Global Spine Journal最新文献

{"title":"Reduced Preoperative Cervical Spine Flexion-Extension Range of Motion Is Associated With the Development of Upper Thoracic Proximal Junction Kyphosis in Adult Spinal Deformity Patients.","authors":"Justin K Scheer, Fthimnir M Hassan, Chun Wai Hung, Ted Shi, Nathan J Lee, Steven G Roth, Alexander Tuchman, Corey T Walker, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke","doi":"10.1177/21925682261449777","DOIUrl":"https://doi.org/10.1177/21925682261449777","url":null,"abstract":"<p><p>Study DesignRetrospective<b>,</b> Single-center.ObjectiveTo evaluate preoperative cervical range-of-motion via cervical flexion-extension radiographs and its relation to the development of PJK/PJF following ASD correction in patients with a UIV in the upper thoracic spine.MethodsPatients with an UIV between T1-T4, preoperative cervical flexion/extension radiographs and instrumented to the pelvis, and minimum 1yr follow-up were included. Cervical measurements included range-of-motion (ROM), flexion, extension and cervical SVA (cSVA). Patients were stratified into 3 groups: No-PJK, asymptomatic PJK (A-PJK) and symptomatic PJK including PJF (S-PJK/PJF).Results151 patients were included: Mean age 59.6 ± 8.0 yrs, BMI of 25.1 ± 4.5, 88.7% (n = 134) were female. PJK status: No PJK = 111 (73.5%) patients, A-PJK = 21 (13.9%), S-PJK/PJF = 19 (12.6%). S-PJK/PJF patients, however, were more likely to be diagnosed with osteopenia/osteoporosis(S-PJK/PJF: 68.4% vs A-PJK: 23.8% vs No PJK: 52.3%, <i>P</i> = 0.0138). S-PJK/PJF patients had significantly less cervical flexion (No PJK: 19.5 ± 14.2 vs A-PJK: 19.9 ± 10.9 vs S-PJK/PJF: 7.7 ± 11.9, <i>P</i> = 0.0029) and ROM than the other groups (No PJK: 52.8 ± 17.7 vs A-PJK: 53.1 ± 14.5 vs S-PJK/PJF: 39.2 ± 17.9, <i>P</i> = 0.0085). On multivariable models for the development of S-PJK/PJF, reduced baseline cervical flexion and ROM were independent risk factors yielding threshold values of 22.8° and 48.2°, respectively.ConclusionMultivariable models for the development of S-PJK/PJF demonstrated that reduced baseline cervical ROM and flexion were independent risk factors yielding threshold values of 48.2° and 22.8°, respectively. All of S-PJK/PJF patients had preop flexion <22.8°. Flexion-extension radiographs provide a quick and easy option at a relatively low cost to offer additional information that may aid in surgical planning and shared decision making with the patient regarding potential outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261449777"},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837240","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":"Postoperative C-Reactive Protein Trajectories in Spine Surgery - Influence of Vancomycin Powder: A Secondary Analysis of a Prospective Randomized Controlled Trial.","authors":"Lukas F Panzenböck, George Abdel Nour, Damian L Dürrschnabel, Petra Krepler","doi":"10.1177/21925682261450878","DOIUrl":"https://doi.org/10.1177/21925682261450878","url":null,"abstract":"<p><p>Study DesignRandomized controlled trial.ObjectivesTo characterize postoperative C-reactive protein (CRP) trajectories as predictors of surgical site infection (SSI) following lumbar spine surgery, to determine optimal CRP thresholds, and to assess whether intrawound vancomycin powder affects postoperative CRP kinetics.MethodsData were drawn from a prospective randomized controlled trial enrolling 292 patients undergoing posterior lumbar interbody fusion. Patients received intrawound vancomycin powder (1 g) plus standard prophylaxis or standard prophylaxis alone. CRP was measured preoperatively and on days 1, 2, 3, 5, and 7. SSI was classified as overt (CDC criteria) or subclinical. ROC analysis evaluated prediction of any SSI at each time point.Results22 patients (7.5%) developed any SSI: 9 overt (3.1%) and 13 subclinical (4.5%). CRP peaked at day 5 in the overall cohort. SSI patients showed persistently elevated CRP through day 7, while uncomplicated patients declined after day 3. Day 7 CRP showed the highest discriminatory ability (AUC = 0.813; cutoff ≥79 mg/L; sensitivity 61.1%; specificity 91.4%; NPV 95.2%). Vancomycin did not alter CRP kinetics at any time point (all <i>P</i> > 0.08).ConclusionsIn 292 spine surgery patients, day 7 CRP (AUC = 0.813) was the strongest predictor of any SSI. A cutoff of 79 mg/L on day 7 provided NPV of 95.2%, supporting CRP as a rule-out biomarker. Day 3 CRP ≥92 mg/L (AUC = 0.761) offers early warning capability. CRP trajectories did not differ significantly between the vancomycin and control groups. ClinicalTrials.gov: NCT02631408; EudraCT: 2014-002096-29.