Journal of neurosurgery. Spine最新文献

{"title":"Outcomes after total en bloc spondylectomy at a mean follow-up of 11 years.","authors":"Wai Kiu Thomas Liu, Yat Wa Wong, Kenny Yat Hong Kwan","doi":"10.3171/2025.3.SPINE241451","DOIUrl":"10.3171/2025.3.SPINE241451","url":null,"abstract":"<p><strong>Objective: </strong>Total en bloc spondylectomy (TES) of spinal tumors results in a large vertebral defect. Despite reconstruction and fusion, there is the potential concern for long-term mechanical stability. This retrospective cohort study investigated the long-term outcome of TES and reconstruction.</p><p><strong>Methods: </strong>Twenty-three patients (mean age 40.0 ± 15.3 years) underwent TES for either primary spinal tumors or solitary metastasis and reconstruction with instrumented posterior spinal fusion and anterior fusion with titanium mesh cages at the authors' institution from November 2001 to April 2022. The mean follow-up was 11.5 ± 4.9 years. Primary diagnoses included giant cell tumors (n = 13), primary sarcomas (n = 3), hemangiopericytomas (n = 2), solitary metastases (n = 2), aneurysmal bone cyst (n = 1), hemangioma (n = 1), and chordoma (n = 1). Tumors were located in the lumbar (n = 10) or thoracic (n = 13) spine. Fifteen patients had 1 vertebral level resected, 2 patients had 2, 4 patients had 3, 1 patient had 4, and 1 patient had 5 levels resected. The mean operative duration was 751.7 ± 212.6 minutes, and the mean intraoperative blood loss was 2864.3 ± 2124.8 ml. The mean length of resected tumor was 51.6 ± 23.3 mm. Investigated outcomes were instrumentation failure, revision, and postoperative complications.</p><p><strong>Results: </strong>Twelve patients required revision surgery, 8 of whom had instrumentation failure with rod fracture. The mean time to instrumentation failure was 7.6 ± 3.9 years. Instrumentation failure with rod fracture was associated with longer operation time (p = 0.031), more blood loss (p = 0.002), and a longer length of resected tumor (p = 0.035). No significant association was identified between instrumentation failure and radiological bony union, which was demonstrated in 73.9% of patients. The overall revision-free survivals were 67.0% and 48.8% at 5 and 10 years postoperatively, respectively. The 5- and 10-year instrumentation failure-free survivals were 85.2% and 65.7%, respectively. Local recurrence of the pathology occurred in 3 patients (13.0%), with a mean time to local recurrence of 3.4 ± 4.4 years. Kaplan-Meier analysis showed that 91.3% and 84.3% of the patients would be free from local recurrence at 5 and 10 years postoperatively, respectively.</p><p><strong>Conclusions: </strong>Although local recurrence was uncommon after TES, revision surgery, particularly for instrumentation failure, emerged as a common late complication following TES. Long resection length and long complicated operations increase the likelihood of future instrumentation failure. Radiological bony union does not guarantee long-term success of the construct.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336709","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":"Generalizable model to predict new or progressing compression fractures in tumor-infiltrated thoracolumbar vertebrae in an all-comer population.","authors":"Alex Flores, Vijay Nitturi, Arman Kavoussi, Max Feygin, Romulo A Andrade de Almeida, Esteban Ramirez Ferrer, Adrish Anand, Shervin Nouri, Anthony K Allam, Ashley Ricciardelli, Gabriel Reyes, Sandy Reddy, Ihika Rampalli, Laurence Rhines, Claudio E Tatsui, Robert Y North, Amol Ghia, Jeffrey H Siewerdsen, Alexander E Ropper, Christopher Alvarez-Breckenridge","doi":"10.3171/2025.2.SPINE24872","DOIUrl":"10.3171/2025.2.SPINE24872","url":null,"abstract":"<p><strong>Objective: </strong>Neurosurgical evaluation is required in the setting of spinal metastases at high risk for leading to a vertebral body fracture. Both irradiated and nonirradiated vertebrae are affected. Understanding fracture risk is critical in determining management, including follow-up timing and prophylactic interventions. Herein, the authors report the results of a machine learning model that predicts the development or progression of a pathological vertebral compression fracture (VCF) in metastatic tumor-infiltrated thoracolumbar vertebrae in an all-comer population.