European Spine Journal最新文献

{"title":"A predictiament injuryve nomogram for cervical anterior longitudinal ligament injury.","authors":"Yang Li, Dongxiao Zhang, Yishan Liu, Zhongya Gao, Bangke Zhang, Xuhua Lu","doi":"10.1007/s00586-025-09162-8","DOIUrl":"https://doi.org/10.1007/s00586-025-09162-8","url":null,"abstract":"<p><strong>Objective: </strong>To develop a nomogram-based predictive model for anterior longitudinal ligament (ALL) injury caused by cervical spine trauma.</p><p><strong>Methods: </strong>A total of 256 patients with cervical hyperextension injuries were included in this study. Univariate and multivariable logistic regression analyses were used to select the predictive variables, and subsequently, a nomogram model was developed. Finally, the model was validated using both the training and validation datasets.</p><p><strong>Results: </strong>The nomogram model included five predictive factors: thickness of prevertebral soft tissue (TOPST), intervertebral disk angle (IDA), avulsion fracture of the anterior edge of the vertebral body (AFOA), ALL disruption observed in T1-weighted sequence (T1D), and high signal intensity in T2-weighted sequence (T2HS). The areas under the curve (AUC) for the training and validation sets were 0.986 and 0.987, respectively. The calibration curves for both the training and validation sets showed slopes close to 1, indicating good calibration. Decision curve analysis demonstrated that the model performed well and was feasible for making beneficial clinical decisions.</p><p><strong>Conclusions: </strong>The nomogram model based on TOPST, IDA, AFOA, T1D, and T2HS is a reliable tool for predicting cervical ALL injury.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845075","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":"Monitoring curve progression in adolescent idiopathic scoliosis, assessment of the diagnostic performance of rasterstereography in brace-treated and untreated patients.","authors":"Anne Tabard-Fougère, Alice Bonnefoy-Mazure, Nathaly Gavira, Stéphane Armand, Romain Dayer","doi":"10.1007/s00586-025-09213-0","DOIUrl":"https://doi.org/10.1007/s00586-025-09213-0","url":null,"abstract":"<p><strong>Background: </strong>Evaluating curve progression in adolescent idiopathic scoliosis (AIS) patients involves repeated exposure to radiation. Rasterstereography is reported to be a reliable, valid alternative to classic radiography. Few studies have evaluated rasterstereography's responsiveness in detecting curve progression over time or how brace treatment might influence these results.</p><p><strong>Objective: </strong>The present study aimed to evaluate rasterstereography and scoliometer measurement responsiveness in detecting curve progression in a large cohort of AIS patients with a follow-up time of > 6 months and comparing brace-treated and non-braced patients.</p><p><strong>Methods: </strong>We included consecutively AIS patients who underwent same-day rasterstereography, scoliometer and radiography evaluations from 2016 to 2018, with at least 6 months between visits. Each patient's major scoliosis curve was evaluated using their Cobb angle (CA) from radiography, their scoliosis angle (SA) from rasterstereography and their axial trunk rotation (ATR) angle from scoliometer measurement. Patients were separated into brace-treated and non-braced groups. Progressive curves were defined by an increase in CA ≥ 5°. The area under the curve (AUC) of non-parametric receiver operating characteristics (ROC) curves was used to assess responsiveness of SA and ATR in detecting progressive curves. We reported sensitivity and specificity.</p><p><strong>Results: </strong>One-hundred-and-eleven AIS patients (55 brace-treated, 56 non-braced) were evaluated, of whom 17 (16%) had progressive curves: 10/55 (18%) brace-treated and 7/56 (13%) non-braced patients. We found poor AUC and sensitivity (< 50%) in detecting progressive curves among brace-treated patients. However, we found a good AUC (> 75%) and moderate sensitivity (< 70%) in detecting progressive curves among non-braced patients.</p><p><strong>Conclusions: </strong>Rasterstereography and scoliometer measurements both showed poor and moderate sensitivity in detecting curve progression in brace-treated and non-braced AIS patients, respectively. This suggests that rasterstereography should not be used to monitor curve progression among AIS patients to reduce their exposure to radiation, particularly among brace-treated patients. Presents results adds to ongoing debates about surface topography's role in AIS monitoring, particularly for braced patients where torso shape changes may confound measurements. Although rasterstereography and scoliometer lacks sufficient sensitivity to serve as a standalone monitoring tool, these results identify untreated patients as the most promising target population for future technological refinements of surface topography.