Global Spine Journal最新文献

{"title":"Load Changes on a Short-Segment Posterior Instrumentation After Transosseous Disruption of L3 Vertebra - A Biomechanical Human Cadaveric Study.","authors":"Maximilian Heumann, Alina Jacob, Boyko Gueorguiev, R Geoff Richards, Lorin M Benneker","doi":"10.1177/21925682241282276","DOIUrl":"https://doi.org/10.1177/21925682241282276","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical Cadaveric Study.</p><p><strong>Objectives: </strong>Following the successful use of a novel implantable sensor (Monitor) in evaluating the progression of fracture healing in long bones and posterolateral fusion of the spine based on implant load monitoring, the aim of this study was to investigate its potential to assess healing of transosseous fractures of a lumbar vertebra stabilized with a pedicle-screw-rod construct.</p><p><strong>Methods: </strong>Six human cadaveric spines were instrumented with pedicle screws and rods spanning L3 vertebra. The spine was loaded in Flexion-Extension (FE), Lateral-Bending (LB) and Axial-Rotation (AR) with an intact L3 vertebra and after its transosseous disruption, creating an AO B1 type fracture. The implant load was measured on the one rod using the Monitor and on the contralateral rod by strain gauges to validate the Monitor's measurements. In parallel, the range of motion (ROM) was assessed.</p><p><strong>Results: </strong>ROM increased significantly in all directions in the fractured model (<i>P</i> ≤ 0.049). The Monitor measured a significant increase in implant load in FE (<i>P</i> = 0.002) and LB (<i>P</i> = 0.045), however, not in AR. The strain gauge - aligned with the rod axis and glued onto its posterior side - detected an increased implant load not only in FE (<i>P</i> = 0.001) and LB (<i>P</i> = 0.016) but also in AR (<i>P</i> = 0.047).</p><p><strong>Conclusion: </strong>After a complete transosseous disruption of L3 vertebra, the implant load on the rods was considerably higher vs the state with an intact vertebral body. Innovative implantable sensors could monitor those changes, allowing assessment of the healing progression based on quantifiable data.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106603","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":"An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis.","authors":"Tariq Z Issa, Teeto Ezeonu, Mason Sellig, Chester J Donnally, Rajkishen Narayanan, Brian A Karamian, Parthik D Patel, Srikanth N Divi, William A Robinson, Kartik Shenoy, Christopher K Kepler, Alexander R Vaccaro, Jose A Canseco","doi":"10.1177/21925682241279526","DOIUrl":"https://doi.org/10.1177/21925682241279526","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review and meta-analysis.</p><p><strong>Objective: </strong>To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons).</p><p><strong>Methods: </strong>A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model.</p><p><strong>Results: </strong>54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall complication rate associated with anterior lumbar surgery was 13.1%, including an intraoperative complication rate of 3.8%, postoperative complication rate of 7.4%, infection rate of 1.5%, and reoperation rate of 1.7%. Forest plot analysis showed no significant difference in overall complication rates between open and mini-open techniques, although mini-open techniques were associated with lower overall reoperation rates. The use of CTA was associated with an increase in intraoperative and overall complications, and the use of an access surgeon was associated with a decreased risk of reoperation. The use of rhBMP-2 was not associated with overall complication risk.</p><p><strong>Conclusions: </strong>While anterior lumbar surgery provides numerous benefits, surgeons and patients alike should be aware of the complication and safety profile prior to surgery. High quality studies are warranted to help elucidate the true benefit of certain techniques and adjuvant resources in reducing complications.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092725","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":"Revision Surgery after Single Level Anterior Cervical Discectomy and Fusion With Plate vs Stand-Alone Cage over 2 to 5 Year Follow-Up.","authors":"Wesley M Durand, Rajan Khanna, Gabriel I Nazario-Ferrer, Sang H Lee, Richard L Skolasky, Amit Jain","doi":"10.1177/21925682241279528","DOIUrl":"https://doi.org/10.1177/21925682241279528","url":null,"abstract":"<p><strong>Study design: </strong>retrospective study.</p><p><strong>Objective: </strong>To investigate the incidence of all-cause revision surgery between plated vs stand-alone cage constructs for single level ACDF.</p><p><strong>Methods: </strong>We retrospectively analyzed a commercial insurance claims database. Patients 18-65 years-old were included if they underwent single-level inpatient ACDF (defined with CPT codes) from 2010 - 2018, with a minimum of 2-year continuous insurance enrollment. The primary independent variable was the use of anterior plating vs zero profile device or stand-alone cage. Synthetic (ie, metal, PEEK, etc.) vs allograft interbody was a secondary independent variable. The primary outcome variable was revision cervical arthrodesis after the index operation.</p><p><strong>Results: </strong>In total, 21092 patients undergoing single-level inpatient ACDF were included. 