European Spine Journal最新文献

{"title":"The LL-TK index as a regional marker of sagittal balance and disability in adults with chronic low back pain.","authors":"Juliano Rodrigues Dos Santos, Claudio Piras, Guilherme Galito Henriques, Carlos Fernando Pereira da Silva Herrero, João Heitor Dal Bello Gonzales, Jefferson Soares Leal","doi":"10.1007/s00586-026-10426-0","DOIUrl":"https://doi.org/10.1007/s00586-026-10426-0","url":null,"abstract":"<p><strong>Purpose: </strong>Population aging has increased both the prevalence and clinical impact of adult spinal deformity (ASD). Sagittal and regional parameters (e.g., SVA, PI-LL, LL-TK) guide assessment and treatment planning, but it remains unclear which indices are most closely associated with sagittal imbalance and functional disability. This study therefore evaluated the associations between regional and global spinopelvic parameters and clinical status in an adult outpatient cohort with chronic low back pain, and compared the ability of the LL-TK and PI-LL indices to discriminate concurrent sagittal imbalance.</p><p><strong>Methods: </strong>Cross-sectional study including 142 patients (mean age 56.6 ± 13.2 years) with chronic low back pain, evaluated between 2018 and 2019. Standing full-length AP and lateral radiographs were analyzed using Surgimap to measure SVA, LL, TK, PI, PT and SS. Regional indices (LL-TK and PI-LL) were calculated. Patients were classified as balanced (SVA < 4 cm) or unbalanced (SVA ≥ 4 cm). Pearson correlations, independent-samples t tests and ROC analysis were performed; significance threshold p < 0.05.</p><p><strong>Results: </strong>Mean values were: ODI 23.6 ± 14.2; VAS 4.5 ± 2.3; LL 55.3° ± 13.0; TK 44.1° ± 13.8; PI 52.8° ± 10.9; PT 16° ± 9.0; SS 36.9° ± 9.0; PI-LL - 2.5° ± 12.8. SVA correlated significantly with age (r = 0.50), ODI (r = 0.40), VAS (r = 0.42), LL (r = - 0.28), LL-TK (r = - 0.43) and PI-LL (r = 0.42) (all p < 0.001). LL-TK also demonstrated significant correlations with clinical and radiographic measures. Twenty-nine patients (20.4%) were sagittally unbalanced. For the identification of concurrent sagittal imbalance, ROC analysis yielded optimal cutoffs of 12° for LL-TK (AUC = 0.755; sensitivity 96.6%; specificity 55.8%) and 9° for PI-LL (AUC = 0.699; sensitivity 44.8%; specificity 86.7%); the AUC of LL-TK was numerically higher, but the two correlated curves were not compared statistically. The combined criterion LL-TK > 12° and PI-LL ≤ 9° was met by 56 patients, of whom 55 (98%) had satisfactory sagittal alignment (SVA < 4 cm). Conversely, LL-TK ≤ 12° combined with PI-LL > 9° identified 14 patients, 11 (78%) of whom were sagittally unbalanced (positive predictive value 78%; negative predictive value of the favorable combination 98%). The remaining 72 patients (50.7%) had discordant index values and were not classified by this rule.</p><p><strong>Conclusions: </strong>In this cross-sectional cohort of adults with chronic low back pain, the regional LL-TK index was moderately associated with SVA and with patient-reported disability, and its AUC for discriminating sagittal malalignment was numerically higher than that of PI-LL; the two AUCs were not formally compared, so no superiority is claimed. The combination of regional and pelvic parameters yielded a high predictive values in the concordant subgroups, suggesting potential value as an adjunct screening aid rather than a basis for outcom","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135638","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":"Addressing limitations of previous meta-analyses of uniportal versus biportal endoscopic lumbar surgery: an umbrella review and de-duplicated, pathology-stratified meta-analysis.","authors":"Rafael Lindi Sugino, Gabriel Pokorny, Jullyene Pokorny, Weby Mizael","doi":"10.1007/s00586-026-10375-8","DOIUrl":"https://doi.org/10.1007/s00586-026-10375-8","url":null,"abstract":"<p><strong>Purpose: </strong>Previous meta-analyses of uniportal versus biportal endoscopic lumbar surgery are affected by overlapping primary studies, discordant study-level extraction, and aggregation of pathologies requiring different operative tasks. We appraised the review-level evidence and generated a de-duplicated, pathology-stratified synthesis of operative time, complications, disability, and leg pain.