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261450878"},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856115","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":"Beyond Cord Compression: Instability as a Major Driver for Neurological Deficit in Active Thoracic Spinal Tuberculosis.","authors":"Harikrishna Raghuraj Ramasamy, Gnanaprakash Gurusamy, Sri Vijay Anand K S, Ajoy Prasad Shetty, Rishi Mugesh Kanna, Mogan Kaviprawin, Shanmuganathan Rajasekaran","doi":"10.1177/21925682261451174","DOIUrl":"https://doi.org/10.1177/21925682261451174","url":null,"abstract":"<p><p>Study DesignRetrospective.ObjectiveTo evaluate the association between mechanical instability and neurological deficit in spinal tuberculosis (TB), and compare it against previously recognized radiological parameters.MethodsClinical and radiological data of patients with active thoracic spinal TB were evaluated. Instability was assessed using the Spinal Tuberculosis Instability Scoring System (STISS) by Rajasekaran et al. Neurological status and radiological parameters were analysed to identify the factors associated with neurological deficit.ResultsA total of 122 patients were included. The average age was 51 ± 18 years, and 54.9% were males. 40 (32.8%) patients had neurological deficits at presentation. Based on the STISS, 71 (58%) patients were categorised as stable, 10 (8.2%) as potentially unstable, and 41 (34%) as definitely unstable. On MRI, cord signal changes and epidural compression were noted in 18% and 64% of the patients, respectively. Definite instability was found to be the strongest independent association of neurological deficit (OR 9.77, 95% CI 2.85-38.9, <i>P</i> < 0.001), followed by greater canal encroachment area (CEA) (OR 1.08, 95% CI 1.03-1.13, <i>P</i> = 0.002). In a stable spine with epidural compression, the predicted probability of neurological deficit is 27%. In an unstable spine, the likelihood of neurological deficit is 50% even without epidural compression, and highest (63%) when instability was associated with epidural compression.ConclusionMechanical instability is the strongest independent association of neurological deficit in spinal TB, even in the absence of epidural compression. Incorporating the Spine Instability Scoring System into routine clinical evaluation improves risk stratification, enables timely decision-making, and can prevent irreversible neurological deficits.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261451174"},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856139","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":"Comment on \"Sarcopenia as a Predictor of Mortality Following Vertebral Compression Fractures Treated with Vertebroplasty\".","authors":"Natsuko Hashikawa, Yu Toda, Hirohito Hirata, Tomohito Yoshihara, Masatsugu Tsukamoto, Tadatsugu Morimoto","doi":"10.1177/21925682261452227","DOIUrl":"https://doi.org/10.1177/21925682261452227","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261452227"},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856135","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":"Association Between Adjacent Disc Vacuum Phenomenon and Adjacent Vertebral Fracture After Balloon Kyphoplasty for Osteoporotic Vertebral Fractures: A Retrospective Multicenter Study.","authors":"Kento Okamoto, Ryota Kimura, Michio Hongo, Yuji Kasukawa, Kazunobu Abe, Fumihito Kasama, Kyoko Nomura, Naohisa Miyakoshi","doi":"10.1177/21925682261450872","DOIUrl":"https://doi.org/10.1177/21925682261450872","url":null,"abstract":"<p><p>Study DesignRetrospective observational study.ObjectivesTo determine whether the preoperative adjacent disc vacuum phenomenon (ADVP) is associated with an increased risk of adjacent vertebral fracture (AVF) after balloon kyphoplasty (BKP) for osteoporotic vertebral fractures.MethodsThe clinical and radiological data of 124 consecutive patients who underwent BKP at T11-L2 were retrospectively reviewed. ADVP was defined as radiolucent gas within the intervertebral disc space on preoperative computed tomography (CT). Patients were classified as ADVP-positive or ADVP-negative. The incidence of AVF was compared between the groups, and independent