Journal of neurosurgery. Spine最新文献

{"title":"Association between subaxial paraspinal muscle parameters and cervical vertebral bone quality in preoperative patients.","authors":"Artine Arzani, Bruno Verna, Thomas Caffard, Vidushi Tripathi, Erika Chiapparelli, Gaston Camino-Willhuber, Lukas Schonnagel, Maximilian Muellner, Lisa Oezel, Ichiro Okano, Stephan Salzmann, Jiaqi Zhu, Ek Tsoon Tan, John A Carrino, Jennifer Shue, Timo Zippelius, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Alexander P Hughes","doi":"10.3171/2024.12.SPINE24616","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24616","url":null,"abstract":"<p><strong>Objective: </strong>Evidence that individuals with osteoporosis have an increased susceptibility to and frequency of sarcopenia has led to the creation of the term \"osteosarcopenia.\" Given the limitations of dual-energy X-ray absorptiometry in spine bone mineral density assessment, novel techniques such as MRI-based vertebral bone quality (VBQ) are increasingly being utilized to quantify site-specific bone quality in the spine. The relationship between cervical paraspinal muscle morphology and cervical bone quality has not been investigated. This study aimed to explore the relationship between cervical VBQ scores and paraspinal muscles parameters.</p><p><strong>Methods: </strong>Patients with preoperative cervical MRI who underwent anterior cervical discectomy and fusion between 2015 and 2018 were reviewed. Muscles from C3 to C7 were categorized into 4 functional groups: sternocleidomastoid, anterior, posteromedial, and posterolateral groups. For all groups, the cross-sectional area (CSA), functional CSA (fCSA), and percent fat infiltration (FI) were measured. VBQ scores of the cervical vertebral bodies were performed using prior established methodologies. Multivariable linear regression analyses adjusted for age, sex, and body mass index were performed. The Benjamini-Hochberg procedure was applied to adjust p values.</p><p><strong>Results: </strong>A total of 75 patients (median age 55.4 years; 26 females) were included. A greater VBQ score indicates high fat content of the bone and was significantly associated with the presence of osteopenia/osteoporosis, meaning that high VBQ scores indicate lower bone quality and low VBQ scores indicate better bone quality. After adjustment for age, sex, and body mass index and adjustment of the p values with the Benjamini-Hochberg procedure, regression analysis revealed significant negative associations between fCSA of the anterior muscle group and VBQ scores and a significant positive association between FI of the anterior muscle group with VBQ scores from C2 to T1.</p><p><strong>Conclusions: </strong>This study presents novel insights into the relationship between cervical vertebral bone mineral quality and paraspinal muscle parameters, particularly at the C3 level, which showed the highest number of significant associations. The findings suggest that measurements of paraspinal muscles at C3 could serve as a proxy for assessing bone quality across the subaxial cervical spine, offering a new perspective in preoperative evaluations for cervical spine surgery. This study is the first to report significant associations between VBQ and paraspinal muscle parameters throughout the subaxial cervical spine.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of systemic and radiation therapy in patients undergoing spine surgery for metastatic breast cancer: a dual-institution study.","authors":"Hani Chanbour, Joshua P Koleske, Gabriel Bendfeldt, Harsh Jain, Miguel A Ruiz-Cardozo, Jeffrey W Chen, Lakshmi Suryateja Gangavarapu, Mahmoud Ahmed, Leo Y Luo, Amir M Abtahi, Byron F Stephens, Matthew L Goodwin, Brian J Neuman, Camilo A Molina, Jacob K Greenberg, Scott L Zuckerman","doi":"10.3171/2024.12.SPINE241008","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE241008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Although targeted systemic therapies and postoperative radiation therapy (RT) have improved outcomes in patients with metastatic breast cancer, how treatment combinations impact spine surgery outcomes remains understudied. In patients undergoing spine surgery for metastatic breast cancer, the authors sought to do the following: 1) describe patterns of postoperative therapy; 2) report perioperative outcomes; and 3) evaluate the impact of the treatment plan on local recurrence (LR) and overall survival (OS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A dual-institution, retrospective cohort study of patients undergoing spine surgery for metastatic breast cancer was undertaken. Patients were divided into 4 groups based on the postoperative treatment: systemic therapy alone, RT alone, combined, or neither. Patients were also classified by their breast cancer molecular subtype: HR+/HER2+, HR+/HER2-, HR-/HER2+, or