</p><p><strong>Methods: </strong>Five databases were searched for systematic reviews. Primary citations were normalized across reviews, each eligible comparison was included once per outcome, and discordant group allocation, sample size, follow-up, and numerical values were checked against the original primary publication wherever accessible. Random-effects models and meta-regression examined pathology, approach, and country. Review quality, primary-study risk of bias, and certainty were assessed with AMSTAR 2, RoB 2 or the Newcastle-Ottawa Scale, and GRADE, respectively.</p><p><strong>Results: </strong>Five reviews and 35 analytic comparisons from 34 primary publications were included. Operative time did not differ overall (35 comparisons; 3,338 participants; MD, 0.09 min; 95% CI, - 8.29 to 8.47), but the direction differed by pathology (P < 0.001): the estimate favored shorter uniportal procedures for LDH (13 comparisons; MD, - 17.67 min; 95% CI, - 26.90 to - 8.44; I² = 92.6%) and shorter biportal procedures for LSS (22 comparisons; MD, 10.45 min; 95% CI, 0.73 to 20.17; I² = 98.9%). Complications (OR, 1.44; 95% CI, 0.94 to 2.23), ODI (MD, 1.96; 95% CI, - 0.60 to 4.52), and leg-pain VAS (MD, 0.01; 95% CI, - 0.05 to 0.06) did not differ clinically. Certainty was low to very low.</p><p><strong>Conclusion: </strong>De-duplication and pathology stratification showed that an overall null operative-time estimate may average effects in opposite directions. These findings support possible effect modification by pathology but, given substantial residual heterogeneity and low to very low certainty, do not establish the superiority of either technique for LDH or LSS.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135633","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":"One- to two-year outcomes after surgery for cervical myelopathy: a systematic review of symptom duration and baseline severity.","authors":"Elie Najjar, Ali Akil, Hussein Akil, Negin Nematiniaye Masooleh, Neel Badhe, Harris Mangal, Chinedu Egu, Rawan Masarwa, Khalid Salem, Nasir A Quraishi","doi":"10.1007/s00586-026-10412-6","DOIUrl":"https://doi.org/10.1007/s00586-026-10412-6","url":null,"abstract":"<p><strong>Background: </strong>Degenerative cervical myelopathy is a progressive cause of spinal cord dysfunction. While surgery is recommended for moderate, severe, or progressive disease, > 12 months recovery beyond the first postoperative year and the influence of symptom duration remain less clearly defined.</p><p><strong>Methods: </strong>A PRISMA-based systematic review was performed of surgical studies in degenerative cervical myelopathy reporting outcomes at 12 months or longer, with data on symptom duration, baseline severity, or recovery modifiers. Risk of bias was assessed using ROBINS-I. Comparable JOA/mJOA change scores were pooled as standardised mean changes using a random-effects model with Hartung-Knapp adjustment. Leave-one-out sensitivity analysis was performed.</p><p><strong>Results: </strong>Eight studies including 3,991 surgically treated patients met the inclusion criteria; 3,933 contributed > 12 months outcome data. The weighted mean age was 61.4 years, and 62.3% of patients were male. All studies were judged to be at overall moderate risk of bias. Three studies, comprising 1,218 patients, provided extractable JOA/mJOA change-score data. Random-effects meta-analysis showed a pooled neurological improvement of + 1.41 JOA/mJOA points (95% CI + 0.62 to + 2.19), with substantial heterogeneity (I² = 90.4%). Across the remaining studies, neurological improvement was consistently reported at 12 months or longer. Six studies found that longer symptom duration was associated with poorer recovery in at least one outcome domain, although reported thresholds varied from 4 months to more than 2 years. The effect of delayed surgery appeared more consistent for disability, physical function, quality of life, bladder function, and extremity-function outcomes than for JOA/mJOA alone. Evidence on baseline severity was limited to one study and suggested greater absolute neurological improvement in patients with more severe baseline myelopathy; this finding should be considered exploratory.