10.0% received a stand-alone cage during the index operation. Mean follow-up duration was 4.5 years. Revision arthrodesis occurred in 8.2% of patients overall, at a mean of 2.4 years after the index surgery. Patients with anterior plating had a lower rate of all-cause revision surgery in unadjusted (overall rate 8.1% vs 9.6%, <i>P</i> = 0.0185) and adjusted analysis (OR 0.78, <i>P</i> = 0.0016) vs stand-alone cages. Patients with stand-alone cages had higher rates of revision with a posterior approach than did patients with plated constructs. In sub-analysis, the combination of a stand-alone interbody device with an allograft had significantly higher odds of revision than other combinations of devices.</p><p><strong>Conclusion: </strong>Among commercially insured patients ≤65 years-old undergoing single-level ACDF, anterior plating was associated with a reduced incidence of revision surgery compared to stand-alone cages within the follow up period of our study.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080106","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":"Response to Letter to the Editor Regarding \"Characteristics of Spinal Morphology According to the \"Current\" and \"Theoretical\" Roussouly Classification Systems in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study \".","authors":"Yong Shen, Justin L Reyes, Zeeshan M Sardar","doi":"10.1177/21925682241280641","DOIUrl":"https://doi.org/10.1177/21925682241280641","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072559","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":"Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.","authors":"Andrei F Joaquim, Sebastian F Bigdon, Richard Bransford, Harvinder Singh Chhabra, Ratko Yurac, Vishal Kumar, Mohammad El-Sharkawi, Lorin M Benneker, Brian A Karamian, Jose A Canseco, Julian Scherer, Ahmed Abdelazim Hassan, Gregory D Schroeder, Cumhur F Öner, Shanmuganathan Rajasekaran, Emiliano Vialle, Rishi M Kanna, Alexander R Vaccaro, Jin Tee, Gaston Camino-Willhuber, Charles G Fisher, Marcel F Dvorak, Klaus J Schnake","doi":"10.1177/21925682241278953","DOIUrl":"10.1177/21925682241278953","url":null,"abstract":"<p><strong>Study design: </strong>Literature review with clinical recommendations.</p><p><strong>Objective: </strong>To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders.</p><p><strong>Methods: </strong>4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology.</p><p><strong>Results: </strong>4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. <b>Conditional</b> recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. <b>Strong</b> recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. <b>Conditional</b> recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A <b>conditional</b> recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF.</p><p><strong>Conclusions: </strong>Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046564","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":"Explainable Machine Learning Approach to Prediction of Prolonged Intesive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression.","authors":"Bashar Zaidat, Mark Kurapatti, Jonathan S Gal, Samuel K Cho, Jun S Kim","doi":"10.1177/21925682241277771","DOIUrl":"https://doi.org/10.1177/21925682241277771","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Prolonged ICU stay is a driver of higher costs and inferior outcomes in Adult Spinal Deformity (ASD) patients. Machine learning (ML) models have recently been seen as a viable method of predicting pre-operative risk but are often 'black boxes' that do not fully explain the decision-making process. This study aims to demonstrate ML can achieve similar or greater predictive power as traditional statistical methods and follows traditional clinical decision-making processes.</p><p><strong>Methods: </strong>Five ML models (Decision Tree, Random Forest, Support Vector Classifier, GradBoost, and a CNN) were trained on data collected from a large urban academic center to predict whether prolonged ICU stay would be required post-operatively. 535 patients who underwent posterior fusion or combined fusion for treatment of ASD were included in each model with a 70-20-10 train-test-validation split. Further analysis was performed using Shapley Additive Explanation (SHAP) values to provide insight into each model's decision-making process.</p><p><strong>Results: </strong>The model's Area Under the Receiver Operating Curve (AUROC) ranged from 0.67 to 0.83. The Random Forest model achieved the highest score. The model considered length of surgery, complications, and estimated blood loss to be the greatest predictors of prolonged ICU stay based on SHAP values.</p><p><strong>Conclusions: </strong>We developed a ML model that was able to predict whether prolonged ICU stay was required in ASD patients. Further SHAP analysis demonstrated our model aligned with traditional clinical thinking. Thus, ML models have strong potential to assist with risk stratification and more effective and cost-efficient care.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016914","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":"Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts.","authors":"Anthony L Mikula, Laurence D Rhines, Shalin S Patel, Zach Pennington, S Mohammed Karim, Jonathan M Morris, Karthik Tappa, Christopher Alvarez-Breckenridge, Robert Y North, Claudio E Tatsui, Peter S Rose, Michelle J Clarke, Justin E Bird","doi":"10.1177/21925682241278323","DOIUrl":"https://doi.org/10.1177/21925682241278323","url":null,"abstract":"<p><strong>Study design: </strong>Survey study.