European Spine Journal最新文献

{"title":"Microbiome impacts surgical outcomes- comparison of gut microbiome dysbiosis in patients undergoing lumbar microdiscectomy: results from the MISO pilot study.","authors":"Stone Sima, Thomas Jeffries, Alisha Sial, Suhani Sharma, Robert De La Lande, Neha Chopra, Saeed Kohan, Peter Khong, Ashish Diwan","doi":"10.1007/s00586-025-09046-x","DOIUrl":"https://doi.org/10.1007/s00586-025-09046-x","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505310","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 novel plain radiographic measurement for precise detection of pedicle screws breaching the medial pedicle wall in thoracic and lumbar spine.","authors":"Pinxin Fu, Yueqi Huang, Kai Huang, Shengchang Pu, Chaozhi Pang, Minyu Zhu, Jing Wang, Honglin Teng, Yu Wang","doi":"10.1007/s00586-025-09097-0","DOIUrl":"https://doi.org/10.1007/s00586-025-09097-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate a novel measurement method based on X-ray images for accurately determining the relationship between pedicle screws and the medial wall of the pedicle in thoracic and lumbar spine surgery.</p><p><strong>Methods: </strong>A total of 650 pedicle screws from 126 patients who underwent thoracic or lumbar internal fixation surgery were included. Postoperative X-ray images were used to calculate the distance between the medial edge of the screw threads and the medial wall of the pedicle (\"b-x\") based on our measurement method. This distance was also measured using postoperative CT (\"Y\"). The agreement of \"b-x\" and \"Y\" was assessed using Spearman's correlation analysis, intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. The cutoff value of \"b-x\" and its accuracy in predicting \"Y\" value was evaluated using the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Of the 650 screws, 59 (9.08%) showed medial wall breaching on CT. A strong positive correlation (r = 0.82) and strong agreement (ICC = 0.855) were shown between \"b-x\" and \"Y\" in Spearman's correlation and ICC analysis, respectively. Bland-Altman plot analysis indicated most values (96.2%) fell within the 95% confidence interval. The cutoff value for predicting medial wall breaching (\"Y\" < 0) was determined as \"b-x\" < 0.97 mm, with sensitivity of 89.83% and specificity of 88.49%.</p><p><strong>Conclusion: </strong>This novel measurement method, based on X-ray images, accurately determines the relationship between the pedicle screws and medial wall of the pedicle. It offers the advantages of high efficiency and low cost, facilitating timely detection and correction of screws that breach the medial pedicle wall during surgery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511768","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":"Perioperative outcomes and technical and patient-reported success of rigid occipitocervical fusions in adults: a systematic review and meta-analysis.","authors":"Alexander O Aguirre, Mohamed A R Soliman, Isabelle G Stockman, Gaitree R Boojraj, Esteban Quiceno, Asham Khan, Kyungduk Rho, John Pollina, Jeffrey P Mullin","doi":"10.1007/s00586-025-09051-0","DOIUrl":"https://doi.org/10.1007/s00586-025-09051-0","url":null,"abstract":"<p><strong>Purpose: </strong>Occipitocervical (OC) fusions are uncommon and challenging surgeries as patients have a wide range of pathologies that could necessitate this procedure. Due to this rarity, limited outcomes data are available for OC fusions. To the authors' knowledge, this is the first meta-analysis on the topic of OC fusions with a specific focus on the current preference of treatment with rigid constructs.</p><p><strong>Methods: </strong>A literature search of the Embase and PubMed databases was completed from each database's earliest records to April 23, 2024. Studies were included if they focused on rigid construct methods for OC fusions in adults. Meta-analysis was completed adhering to the random effects models, where continuous variables were analyzed with pooled-weighted means (95% confidence intervals [CI]) and categorical variables with pooled-weighted prevalence rates (CI).</p><p><strong>Results: </strong>A total of 42 studies, encompassing 1,274 patients, were included in this study. Included patients had a mean age of 57.18 years (CI, 52.21-62.15; I² = 94.47%), with women representing 57.2% (CI, 50.14-64.03; I² = 53%) of the population. Successful bony fusion was found in 96.7% (CI, 92.54-98.59; I² = 0%) of cases, with reoperation occurring in 4.7% (CI, 2.62-8.36; I² = 0%) of patients. Surgical site infection was the most common complication at a rate of 6.97% (CI, 5.19-9.29; I² = 0%), followed by cerebrospinal fluid leak at 2.9% (CI, 1.32-6.36; I² = 0%), instrumentation failure at 2.6% (CI, 1.16-5.71; I² = 0%), vertebral artery injury at 1.6% (CI, 0.74-3.61; I² = 0%), and screw loosening at 1.4% (CI, 0.65-3.16; I² = 0%).