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845093","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":"Epidemiological trends and predictive factors of adolescent scoliosis in qingdao: insights from a Large-scale screening program (2022-2024).","authors":"Xiaofan Du, Tianyu Bai, Changlin Lv, Ziang Zhang, Xuanyu Dong, Wenkang Yang, Han Zhang, Shiqi Xu, Li Zhang, Yongming Xi, YuKun Du","doi":"10.1007/s00586-025-09245-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09245-6","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) is a systemic musculoskeletal disorder characterized by a three-dimensional curvature of the spine. It often progresses silently during puberty and can have significant physical and psychological consequences for affected adolescents. Early detection through school-based screening is vital for timely intervention, yet region-specific epidemiological data from northern coastal China remain limited.</p><p><strong>Methods: </strong>This school-based cross-sectional study screened 57,393 students from grades 3 to 9 in Qingdao City between 2022 and 2024. Standardized assessments included postural observation, the Adams forward bending test, angle of trunk rotation (ATR) measurement, and plantar scanning for foot deformities. Students with ATR ≥ 5° were referred for radiographic evaluation, and scoliosis was confirmed by Cobb angle > 10° on standing full-spine X-rays.</p><p><strong>Results: </strong>A modest but consistent decline in postural abnormality prevalence was observed over three years, with Adams test positivity decreasing from 4.5 to 4.3%. Peak ATR positivity occurred in students aged 11-13, particularly age 12. Female sex and right-sided rib hump were significantly associated with higher ATR and scoliosis severity. Among 370 students undergoing radiographs, ATR showed a strong correlation with Cobb angle (R = 0.65, p < 0.001). The majority had Cobb angles of 10-20°, with severe curves (> 20°) predominantly observed in older female students.</p><p><strong>Conclusion: </strong>This study highlights the stable yet concerning prevalence of scoliosis in coastal northern China and validates the utility of a stepwise screening approach centered on ATR. Age, sex, and rib hump laterality are key risk indicators. Findings support targeted early screening and intervention strategies tailored to high-risk adolescent groups.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845091","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":"Feasibility and safety of outpatient spine surgery: insights from 555 neurosurgical interventions.","authors":"Aram A Bani, Katharina Köhlert, Marek Zelenka","doi":"10.1007/s00586-025-09257-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09257-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to determine the feasibility of outpatient neurosurgery, which modern microsurgery enables through minimally invasive, tissue-sparing, and low-risk spinal procedures. Outpatient care offers several advantages, including rapid return to the home environment, avoidance of hospital-acquired infections and multi-resistant germs, significant cost savings, and increased patient satisfaction.</p><p><strong>Methods: </strong>Between October 2023 and May 2025, a total of 555 patients underwent surgery at our outpatient neurosurgical center. The procedures performed included; Lumbar spinal canal decompression: 287 cases (51.7%), Microdiscectomy for lumbar disc herniation: 124 cases (22.3%), Extradural tumor resection: 53 cases (9.5%), Removal of spinal implants: 37 cases (6.7%), Cervical posterior foraminotomy 18 cases (3.2%), Spinal cord stimulation (implantation): 16 cases (2.9%), Percutaneous balloon kyphoplasty: 7 cases (1.3%), Sacral Tarlov cyst fenestration or occlusion: 7 cases (1.3%), Baclofen or morphine pump implantation: 6 cases (1.1%). Each patient was monitored for three to four hours in the recovery area following surgery. Discharge was approved once the patient was fully mobilized and had voided spontaneously. Notably, no surgical drains were used in any of the cases. The age of patients ranged from 15 to 88 years. Gender distribution was 46% male and 54% female. According to the American Society of Anesthesiologists (ASA) physical status classification, 32% of patients were categorized as ASA I, 59% as ASA II 32% and 9% as ASA III.</p><p><strong>Results: </strong>Home care was clarified in advance. There were 5 Cases (1.2%) of postoperative secondary haemorrhages within the first four hours which were revised immediately with complete recovery. In 32 (5,7%) patients, the dura was accidentally injured, of which three patients required revision with a delay due to a symptomatic cerebrospinal fluid collection. Three patients experienced a deterioration of neurological status after the dural injury, of whom two improved completely within 8 weeks and through inpatient treatment. There were three cases of wound dehiscence which were treated conservatively and 17 (3,0%) Cases with superficial wound infection. One patient deteriorated directly after intubation before starting the operation and passed away two days later of cardiopulmonary failure.</p><p><strong>Conclusion: </strong>Ambulatory care for uncomplicated lumbar spine conditions is feasible, safe, and effective. It saves significant costs, increases patient satisfaction, and relieves the burden on large hospitals. In particular, patient waiting times for surgery were reduced.