Global Spine Journal最新文献

{"title":"Management and Risk Factors of Fracture-Type Proximal Junctional Kyphosis: Focus on Myelopathy and Intervention.","authors":"Atsuyuki Kawabata, Keisuke Hide, Takayuki Motoyoshi, Jun Hashimoto, Yu Matsukura, Takuya Oyaizu, Takashi Hirai, Hiroaki Onuma, Satoru Egawa, Kentaro Yamada, Shingo Morishita, Kazuo Kusano, Kazuyuki Otani, Shigeo Shindo, Toshitaka Yoshii","doi":"10.1177/21925682251359948","DOIUrl":"10.1177/21925682251359948","url":null,"abstract":"<p><p>Study DesignRetrospective observational study.ObjectivesTo identify radiographic and clinical predictors of fracture-type proximal junctional kyphosis (PJFx) and associated myelopathy (PJFx-M), with the goal of facilitating timely surgical intervention.MethodsWe retrospectively reviewed 438 patients with adult spinal deformity who underwent long-segment fusion surgery at our institution between 2013 and 2023. Risk factors for PJFx and PJFx-M were analyzed, focusing on demographic and radiographic parameters. In PJFx-M cases, we specifically assessed sliding length, screw protrusion, and superior articular facet fractures.ResultsPJFx occurred in 102 patients (23.3%). Significant risk factors for PJFx included a lower Hounsfield unit (HU) value at the upper instrumented vertebra (UIV) and reduced preoperative lumbar lordosis. PJFx-M was identified in 10 patients (2.3%). Radiographic predictors of PJFx-M included increased sliding length, screw protrusion into the upper vertebra, and bilateral superior articular facet fractures (all <i>P</i> < 0.001). Additionally, a fall within 1 month of symptom onset was frequently observed in PJFx-M cases. PJFx-M was not associated with demographic factors or body mass index.ConclusionsLower HU at the UIV and reduced preoperative lumbar lordosis were key predictors of PJFx. PJFx-M should be suspected in the presence of increased sliding length, screw protrusion into the upper vertebra, superior articular facet fractures, and a recent fall. These findings highlight the importance of vigilant postoperative radiographic and clinical monitoring to enable early detection and intervention, potentially preventing neurological deterioration.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251359948"},"PeriodicalIF":2.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600222","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":"Extent of Fatty Infiltration of Lumbar Paraspinal Muscles as a Proxy for Frailty and Its Relationship with Perioperative Outcomes in Patients Undergoing Elective Spinal Surgery.","authors":"Ronit Kulkarni, Chase Walton, Cassandra D'Amico, Melanie Bertolino, Jason Silvestre, Gabriella Rivas, Stephen Lewis, Christopher Nielsen, John Glaser, Charles Reitman, James Lawrence, Robert Ravinsky","doi":"10.1177/21925682251359536","DOIUrl":"10.1177/21925682251359536","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectivesThe purpose of this study was to identify the role of lumbar paraspinal muscle fatty infiltration using the Goutallier classification in predicting perioperative outcomes following elective lumbar surgery.MethodsA retrospective review was conducted on patients who underwent elective one- or two-level lumbar decompressions or instrumented fusions for degenerative pathology at a single institution over a 3 year period. Patients were stratified by procedure type. Data included demographics, perioperative outcomes, and the 5-item Modified Frailty Index (MFI-5). Fatty infiltration was graded at L4-5 using the Goutallier classification (intraclass correlation coefficient = 0.908). Opportunistic osteoporosis screening used computed tomography-based Hounsfield units (HU) at L1-2. The relationships between Goutallier grade, demographics, MFI-5 score, and postoperative outcomes were analyzed using Chi-squared analyses, Fisher's exact test, Analysis of Variance, and multivariable logistic and linear regression.ResultsIn total, 314 patients met the inclusion criteria. Mean age was 68.9 ± 8.6 years; mean Goutallier score was 2.2 ± 1.1 and MFI-5 was 1.3 ± 1.0. Goutallier score significantly correlated with age, American Society of Anesthesiologists grade, steroid use, MFI-5, discharge disposition, and 180 day complications and reoperation. Subgroup analyses revealed differing associations between Goutallier score and comorbidities/outcomes across procedure types. Multivariable regression confirmed Goutallier score as predictive of 180 day complications, reoperation, non-home discharge, and frailty.ConclusionGoutallier score is a predictive marker of frailty and postoperative outcomes in lumbar spine surgery. Goutallier classification is an effective tool that can aid in risk stratification for patients undergoing lumbar spinal surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251359536"},"PeriodicalIF":2.