Global Spine Journal最新文献

{"title":"Osteoporosis in Adult Patients Undergoing Spinal Reconstructive Surgery: Associated Complications and Management.","authors":"Zeeshan Sardar, Josephine Coury, David Polly, Kenneth Cheung, Stephen J Lewis","doi":"10.1177/21925682241289899","DOIUrl":"10.1177/21925682241289899","url":null,"abstract":"<p><p>Study DesignLiterature review.ObjectivesTo provide an overview of the complications associated with and management strategies for adult patients with osteoporosis requiring spinal reconstructive surgery. Emphasis will be placed on screening, diagnosis, and perioperative medical and surgical management of these patients.MethodsA review of the literature was performed for studies examining osteoporosis in adult patients undergoing spine surgery, associated complications, treatment and prevention methodologies.ResultsThe reported incidence of osteoporosis in adult patients undergoing spinal reconstructive surgery was found to be 10% - 50%, whereas the incidence of osteopenia was 41.4% - 58.6%. DEXA scan is the most widely used modality for assessing bone mineral density (BMD) despite its limitations. Quantitative CT has been found to be the most optimal method for measuring BMD in the spine, yet, its availability is limited. Opportunistic CT scan-based Hounsfield Units (CTHU) have been found to correlate with osteoporosis and osteopenia, instrumentation loosening, proximal and distal junctional kyphosis, and pseudarthrosis. Patients treated with Teriparatide preoperatively and postoperatively were found to have a decreased rate of pseudarthrosis, screw loosening, and reoperation. Modifying surgical techniques can also improve outcomes. Such strategies could involve vertebral cement augmentation, iliac fixation in long constructs to the sacrum, and utilizing longer constructs when addressing spinal deformity or spinal instability.ConclusionsThe incidence of osteoporosis in patients undergoing spinal reconstruction is high. Appropriate preoperative and postoperative medical treatment can result in lower rates of adverse events related to osteoporosis. Surgical treatment and fixation can also be modified to account for suboptimal bone health.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"61S-74S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591069","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":"A Narrative Review of Symptom Severity and Duration in Nonoperative vs Operative Patients With Adult Spinal Deformity.","authors":"Thomas J Buell, Juan P Sardi, Theresa Williamson, Clifford L Crutcher, Christopher I Shaffrey, Justin S Smith","doi":"10.1177/21925682241309342","DOIUrl":"10.1177/21925682241309342","url":null,"abstract":"<p><p>Study DesignNarrative review.ObjectiveOur objective was to provide an evidence-based summary of how symptoms (severity/duration) impact timing of surgery for adult spinal deformity (ASD).MethodsThe authors queried PubMed, MEDLINE, and Scopus to identify potentially relevant studies. Articles were included based on quality of design, methodology, assessment of symptoms (back/leg pain, neurological deficits) and other factors which could influence timing of surgery.ResultsDatabase query produced 138 potentially relevant studies. Review of these studies and relevant references generated 29 studies that were included. Back and leg pain were the most common assessed symptoms: NRS back pain (nonoperative 4.4-5.3, operative 6.3-7.1) and NRS leg pain (nonoperative 2.3-4.1, operative 4.2-5.4). Leg pain was an independent predictor of surgery. Back/leg pain positively correlated with disability and worse health status, which were important factors driving surgery. ODI ≥40 was identified as a potential disability threshold associated with surgery. Few studies (n = 2) provided assessment of neurological deficits, and development of weakness was associated with surgery. Symptom duration was assessed using post hoc analysis of nonoperative to operative crossover (n = 6; mean time to crossover 0.8-1.1 years).ConclusionsOur results suggest at least moderate symptoms should be present prior to considering surgery. Less data exists for symptom duration and is from studies reporting nonoperative to operative treatment crossover. Future research is needed to determine clinically meaningful differences in validated outcome instruments for baseline comparisons prior to treatment, provide more detailed assessments of leg pain (radiculopathy vs claudication) and deficits, and include dynamic functional testing.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"24S-38S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591052","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":"Blood Management and Conservation During Adult Spine Deformity Surgery.","authors":"Brett Rocos, So Kato, Colby Oitment, Justin Smith, Thorsten Jentszch, Allan Martin, Anna Rienmuller, Christopher Nielsen, Christopher I Shaffrey, Lawrence G Lenke, Stephen J Lewis","doi":"10.1177/21925682231188810","DOIUrl":"10.1177/21925682231188810","url":null,"abstract":"<p><p>Study DesignNarrative literature review.ObjectivesTo summarize the evidence for perioperative blood conservation for patients undergoing surgery for adult spine deformity.MethodsA systematic literature review with narrative analysis was conducted to describe the evidence for blood conservation strategies before, during and after surgery for adult spine deformity. The evidence is critically analyzed and recommendation drawn.ResultsThe evidence for iron supplementation, autologous blood