</p><p><strong>Conclusion: </strong>At ≥ 12 months, neurological scores were generally higher than baseline, although the magnitude of change varied. Longer symptom duration was associated with poorer recovery in several patient-reported and functional domains, while improvement was also reported after prolonged symptoms.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106459","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":"Full versus partial correction of pelvic incidence-lumbar lordosis mismatch in lumbar fusion: a systematic review and meta-analysis.","authors":"Daniel Bour, Kevin Jieyi Wang, Gurjovan Sahi, Jaskaran Singh, Nischal Ghimire, Robert Koucheki, Stephen Lewis, Han Jo Kim, Jay Toor, Aazad Abbas","doi":"10.1007/s00586-026-10409-1","DOIUrl":"https://doi.org/10.1007/s00586-026-10409-1","url":null,"abstract":"<p><strong>Purpose: </strong>Restoration of sagittal balance, specifically the mismatch between pelvic incidence and lumbar lordosis (PI-LL), is an important objective in lumbar fusion, particularly for degenerative deformity correction. While a postoperative PI-LL of ≤ 10° is generally considered optimal, the clinical necessity of achieving this threshold versus partial correction (PI-LL > 10°) remains uncertain. This study aimed to systematically review the differences in disability outcomes and mechanical complications between \"full\" (≤ 10°) versus \"partial\" (> 10°) PI-LL correction.</p><p><strong>Methods: </strong>Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Cochrane CENTRAL were searched from database inception to May 9, 2025. Studies were included if they compared full and partial PI-LL correction in adults undergoing lumbar fusion due to degenerative spinal conditions. Correction status was defined by a fixed PI-LL threshold only; the full SRS-Schwab classification was not applied. Using random-effects models, continuous outcomes were pooled as mean differences (MD) in pre-post change and dichotomous outcomes as odds ratios (ORs), both with 95% CIs. Risk of bias was assessed using ROBINS-I.</p><p><strong>Results: </strong>Twenty-seven studies involving 3,682 patients met the inclusion criteria. Patients who achieved full correction had a modestly greater ODI improvement than patients with partial correction (MD - 2.21; 95% CI [- 4.21, - 0.21]; I² = 69.3%; p = 0.033). Full correction was also associated with lower odds of developing ASD than partial correction (OR 0.19; 95% CI [0.08, 0.47]; I² = 81.5%; p = 0.003). There was no significant difference in VAS improvement between correction groups (p = 0.298).</p><p><strong>Conclusions: </strong>Postoperative PI-LL ≤ 10° (\"full\" correction) is associated with a small improvement in ODI that falls below established minimal clinically important difference thresholds. In short-segment degenerative cohorts, full correction is associated with reduced odds of ASD. However, these findings are associational, and PI-LL should be treated as an important guidepost within an individualized alignment strategy that accounts for patient-specific factors and global sagittal balance, rather than as a universal numeric target.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106504","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":"Comparative analysis of novel vertebral bone quality score variants for predicting cage subsidence following single-level anterior cervical discectomy and fusion: a retrospective cohort study.","authors":"Omar Lubbad, Laila Lubbad, Nour Jaouni, Omar Hamed, Akram Hagos, Cameron Bicknell, Suzanne Murphy, Nektarios K Mazarakis","doi":"10.1007/s00586-026-10418-0","DOIUrl":"https://doi.org/10.1007/s00586-026-10418-0","url":null,"abstract":"<p><strong>Background: </strong>Several modifications of the MRI-derived vertebral bone quality (VBQ) score have been proposed to improve assessment of vertebral bone quality, including anterior-modified, posterior-modified, calibrated, and T2-weighted adaptations. However, these methodologies have not been systematically evaluated in the cervical spine. This study compared the performance of VBQ-derived metrics for predicting cage subsidence following single-level anterior cervical discectomy and fusion (ACDF).