risk factors were assessed using multivariate logistic regression. Multiple imputation was performed, and propensity score matching (PSM) was used to adjust for potential confounding factors because bone mineral density data were partially missing.ResultsADVP was identified in 48 patients (38.7%). AVF occurred in 21 patients (16.9%) and was significantly more frequent in the ADVP-positive group than in the ADVP-negative group (31.2% vs 7.9%; <i>P</i> < 0.01). Univariate analysis showed that the presence of ADVP and longer symptom duration were significantly associated with AVF. Multivariate logistic regression identified ADVP as an independent risk factor for AVF (odds ratio 4.97; 95% confidence interval 1.71-14.5; <i>P</i> = 0.003). This association remained consistent after multiple imputation and PSM.ConclusionsPreoperative ADVP is associated with an increased risk of AVF after BKP. Incorporating the assessment of ADVP into preoperative CT evaluation may help identify patients at a higher risk of AVF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261450872"},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856169","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":"Benchmarking Multimodal Vision Frontier Models With Lumbar Spine MRIs for Grading Lumbar Spinal Stenosis.","authors":"Harry Gebhard, Ahmet Kartal, Noel F Manalil, Lawrance K Chung, Sohail R Daulat, Chiungwen D Cheng, Ayesha Akbar Waheed, Andia Shahzadi, Ibrahim Hussain, Roger Härtl, Galal A Elsayed","doi":"10.1177/21925682261448823","DOIUrl":"10.1177/21925682261448823","url":null,"abstract":"<p><p>Study DesignDiagnostic accuracy study.ObjectivePrior evaluations of frontier models as radiology decision-support tools relied on 2-dimensional images or text reports; their ability to interpret volumetric data remains unclear. This study assessed Google Gemini 3 Pro for grading lumbar spinal canal stenosis on video lumbar magnetic resonance imaging (MRI) and evaluated diagnostic accuracy, agreement with neuroradiologist consensus, and the effect of localizer-assisted input.MethodsThe Radiological Society of North America (RSNA) 2024 Lumbar Spine Degenerative Classification Dataset, with American Society of Neuroradiology (ASNR) consensus labels, served as a reference benchmark; interobserver agreement among contributing readers was not reported. 100 examinations yielded 500 disc-level observations (371 normal/mild, 74 moderate, 55 severe), demonstrating marked class imbalance. Native imaging series were converted into synchronized video montages. Gemini 3 Pro generated one grade per disc level with and without localizer overlays. Primary outcome was linearly weighted kappa (κw); secondary outcomes included class-wise performance, severe-case error patterns, and overall accuracy.ResultsWithout localizer, overall accuracy was 75.6% (378/500) with fair agreement (κw = 0.39). Severe stenosis sensitivity was 41.8%; 43.6% of severe cases were downgraded to normal/mild, and 58.2% to non-severe. With localizer overlays, accuracy was 73.2% (366/500) with κw = 0.32, and severe sensitivity decreased to 30.9%; severe-to-normal/mild misses increased to 52.7%. Differences were not significant.ConclusionsGemini 3 Pro showed fair agreement with the neuroradiologist consensus benchmark, but apparent overall accuracy was inflated by the majority normal/mild class and masked clinically unacceptable under-detection of severe stenosis. Localizer-assisted input did not improve performance.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261448823"},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic BMD to Trajectory-Specific Bone Quality.","authors":"Shabir A Dhar","doi":"10.1177/21925682261449762","DOIUrl":"10.1177/21925682261449762","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261449762"},"PeriodicalIF":3.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Concerning \"Long-Term Impact of Total Hip Arthroplasty on Subsequent Lumbar Spine Surgery in Patients With Hip-Spine Disease: A Nationwide Analysis of Risk Factors and Outcomes\".","authors":"Yujia Cai, Xiaoting Li, Qingqiang Zeng","doi":"10.1177/21925682261449767","DOIUrl":"10.1177/21925682261449767","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682261449767"},"PeriodicalIF":3.