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600220","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":"Learning Curve of Unilateral Biportal Endoscopy in Spinal Stenosis: A Neuromonitoring-Assisted Analysis.","authors":"Ali Gulec, Ebubekir Eravsar, Sadettin Ciftci, Selim Safali, Ali Özdemir, Fatih Durgut, Bahattin Kerem Aydin","doi":"10.1177/21925682251358819","DOIUrl":"10.1177/21925682251358819","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectivesUnilateral biportal endoscopy (UBE) provides a minimally invasive option for treating lumbar spinal stenosis, enabling faster recovery but requiring surgical precision. This study aims to establish a learning curve model for UBE in central lumbar spinal stenosis, focusing on surgical duration and neuromonitoring data.MethodsData were collected from a senior orthopedic spine surgeon's cases involving lumbar spinal stenosis. Neuromonitoring was performed during UBE, recording each dural and root irritation as a risk. Surgical details, including operative time (from first incision to final suture) and neuromonitoring events, were documented. The RA-CUSUM method in Python was used to evaluate proficiency, adjusting for procedure time.ResultsSeventy-eight patients with central lumbar spinal stenosis were included. RA-CUSUM analysis, integrating neuromonitoring and surgical time, indicated significant proficiency gains by the 16th case, with reductions in procedural time and neural irritations. CUSUM analysis based solely on operative time showed stabilization and efficiency improvements by the 35th case.ConclusionProficiency in UBE surgery is generally achieved by the 16th case regarding neuromonitoring management and by the 35th case regarding time efficiency. These findings are valuable for surgeons transitioning to UBE, although the results may not fully generalize to those without prior surgical experience. Continued research and structured training are essential to optimize UBE outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251358819"},"PeriodicalIF":2.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600221","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":"Patients With Myopathy and Scoliosis Treated Conservatively: Retrospective Long-Term Follow-Up and Prospective Outcomes.","authors":"Sharon Eylon, Patrice L Weiss, Amihai Rigbi, Rana Hanna, Joshua E Schroeder, Alexandra Satanovsky","doi":"10.1177/21925682251356914","DOIUrl":"10.1177/21925682251356914","url":null,"abstract":"<p><p>Study DesignAmbispective study.ObjectivesTo determine the long-term natural history of non-surgically treated patients with myopathy and spinal deformity.MethodsData were analyzed from 118 files from a children's rehabilitation hospital. Seventeen patients were operated on; the remaining 101 patients (86%) were managed conservatively. Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), and pelvic obliquity (PO). Prospective data were obtained via telephone interviews and included the Scoliosis Research Society (SRS-22r), World Health Organization Quality of Life (QoL) (WHO-QoL) and Functional Independence Measure for Children (WeeFIM).ResultsOne hundred and one patients with myopathy and scoliosis did not have surgery and were followed for up to 33 years. Their mean age at first visit was 5.45 ± 5.27 years. CA and PO at the first visit were 27.05 ± 27.07 and 7.74 ± 9.81°, worsening to 46.95 ± 39.26 and 15.61 ± 8.57° at last visit. Respiratory data for 67 patients showed 45 who remained stable and 14 who worsened moderately and 5 severely. Mobility status worsened but not significantly. Of the 24 participants who responded to the survey (mean age 17.41 ± 10.84 years), 92% are single or divorced. They reported being generally satisfied with their QoL, although their functional scores indicated limited independence.ConclusionsDespite worsening of scoliosis and limited independence, participants were generally satisfied with their QoL.