TNBC. Preoperative data were used to calculate commonly cited spine surgery prognostic scores. Perioperative and survival outcomes were evaluated. Chi-square, ANOVA, log-rank, and Cox regression tests were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this cohort of 66 patients undergoing spine surgery for metastatic breast cancer, the majority received combined systemic therapy and RT (59.1%), with fewer receiving systemic therapy alone (18.2%), RT alone (7.6%), or neither (15.2%). There was a significant difference based on the type of postoperative therapy in having a motor deficit on presentation (p = 0.004; V = 0.448), preoperative Karnofsky Performance Scale score (p = 0.012; η2 = 0.160), and preoperative American Spinal Injury Association Impairment Scale score (p = 0.015; V = 0.329). Patients who received RT alone or neither therapy presented at a higher rate with a motor deficit and tended to have worse preoperative Karnofsky Performance Scale and American Spinal Injury Association Impairment Scale scores compared to those who received combined or systemic-only treatment. No significant differences in prognostic scores were detected between molecular subtypes. Patients who underwent any postoperative treatment had a longer OS (combined, 4.23 years; systemic, 3.78 years; RT, 5.15 years) than patients who received neither (0.26 years). No significant difference was observed in LR. Multivariable Cox regression revealed that any adjuvant treatment significantly improved survival compared to no treatment: combined, hazard ratio 0.041 (95% CI 0.009%-0.169%), p &lt; 0.0001; systemic, hazard ratio 0.073 (95% CI 0.016%-0.316%), p = 0.0006; and RT, hazard ratio 0.139 (95% CI 0.016%-0.848%), p = 0.0431, whereas readmission within 90 days following surgery significantly worsened survival: hazard ratio 5.372 (95% CI 1.753%-15.895%), p = 0.0024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this dual-institution study of patients undergoing spine surgery for metastatic breast cancer, any treatment with systemic therapy and/or RT was asso","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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. Enhanced recovery after surgery and unilateral biportal endoscopy.","authors":"Aurore Sellier, Guillaume Lonjon, François Lechanoine, Philippe Cam, Anthony Melot, Louis-Marie Terrier, François-Xavier Ferracci, Bertrand Debono, Joseph Cristini","doi":"10.3171/2025.1.SPINE241670","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241670","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for distal junctional failure following three-column osteotomy for cervical deformity correction.","authors":"Anthony L Mikula, Winward Choy, Zach Pennington, Alexa M Semonche, Thomas A Wozny, David J Mazur-Hart, Jaemin Kim, Terry H Nguyen, Aaron J Clark, Vedat Deviren, Christopher P Ames","doi":"10.3171/2025.1.SPINE241325","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241325","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to determine risk factors for distal junctional failure (DJF) following three-column osteotomy (3CO) for the correction of cervical deformity.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent a cervical or upper thoracic 3CO for cervical deformity correction by the senior author from 2008 to 2023. The main outcome of interest was DJF, defined as revision surgery with extension of the distal end of the fusion construct. Patients were excluded if the lowest instrumented vertebra (LIV) was the sacrum/pelvis, and if patients had prior autofusion throughout the distal part of the spine to the sacrum (e.g., ankylosing spondylitis). The minimum follow-up duration was 1 year.</p><p><strong>Results: </strong>One hundred fourteen patients were identified who underwent a cervical or upper thoracic 3CO for cervical deformity correction, 41 of whom met inclusion criteria for this study. The median patient age was 66 years, median BMI was 27, and 61% were male. Ten patients (24%) experienced DJF, requiring reoperation and distal extension of the construct to the pelvis in 9 cases and to L1 in 1 case. On univariable analysis, patients who experienced DJF compared with those who did not were more likely to be female (80% vs 35%, p = 0.007), had lower LIV Hounsfield units (HUs; 127 vs 167, p = 0.041), were less likely to have an LIV in a small autofused segment (10% vs 45%, p = 0.02), had an LIV that was closer to the first lordotic level (one level above vs three, p = 0.043), and had a longer length of fusion (17 vs 13 levels, p = 0.033). A stepwise multivariable regression model showed that having an LIV closer to the first lordotic vertebra was the only statistically significant predictor of DJF (OR 0.49, p = 0.013) and low LIV HUs did not reach statistical significance (OR 0.97, p = 0.09).