Global Spine Journal最新文献

{"title":"Revisiting Anticoagulation in Spine Surgery: Balancing Venous Thromboembolic Events and Epidural Hematoma.","authors":"Allie M Massaro, Sven Frier, Sarah M Strot, Ashley Scherman, Rod J Oskouian, Jens R Chapman","doi":"10.1177/21925682231190616","DOIUrl":"10.1177/21925682231190616","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>Venous thromboembolic events (VTE) and post-operative epidural hematoma (EDH) are significant complications after spine surgery. Guidelines for chemoprophylaxis are controversial and variability amongst surgeons remains. The objective of this study was to establish the incidence of clinical VTE and EDH at our institution and evaluate the association of chemoprophylaxis with clinical VTE and EDH.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients undergoing spine surgery at a high-volume tertiary care center in Seattle, WA between January 2016 and December 2019. The Premier Health Care Database and Agency for Healthcare Research and Quality (AHRQ) patient indicators PSI-9 (Perioperative hemorrhage and hematoma) and PSI-12(Perioperative PE or DVT) were used to identify patients experiencing VTE and/or post-operative EDH. The primary outcome was the incidence of clinical VTE and EDH in post-operative spine patients. Secondary outcomes included the association of chemoprophylaxis with clinical VTE and EDH.</p><p><strong>Results: </strong>From 2016 to 2019, 4587 patients underwent spine surgery, totaling 4764 hospital stays. The incidence of clinical VTE was .21% (10/4764) and the incidence of EDH was .10% (5/4764). Most hemorrhages occurred prior to the initiation of chemoprophylaxis. One patient with EDH received chemoprophylaxis prior to hemorrhage.</p><p><strong>Conclusions: </strong>The rate of post-operative clinical VTE and EDH in spine surgery is low. Despite early initiation of chemoprophylaxis after major spine surgery we did not appreciate a high rate of EDH. We attribute our low rate of clinical VTE to multimodal prophylaxis with SCDs, early mobilization and chemoprophylaxis on post-operative day 1.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"363-369"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892692","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":"Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study.","authors":"Yogin Patel, Karthik Ramachandran, Ajoy Prasad Shetty, Sekar Chelliah, Balavenkat Subramanian, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan","doi":"10.1177/21925682231203653","DOIUrl":"10.1177/21925682231203653","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomized controlled double-blinded study.</p><p><strong>Objective: </strong>To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia.</p><p><strong>Methods: </strong>81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded.</p><p><strong>Results: </strong>The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; <i>P</i> < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29 mg; <i>P</i> < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03 mL, 380.74 ± 77.80 mL) than the control group (498.89 ± 71.22 mL) (<i>P</i> < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief.</p><p><strong>Conclusion: </strong>Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"639-647"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41127118","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":"Evaluating Dysphagia Duration and Severity After ACDF in Patients With Underlying Dysphagia - A Prospective, Multicenter Study.","authors":"Aditya Mazmudar, Taylor Paziuk, Khoa S Tran, Tyler Henry, Samuel Oh, Caroline Purtill, Daniel Habbal, Goutham Yalla, Quinlin Harrill, Brandon Sherrod, Erica Bisson, Darrel Brodke, Christopher Kepler, Gregory Schroeder, Alexander Vaccaro, Alan Hilibrand, Jeffrey A Rihn","doi":"10.1177/21925682231201249","DOIUrl":"10.1177/21925682231201249","url":null,"abstract":"<p><strong>Study design: </strong>Prospective Cohort Study.</p><p><strong>Objectives: </strong>The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions.</p><p><strong>Methods: </strong>After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these dysphagia surveys were repeated immediately postoperatively, at two weeks and again at six, 12, and 24 weeks postoperatively. Patients were stratified into three subgroups based on dysphagia status preoperatively and immediately postoperatively and compared using ANOVA tests or Kruskal-Wallis tests for continuous variables and Pearson chi-square analysis or Fisher's Exact test for categorical variables.