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251356914"},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583751","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":"Normative Relationships Between Spinopelvic Alignment and Femoroacetabular Orientation: A Cross-Sectional Study.","authors":"Taryn Ludwig, Jonathan Bourget-Murray, Sarup Sridharan, Ariana Frederick, Victoria Smith, Kelly Johnston, Nathan Evaniew, Brent Edwards, Michael Asmussen, Fred Nicholls","doi":"10.1177/21925682251353725","DOIUrl":"10.1177/21925682251353725","url":null,"abstract":"<p><p>Study DesignCross-sectional study.ObjectivesNormative data describing the relationship between spinopelvic and femoroacetabular alignment is not thoroughly described in the literature; we aimed to explore potential associations in healthy young adults.MethodsVolunteers with no hip or spine pathology were recruited for this study (N = 395.) Full body EOS scans were used to obtain 3D reconstructions of participants' acetabula and femurs. Associations between femoroacetabular parameters (acetabular anteversion (AA), acetabular inclination (AI), femoral version (FV)) and spinopelvic parameters (pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL)) were tested using multiple linear regression analyses.ResultsWe included 395 healthy volunteers (mean age 28.90 ± 5.1; 57% female; mean BMI 24.8 ± 4.2). Linear regression analysis demonstrated that AA is associated with PI, PT, age, sex and weight (<i>R</i>² = 0.381). AI is largely conserved across participants, but associated with FV, PT, age, height and weight (<i>R</i>² = 0.0949).ConclusionWe identified that normative relationships exist between acetabular orientation and spinopelvic parameters; however there remains residual variability in AA that is not comprehensively predicted by spinopelvic parameters alone. This knowledge provides the foundation for understanding changing alignment with normal aging and compensatory mechanisms. This will ultimately help guide restoration of pre-degenerative acetabular orientation in THA and spinopelvic alignment in spinal fusion in order to optimize patient care and reduce the need for revision surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251353725"},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583750","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 Pedicle Inlet Screws: A Novel Trajectory for Navigated Sub-axial Cervical Screw Placement With Improved Biomechanical Characteristics Compared to Lateral Mass Screws.","authors":"Christopher T Martin, Deb A Bhowmick, Vincent Rossi, Domagoj Coric, Martin H Pham, Amber Schweitzer, Daniel Woods, Jeremy J Rawlinson","doi":"10.1177/21925682251352439","DOIUrl":"10.1177/21925682251352439","url":null,"abstract":"<p><p>Study DesignCadaveric Biomechanical.ObjectiveTo investigate the biomechanical characteristics of a new screw trajectory, which we have deemed the \"pedicle inlet\" trajectory.MethodsFour surgeons familiar with standard and image-guided cervical pedicle screw fixation techniques placed 3.5 mm diameter cervical fixation screws randomized at each sub-axial level to one of three fixation techniques: cervical pedicle, pedicle inlet, and lateral mass screw. A total of 180 screws were placed from C3 to C7 in 18 cadaveric spine samples. Maximal insertional torque was measured during the final seating of the screws. After confirmation of accuracy of screws with post-procedural CT-imaging, individual screws in the cadaveric samples were biomechanically tested for pull-out strength.ResultsAll screws were placed without breach into neurovascular spaces. The final insertional torque was equivalent (ANOVA, <i>P</i> > .05, 3.6 ± 1.7 Nm) across cervical pedicle screws, pedicle inlet, and lateral mass screws. Maximal pullout strength was observed for cervical pedicle screws (814.6 ± 387.3 N). Pedicle inlet screws had a 51% higher pullout strength as compared to lateral mass screws (593.2 ± 289.9 N v 392.4 ± 284.0 N, <i>P</i> < .01). All differences were statistically distinct from each other (ANOVA, <i>P</i> < .01).ConclusionsUse of image-guidance allows for safe placement along the pedicle inlet trajectory, with no recorded screw malposition, and a 51% improvement in pull out strength as compared to lateral mass screws. The pedicle inlet trajectory offers an alternative to traditional lateral mass screws with better fixation quality and may have particular application in percutaneous or minimally invasive posterior fusions.