</p><p><strong>Methods: </strong>Patients undergoing single-level ACDF with preoperative MRI and postoperative radiographic follow-up were retrospectively analysed. Traditional VBQ, anterior-modified VBQ (MVBQ), posterior-modified VBQ (PVBQ), calibrated VBQ (cVBQ), and T2-weighted scores were calculated from preoperative MRI. Associations with cage subsidence and predictive performance were evaluated using multivariable logistic regression and receiver operating characteristic analysis.</p><p><strong>Results: </strong>A total of 170 patients were included, of whom 67 (39.4%) developed cage subsidence. All T1-weighted bone quality metrics were significantly higher in patients with subsidence and remained independently associated after adjustment for clinical and surgical factors. Among the evaluated methodologies, cVBQ demonstrated the strongest association with subsidence and the highest discriminatory performance (AUC: 0.83). T2-weighted metrics showed weaker predictive ability, with one methodology demonstrating no significant association with subsidence.</p><p><strong>Conclusion: </strong>MRI-derived bone quality metrics are associated with cage subsidence following single-level ACDF. Among the evaluated approaches, cVBQ demonstrated the highest predictive performance, supporting its potential role as a practical tool for preoperative risk stratification and identification of patients at increased risk of mechanical complications.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126964","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":"A global sagittal deviation index (GSDI-5) incorporating upper cervical alignment: initial construct validation in forward head posture.","authors":"Katterine N Ríos-Peralta, Kathleen M Curran, David B MacManus, Lukas Schönnagel, Matthias Pumberger, Hendrik Schmidt, Ali Firouzabadi","doi":"10.1007/s00586-026-10390-9","DOIUrl":"https://doi.org/10.1007/s00586-026-10390-9","url":null,"abstract":"<p><strong>Purpose: </strong>Forward head posture (FHP) is commonly assessed using isolated cervical measures, potentially overlooking its relationship with global sagittal alignment. This study introduces the Global Sagittal Deviation Index (GSDI-5), a composite measure integrating multiregional sagittal alignment with explicit inclusion of the upper cervical spine.</p><p><strong>Methods: </strong>Standing lateral EOS radiographs from 201 adults referred for evaluation of low back pain were analysed and classified into FHP and non-FHP groups. Standardized sagittal parameters across the cervical, thoracic, lumbar, and global spine were combined into a single score. Initial construct validity was examined through known-groups comparisons and convergent analyses with TPA and PI-LL.</p><p><strong>Results: </strong>Individuals with FHP demonstrated higher GSDI-5 scores. GSDI-5 showed a large effect size for differentiating FHP from non-FHP (Hedges' g = 0.85), slightly exceeding that of TPA (g = 0.81) and PI-LL (g = 0.32), with increasing severity associated with progressive changes in global alignment measures.</p><p><strong>Conclusion: </strong>By integrating upper cervical alignment into a whole-spine framework, GSDI-5 summarizes cranio-cervical behaviour relevant to FHP and may serve as a complementary exploratory measure for global sagittal deviation in radiographic and postural assessment, alongside existing sagittal alignment metrics.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106482","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":"The role of sleep and circadian rhythms in intervertebral disc degeneration.","authors":"Xin Zheng, Lei Liu, Yu-Ao Tao, Xi Li, Jia-Dong Wang, Xiao-Long Li, Ming-Kai Chen, Zhao-Xiang Qian, Yun-Tao Wang, Pan Fan","doi":"10.1007/s00586-026-10397-2","DOIUrl":"https://doi.org/10.1007/s00586-026-10397-2","url":null,"abstract":"<p><strong>Purpose: </strong>Low back pain is a globally prevalent disabling condition, with intervertebral disc degeneration (IDD) as a key inducer. Sleep abnormalities and circadian rhythm disorders are widespread, but their bidirectional associations with IDD and underlying pathophysiological mechanisms remain unclear. This narrative review synthesizes existing studies to clarify the mutual regulatory relationship and corresponding intervention strategies.