donation, screening for diatheses, the constitution of the surgical team, hypotensive anaesthesia, osteotomy, patient positioning, antifibrinolytics, transfusion thresholds, cell salvage, surgical technique, topical hemostasis, postoperative drainage, postoperative tranexamic acid and the management of thromboprophylaxis and anticoagulants is critically evaluated. The management of haemorrhage in surgery for adult spine deformity is complex and multifaceted, requiring the surgeon to consider tactics in conservation at every stage of the process. There is a paucity of evidence for many techniques, whilst hypotensive anaesthesia, tranexamic acid, surgical team members and surgical duration have the most significant effects on blood loss and transfusion requirements.ConclusionsThe astute surgeon must consider strategies to prevent excessive haemorrhage in the pre- intra- and postoperative phases of care. Although some commonly used techniques have robust evidence, others may be at best poorly evidenced, and at worst ineffective. Surgeons should consider the members of the operative team, minimizing surgical time, preoperative correction of anemia, hypotensive anesthesia and the use of intravenous and topical tranexamic acid at a minimum.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"95S-107S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591054","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":"Perioperative Medical Complications in Adult Spine Deformity Surgery: Classification and Prevention Strategies.","authors":"Go Yoshida, Kazunori Hayashi, Louis Boissiere, Allan Martin, Sigurd Berven, Lawrence G Lenke, Stephen J Lewis, Yukihiro Matsuyama, Eric Klineberg","doi":"10.1177/21925682241264227","DOIUrl":"10.1177/21925682241264227","url":null,"abstract":"<p><p>Study DesignNarrative review.ObjectiveWe aimed to propose the classifications of, risk factors for, and prevention strategies for perioperative complications from previously published papers in adult spinal deformity (ASD) surgeries.MethodsA literature search was conducted in the PubMed/MEDLINE database to identify studies reporting perioperative complications of spinal deformity surgery, their classifications, risk factors, and prevention strategies. Main search terms included \"perioperative complications\", \"medical complications\" and \"adult spinal deformity\". In the various complications associated with deformity surgeries, we focused the medical complications which will directly link to patient's life prognosis rather than postoperative mechanical complications.ResultsThe overall perioperative complication rate ranged from 12.8% to 52.2%. Risk factors for perioperative medical complications included age, body mass index, osteoporosis, frailty, comorbidities, preoperative medication, smoking habit, and alcohol intake. Perioperative medical complications mostly depend on patient-related factors. Taking reference from the previous reported classification of surgical complications, the AO Spine Deformity Knowledge Forum developed a classification for complications of spinal deformity surgery via a Delphi exercise.ConclusionComplication classification system is important for understanding the impact of complications on patients. Further research should aim to determine the correlation between the new complication classification and patient outcomes in spinal deformity surgery. Various pre-, intra-, and postoperative strategies should be implemented to prevent perioperative complications.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"148S-158S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591072","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":"Preoperative Surgical Planning and Intraoperative Considerations for the Treatment of Adult Spinal Deformity Surgery.","authors":"Joseph M Lombardi, Fthimnir M Hassan, Joseph A Osorio, Lawrence G Lenke","doi":"10.1177/21925682251341276","DOIUrl":"10.1177/21925682251341276","url":null,"abstract":"<p><p>Study DesignNarrative Review of published literature.ObjectiveThe objective of this article is to review the current state of treatment for patients with adult spinal deformity (ASD) with a focus on preoperative planning, optimization and intraoperative surgical techniques, including the application of current enabling technologies to spinal deformity surgery.MethodsA literature review of publications related to preoperative planning, patient optimization, intraoperative techniques, and surgical outcomes for the treatment of ASD was performed.Results/ConclusionStandardized preoperative evaluation including imaging analysis now allows patient specific planning for the planned surgical procedure. The current work on patient optimization along with understanding and mitigating the surgical insult are being utilized as appropriate and should improve patient outcomes. The intraoperative application of enabling technologies including navigation, robotics and confirmatory radiographic software will continue to assist surgeons in safe placement of instrumentation, often with less invasive surgical techniques and achievement of intraoperative alignment goals.