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251352439"},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583748","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":"Gastrointestinal Management Enhanced Recovery after Surgery Protocol Improves Postoperative Recovery in Patients Undergoing Posterior Lumbar Interbody Fusion.","authors":"Cheng Zeng, Hongtao Ding, Andrew Y Xu, Jiayuan Wu, Bassel G Diebo, Alan H Daniels, Da He","doi":"10.1177/21925682251356905","DOIUrl":"10.1177/21925682251356905","url":null,"abstract":"<p><p>Study designRetrospective Study.ObjectivesPostoperative gastrointestinal dysfunction (POGD) adversely affects patient outcomes. ERAS protocols can improve postoperative outcomes by optimizing gastrointestinal (GI) function. This study aims to evaluate the effectiveness of a GI management ERAS protocol in patients with posterior lumbar interbody fusion (PLIF) surgery.MethodsA retrospective analysis was conducted on patients who underwent PLIF between 2017 and 2020 in a single institution. The control group included patients treated before the institution adopted updated ERAS protocols including GI management, and the intervention group included patients treated after, with special intestinal preparation, intake and GI management. Demographic data, intraoperative and postoperative variables, and GI assessments were analyzed.ResultsThe study included 163 patients: 78 in the intervention group and 85 in the control group. No significant differences were found in demographics, perioperative variables, comorbidities, or postoperative VAS and ODI scores. In the intervention group, the postoperative length of stay and ambulation time were reduced by 45.0% (<i>P</i> = 0.02) and 68.0% (<i>P</i> = 0.01), respectively. They also had lower rates of postoperative complications, including poor feeding (11.6%, <i>P</i> = 0.02), nausea and vomiting (11.6%, <i>P</i> = 0.03), hypoalbuminemia (10.3%, <i>P</i> = 0.04), and constipation (24.4%, <i>P</i> < 0.01). The time to first postoperative flatus and defecation was reduced by 41.5% (<i>P</i> < 0.01) and 30.1% (<i>P</i> = 0.02). PAC-SYM was decreased by 31.9% (<i>P</i> < 0.01), and GIS was decreased by 41.2% (<i>P</i> < 0.01).ConclusionsImplementing a GI management ERAS protocol accelerates postoperative recovery in PLIF surgery. Integrating these strategies into standard perioperative care may not only diminish the incidence of postoperative GI dysfunction but also reduce complications, enhancing surgical outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251356905"},"PeriodicalIF":2.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583749","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":"Timing of Chemical Anticoagulant Administration in Spine Trauma and its Impact on VTE, Bleeding, and Mortality: A Systematic Review and Meta-Analysis.","authors":"Sarthak Mohanty, Hanna von Riegen, Michael Akodu, Elizabeth Oginni, Diana Yeritsyan, Kaveh Momenzadeh, Anne Fladger, Mario Keko, Michael McTague, Ara Nazarian, Jason L Pittman, Sapan D Gandhi","doi":"10.1177/21925682251353138","DOIUrl":"10.1177/21925682251353138","url":null,"abstract":"<p><p>Study DesignSystematic review and meta-analysis.ObjectiveTo evaluate the timing of anticoagulation in acute spinal trauma, specifically assessing the efficacy and safety of early (<48 hours) vs delayed administration for chemical venous thromboembolism prophylaxis.MethodsA systematic search of Medline, EMBASE, Web of Science, and Cochrane was conducted through February 2023 for studies comparing early vs delayed anticoagulation in acute spinal trauma patients. Studies reporting deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality were included. Three reviewers independently screened and extracted data. Risk of bias was assessed using MINORS and the Newcastle-Ottawa Scale. The protocol was registered on PROSPERO (CRD42023397717).ResultsFive studies, comprising a total of 13,110 patients, compared anticoagulant administration within 48 hours of trauma vs after 48 hours, reporting DVT and PE as outcomes. Early administration was associated with significantly lower odds of DVT (OR: 0.20 [95% CI: 0.17-0.25], <i>P</i> = .0001, <i>I</i>^<i>2</i> = 34%) and PE (OR: 0.46 [95% CI: 0.34-0.62], <i>P</i> = .0001, <i>I</i>^<i>2</i> = 0%). Four studies evaluated major bleeding as an outcome and found slightly lower odds with early initiation, though the association was not statistically significant (OR: 0.85 [95% CI: 0.66-1.09], <i>P</i> = .1992). Similarly, 4 studies assessed mortality, with results that were also nonsignificant.ConclusionsThe current evidence indicates that early initiation of chemical anticoagulation within 48 hours of injury in spine trauma patients is associated with favorable outcomes in preventing thromboembolic complications, without significantly increasing the risk of bleeding or mortality.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251353138"},"PeriodicalIF":2.