</p><p><strong>Results: </strong>A total of 168 patients (23 with preoperative dysphagia, 145 without preoperative dysphagia) met study criteria and were enrolled in the study. Patients with preoperative dysphagia had less frequent alcohol consumption (23.8% vs 53.7%, <i>P</i> = .0210), and higher rates of dysphagia at 2-weeks (77.8% vs 38.7%, <i>P</i> = .004) and 24-weeks (43.8% vs 14.8%, <i>P</i> = .010) postoperatively. These patients also had higher severity scores for dysphagia on the Bazaz (<i>P</i> = .001), DSQ (<i>P</i> = .012), EAT10 (<i>P</i> = .022) questionnaires at the 2-week follow-up period, higher DSQ scores (<i>P</i> = .036) at the 6-week follow-up period, higher EAT-10 scores (<i>P</i> = .009) at the 12-week follow-up period, and higher Bazaz (<i>P</i> = .001), DSQ (<i>P</i> = .002), and EAT-10 (<i>P</i> = .005) scores at the 24-week follow-up period. There were no differences in demographic, medical history, surgical variables, rates of ENT consultation, length of stay, or other in-hospital events between groups.</p><p><strong>Conclusions: </strong>Patients undergoing ACDF who had preoperative dysphagia have prolonged postoperative dysphagia and greater dysphagia severity. Surgeons should be aware of the risk of prolonged dysphagia severity that may persist past 24 weeks after surgery when discussing clinical decisions with patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"571-579"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10159770","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":"Interobserver Agreement and Satisfaction With the use of Telemedicine for Evaluating low Back Pain: A Primary, Observational, Cross-Sectional, Analytical Study.","authors":"Jair Moreira Dias, Adriano Fernando Mendes, Eduardo Pestana de Aguiar, Luan Costa Silveira, Maria Fernanda Noel Dias, Nádia Rezende Barbosa Raposo","doi":"10.1177/21925682231194453","DOIUrl":"10.1177/21925682231194453","url":null,"abstract":"<p><strong>Study design: </strong>A primary, observational, cross-sectional, analytical study.</p><p><strong>Objective: </strong>The development of a framework for systematic telemedicine (TM) for orthopedic physicians in frequent clinical care may increase agreement in diagnosis and satisfaction among users of TM. Therefore, this study aimed to estimate the agreement in the diagnosis of low back pain (LBP) between TM, systematized by a self-completed digital questionnaire, and face-to-face (FF) care in patients with LBP.</p><p><strong>Methods: </strong>This study included adults up to 75 years of age with LBP for more than 6 weeks. They were evaluated at 2 independent time points (TM and FF) by different orthopedists with 3 different levels of expertise. Professionals evaluated the sample without prior knowledge of the diagnosis, and each orthopedist provided a diagnosis. Diagnostic agreement was the primary outcome. Secondary outcomes were the duration of the visit and satisfaction among healthcare professionals.</p><p><strong>Results: </strong>A total of 168 participants were eligible, of whom 126 sought care through TM and 122 sought FF care (mean age, 47 years [range, 18-75 years]; 66.4% women). The agreement among professionals regarding the diagnosis was moderate (kappa = .585, <i>P</i> = .001). TM was faster than FF (11.9 minutes (standard deviation = 4.1) vs 18.6 (SD = 6.9), <i>P</i> < .001). Professional satisfaction was higher among spine specialists than among orthopedic residents and orthopedists who were not specialists in spine surgery.</p><p><strong>Conclusion: </strong>Agreement in diagnosis was moderate for TM, with a 30% shorter visit duration than FF. Satisfaction varied by professional expertise and was higher among spine specialists than among professionals with other expertise.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"482-489"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10367368","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":"Artificially Intelligent Billing in Spine Surgery: An Analysis of a Large Language Model.","authors":"Bashar Zaidat, Yash S Lahoti, Alexander Yu, Kareem S Mohamed, Samuel K Cho, Jun S Kim","doi":"10.1177/21925682231224753","DOIUrl":"10.1177/21925682231224753","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>This study assessed the effectiveness of a popular large language model, ChatGPT-4, in predicting Current Procedural Terminology (CPT) codes from surgical operative notes. By employing a combination of prompt engineering, natural language processing (NLP), and machine learning techniques on standard operative notes, the study sought to enhance billing efficiency, optimize revenue collection, and reduce coding errors.