</p><p><strong>Conclusion: </strong>Rigid OC fusions have an extremely high likelihood of successful bony fusion and lower complication rates than those previously published, demonstrating a promising current state and future for the procedure.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511769","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":"Abdominal wall tension after spinal deformity correction compromises postoperative biomechanics and may contribute to proximal junctional kyphosis.","authors":"Elisa Jolas, Fabio Galbusera, Tamas F Fekete, Daniel Haschtmann, Dezsö Jeszenszky, Sarah Richner-Wunderlin, Ferran Pellisé, Ibrahim Obeid, Javier Pizones, Ahmet Alanay, Frank Kleinstück, Caglar Yilgor, Stephen J Ferguson, Markus Loibl, Dominika Ignasiak","doi":"10.1007/s00586-025-09063-w","DOIUrl":"https://doi.org/10.1007/s00586-025-09063-w","url":null,"abstract":"<p><strong>Purpose: </strong>Proximal junctional kyphosis (PJK) is a common complication after fusion surgery for adult spinal deformity (ASD). Tissue adaptation to deformity may cause abdominal wall shortening/stiffening. This study evaluated, using musculoskeletal modeling, the effect of these adaptations and sarcopenia on trunk muscle effort required to maintain postoperative alignment in PJK patients versus controls.</p><p><strong>Methods: </strong>ASD patient data was grouped by mechanical complication status: PJK (N=44), other (N=56), none (N=260). Spinopelvic landmarks were annotated in pre-op, post-op, and follow-up X-ray images. Patient-specific musculoskeletal models of corresponding alignments were built. Forces due to stretching of the abdominal wall beyond pre-op length (assumed slack) were applied, representing abdominal wall stiffness. Sarcopenia was implemented by reducing paraspinal muscle strength based on patient age and gender. Inverse-static simulations predicted overall muscle effort by summing muscle activities.</p><p><strong>Results: </strong>Postoperatively, the abdominal wall was more elongated in the PJK group (+8.4%[-0.3;20.0]) versus the no-complication group (+2.4%[-4.9;10.2], p<0.01) due to larger preoperative deformities and greater surgical correction. This elongation correlated more with pelvic tilt change (r=-0.53) than lumbar lordosis correction (r=0.16). Greater muscle effort was estimated for post-op alignment in the PJK group (12.40[6.42;28.6]) versus the no-complication group (8.42[4.34;13.3], p<0.05). Muscle effort was reduced at follow-up in groups with mechanical complications.</p><p><strong>Conclusion: </strong>Alignment restoration tensions abdominal structures, requiring increased extensor muscle forces to maintain postoperative alignment. Patients might develop PJK to reduce unsustainable muscle effort or due to spinal structure failure. More attention should be given to pelvic reciprocal changes to improve surgical planning and perioperative rehabilitation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495442","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":"Effects of visual input on contralateral foot touch and postural stability during one-leg standing in older adults with chronic low back pain.","authors":"Paul Sung, Dongchul Lee","doi":"10.1007/s00586-025-09083-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09083-6","url":null,"abstract":"<p><strong>Background: </strong>Compensatory weight transfer is essential for balance control and functional mobility, yet few studies have investigated contralateral touch behavior during one-leg standing, particularly in individuals with chronic low back pain (LBP).</p><p><strong>Purpose: </strong>This study evaluated the influence of visual input on postural stability, with specific attention to the initiation and total duration of contralateral foot touches across three repeated trials in adults with LBP.</p><p><strong>Methods: </strong>Twenty-seven participants with LBP and 44 control participants performed 10-second one-leg standing tasks on their non-dominant limb under eyes-open and eyes-closed conditions. Two primary outcomes were assessed across three trials: (1) occurrence of contralateral foot touch within the first second (early stance response), and (2) total duration of foot contact during the entire trial.</p><p><strong>Results: </strong>Sample size estimation indicated that a minimum of 25 participants per group would yield 80% power to detect a moderate effect size (Cohen's d = 0.4). A significant interaction was observed between visual condition and repetition (F = 7.86, p = 0.01), although no significant group interaction was found for total contralateral touch duration (F = 1.59, p = 0.21). The LBP group exhibited significantly more early contralateral touches during the first trial with visual input (t = 3.46, p = 0.001) and during the third trial without visual input (t = -3.53, p = 0.001), suggesting impaired adaptability to sensory conditions.