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"39S-60S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591073","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":"Determining the Magnitude of Surgery in Patients With Adult Scoliosis: A Systematic Review of the Role of Limited Fusions.","authors":"Juan Pablo Sardi, Bruno Lazaro, Thomas J Buell, Chun Po Yen, Christopher Shaffrey, Sigurd Berven, Justin S Smith","doi":"10.1177/21925682231203656","DOIUrl":"https://doi.org/10.1177/21925682231203656","url":null,"abstract":"<p><p>Study DesignSystematic reviewObjectiveThe role of limited fusions compared with extensive reconstructions of the spine has not been well defined. The objective of this study is to review the current literature and provide evidence-based recommendations regarding the magnitude of surgery for patients with adult scoliosis, including indications and limitations of short-segment (≤3 levels) fusions.MethodsA systematic review of the literature was conducted using PubMed/MEDLINE, Cochrane Library, Ovid and Google-Scholar using the following terms: \"adult spinal deformity\", \"adult scoliosis\", \"degenerative scoliosis\", \"scoliosis\" together with \"spinal fusion\", \"spinal instrumentation\" and \"fusion\". Inclusion criteria were comparative studies comprised of thoraco-lumbar or lumbo-sacral adult scoliosis treated with short- or long-segment fusion. Other types of deformities were excluded.ResultsOf the 1736 articles identified from initial query, 9 studies comprised of 660 patients with adult scoliosis who underwent a short-segment fusion (SSF, n = 366) or a long-segment fusion (LSF, n = 294) were included and analyzed for clinical and radiographic outcomes. Summative results indicate that patients undergoing SSF have lower complication rates (.21 vs .36 complications/patient), lower revision rates (9% vs 28%), and though LSF patients had greater scoliotic curvatures and sagittal imbalance at baseline, both groups had significant clinical improvement after surgery. However, the heterogeneous nature of the published data calls into question the reliability of these summative results.ConclusionsJudicious use of SSF can achieve satisfactory clinical outcomes in carefully-selected patients with adult scoliosis. Factors to consider when selecting patients for SSF include predominant symptoms, patient expectations, comorbidities and spino-pelvic parameters.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"7S-23S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591055","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":"Pelvic Fixation in Adult Spinal Deformity: Complications, Controversies, and Future Directions.","authors":"Kristen E Jones, Kenneth J Holton, Bryan Ladd, Jonathan N Sembrano, Christopher T Martin, Justin S Smith, David W Polly","doi":"10.1177/21925682241242454","DOIUrl":"10.1177/21925682241242454","url":null,"abstract":"<p><p>Study DesignNarrative Review.ObjectivePelvic fixation is a crucial technique in modern adult spinal deformity surgery, yet complications and failure rates remain high. Significant controversy exists regarding the type and number of points of pelvic fixation needed but remains poorly defined. The purpose of this article is to summarize current literature on pelvic fixation techniques, complications, and outcomes, discuss controversies, and suggest future directions.MethodsA literature search was conducted in PubMed for publications written in English with full text available from January 2000 to January 2022 using the following search terms: \"spinopelvic fixation\", \"sacroiliac fixation\", \"iliac screw\", \"S2AI screw\" and \"complications\" or \"outcomes\" together with \"adult spinal deformity\" and \"scoliosis\".ResultsTwenty-two articles were identified as describing complications/outcomes comparing pelvic fixation techniques (S2AI vs iliac; n = 6) or as reporting on a single technique (n = 16). The main categories of pelvic fixation complications were mechanical, pseudarthrosis, wound infection, sacroiliac joint pain, and revision. Four studies found lower complication rates for S2AI screws vs iliac screws. Descriptive studies reported high rates of complications for both S2AI and iliac screws. The frequency of complications was as follows: screw fracture 1.9%-9%, screw loosening 2%-65%, L5-S1 pseudarthrosis 6%-23.9%, sacroiliac joint pain 3.2%-52.5%, revision rate 2.4%-50%.ConclusionsPelvic fixation with either S2AI or iliac screws provides significant stability to constructs that extend to the sacrum. Further study is needed to characterize the number of points of pelvic fixation needed and clarify the role of pelvic fixation in causation or treatment of sacroiliac joint pain.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"123S-134S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591071","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":"Identification and Management of Neurologic Complications in Patients Undergoing Adult Spinal Deformity Surgery.","authors":"Christopher J Nielsen, Justin S Smith, Allan R Martin, Brett Rocos, Thorsten Jentzsch, Robert A Ravinsky, Colby Oitment, Markian Pahuta, So Kato, Stephen J Lewis","doi":"10.1177/21925682241264221","DOIUrl":"10.1177/21925682241264221","url":null,"abstract":"<p><p>Study DesignNarrative Literature Review.ObjectiveTo provide a comprehensive literature review of neurologic complications in Adult Spinal Deformity (ASD) surgery in the pre-operative, peri-operative and post-operative periods.MethodsA broad review of the literature was conducted using the multiple databases including Pubmed, Embase, Scopus and the Cochrane library. Individual studies of relevance were appraised and included at the discretion of the authors on the basis of pertinence, impact on practice and scientific merit.ResultsThe evidence regarding epidemiology, classification of complications, pre-operative evaluation of patients, peri-operative strategies to mitigate