</p><p><strong>Methods: </strong>The model was given 3 different types of prompts for 50 surgical operative notes from 2 spine surgeons. The first trial was simply asking the model to generate CPT codes for a given OP note. The second trial included 3 OP notes and associated CPT codes to, and the third trial included a list of every possible CPT code in the dataset to prime the model. CPT codes generated by the model were compared to those generated by the billing department. Model evaluation was performed in the form of calculating the area under the ROC (AUROC), and area under precision-recall curves (AUPRC).</p><p><strong>Results: </strong>The trial that involved priming ChatGPT with a list of every possible CPT code performed the best, with an AUROC of .87 and an AUPRC of .67, and an AUROC of .81 and AUPRC of .76 when examining only the most common CPT codes.</p><p><strong>Conclusions: </strong>ChatGPT-4 can aid in automating CPT billing from orthopedic surgery operative notes, driving down healthcare expenditures and enhancing billing code precision as the model evolves and fine-tuning becomes available.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1113-1120"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037579","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":"Cervical Disc Arthroplasties Fail to Maintain Physiological Kinematics Under Lateral Eccentric Loads.","authors":"Paul Jonathan Roch, Constantin Hemprich, Friederike Klockner, Marc-Pascal Meier, Katharina Jäckle, Wolfgang Lehmann, Martin Michael Wachowski, Lukas Weiser","doi":"10.1177/21925682231193642","DOIUrl":"10.1177/21925682231193642","url":null,"abstract":"<p><strong>Study design: </strong>In vitro human cadaveric biomechanical analysis.</p><p><strong>Objectives: </strong>Optimization of prostheses for cervical disc arthroplasties (CDA) reduces the risk of complications. The instantaneous helical axis (IHA) is a superior parameter for examining the kinematics of functional spinal units. There is no comprehensive study about the IHA after CDA considering all 3 motion dimensions.</p><p><strong>Methods: </strong>Ten human functional spinal units C4-5 (83.2 ± 7.9 yrs.) were examined with an established measuring apparatus in intact conditions (IC), and after CDA, with 2 different types of prostheses during axial rotation, lateral bending, and flexion/extension. Eccentric preloads simulated strains. The IHA orientation and its position at the point of rest (IHA₀-position) were analyzed.</p><p><strong>Results: </strong>The results confirmed the existing data for IHA in IC. Lateral preloads showed structural alterations of kinematics after CDA: During axial rotation and lateral bending, the shift of the IHA₀-position was corresponding with the lateral preloads' applied site in IC, while after CDAs, it was vice versa. During lateral bending, the lateral IHA orientation was inclined, corresponding with the lateral preloads' applied site in the IC and oppositely after the CDAs. During flexion/extension, the lateral IHA orientation was nearly vertical in the IC, while after CDA, it inclined, corresponding with the lateral preloads' applied site. The axial IHA orientation rotated to the lateral preloads' corresponding site in the IC; after CDA, it was vice versa.</p><p><strong>Conclusion: </strong>Both CDAs failed to maintain physiological IHA characteristics under lateral preloads, revealing a new aspect for improving prostheses' design and optimizing their kinematics.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"445-458"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10020794","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 Meta-Analysis of Surgical Outcomes in 25727 Patients Undergoing Anterior Cervical Discectomy and Fusion or Anterior Cervical Corpectomy and Fusion for Cervical Deformity.","authors":"Karma Barot, Miguel A Ruiz-Cardozo, Som Singh, Gabriel Trevino, Michael R Kann, Samuel Brehm, Tim Bui, Karan Joseph, Rujvee Patel, Angela Hardi, Alexander T Yahanda, Julio J Jauregui, Magalie Cadieux, Brenton Pennicooke, Camilo A Molina","doi":"10.1177/21925682241270100","DOIUrl":"10.1177/21925682241270100","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review.</p><p><strong>Objectives: </strong>To evaluate which cervical deformity correction technique between anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) produces better clinical, radiographic, and operative outcomes.