</p><p><strong>Objectives: </strong>The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries.</p><p><strong>Methods: </strong>A survey of individual members of an international study group of spinal oncology surgeons was performed. Participants were provided a clinical vignette, pathologic diagnosis, and pre-operative imaging for three primary spinal oncology cases. Study participants provided a free text surgical plan for resection and were then presented an associated 3D printed model for each case and asked to re-evaluate their surgical plan.</p><p><strong>Results: </strong>Ten spinal oncology surgeons participated in the study, representing nine institutions across five countries. Four of the surgeons (40%) made significant changes to their surgical plan after reviewing the 3D models, including sacrifice of an additional nerve root to obtain negative margins, sparing an SI joint that was originally planned for inclusion in the en bloc resection, adjusting the location of osteotomy cuts, changes to the number of surgical stages and/or staging order, and preservation of neurology that was originally planned for sacrifice. The overall impression of the 3D models was positive, with 90% of the participants stating they found the 3D model useful in developing a surgical plan.</p><p><strong>Conclusions: </strong>Surgical planning for resection of primary spinal column tumors is challenging and time intensive. 3D printed patient specific surgical models may be an additional tool that can augment surgical planning and execution by improving the chance of accomplishing surgical resection goals and minimizing morbidity.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016915","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":"Long-Term Incidence of Adjacent Segmental Pathology After Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion.","authors":"Jae-Won Shin, Yung Park, Sang-Ho Kim, Sung-Ryul Choi, Joong-Won Ha, Hak Sun Kim, Kyung-Soo Suk, Sung-Hwan Moon, Si-Young Park, Byung-Ho Lee, Ji-Won Kwon, Hee-Min Choi","doi":"10.1177/21925682241266210","DOIUrl":"https://doi.org/10.1177/21925682241266210","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999768","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":"Letter to the Editor Regarding the Article \"Comparison of Surgical Site Infection After Instrumented Spine Surgery in Patients With High Risk of Infection According to Different Antibiotic Prophylaxis Protocols: A Cohort Study of 132 Patients With a Minimum Follow-Up of 1 year\".","authors":"Xinjie Wang, Hui Ma","doi":"10.1177/21925682241278322","DOIUrl":"https://doi.org/10.1177/21925682241278322","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987781","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":"Artificial Intelligence-Assisted MRI Diagnosis in Lumbar Degenerative Disc Disease: A Systematic Review.","authors":"Wongthawat Liawrungrueang, Jong-Beom Park, Watcharaporn Cholamjiak, Peem Sarasombath, K Daniel Riew","doi":"10.1177/21925682241274372","DOIUrl":"https://doi.org/10.1177/21925682241274372","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objectives: </strong>Lumbar degenerative disc disease (DDD) poses a significant global health care challenge, with accurate diagnosis being difficult using conventional methods. Artificial intelligence (AI), particularly machine learning and deep learning, offers promising tools for improving diagnostic accuracy and workflow in lumbar DDD. This study aims to review AI-assisted magnetic resonance imaging (MRI) diagnosis in lumbar DDD and discuss current research for clinical use.</p><p><strong>Methods: </strong>A systematic search of electronic databases identified studies on AI applications in MRI-based lumbar DDD diagnosis, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included combinations of \"Artificial Intelligence,\" \"Machine Learning,\" \"Deep Learning,\" \"Low Back Pain,\" \"Lumbar,\" \"Disc,\" \"Degeneration,\" and \"MRI,\" targeting studies in English from January 1, 2010, to January 1, 2024. Inclusion criteria encompassed experimental and observational studies in peer-reviewed journals. Data extraction focused on study characteristics, AI techniques, performance metrics, and diagnostic outcomes, with quality assessed using predefined criteria.</p><p><strong>Results: </strong>Twenty studies met the inclusion criteria, employing various AI methodologies, including machine learning and deep learning, to diagnose lumbar DDD manifestations such as disc degeneration, herniation, and bulging. AI models consistently outperformed conventional methods in accuracy, sensitivity, and specificity, with performance metrics ranging from 71.5% to 99% across different diagnostic objectives.</p><p><strong>Conclusion: </strong>The algorithm model provides a structured framework for integrating AI into routine clinical practice, enhancing diagnostic precision and patient outcomes in lumbar DDD management. Further research and validation are needed to refine AI algorithms for real-world application in lumbar DDD diagnosis.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987780","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}