</p><p><strong>Conclusions: </strong>Patients with cervical deformity undergoing a 3CO are at higher risk for DJF with constructs terminating near the first lordotic vertebra. While LIV selection is complex and patient specific, choosing an LIV at least two levels above the first lordotic vertebra may help prevent DJF.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical evolution, management, and outcome of surgical treatment for high-grade spondylolisthesis: a systematic review.","authors":"Elias Elias, Ali Daoud, Charbel Elias, Ryan G Chiu, Jose Marin Sanchez, Zeina Nasser","doi":"10.3171/2024.12.SPINE241109","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE241109","url":null,"abstract":"<p><strong>Objective: </strong>High-grade spondylolisthesis (HGSL) is a rare condition characterized by a vertebral slippage of more than 50% relative to the inferior adjacent vertebra. Despite the range of surgical techniques available, there is no consensus regarding the optimal management approach for HGSL. Although various interventions are documented in the literature, definitive guidelines remain absent. In this systematic review the authors aimed to provide a comprehensive analysis of the chronological evolution of surgical management strategies for HGSL, along with the clinical and radiographic outcomes and complications, to assist surgeons in selecting the optimal approach for their patients.</p><p><strong>Methods: </strong>PubMed, Ovid MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus were systematically searched for eligible studies published in peer-reviewed journals up until May 2024. Following data extraction, the National Institutes of Health quality assessment tools were used to evaluate the methodological quality of the included studies.</p><p><strong>Results: </strong>Of 1798 papers found in the literature, 33 met the inclusion criteria. Eligible articles assessed 463 patients with HGSL. Fifteen papers described the reduction approach, whereas 19 papers described the in situ fusion technique. Most of the reported neurological injuries were associated with reduction techniques, whereas most of the graft failures were associated with Bohlman's technique. Most patients in both the in situ fusion and the decompression and fusion groups reported good outcomes postoperatively in terms of back pain and leg pain.</p><p><strong>Conclusions: </strong>The historical progression of HGSL treatment, from the early interventions in 1932 to the techniques used today, has been pivotal in shaping patient outcomes. The authors' findings have many implications for clinical practice, and they provide a framework for implementing treatment guidelines. The authors underscore the importance of a comprehensive evaluation of the benefits and risks of each surgical approach, with particular emphasis on customizing interventions to accommodate the specific anatomical features of each patient.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy: a systematic review and meta-analysis.","authors":"WeiDong Huang, ShuangHua Liu, ZePeng Cai, Jia Liao, YiMei Tan, Shuan Wu, JunLang Zhu, XuQiao Zhang","doi":"10.3171/2024.12.SPINE24623","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24623","url":null,"abstract":"<p><strong>Objective: </strong>The management of cervical spondylotic myelopathy (CSM) presents a clinical conundrum, with cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) emerging as primary contenders. However, the comparative advantages and limitations of these interventions remain contentious. This meta-analysis aimed to scrutinize the efficacy and safety profiles of CDA and ACDF in addressing CSM.</p><p><strong>Methods: </strong>Adhering rigorously to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted an exhaustive systematic search across reputable databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, and the Chinese National Knowledge Infrastructure. Randomized controlled trials evaluating the efficacy and safety of CDA versus ACDF for CSM were meticulously selected for comprehensive evaluation.</p><p><strong>Results: </strong>A total of 12 randomized controlled trials involving 2612 patients (1464 CDA, 1148 ACDF) were included in this meta-analysis. The pooled results showed that compared with ACDF, CDA was associated with better overall success (RR 1.21, 95% CI 1.06-1.37; p = 0.004; I2 = 71%). In terms of Neck Disability Index and neck visual analog scale (VAS), compared with ACDF, the CDA group showed superior performance at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The performance on the arm VAS at 3 and 12 months after surgery was the same. The operative time for the CDA group was significantly longer than that of the ACDF group. There were no significant differences in neurological success; radiological success; arm VAS scores at 6 weeks, 6 months, and 24 months postoperatively; range of motion; SF-36 mental component summary and physical component summary scores; surgical blood loss; dysphagia/dysphonia; and rate of any adverse event.