilateral decompression have largely replaced traditional open laminectomy because of effective decompression and reduced tissue damage. This study compared the radiological and clinical outcomes of tubular decompression and unilateral biportal endoscopy (UBE) in patients with severe stenosis.</p><p><strong>Methods: </strong>This was a retrospective, monocentric, nonrandomized study including 103 patients with severe lumbar spinal stenosis (52 tubular decompression, 51 UBE) from July 2020 to April 2024. The primary radiological outcomes were changes in anteroposterior diameter and dural sac surface area, assessed by MRI. Clinical outcomes included operative time, complication rates, and patient-reported outcomes with the Oswestry Disability Index and visual analog scale for pain, evaluated preopertatively, 3 and 12 months postoperatively.</p><p><strong>Results: </strong>As compared with tubular decompression, UBE resulted in a more significant increase in anteroposterior diameter (+ 4.9 vs. + 3.75 mm, p < 0.001) and dural sac surface area (+ 95.8 vs. + 85.4 mm², p = 0.038). However, with both techniques, clinical improvements were similar at 3 and 12 months, with no significant difference in Oswestry Disability Index, visual analog scale score, or patient satisfaction. The complication rate, including reoperation, was low in both groups, but the incidence of symptomatic hematoma was higher with UBE than tubular decompression.</p><p><strong>Conclusion: </strong>Both tubular decompression and UBE were effective for spinal stenosis treatment, with UBE providing superior radiological decompression, even in the early learning phase. However, the techniques were comparable in clinical outcomes at 3 months and 1 year. Further studies are needed to assess long-term results and refine patient selection criteria.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Painful symptoms and spine-specific activity limitations associated with dural ectasia in individuals with Marfan syndrome: a cross-sectional comparative study (MARFANLOMB).","authors":"Sébastien Troussier, Olivier Milleron, François Rannou, Ludivine Eliahou, Guillaume Jondeau, Christelle Nguyen","doi":"10.1007/s00586-025-08911-z","DOIUrl":"https://doi.org/10.1007/s00586-025-08911-z","url":null,"abstract":"<p><strong>Purpose: </strong>To compare frequencies and characteristics of painful symptoms, spine-specific activity limitations and health-related quality of life, between individuals with Marfan syndrome with dural ectasia, and those without.</p><p><strong>Methods: </strong>We conducted a cross-sectional comparative study. All individuals with Marfan syndrome followed in a single center were screened. The presence of dural ectasia was assessed using CT-scan or magnetic resonance imaging. Endpoints were the frequencies and characteristics of painful symptoms, spine-specific activity limitations and health-related quality of life.</p><p><strong>Results: </strong>Overall, 90 individuals were included: 86 (96%) had FBN1 mutations, 55 (61%) had dural ectasia and 35 (39%) had not. Mean age was 39.3 (9.4) years, 45 (50%) were women and 80 (89%) had back pain. The frequencies of headache with upright posture and of pain in the lower back when coughing, laughing and/or sneezing were numerically higher in participants with dural ectasia (49% vs. 26% and 13% vs. 0%, respectively). We found no difference between the 2 groups for health-related quality of life.</p><p><strong>Conclusion: </strong>Individuals with Marfan syndrome and dural ectasia, as compared to individuals with Marfan syndrome without dural ectasia, could display a specific pattern of painful symptoms, including lower back pain and headache with upright posture. However, none of the comparisons performed reached statistically significant difference.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological mechanisms underlying the ossification of ligamentum flavum and potential therapeutic targets derived from current research.","authors":"Zhimin Ye, Xianxiong Yin, Jun Ao, Jianpu Qin, Zairong Wei, Hu Qian","doi":"10.1007/s00586-025-08907-9","DOIUrl":"https://doi.org/10.1007/s00586-025-08907-9","url":null,"abstract":"<p><strong>Purpose: </strong>Ossification of ligament flavum (OLF), a prevalent cause of thoracic myelopathy, continues to present significant challenges for clinicians. While recent studies have illuminated various pathogenic molecular cascades associated with OLF. Comprehensive review of the underlying signaling pathways involved in its development remains absent from the literature. This study aims to synthesize and critically discuss the current evidence, providing a thorough overview of the progress made in the understanding OLF pathogenesis.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, Medline, Web of Science, ChiCTR.org.cn, and ClinicalTrials.gov databases to identify studies investigating the mechanisms involved in the development of OLF. The selected studies were categorized based on the type of mechanism explored. Initialing factors were summarized in tables and figures, and the related content were discussed systematically discussed.</p><p><strong>Results: </strong>The mechanisms underlying OLF formation primarily involve genetic background and modification, mechanical stress, osteogenesis-related proteins, non-coding RibonucleicAcid (RNA) and metabolism. However, clinical trials reporting the translational application of these existing mechanisms were scarce.</p><p><strong>Conclusions: </strong>The formation and development of OLF are multi-factorial, and the underlying mechanisms have been preliminarily elucidated. Future research should focus on the clinical application of these mechanisms. This review may provide a theoretical basis for the development of therapeutic agents and offer new perspectives further studies on OLF.