risk, intra-operative management of neuromonitoring changes and post-operative management of neurologic injury was critically appraised. Patients with the highest risk of neurologic complication include those with pre-surgery neuroaxis abnormality, high Deformity Angular Ratio, 3 column osteotomies and increased blood loss. Accurate and timely identification of intraoperative neuromonitoring changes is critical to ensuring appropriate response depending on whether changes are perfusion based (maintain adequate MAP and Hb, reverse corrective maneuvers) or traumatic (decompression of neural elements, assessment of instrumentation, reversal of corrective maneuvers, steroids). Surgical checklists can help surgeons navigate these stressful events to ensure appropriate steps and interventions are taken.ConclusionNeurological injuries occurring during the course of ASD surgery are potentially devastating complication, with regards to both patient morbidity and economic impact. Pre-operative identification of high risk patients, perioperative strategies to improve safety, timely recognition and management of intra-operative neuromonitoring changes and post-operative supportive measures can potentially reduce the incidence and significance of neurological injuries.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"135S-147S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591056","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":"Late Complications and Adverse Events in Adult Deformity Surgery: A Narrative Review of Event Types, Prevalence, and Information Gaps.","authors":"Sigurd H Berven, Justin S Smith, John T Street, Eric Klineberg, Yong Qiu, Aboubacar Wague, Stephen J Lewis","doi":"10.1177/21925682251342556","DOIUrl":"10.1177/21925682251342556","url":null,"abstract":"<p><p>Study DesignLiterature review.ObjectivesThe purpose of this paper is to provide a narrative review of late complications in adult deformity surgery, including infection, pseudarthrosis and junctional pathology after deformity correction. This review aims to highlight limitations of current management and identify potential areas of improvement and further study.MethodsWe identified common challenges of late complications in adult spinal deformity surgery and performed a directed literature review to summarize the current management and issues encountered in these adverse events. Through consensus, we highlighted the knowledge gaps in the current literature and suggested areas of interest for further study to improve understanding and management of these conditions.ResultsA summary is provided with detailed review of late complications that include infection, pseudarthrosis, junctional pathology, and late decompensation after deformity correction. Important consideration to choosing the appropriate upper and lower instrumented levels, obtaining desired coronal and sagittal alignment, preserving the adjacent ligamentous and muscular structures, obtaining solid arthrodesis, recognizing and optimizing patients for surgery, appropriate pre and post-operative protocols, and appropriately defining normal and pathological parameters.ConclusionsRecognizing appropriate predictor and outcome variables are important for identifying factors, modifiable and fixed, that may be important to make a clinically important difference in outcomes in the surgical treatment of adult spinal deformity. Future studies to reduce late complications are important to improve value and outcome in adult spinal deformity surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":"15 3_suppl","pages":"159S-171S"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591067","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 Cement Leakage in Cement-Augmented Pedicle Screw Fixation: A Multicenter Study of 140 Patients and 650 Screws.","authors":"Shota Tamagawa, Hidetoshi Nojiri, Hiromitsu Takano, Akira Itoi, Ryosuke Yokota, Takao Shiobara, Kentaro Ishii, Taishi Takeuchi, Tomoya Kojo, Yuya Ishii, Arihisa Shimura, Juri Teramoto, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Yukoh Ohara, Takeshi Hara, Eiji Abe, Takatoshi Okuda, Ryosuke Takahashi, Yutaka Kono, Yoshio Sakuma, Shigemasa Takamiya, Muneaki Ishijima","doi":"10.1177/21925682251357826","DOIUrl":"10.1177/21925682251357826","url":null,"abstract":"<p><p>Study DesignMulticenter retrospective cohort study.ObjectivesCement-augmented pedicle screws (CAPS) enhance fixation in osteoporotic patients, but carry a risk of cement leakage (CL), potentially leading to pulmonary embolism and neurological deficits. This study aimed to investigate the incidence and classification of CL and identify risk factor.MethodsWe included 140 patients undergoing thoracic or lumbar spinal fusion with CAPS at 7 institutions. CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; <i>P</i> = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; <i>P</i> = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; <i>P</i> < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; <i>P</i> = 0.030). Type B leakage was associated with shorter distance to the vertebral posterior wall (aOR: 0.71; <i>P</i> < 0.001) and lower pedicle Hounsfield units (aOR: 0.99; <i>P</i> = 0.041).ConclusionsAsymptomatic CL was frequently observed following CAPS fixation. Preoperative imaging assessments and precise screw placement may reduce the CL risk.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251357826"},"PeriodicalIF":2.6,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527555","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}