</p><p><strong>Methods: </strong>We conducted a meta-analysis comparing studies involving ACDF and ACCF. Adult patients with either original or previously treated cervical spine deformities were included. Two independent reviewers categorized extracted data into clinical, radiographic, and operative outcomes, including complications. Clinical assessments included patient-reported outcomes; radiographic evaluations examined C2-C7 Cobb angle, T1 slope, T1-CL, C2-7 SVA, and graft stability. Surgical measures included surgery duration, blood loss, hospital stay, and complications.</p><p><strong>Results: </strong>26 studies (25727 patients) met inclusion criteria and were extracted. Of these, 14 studies (19077 patients) with low risk of bias were included in meta-analysis. ACDF and ACCF similarly improve clinical outcomes in terms of JOA and NDI, but ACDF is significantly better at achieving lower VAS neck scores. ACDF is also more advantageous for improving cervical lordosis and minimizing the incidence of graft complications. While there is no significant difference between approaches for most surgical complications, ACDF is favorable for reducing operative time, intraoperative blood loss, and length of hospital stay.</p><p><strong>Conclusions: </strong>While both techniques benefit cervical deformity patients, when both techniques are feasible, ACDF may be superior with respect to VAS neck scores, cervical lordosis, graft complications and certain perioperative outcomes. Further studies are recommended to address outcome variability and refine surgical approach selection.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1390-1404"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874625","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":"The Role of Trabecular, Ligamentous-Intervertebral Disk and Facet Joints Systems: A Finite Element Analysis in the L4-S1 Vertebrae.","authors":"José Alejandro Guerrero-Vargas, Pablo Sanchez-Quinones, Brayan Felipe Pinzón, Melisa Vélez-Muriel, Humberto Madriñan-Navia, Leonardo Laverde-Frade","doi":"10.1177/21925682241231525","DOIUrl":"10.1177/21925682241231525","url":null,"abstract":"<p><strong>Study design: </strong>Descriptive.</p><p><strong>Objectives: </strong>Trabecular bone in the vertebrae is critical for the distribution of load and stress throughout the neuroaxis, as well as the intervertebral disk, ligamentous complex, and facet joints. The objective was to assess the stress and strain distribution of the L4-S1 spine segment by a finite element analysis.</p><p><strong>Methods: </strong>A lumbosacral spine model was built based on a CT-Scan. Trabecular-to-cortical bone distribution, ligaments, intervertebral disk, and facet joints with cartilage were included. A perpendicular force was applied over the L4 upper terminal plate of 300 N, 460 N and 600 N in neutral, plus 5 Nm and 7.5 Nm for flexion and extension movements. Maximum principal stress and total deformation were the main studied variables.</p><p><strong>Results: </strong>Trabecular bone confers resistance to axial loads on the vertebrae by elastic capacity and stress distribution. MPS and TD showed axial stress attenuation in the nucleus pulposus and longitudinal ligaments, as well as load distribution capacity. Facet joints and discontinuous ligaments showed greater TD values in flexion moments but greater MPS values in extension, conferring stability to the lumbosacral junction and axial load distribution.</p><p><strong>Conclusion: </strong>We propose 3 anatomical systems for axial load distribution and stress attenuation in the lumbosacral junction. Trabecular bone distributes loads, while the ligamentous-intervertebral disk transmits and attenuate axial stress. Facet joints and discontinuous ligaments act as stabilizers for flexion and extension postures. Overall, the relationship between trabecular bone, ligamentous-intervertebral disk complex and facet joints is necessary for an efficient load distribution and segmental axial stress reduction.This slide can be retrieved from the Global Spine Congress 2023.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1212-1228"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722280","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":"Comparing Spinal Cord Drift, Clinical Outcomes and C5 Palsy in Degenerative Cervical Myelopathy: A Study of Cervical Laminoplasty Versus Laminectomy/Fusion.","authors":"Saumyajit Basu, Kushal Gohil","doi":"10.1177/21925682241235608","DOIUrl":"10.1177/21925682241235608","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Objectives: </strong>(i)to compare spinal cord drift between laminectomy and fusion(LF) and cervical laminoplasty(LP) for degenerative cervical myelopathy(DCM) treatment,(ii)to study relationship between preoperative cervical alignment, postoperative spinal cord drift, functional outcome, and C5 palsy.