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575322","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":"Risk Factors for Lower Extremity Deep Vein Thrombosis by Spinal Cord Injury Level: A Population-Based Analysis.","authors":"Alejandro Pando, Caryn J Ha, Yaxel Levin-Carrion, Ahmed Sabra, Max Ward, Daniel M Schneider, Drew Thibault, Sheng-Fu Larry Lo, Daniel M Sciubba","doi":"10.1177/21925682251358721","DOIUrl":"10.1177/21925682251358721","url":null,"abstract":"<p><p>Study DesignA retrospective database analysis.ObjectiveTo determine the incidence of lower extremity deep vein thrombosis (DVT) and identify risk factors associated with DVT development in patients with spinal cord injury (SCI), stratified by level of injury.MethodsThe National Inpatient Sample from 2016 to 2021 was used to identify adult inpatients with SCI who developed DVT within the same admission and to categorize them by anatomical injury level. Multivariable logistic regression was used to assess independent risk factors by SCI level.ResultsAmong 59,498 SCI patients, the overall DVT incidence was 2.8%. The DVT rate was lowest in cervical SCI (2.6%) and highest in thoracic SCI (3.2%). Pulmonary embolism was a strong independent risk factor for DVT across all SCI levels ([Cervical] OR: 12.82, CI: 10.46-15.63, [Thoracic] OR: 11.82, CI: 9.13-15.20, [Lumbar] OR: 11.38, CI: 6.74-18.74). For cervical SCI, risk factors included coagulopathies (OR: 1.90, CI: 1.54-2.32), older age (OR: 1.01, CI: 1.01-1.02), complete (OR: 1.84, CI: 1.43-2.35) or incomplete cervical lesion (OR: 1.38, CI: 1.17-1.63), cervical (OR: 1.34, CI: 1.16-1.54) or lumbar fracture (OR: 1.58, CI: 1.17-2.11), and upper extremity DVT (OR: 3.58, CI: 2.53-4.97). For thoracic SCI, risk factors included thoracic fracture (OR: 1.46, CI: 1.20-1.77), upper extremity DVT (OR: 3.82, CI: 2.18-6.36), and fluid/electrolyte disorder (OR: 1.35, CI: 1.13-1.62). For lumbar SCI, fluid/electrolyte disorder (OR: 1.92, CI: 1.38-2.66) was an independent predictor.ConclusionDVT incidence and risk factors vary by SCI level. Identifying these factors is critical for stratifying care and developing tailored prophylactic strategies that prevent adverse events and optimize patient outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251358721"},"PeriodicalIF":2.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564654","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":"Lumbar Endplate Hounsfield Units Enhance Transforaminal Lumbar Interbody Fusion Subsidence Prediction Compared to Trabecular Hounsfield Units Alone.","authors":"Hannah A Levy, Christopher A Magera, Caden J Messer, Maria D Astudillo Potes, Tyler Allen, Jayanth Kumar, Abdelrahman M Hamouda, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, Bradford Currier, Ahmad N Nassr, Brett A Freedman, Brian A Karamian, Arjun S Sebastian","doi":"10.1177/21925682251356986","DOIUrl":"10.1177/21925682251356986","url":null,"abstract":"<p><p>Study DesignRetrospective cohort analysis.Objective(1) Develop a novel computed tomography (CT)-based assessment of endplate bone density (EP-HU), (2) Determine if EP-HU was a stronger predictor than trabecular HU for subsidence after transforaminal lumbar interbody fusion (TLIF).MethodsAll adult patients who underwent single-level TLIF for lumbar degenerative conditions at an academic center between 2017-2022 were retrospectively identified. EP-HU was calculated from a 2 mm superior and inferior endplate region on the preoperative mid sagittal CT scans, accounting for surface undulations. Lumbar vertebral HUs (trabecular region) were determined in a standard fashion on axial CT. EP-HU + vertebral HU served as an aggregate bone quality metric. Interbody subsidence (≥2 mm threshold) was directly measured on the endplate-facing surface of 1 year CT scans. Univariate and multivariate analysis compared subsidence based on CT bone metrics.ResultsA total of 114 patients met the inclusion/exclusion criteria. There was no significant difference in fusion or reoperation rate based on subsidence occurrence. Both vertebral HU (<i>P</i> = .012) and EP-HU (<i>P</i> < .001) were associated with subsidence. In receiver operating curves, EP-HU was more optimal for subsidence prediction than vertebral HU, but the aggregate metric further optimized the specificity and total area under the curve. In a predictive logistic regression model EP-HU + vertebral HU (aggregate HU < 515 odds ratio: 7.82, <i>P</i> < .001) was a strong independent predictor of subsidence.ConclusionPreoperative calculation of EP-HUs in addition to vertebral HUs may enhance prediction of TLIF subsidence where aggregate endplate and vertebral HU < 515 can be used to identify high risk patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251356986"},"PeriodicalIF":2.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559970","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}