</p><p><strong>Methods: </strong>A structured literature search was conducted across PubMed, Embase and Web of Science from database inception through November 2025. Peer-reviewed original research and review articles were included, while conference abstracts, case reports, editorials and non-English manuscripts were excluded. Two independent reviewers performed title/abstract screening and full-text assessment, with discrepancies resolved by a third reviewer.</p><p><strong>Results: </strong>Sleep and circadian disturbances promote IDD via five interconnected pathways: peripheral circadian clock disruption, mechanical/osmotic rhythm dysregulation, inflammation and oxidative stress imbalance, autophagy dysfunction, and hormonal rhythm dysregulation. Reciprocally, IDD further disrupts sleep homeostasis through pain signals, emotional-cognitive mediation and behavioral alterations, forming a vicious cycle. Three evidence-based interventions (CBT-I, exogenous melatonin and morning bright light therapy) exert dual benefits on sleep improvement and IDD alleviation.</p><p><strong>Conclusion: </strong>Sleep and circadian rhythms drive a bidirectional vicious cycle with IDD and play a pivotal role in its progression. Future research should elucidate core clock gene-downstream pathway interactions, develop individualized regimens and expand longitudinal studies to support precision prevention and treatment of IDD and low back pain.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126972","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":"Is facet joint tropism associated with spondylolysis and isthmic spondylolisthesis?","authors":"Julio Urrutia, Hugo Demandes, Raul Zilleruelo, Christian Neumann","doi":"10.1007/s00586-026-10388-3","DOIUrl":"https://doi.org/10.1007/s00586-026-10388-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between facet joint tropism (FJT) and spondylolysis, with or without isthmic spondylolisthesis (IS), in a large cohort of patients across a wide age range.</p><p><strong>Methods: </strong>We retrospectively analyzed lumbar computed tomography scans from 358 patients (mean age 48.2 ± 20 years), including 191 patients with spondylolysis (137 with IS) and 167 age- and sex-matched controls without spondylolysis. Bilateral facet joint angles (FJA) were measured at L3-L4, L4-L5, and L5-S1. FJT was defined as a right-to-left FJA difference >6°. Absolute FJA differences and the prevalence of dichotomous FJT were compared between groups. Inter- and intra-observer agreement were assessed using intraclass correlation coefficients (ICC).</p><p><strong>Results: </strong>Inter- and intra-observer agreement for FJA measurements were excellent (ICC = 0.88 for both). Patients with spondylolysis demonstrated more FJA asymmetry than controls at L3-L4 (5.8° versus 3.7%; p = 0.02), L4-L5 (6.6° versus 3.9°; p < 0.01), and L5-S1 (6.7° versus 4.5°; p < 0.01), with a higher prevalence of FJT at all levels (56% versus 38%, 66% versus 36%, and 68% versus 47%, respectively; all p < 0.01). Patients with IS also showed greater FJA asymmetry and more frequent FJT at L3-L4 and L4-L5, but not at L5-S1.</p><p><strong>Conclusion: </strong>Patients with spondylolysis, with or without IS, demonstrated significantly greater facet joint asymmetry and a higher prevalence of FJT than controls. The presence of FJT at adjacent levels suggests that it may represent a generalized anatomical characteristic rather than a purely local phenomenon.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106416","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":"Are pain intensity measures interchangeable? agreement among ODI, SRS-22, and COMI in chronic low back pain with and without scoliosis.","authors":"Carmelo Pulici, Tito Bassani, René Marten Castelein, Antonio Pizzicato, Silvano Ferrari, Stefano Negrini, Fabio Zaina","doi":"10.1007/s00586-026-10420-6","DOIUrl":"https://doi.org/10.1007/s00586-026-10420-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pain intensity in chronic low back pain (CLBP) is often assessed using pain items embedded in multidimensional patient-reported outcome measures (PROMs), but differences in scale format and recall period may limit score interchangeability. The purpose of this study was to evaluate the association and agreement among three commonly used pain intensity items derived from ODI, SRS-22, and COMI in adults with CLBP, with and without scoliosis.