</p><p><strong>Conclusions: </strong>In contrast to ACDF, CDA exhibited superior clinical efficacy and a more favorable safety profile in the management of CSM. Notably, discernible disparities were observed in the enhancement of neck pain as measured by the VAS within the initial postoperative year. It is imperative to note, however, that the body of evidence supporting these conclusions remains relatively scant, necessitating comprehensive validation through expanded multicenter randomized controlled trials encompassing substantial sample sizes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes of unilateral painful foot drop secondary to lumbar disc herniation: a multicenter retrospective study.","authors":"Asfand Baig Mirza, Amisha Vastani, Feras Fayez, Rishabh Suvarna, Mustafa El Sheikh, Chaitanya Sharma, Maria Alexandra Velicu, David Rowland, Jandira Trindade, Sebastian M Toescu, Suzanne M Murphy, Malaika Jindal, Gerda Reischer, Paula Corr, Deirdre Nolan, Alice Sims-Williams, Charlotte Read, Eranga Goonewardena, Nabilah Johani, Christoforos Syrris, Anand S Pandit, Sami Rashed, Abbas Khizar Khoja, Samir Matloob, Jonathan Bull, Alexander Montgomery, Catherine Moran, Parag Sayal, Samih Hassan, Mohamed Okasha, Ali Nader-Sepahi, Irfan Malik, Babak Arvin, Ahmed-Ramadan Sadek, Gordan Grahovac","doi":"10.3171/2024.12.SPINE24713","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24713","url":null,"abstract":"<p><strong>Objective: </strong>Foot drop is characterized by weakness in ankle dorsiflexion, primarily due to failure of activation of dorsiflexor muscles secondary to neural compromise. The aim of this study was to evaluate surgical outcomes for unilateral painful foot drop secondary to lumbar disc herniation, specifically excluding cases with cauda equina syndrome.</p><p><strong>Methods: </strong>This retrospective study spanned 7 centers, focusing on adult patients who underwent lumbar discectomies from September 2011 to September 2022 due to painful unilateral foot drop (Medical Research Council [MRC] grade ≤ 3). Clinical records were analyzed to identify patients matching the inclusion criteria, with data collection adhering to PROCESS guidelines. Outcomes were assessed based on the MRC scale for muscle strength, and statistical analysis was conducted to determine outcome predictors.</p><p><strong>Results: </strong>This study included 75 patients (mean age 49.03 years, 1:1.007 male/female ratio). Early surgery in younger and less frail patients was associated with better outcomes, with no precise surgical timing cutoff identified. Improvement in MRC grades was seen in 41 patients (55%), with no change in 23 patients (31%) and worsening grades in 11 patients (15%). For every day delaying surgery, the likelihood of improvement decreased by 0.2%. The severity of foot drop was associated with a reduced likelihood of complete resolution, although some recovery was demonstrated. Functional recovery was consistently higher in patients with higher presenting MRC grades. Radicular pain consistently improved following surgical intervention irrespective of all other analyzed metrics.</p><p><strong>Conclusions: </strong>Prompt surgical intervention for patients with foot drop improved outcomes, especially in those who were younger and less frail. While the study did not identify a specific cutoff for the timing of surgery, the findings emphasize the importance of early surgical consideration as delays were associated with reduced likelihood of recovery. Future research should focus on prospective studies to validate these findings and refine guidelines for surgical intervention in this patient population.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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. Predicting spinopelvic parameters using artificial intelligence.","authors":"Mert Marcel Dagli, Jaskeerat Gujral, Yohannes Ghenbot, Ali K Ozturk, William C Welch, Jang W Yoon","doi":"10.3171/2024.8.SPINE24926","DOIUrl":"https://doi.org/10.3171/2024.8.SPINE24926","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and operating room time savings with single-position prone lateral lumbar interbody circumferential fusion.","authors":"Jonathan J Lee, Juan P Giraldo, Clinton D Morgan, Gennadiy A Katsevman, Stefan W Koester, Robert K Dugan, Joshua S Catapano, S Harrison Farber, Juan S Uribe","doi":"10.3171/2024.11.SPINE23706","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE23706","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine efficiencies associated with dual-position versus single-position lateral lumbar interbody fusion (LLIF).