</p><p><strong>Methods: </strong>A cohort of 114 patients who underwent LP or LF for DCM were identified. After propensity-score matching, both groups included 30 patients each.Cobb angle(C2-C7) was used to assess pre-and postoperative cervical spine alignment(at 2-year follow-up).Based on alignment, there were lordotic(L) and straight(S) subgroups.Spinal cord position was measured on sagittal-and axial-T2W MRI of cervical spine pre-and postoperatively at 2-year follow-up and cord drift was measured by subtracting preoperative values from postoperative values.Functional recovery(mJOA score, mJOA recovery rate),and C5 palsy in patients were recorded and compared.</p><p><strong>Results: </strong>LF had higher mean spinal cord drift than LP(2.66 ± .77 vs 2.16 ± .80 mm, <i>P</i> = .049).Lordotic subgroups exhibited greater cord drift than straight subgroups within LP and LF groups.Both groups significantly improved mJOA scores at 2-year follow-up, with no LP-LF difference in mJOA recovery rate(mJOA-RR).Lordotic subgroups had significantly higher mJOA-RR(LP-L vs LP-S,<i>P</i> = .048; LF-L vs LF-S,<i>P</i> = .045).Preoperative cervical alignment, cord drift, and mJOA-RR correlated well(Spearman's ρ .7143 and .6053 respectively).Patients with >2.5 mm cord drift(n = 24) had significantly higher mJOA-RR as compared to <2.5 mm cord drift(n = 18). Substantial clinical difference was seen in C5 palsy risk between LP-S and LF-L, with the LF-L group having 3-fold higher risk.</p><p><strong>Conclusion: </strong>LF had a biomechanical advantage in maximizing spinal cord drift in severe DCM cases, while both LP and LF showed significant improvements in neurological function. However, variability in C5 palsy rates highlights the need for individualized patient assessment.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"1277-1287"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930802","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":"Obesity Limits Utility of Vertebral Bone Quality Score for Opportunistic Osteopenia/Osteoporosis Screening in Cervical Surgery Patients.","authors":"Mingliang Shi, Cheng Ye, Baocheng Niu, Dong Xie, Qing Chen, Qi Zhao, Hao Wu, Lili Yang","doi":"10.1177/21925682251325181","DOIUrl":"10.1177/21925682251325181","url":null,"abstract":"<p><strong>Study design: </strong>Comparative study.</p><p><strong>Objective: </strong>The vertebral bone quality (VBQ) score is a validated opportunistic screening tool for bone mineral density (BMD). Obesity, often associated with hyperlipidemia and fat infiltration, may result in lower VBQ-derived BMD. However, studies have shown that dual-energy x-ray absorptiometry (DXA)-derived BMD tends to increase in obesity. Given this paradox, the aim of this study was to evaluate the effect of obesity on the utility of VBQ in opportunistic osteopenia/osteoporosis screening.</p><p><strong>Methods: </strong>A total of 310 consecutive patients with degenerative cervical myelopathy were included. Body mass index (BMI) classified patients into underweight/normal, overweight, and obesity groups. Pearson's correlation assessed the associations of BMI with VBQ score, Hounsfield unit (HU) values, and T-score. The utility of VBQ score and HU values to discriminate normal BMD from osteopenia/osteoporosis was analyzed using receiver operating characteristic curve analysis and area under the curve (AUC).</p><p><strong>Results: </strong>BMI was associated with lower VBQ score and higher T-score, but not with HU values. The correlation between VBQ score and T-score decreased with increasing BMI, eventually becoming nonsignificant in the obesity group (r = 0.241, <i>P</i> = .082). The VBQ score was not effective in identifying osteopenia/osteoporosis in the obese group (AUC = 0.59, <i>P</i> = .282). Compared with VBQ score, HU values were effective in several BMI subgroups (AUC = 0.75 to 0.88, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>The Cervical VBQ score is no longer a reliable indicator of DXA-derived BMD in obese patients. Even when the VBQ-derived BMD appears normal, it should not be solely relied upon to preclude further DXA evaluation.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251325181"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531241","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}