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of metabolic syndrome on the accuracy of vertebral bone quality in determining bone mineral density in patients undergoing lumbar fusion surgery.","authors":"Xuan Zhao, Wei Wang, Xiaolong Chen, Shibao Lu","doi":"10.1007/s00586-025-08934-6","DOIUrl":"https://doi.org/10.1007/s00586-025-08934-6","url":null,"abstract":"<p><strong>Objective: </strong>Existing evidence indicates that MRI-based vertebral bone quality (VBQ) provides a tool for primary screening of bone density. However, the diagnostic accuracy of this tool is not well understood. The study aims to investigate whether metabolic symptom (MetS) affects the accuracy of VBQ in determining bone mineral density (BMD) in patients undergoing lumbar fusion surgery.</p><p><strong>Methods: </strong>In this retrospective study, patients with preoperative non-contrast T1-weighted MRI were included. Patients' demographics and medical profiles were identified and analyzed. Patients were separated into two groups according the presence of MetS. Pearson correlation analysis and linear regression were used to analyze the correlation between VBQ and the BMD in different groups. Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was used to assess diagnostic efficacy.</p><p><strong>Results: </strong>A total of 536 patients (241 female and 295 male patients) with a mean age of 66.5 ± 5.1 years were included in the final analysis. Sufficient intra- and interobserver reliability were determined for VBQ measures (≥ 0.8). Patients with MetS have higher lumbar BMD T-score and MetS increases the MRI-based VBQ score in patients with normal BMD. However, patients with MetS present higher proportion of history of fragility fracture. The correlation coefficient between VBQ and the lumbar BMD was - 0.42 for patients with MetS and - 0.54 for patients without MetS. VBQ demonstrated statistically significant differences among patients across the two subgroups (p < 0.001). The ROC analysis revealed indicated that there was significant better diagnostic accuracy in determining osteoporosis based on VBQ in patients without MetS than patients with MetS (AUC 0.84 vs. 0.63, p = 0.011).</p><p><strong>Conclusions: </strong>In the study, we found better performance among patients without MetS and the correlation between VBQ and BMD was stronger in patients without MetS. Interestingly, although higher lumbar T-score, there was significant more patients with a history of fragility fracture in patients with MetS.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Support or constraint? A comprehensive analysis of postoperative cervical bracing practices: insights from the Italian society of neurosurgery (SINch) survey and a systematic review of the literature.","authors":"Claudio Bernucci, Giorgio Cracchiolo, Luca Raspagliesi, Filippo Rambelli, Matteo Borrotti, Caterina Liberati, Angela Dele Rampini, Giorgio Cane, Carlo Brembilla, Andrea Fanti","doi":"10.1007/s00586-025-08913-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08913-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to capture current bracing practices for cervical spine surgery among members of the Spine Section of the Italian Society of Neurosurgery (SINch). It explores the rationale behind these practices and compares them with available evidence in the literature. A systematic review was conducted to evaluate whether patients undergoing single- or double-level anterior cervical discectomy and fusion (ACDF) without plating experience better clinical or radiological outcomes with or without postoperative cervical bracing.</p><p><strong>Methods: </strong>An anonymous 45-item survey was distributed to SINch Spine Section Members to collect data on bracing protocols following various cervical spine procedures, including degenerative and traumatic conditions, and fusion and non-fusion procedures. Additionally, a systematic review adhering to PICO standards and PRISMA guidelines, was performed to evaluate the evidence on bracing after ACDF without plating. Eligible studies included prospective data on the Neck Disability Index (NDI) and fusion rates following single- or multiple-level ACDF without plating for cervical spondylosis. Methodological quality was evaluated using the Jadad Scale for randomized controlled trials and the GRADE framework for overall evidence assessment.</p><p><strong>Results: </strong>The survey (61 respondents, 15% response rate) revealed that 85.2% of surgeons prescribed cervical collars for 2-level ACDF without plating. The main reasons cited were pain reduction and early mobilization, often based on personal experience and colleague recommendations, rather than literature evidence (14%). The systematic review identified two prospective studies, both showing no statistically significant impact of bracing on fusion rates. One study reported minor short-term improvements in neck pain (p0.05) with bracing, but no long-term differences in NDI were found.</p><p><strong>Conclusions: </strong>Cervical bracing following single- or double-level ACDF without plating remains controversial, with no significant difference in fusion rates, kyphosis progression, or cage migration between braced and non-braced patients. The routine use of postoperative bracing appears driven by tradition rather than strong evidence, suggesting that a more selective and evidence-based approach is warranted. Further high-quality research is needed to establish standardized guidelines.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}