</p><p><strong>Methods: </strong>Billing databases were queried for LLIF procedures performed by a single surgeon at a high-volume tertiary care center. Case-specific costs for each procedure were collected. Cases were matched by the number of levels treated. One-level and 2-level LLIFs with percutaneous pedicle screw (PPS) fixation (LLIF+PPS) using a single vendor system were included. Length of stay, operative time, and operative costs were compared for dual-position and single-position LLIF cases using continuous and categorical variable comparisons.</p><p><strong>Results: </strong>Among 9 patients with 1-level LLIF+PPS, dual-position LLIF+PPS (n = 3) compared with single-position LLIF+PPS (n = 6) was associated with similar mean lengths of stay (2.0 vs 2.2 days), longer operating room time (160.1 vs 149.7 minutes), and greater mean costs for operating room staff and supplies ($1347 vs $1263); however, the differences were not statistically significant. Time-based anesthesiology costs were higher for dual-position LLIF+PPS than for single-position LLIF+PPS ($741 vs $521, p = 0.03). Among 8 patients with 2-level LLIF+PPS, patients undergoing dual-position (n = 5) and single-position (n = 3) LLIF+PPS had similar mean lengths of stay (1.2 vs 1.5 days). However, dual-position surgery was associated with a longer mean operating room time (257.8 vs 182.3 minutes, p = 0.03), greater mean operating room cost ($2275 vs $1352, p = 0.02), and greater time-based cost of anesthesiology coverage ($864 vs $644, p = 0.01).</p><p><strong>Conclusions: </strong>In this cohort of patients undergoing 1- and 2-level LLIF+PPS, single-position surgery was associated with shorter operating room time, lower operating room costs, and similar postoperative hospital length of stay when compared with dual-position surgery for a similar pathology.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of the magnitude of sagittal correction and local junctional factors on proximal junctional kyphosis and failure following correction of adult spinal deformity: an inverse probability weighted analysis.","authors":"Yohannes Ghenbot, John D Arena, Mert Marcel Dagli, Dominick Macaluso, Sennay Ghenbot, Connor Wathen, Harmon Khela, Hasan S Ahmad, Gabrielle Santangelo, Josh Gobulovsky, Johnny Wright, Jonathan Heintz, Zarina S Ali, Neil R Malhotra, William C Welch, Jang W Yoon, Vincent Arlet, Ali K Ozturk","doi":"10.3171/2024.12.SPINE24899","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24899","url":null,"abstract":"<p><strong>Objective: </strong>Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) remain difficult problems following correction of adult spinal deformity (ASD). The goal of this study was to perform a comprehensive evaluation of risk factors associated with PJK and PJF using advanced statistical methods through inverse probability weighting (IPW).</p><p><strong>Methods: </strong>Patients who presented to the authors' institution with symptomatic ASD from 2013 to 2021 and who underwent thoracolumbar fusion ending in the pelvis were included in the study. The primary outcomes were development of PJK and PJF following ASD correction. PJK was classified using Glattes' criteria. PJF was defined as a proximal junctional angle > 20° from preoperative measures or complications at the upper instrumented vertebra (UIV) including vertebral body fracture, instability, and/or hardware failure. Patient charts and images (radiography, CT, and MRI) were used to extract demographics, measures of sagittal and coronal balance on pre- and postoperative radiography, operative techniques, and bone health metrics. Propensity score generation with IPW was used to control for confounding variables.</p><p><strong>Results: </strong>In total, 187 patients were included in the study with a median follow-up of 24.6 months. Sixty-nine patients (36.9%) developed PJK, while 26 (13.9%) developed PJF. Kaplan-Meier analysis showed that both PJK and PJF largely occurred within the 1st year of index ASD correction. IPW showed that patients who developed PJK had a larger correction in the sagittal plane including global lumbar lordosis (p < 0.001) and sagittal vertical axis (p = 0.020). PJF development was associated with factors at the UIV including low Hounsfield units (p = 0.026) and cranially directed screws at the UIV (p = 0.040).</p><p><strong>Conclusions: </strong>PJK and PJF remain challenging postoperative complications following correction of ASD. In this large retrospective study that utilized IPW analysis, the authors found factors unique to each outcome. These results suggest that increased correction in the sagittal plane is more commonly associated with PJK, while junctional factors including bone quality and cranially directed screws at the UIV are associated with PJF. These findings can inform pre- and intraoperative medical and surgical strategies to reduce the incidence of PJK and PJF following ASD correction.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}