</p><p><strong>Conclusion: </strong>Although total contralateral touch duration did not differ significantly between groups, individuals with LBP demonstrated greater instability during the initial phase of one-leg stance. These findings highlight early stance responses as a sensitive marker of balance impairment in LBP and support the need for interventions that enhance somatosensory integration and postural initiation strategies.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495445","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":"Expectation fulfillment, MCID achievement and postoperative outcomes in elderly patients with degenerative spinal deformity: minimum two-year evaluation.","authors":"Qingyang Huang, Peng Cui, Peng Wang, Shibao Lu","doi":"10.1007/s00586-025-09087-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09087-2","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to explore the fulfillment of expectations and the minimum clinically important difference (MCID) achievement following surgery by comparing preoperative expectations with 2-year follow-up patient-reported outcomes (PROs) in elderly patients with degenerative spinal deformity (DSD).</p><p><strong>Methods: </strong>Preoperatively, all elderly patients with degenerative spinal deformity completed the validated 20-item Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey, alongside the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). At 2 years postoperatively, patients were resurveyed to evaluate expectation fulfillment and MCID achievement. Patients also completed ODI and VAS and reported perioperative events, including subsequent surgeries. Based on expectation fulfillment and MCID achievement, patients were categorized into: Group A: Did not achieve MCID and had unfulfilled expectations. Group B: Achieved MCID with unfulfilled/partially fulfilled expectations or did not achieve MCID with partially/fully fulfilled expectations. Group C: Achieved MCID and fully fulfilled expectations. Also, we conducted a detailed subgroup analysis within Group B to explore potential variations.</p><p><strong>Results: </strong>Of 233 preoperative patients, 200 completed the 2-years follow-up (Group A: 49; Group B: 66; Group C: 85). Demographic and clinical variables did not differ significantly among groups. Group A had longer postoperative hospital stays, higher drainage volumes, and more complications. Multivariable analysis identified factors correlated with unfulfilled expectations and unachieved MCID: higher preoperative expectation counts, spine surgery-related complications, and lesser improvement in low back pain from preoperative to follow-up (all p ≤ 0.05).</p><p><strong>Conclusion: </strong>Better fulfillment of expectations and achievement of MCID was associated with improved clinical outcomes and satisfaction in elderly patients with degenerative spinal deformity at 2 years follow-up. Expectation fulfillment and MCID achievement are influenced by preoperative and postoperative factors, including the magnitude of improvement patients anticipated preoperatively.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495446","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":"Answer to the Letter to the Editor of N. Khaledian, et al. concerning \"Percutaneous pedicle screw placement with a mini-open decompression versus open surgery in the treatment of lumbar spondylolisthesis: one-year results of a randomised controlled trial\" by A. Broekema, et al. (Eur Spine J [2025]: doi:10.1007/s00586-025-08855-4).","authors":"A E H Broekema, J M A Kuijlen, M P Arts","doi":"10.1007/s00586-025-09094-3","DOIUrl":"https://doi.org/10.1007/s00586-025-09094-3","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495443","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":"Health education using customized aids for patients with osteoporotic vertebral fractures- a non-randomized controlled study.","authors":"Lifang Huang, Chengyi Chang, Borren Huang","doi":"10.1007/s00586-025-09023-4","DOIUrl":"https://doi.org/10.1007/s00586-025-09023-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the impact of customized educational tools for improving disease awareness, shared decision-making effectiveness, and medical satisfaction among patients with osteoporotic vertebral fractures.</p><p><strong>Methods: </strong>This prospective non-randomized controlled study included patients with radiographically confirmed vertebral fractures, with bone density T-score below - 2.5 as an independent inclusion criterion, inadequate medication response, and no prior surgical treatment who were treated at the neurosurgery outpatient department of a regional hospital in central Taiwan from June 2022 to October 2022. The experimental group received customized educational tools including a multimedia video, detailed leaflets, and a spinal model demonstration. In contrast, the control group's education was limited to colorful graphic leaflets. Three scales for outcome measurement were used: the Disease Care Awareness Scale, the Shared Decision-Making Effectiveness Scale, and the Shared Decision-Making Satisfaction Scale.