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845092","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":"Wearing a brace for idiopathic scoliosis above 18 hrs/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees.","authors":"Stefano Negrini, Francesco Negrini, Tito Bassani, Francesca Febbo, Greta Jurenaite, Alessandra Negrini, Carmelo Pulici, Fabio Zaina","doi":"10.1007/s00586-025-09124-0","DOIUrl":"https://doi.org/10.1007/s00586-025-09124-0","url":null,"abstract":"<p><strong>Purpose: </strong>The Brace Adolescent Idiopathic Scoliosis Trial (BrAIST) reported a bracing dose-response curve in AIS for brace-wearing time (BWT) up to 18 h/day (h/d) on the outcome end-of-treatment < 50°. We aimed to examine the dose-response curve for this and other relevant outcomes in cases of BWT > 18 h/d.</p><p><strong>Methods: </strong>Design: Retrospective secondary analysis of consecutively collected data.</p><p><strong>Participants: </strong>braced AIS patients with curves < 45° and a subgroup with BrAIST inclusion criteria.</p><p><strong>Treatment: </strong>different braces, prescribed 18 to 24 h/d, according to curve topography, Cobb angle and a shared decision-making approach. We divided patients into BWT quartiles and developed dose-response curves using the BrAIST methodology for the end-of-growth outcomes END < 50°, END < 30°, avoidance of progression, and improvement.</p><p><strong>Results: </strong>We included 884 patients (85% female), with a mean age of 13.0 ± 1.3 years and a mean Cobb angle of 28 ± 7°. In the higher BWT quartiles, we found larger scoliosis curves but also better final Cobb angle results. The dose-response curves showed statistically significant improvements for the outcomes END < 30° and improvement (outcomes improvements ranging 45-60% and 25-35%, respectively). The outcomes END < 50° and avoiding progression showed a ceiling effect due to a very high success rate (range 97-98% and 85-87%, respectively).</p><p><strong>Conclusion: </strong>BWT > 18 h/d is associated with avoiding surgery (END < 50°), reduced progression, and increased improvement rates, and achieving END < 30°, which is particularly relevant because it reduces the risk of problems in adulthood. Decisions on daily BWT should be based on the desired outcomes and an honest conversation with the patients and parents.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821054","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":"Spontaneous facet fusion following lateral lumbar interbody fusion supplemented with percutaneous pedicle screw fixation in degenerative lumbar disease.","authors":"Jaewan Soh, Young-Ho Roh, Jae Chul Lee, Dae Woong Kim, Byung-Joon Shin","doi":"10.1007/s00586-025-09227-8","DOIUrl":"https://doi.org/10.1007/s00586-025-09227-8","url":null,"abstract":"<p><strong>Purpose: </strong>To identify factors contributing to spontaneous facet fusion (SFF) after lateral lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation and evaluate its clinical significance.</p><p><strong>Methods: </strong>We analyzed 43 patients (150 facet joints) who underwent LLIF with percutaneous pedicle screw fixation without posterior decompression and had at least one year of follow-up. Factors associated with SFF included patient-related factors (age, BMI, diabetes, smoking, osteoporosis), lumbar spinal factors (preoperative diagnosis, number of fused segments), and radiologic factors (facet osteoarthritis, interbody fusion status, cage position, and subsidence). Clinical outcomes were assessed using VAS for lower back pain (LBP) and radiating pain (RP) and the Oswestry Disability Index (ODI). Patients were categorized into three groups based on facet and interbody fusion status.</p><p><strong>Results: </strong>SFF was observed in 65.3% (98/150) of facet joints, and in 52.0% of cases, SFF preceded interbody fusion. Preoperative facet osteoarthritis (p = 0.009, OR = 9.951) and solid interbody fusion (p = 0.048, OR = 9.837) were significant predictors of SFF. Clinical analysis showed significantly lower VAS for LBP in fused segments (p = 0.023), though no difference between facet fusion-only and interbody fusion groups.</p><p><strong>Conclusions: </strong>SFF frequently occurs after LLIF with percutaneous pedicle screw fixation, often before interbody fusion. It was more common in preoperative facet joint osteoarthritis and was frequently seen with solid interbody fusion. SFF correlates with improved LBP outcomes.