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Night-Time Bracing for Mild Adolescent Idiopathic Scoliosis: A Retrospective Cohort Study.","authors":"Stefan Zwingenberger, Lisa Mersiowsky, Matthew Newton Ede, Andreas Selle, Xinggui Tian, Xuan Pei, Peter Bernstein, Jens Seifert, Klaus-Dieter Schaser, Alexander C Disch, Uwe Platz","doi":"10.1177/21925682251387086","DOIUrl":"10.1177/21925682251387086","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectivesTo assess the efficacy and compliance of early night-time bracing in adolescent idiopathic scoliosis with curve magnitudes between the recently proposed early-intervention threshold (15°) and the traditional treatment threshold (25°) recommended by the Scoliosis Research Society (SRS).MethodsThis dual-center retrospective study included 153 AIS patients (Risser 0-3, Cobb angle 15°-25°) treated with the Dresdner Night-Time Brace (DNTB) between 2002 and 2021. Patient demographics, patient compliance, and radiographic outcomes were analyzed. Treatment success was defined by curve stabilization or regression. Statistical analysis was performed with significance set at <i>P</i> < 0.05.ResultsThe DNTB achieved a mean in-brace correction of 60.9%, moderately correlated with the initial Cobb angle. Compliance was high: 72.6% of patients were compliant, 15.0% partially compliant, and 12.4% non-compliant. The in-brace correction angle was associated with compliance but not with age, sex, or initial curve magnitude. Compliance significantly influenced outcomes (<i>P</i> < 0.05). Overall curve progression was 12.5%, but only 2.7% in compliant patients, compared to 30.4% and 47.4% in partially and non-compliant groups, respectively. Surgery was required in 10.5% of non-compliant cases.ConclusionsEarly intervention with the DNTB is an effective and well-tolerated treatment for mild AIS (15°-25°), with treatment success highly dependent on patient compliance. These findings underscore the importance of timely bracing and sustained compliance.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1775-1785"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Preoperative GLP-1 Receptor Analog Use and Postoperative Complications and Mortality Following Lumbar Fusion Surgery.","authors":"Ahad A Kesaria, Farhad A Marzook, James M Glover, Pouya Alijanipour","doi":"10.1177/21925682251391693","DOIUrl":"10.1177/21925682251391693","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectivesThis study evaluates the association between preoperative GLP-1 RA (glucagon-like-peptide-1 receptor antagonist) use and postoperative outcomes in patients undergoing lumbar fusion surgery.MethodsTriNetX database identified patients undergoing lumbar fusion within 20 years using Current Procedural Terminology (CPT). Patients were categorized by GLP-1 RA use within 1 year preoperatively. 1:1 propensity score match (PSM) balanced demographics and comorbidities including race/ethnicity, age, gender, hypertension, diabetes, obesity, nicotine dependence, sleep apnea, ischemic heart diseases, chronic kidney disease, acute kidney failure, mood disorders, asthma, chronic obstructive pulmonary disease, heart failure, alcohol dependence, anemia, and vitamin D deficiency. Primary outcomes were 1-year complications postoperatively. Chi-square analysis, risk ratios (RRs), 95% confidence intervals (CI), and <i>P</i>-values were calculated; significance was <i>P</i> < 0.05.Results4331 patients using preoperative GLP-1 RA were propensity score-matched with 179,268 controls without GLP-1 RA use, resulting in 4331 patients in each cohort after matching. At 1 year, GLP-1 RA users had significant reductions in DVT (1.4% vs 2.3%, RR = 0.64, 95% CI [0.464-0.883], <i>P</i> = 0.0061), PE (1.1% vs 1.6%, RR = 0.689, 95% CI [0.476-0.997], <i>P</i> = 0.0466), sepsis (4.0% vs 5.0%, RR = 0.811, 95% CI [0.66-0.995], <i>P</i> = 0.0447), all-cause mortality (2.1% vs 4.6%, RR = 0.46, 95% CI [0.36-0.589], <i>P</i> < 0.0001), pneumonia (2.4% vs 3.3%, RR = 0.716, 95% CI [0.548-0.936], <i>P</i> = 0.0139), and pseudoarthrosis (8.9% vs 13.8%, RR = 0.642, 95% CI [0.564-0.732], <i>P</i> < 0.0001) compared to non-users.ConclusionsPreoperative GLP-1 RA use is associated with a reduction in postoperative complications following lumbar fusion surgery. Further research is necessary to elucidate the underlying mechanisms and evaluate long-term outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1889-1897"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12553540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}