</p><p><strong>Methods: </strong>Secondary cross-sectional analysis of an observational cohort. From 1,092 eligible subjects (552 scoliosis-associated LBP; 540 non-scoliosis LBP), we included participants with complete pain items: ODI Item 1 (pain \"at the moment\", 1-6), SRS-22 pain item (past month, 1-5), and COMI pain (maximum of back/leg pain over the past week, 0-10). Agreement was assessed using Spearman's rho, Kendall's W, and intraclass correlation coefficients (ICC), overall and by pathology group and sex.</p><p><strong>Results: </strong>The final sample included 417 adults (88% female; mean age 65 ± 10 years): 319 SLBP and 98 LBP. Across all subjects, correlations were moderate to strong (rho 0.50-0.70) with substantial ordinal agreement (W = 0.74) but only moderate quantitative concordance (ICC = 0.45). Estimates were similar in SLBP and LBP (rho 0.49-0.70; W 0.74-0.79; ICC 0.43-0.53) and did not differ by sex.</p><p><strong>Conclusions: </strong>Pain items from ODI, SRS-22, and COMI rank patients similarly but yield non-interchangeable absolute scores in CLBP, irrespective of scoliosis. Consistent instrument selection is recommended when comparing or pooling pain outcomes.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106433","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":"Predictors of postoperative shoulder imbalance in adolescent idiopathic scoliosis: a retrospective cohort of 468 patients.","authors":"Anas Al Abdallat, Radwan Abu Romman, Mohammad Obeidallah, Shojaa Aljarajreh, Mutaz Aljaloudi, Faris Alzuheir, Yazan Alomari","doi":"10.1007/s00586-026-10386-5","DOIUrl":"https://doi.org/10.1007/s00586-026-10386-5","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To determine the independent risk factors associated with postoperative shoulder imbalance (PSI) in adolescent idiopathic scoliosis (AIS) patients after posterior spinal fusion.</p><p><strong>Background: </strong>Postoperative shoulder imbalance is one of the most frequent complications following surgery in cases of adolescent idiopathic scoliosis (AIS). Quantitative Radiographic parameters that can be used for the preoperative planning of surgery are not clearly identified. The purpose of this study was to determine independent predictors of postoperative shoulder imbalance and to examine the correction PT/MT ratio as a quantitative radiographic predictor.</p><p><strong>Methods: </strong>For this study, 468 consecutive AIS patients subjected to posterior spinal fusion surgery, during January 2018 through December 2025 have been reviewed retrospectively. Data for this study were collected from the Hakeem electronic medical records system while radiographic measurements were obtained from the Picture Archiving and Communication System (PACS). PT and MT Cobb angles, T1 inclination, clavicle angle, radiographic shoulder height (RSH), and number of fusion segments were some of the radiographic measurements taken. PSI was diagnosed as RSH ≥ 15 mm after at least 24 months of follow up period. Independent predictors of PSI were found using multivariate logistic.</p><p><strong>Results: </strong>Female patients comprised 82%, while the mean age was 14.7 ± 1.9 years. PSI occurred 20.9% (n = 98). In comparison to the non-PSI group, the PSI group had low levels of UIV (below T3, p = 0.003), high preoperative left shoulder elevation, large PT Cobb angles (p < 0.001), and low PT correction rate (p < 0.001). Univariate analysis showed that residual proximal thoracic curvature ≥ 15° (OR 3.1, 95% CI 1.8-5.4, p < 0.001), UIV below T3 (OR 2.8, 95% CI 1.6-4.9, p = 0.001), preoperative left shoulder elevation, and PT/MT correction ratio below 0.59 (r=-0.53, p < 0.001) were independent factors of postoperative shoulder imbalance. The ROC curve analysis revealed an optimal PT/MT correction ratio threshold of 0.59.</p><p><strong>Conclusions: </strong>Residual proximal thoracic deformity and UIV lower than T3 were significant independent risk factors for shoulder imbalance. A PT/MT correction ratio less than 0.59 was an independent risk factor and might serve as a quantifiable radiographic criterion for surgical planning. These findings require prospective external validation before routine clinical implementation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106506","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}