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834684","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":"Effectiveness of single-photon emission computed tomography (SPECT/SPECT-CT) in predicting therapeutic response to facet interventions for facet joint-related low back pain: A systematic review and Meta-Analysis.","authors":"Raul F Vega-Alvear, Santiago Fuentes-Tapias, Alexandra Ramos-Márquez, Antonia Cadavid, Juan P Navarro-Garcia de Llano, Leonardo B O Brenner, Raphael Bertani, Edgar G Ordóñez-Rubiano, Juan F Ramón, Fernando Hakim, Diego F Gómez-Amarillo","doi":"10.1007/s00586-025-09241-w","DOIUrl":"https://doi.org/10.1007/s00586-025-09241-w","url":null,"abstract":"<p><strong>Purpose: </strong>Facet joint pain is a common cause of mechanical low back pain. Single-photon emission computed tomography (SPECT/SPECT-CT) aids in identifying pain foci. Still, its role in guiding therapeutic decisions for facet joint interventions, such as medial branch blocks and intra-articular injections, and their associated clinical response remains uncertain. This study aims to assess the effectiveness of SPECT/SPECT-CT in guiding facet interventions for low back pain.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines, searching seven databases and two clinical trial registries. Studies comparing outcomes between patients undergoing facet joint interventions guided by positive SPECT/SPECT-CT findings and those with negative imaging results, alternative imaging modalities, or physical examination were included. Pain intensity, functionality, and quality of life were assessed. The ROBINS-I tool was used to evaluate the risk of bias. Data were synthesized in tables, and a meta-analysis was performed.</p><p><strong>Results: </strong>Of 2,622 articles screened, six cohort studies met the inclusion criteria, including four that used intra-articular injections, with a total of 308 patients. SPECT alone showed a significant pooled effect favoring pain relief after facet interventions (RR 2.06, 95% CI 1.54-2.75; I² = 3%), while SPECT-CT showed no significant effect (RR 0.93, 95% CI 0.59-1.49; I² = 74%). By intervention type, intra-articular injections guided by SPECT/SPECT-CT showed a significant effect (RR 1.71, 95% CI 1.18-2.46; I² = 61%), whereas medial branch blocks did not (RR 1.03, 95% CI 0.58-1.84; I² = 72%). Sensitivity analysis excluding one high-risk study confirmed the significant pooled effect (RR 1.67, 95% CI 1.12-2.48; I² = 0%).</p><p><strong>Conclusion: </strong>SPECT alone may help predict outcomes for facet interventions, especially intra-articular injections, but evidence for SPECT-CT remains inconclusive. This should be interpreted with caution, given the current study limitations.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834680","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":"Microsurgical removal of a C1-C5 laterally located intramedullary subependymoma through a postero-lateral sulcus approach: case report, surgical video and critical review of diagnostic and surgical challenges.","authors":"Ciro Mastantuoni, Antonio Bocchetti, Maria Rosaria Scala, Valentina Cioffi, Giuseppe Corazzelli, Salvatore Di Colandrea, Stefania Garofalo, Francesco Fiorentino, Rosa Della Monica, Lorenzo Chiarotti, Raffaele de Falco","doi":"10.1007/s00586-025-09246-5","DOIUrl":"https://doi.org/10.1007/s00586-025-09246-5","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal subependymomas are rare, benign, and slow-growing intramedullary tumors, often misdiagnosed preoperatively due to their radiological resemblance to more common spinal cord neoplasms such as ependymomas and astrocytomas. Given their rarity, the optimal surgical approach and oncological strategy remains debated. While these tumors are histologically benign, obtaining a definitive diagnosis is crucial due to the diagnostic overlap with more aggressive lesions. In this case, a postero-lateral sulcus approach was selected based on the tumor's location and spinal cord rotation, allowing for a safe resection while preserving spinal cord function.</p><p><strong>Case presentation: </strong>A 41-year-old female presented with progressive right arm weakness over two years, followed by gait instability, paresthesia, and severe tetraparesis. Neurological examination revealed right-sided paresis, sensory deficits, and an unsteady gait. MRI demonstrated a T2-hyperintense, T1-hypointense intramedullary lesion from C1 to C5, with an eccentric localization and subpial extension, raising suspicion for an astrocytoma or ependymoma, though a subependymoma remained a consideration. Given the patient's progressive deterioration and the need for a histological diagnosis, surgical intervention was performed. A postero-lateral sulcus approach was chosen due to the lesion's lateral subpial emergence. Intraoperative mapping and neuromonitoring were used to preserve the corticospinal tracts and posterior columns. The tumor was carefully dissected through working windows between the dorsal root entry zones and was completely removed without significant neuromonitoring changes. Histological analysis confirmed the diagnosis of subependymoma, with a low Ki-67 index and no high-grade features. Postoperatively, the patient experienced transient worsening of motor deficits but showed progressive improvement, regaining full right arm function and near-normal gait at follow-up. No adjuvant therapy was required.