</p><p><strong>Results: </strong>A total of 128 participants were included (control group: 64; experimental group: 64). Significant post-intervention improvements were observed in the experimental group for disease awareness (pre-intervention mean: 6.11, post-intervention mean: 9.03, p < 0.001), shared decision-making effectiveness (pre-intervention mean: 30.06, post-intervention mean: 40.88, p < 0.001), and medical satisfaction (pre-intervention mean: 19.81, post-intervention mean: 27.70, p < 0.001). The control group showed significant improvement only in shared decision-making effectiveness.</p><p><strong>Conclusions: </strong>Although customized educational tools show significant improvements in disease awareness, shared decision-making effectiveness, and medical satisfaction, these findings are based on within-group comparisons and should be interpreted with caution. Tailored health education may have the potential to improve patient outcomes in osteoporosis care.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495447","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 \"Tubular versus unilateral biportal endoscopy: MRI analysis after unilateral laminectomy for bilateral decompression in lumbar spinal stenosis\" by ross, et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-08953-3).","authors":"Cheng-Zhou Liu, Cheng-Yue Zhu, Wei Zhang","doi":"10.1007/s00586-025-09098-z","DOIUrl":"https://doi.org/10.1007/s00586-025-09098-z","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495448","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":"Machine learning-driven national analysis for predicting adverse outcomes in intramedullary spinal cord tumor surgery.","authors":"Marc Ghanem, Abdul Karim Ghaith, Sung Huang Laurent Tsai, Yu-Cheng Yeh, Oluwaseun O Akinduro, Loizos Michaelides, Victor Gabriel El-Hajj, Hassan Saad, Ali Tfaily, Antonio Bon Nieves, Alfredo Quiñones-Hinojosa, Kingsley Abode-Iyamah, Mohamad Bydon","doi":"10.1007/s00586-025-09029-y","DOIUrl":"https://doi.org/10.1007/s00586-025-09029-y","url":null,"abstract":"<p><p>Spinal tumors represent 15% of all central nervous system malignancies, with intramedullary spinal cord tumors (IMSCTs) being rare. Predominantly ependymomas and astrocytomas, IMSCTs often present late, leading to significant morbidity and mortality. Surgical excision is key but challenging due to the tumors' complex, invasive nature. Treatment involves a multidisciplinary approach, considering tumor type and patient condition, ranging from subtotal to gross total resection, possibly with adjuvant therapy. This study uses machine learning on National Cancer Database data to predict postoperative outcomes, aiming to develop a risk calculator for clinicians to assess mortality and extended hospital stay risks post-surgery.</p><p><strong>Objective: </strong>This study investigates healthcare outcomes in patients undergoing surgical resection for intradural intramedullary spinal cord tumors (IMSCTs), employing the National Cancer Data Base (NCDB) to identify key variables. We aimed to develop supervised machine learning-based risk calculators to predict high-risk patients for mortality and extended length of stay (eLOS), stratifying IMSCTs by histology to enhance understanding and guide intervention strategies for adverse outcomes.</p><p><strong>Methods: </strong>Patients with surgically-treated IMSCTs (2004-2017) was conducted using the NCDB. We extracted demographic and comorbidity data, employing descriptive statistics and supervised machine learning algorithms to predict mortality and eLOS.</p><p><strong>Results: </strong>The study encompassed 7,243 surgically treated IMSCT cases, including 612 astrocytomas (8.5%), 6,041 ependymomas (83.4%), and 590 hemangioblastomas (8.1%). Mortality and eLOS rates were observed at 10.2% and 27.1%, respectively. Over 12 years (2004-2016), significant management shifts were noted for these spinal tumor types. The predictive models achieved AUCs of 0.721 for mortality and 0.586 for eLOS. Key predictive features for mortality included age, diagnosis year, behavior, histology, radiation, insurance status, patient-hospital distance, tumor grade and size, length of stay, subtotal resection (STR) to gross total resection (GTR), and sex. For eLOS, additional predictors were diagnosis-surgery interval, Charlson/Deyo score, and surgical approach. Web-based tools for both outcomes have been deployed: https://imsct-elos-predict.herokuapp.com/ ; https://imsct-risk-calcualor.herokuapp.com/ .</p><p><strong>Conclusion: </strong>Our nationwide analysis underscores the evolution in IMSCT management and demonstrates the efficacy of machine learning in predicting mortality and eLOS, providing valuable insights for improved patient care.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483750","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}