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of spinal subependymomas and the role of surgery in securing a definitive diagnosis. The postero-lateral sulcus approach, enabled by the tumor's location and spinal cord rotation, provided a safe and effective approach. Intraoperative mapping and neuromonitoring were essential in minimizing surgical morbidity. Given their benign nature, complete resection is curative, and no additional treatment is required. This report underscores the importance of an individualized surgical strategy in managing rare intramedullary tumors with uncertain preoperative diagnosis.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834683","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":"Investigation of instrumentation lengthening in the thoracolumbar junction of the spine - an in vitro Biomechanical study.","authors":"Bastian Welke, Michael Schwarze, Christof Hurschler, Shadi Kedah, Dorothea Daentzer, Dennis Nebel","doi":"10.1007/s00586-025-09192-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09192-2","url":null,"abstract":"<p><strong>Purpose: </strong>Instrumented posterior lumbar fixation (PLF) with fusion is the surgical standard for treating various degenerative changes or deformities of the spine. Several studies have shown the risk of adjacent segment pathology following fusion. Therefore, revision procedures are often required which involve extension of instrumentation to adjacent levels. The purpose of this study was to evaluate the stability of multisegmental-instrumentation of the lumbar spine when extended with continuous rods or with connectors to the lower mid thoracic spine.</p><p><strong>Methods: </strong>Eight human specimens from Th5 to S1 were used and loaded with moments of 7.5 Nm about the three anatomical axes. A total of eight different PLF configurations were examined, with three conditions in a short Th10-S1 instrumentation and five conditions with a long Th6-S1 instrumentation. Continuous rods, and axial and lateral connectors were used to extend the PLF. Total range of motion (tROM) and total neutral zone (tNZ), as well as the intersegmental range of motion (iROM), were evaluated.</p><p><strong>Results: </strong>Overall, all configurations of the PLF demonstrated high primary stability. The iROM was less than 2 degrees in all segments studied where lengthening was performed with continuous rods or connectors. We found only a few significant differences, which are unlikely to be clinically relevant due to their very small magnitudes.</p><p><strong>Conclusion: </strong>From a biomechanical point of view, the axial and lateral connectors provide comparable primary stability to a continuous rod system. Thus, the use of connectors is likely to be a suitable approach of extending an existing lumbar fixation to the lower and mid thoracic spine.</p><p><strong>Level of evidence: </strong>Biomechanical study.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834681","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":"Development and validation of machine learning models to predict vertebral artery injury by C2 pedicle screws.","authors":"Bo Ye, Yang Sun, Guolin Chen, Bowen Wang, Hailan Meng, Lequn Shan","doi":"10.1007/s00586-025-09168-2","DOIUrl":"https://doi.org/10.1007/s00586-025-09168-2","url":null,"abstract":"<p><strong>Purpose: </strong>Cervical 2 pedicle screw (C2PS) fixation is widely used in posterior cervical surgery but carries risks of vertebral artery injury (VAI), a rare yet severe complication. This study aimed to identify risk factors for VAI during C2PS placement and develop a machine learning (ML)-based predictive model to enhance preoperative risk assessment.</p><p><strong>Methods: </strong>Clinical and radiological data from 280 patients undergoing head and neck CT angiography were retrospectively analyzed. Three-dimensional reconstructed images simulated C2PS placement, classifying patients into injury (n = 98) and non-injury (n = 182) groups. Fifteen variables, including characteristic of patients and anatomic variables were evaluated. Eight ML algorithms were trained (70% training cohort) and validated (30% validation cohort). Model performance was assessed using AUC, sensitivity, specificity, and SHAP (SHapley Additive exPlanations) for interpretability.</p><p><strong>Results: </strong>Six key risk factors were identified: pedicle diameter, high-riding vertebral artery (HRVA), intra-axial vertebral artery (IAVA), vertebral artery diameter (VAD), distance between the transverse foramen and the posterior end of the vertebral body (TFPEVB) and distance between the vertebral artery and the vertebral body (VAVB). The neural network model (NNet) demonstrated optimal predictive performance, achieving AUCs of 0.929 (training) and 0.936 (validation). SHAP analysis confirmed these variables as primary contributors to VAI risk.</p><p><strong>Conclusion: </strong>This study established an ML-driven predictive model for VAI during C2PS placement, highlighting six critical anatomical and radiological risk factors. Integrating this model into clinical workflows may optimize preoperative planning, reduce complications, and improve surgical outcomes. External validation in multicenter cohorts is warranted to enhance generalizability.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821053","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}