</p><p><strong>Methods: </strong>A multi-institutional all-comer cohort of patients with tumor containing vertebral levels spanning T1 through L5 and at least 1 year of follow-up was included in the study. Clinical features of the patients, diseases, and treatments were collected. CT radiomic features of the vertebral bodies were extracted from tumor-infiltrated vertebrae that did or did not subsequently fracture or progress. Recursive feature elimination (RFE) of both radiomic and clinical features was performed. The resulting features were used to create a purely clinical model, purely radiomic model, and combined clinical-radiomic model. A Spine Instability Neoplastic Score (SINS) model was created for a baseline performance comparison. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity (with 95% confidence intervals) with tenfold cross-validation.</p><p><strong>Results: </strong>Within 1 year from initial CT, 123 of 977 vertebrae developed VCF. Selected clinical features included SINS, SINS component for < 50% vertebral body collapse, SINS component for \"none of the prior 3\" (i.e., \"none of the above\" on the SINS component for vertebral body involvement), histology, age, and BMI. Of the 2015 radiomic features, RFE selected 19 to be used in the pure radiomic model and the combined clinical-radiomic model. The best performing model was a random forest classifier using both clinical and radiomic features, demonstrating an AUROC of 0.86 (95% CI 0.82-0.9), sensitivity of 0.78 (95% CI 0.70-0.84), and specificity of 0.80 (95% CI 0.77-0.82). This performance was significantly higher than the best SINS-alone model (AUROC 0.75, 95% CI 0.70-0.80) and outperformed the clinical-only model but not in a statistically significant manner (AUROC 0.82, 95% CI 0.77-0.87).</p><p><strong>Conclusions: </strong>The authors developed a clinically generalizable machine learning model to predict the risk of a new or progressing VCF in an all-comer population. This model addresses limitations from prior work and was trained on the largest cohort of patients and vertebrae published to date. If validated, the model could lead to more consistent and systematic identification of high-risk vertebrae, resulting in faster, more accurate triage of patients for optimal management.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336708","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":"Sacral fracture risk after stereotactic spinal radiosurgery: a multi-institution, retrospective analysis.","authors":"Eric A Goethe, Romulo A Andrade de Almeida, Francisco Call-Orellana, Anthony L Mikula, Michelle J Clarke, Kenneth W Merrell, Peter S Rose, S Mohammed Karim, Joseph R Linzey, Nicholas J Szerlip, Behrang Amini, Thomas H Beckham, Amol J Ghia, Jing Li, Martin C Tom, Mary Frances McAleer, Subha Perni, Chenyang Wang, Debra N Yeboa, Anthony Price, Christopher Alvarez-Breckenridge, Laurence D Rhines, Claudio E Tatsui, Robert Y North","doi":"10.3171/2025.2.SPINE24770","DOIUrl":"10.3171/2025.2.SPINE24770","url":null,"abstract":"<p><strong>Objective: </strong>Spinal stereotactic radiosurgery (SSRS) is an established treatment modality for spinal metastatic disease. A common complication of SSRS is postradiation pathologic fracture. The authors evaluated the risk of pathologic fracture in sacral SSRS.</p><p><strong>Methods: </strong>All patients receiving SSRS in 1 to 5 fractions to 1 or more sacral levels between 2011 and 2020 at participating institutions were included. Demographic, histological, anatomical, and outcome data were obtained from electronic medical records. Data were analyzed using SPSS version 28.</p><p><strong>Results: </strong>Of 67 total patients, 50 (74.6%) were men and 17 (25.4%) were women. The most common tumor histologies were prostate adenocarcinoma (n = 16 [23.9%]) and renal cell carcinoma (n = 12 [17.9%]). Median (range) age at treatment was 63 (8-87) years. The mean ± SD (range) number of levels treated was 1.5 ± 0.7 (1-4) levels. Mean ± SD (range) bone density at S1 was 208.0 ± 74.4 (-3.0 to 443.3) Hounsfield units (HUs). Median (range) follow-up was 16.6 (1.5-132) months, median ± SD (range) overall survival was 24 ± 21.0 (1.7-83.3) months, and the 1-year local control rate was 83.6%. Fourteen patients (20.9%) experienced fracture within the radiation field. There was no association between fracture and patient sex (p = 0.32), age (p = 0.40), S1 HU (p = 0.28), tumor location according to Denis classification (p = 0.87), presence of pain (p = 0.66), single versus multifraction radiation (p = 0.44), or number of levels treated (p = 0.52). Patients experiencing in-field progression were more likely to experience fracture (61.5% vs 10.2%, p < 0.001), and patients experiencing fracture had a higher average Spine Instability Neoplastic Score than patients without fracture (5.7 vs 4.3, p = 0.049). Only local control remained as a factor associated with sacral fracture in the multivariate analysis. Of the patients experiencing fracture, 10 (71.4%) were symptomatic and 3 of those (30.0%) underwent post-SSRS surgical intervention.</p><p><strong>Conclusions: </strong>Pathologic fracture may occur after sacral SSRS in a significant number of patients and is significantly associated with failure of local control.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336710","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":"Less is more: complication rates and outcome measures of intradiscal osteotomy versus pedicle subtraction osteotomy in adult spinal deformity.","authors":"César Carballo Cuello, Gabriel Flores-Milan, Ryan Screven, Elliot Pressman, Jay I Kumar, Bryan Clampitt, Mohammad Hassan A Noureldine, Adolfo Viloria Hidalgo, Mohammadmahdi Sabahi, Erik Hayman, Mark Greenberg, Puya Alikhani","doi":"10.3171/2025.2.SPINE241128","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241128","url":null,"abstract":"<p><strong>Objective: </strong>Intradiscal osteotomy (IDO), which is used for the treatment of spinal deformities, involves a three-column release that creates lordosis. It is believed to be as effective as pedicle subtraction osteotomy (PSO). The authors of this study compared the two techniques in restoring sagittal balance and evaluated their safety profiles.</p><p><strong>Methods: </strong>They conducted a retrospective database review of patients who had undergone long construct fusions from 2016 to 2022. Long construct fusions were defined as having an upper instrumented vertebra of L2 or higher and a lower instrumented vertebra of S1 or the pelvis. The study included only those patients with lumbar degenerative disease, evidence of fusion at the treatment level on preoperative imaging, and 2 years of follow-up.</p><p><strong>Results: </strong>Fifty-three patients met the study inclusion criteria, of whom 28 had undergone IDO and 25 had undergone PSO. The IDO cohort had a 3.6% frequency of proximal junctional kyphosis (PJK), 17.9% frequency of hardware failure (HF), 10.7% frequency of deep vein thrombosis (DVT), 3.6% frequency of wound infection, and 10.7% frequency of pseudarthrosis. The PSO cohort had a 4.0% incidence of PJK, 28.0% incidence of HF, 16.0% incidence of DVT, 4.0% incidence of wound infection, and 12.0% incidence of pseudarthrosis. The average postoperative sagittal vertical axis (SVA) for the PSO group was 7 cm, whereas the average for the IDO group was 5 cm (p = 0.01). Patients who had undergone IDO reported less back pain on their visual analog scale assessments at 3 months postoperatively (p = 0.01). The IDO cohort had an average operative time (OT) of 7 hours and estimated blood loss (EBL) of 800 ml, whereas the PSO group had an OT of 8.5 hours (p = 0.01) and EBL of 1400 ml (p = 0.01).</p><p><strong>Conclusions: </strong>IDO can be as effective as PSO in lordosis restoration and is a powerful technique for SVA correction (p = 0.01), significantly improving postoperative back pain, as compared with PSO (p = 0.01), while maintaining a similar risk profile.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293926","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":"Minimum clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state for patients with spinal metastasis who underwent surgical treatment: a multicenter prospective clinical study.","authors":"Mengchen Yin, Xinghai Yang, Haohan Zhou, Wenlong Yu, Fan Zhang, Zihuan Zhou, Dingbang Chen, Luosheng Zhang, Xin Gao, Tao Wang, Peilin Chu, Yueli Sun, Zhengwang Sun, Wen Mo, Junming Ma, Quan Huang, Jianru Xiao","doi":"10.3171/2025.3.SPINE241329","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE241329","url":null,"abstract":"<p><strong>Objective: </strong>There is increasing emphasis on patient-reported outcomes (PROs) in assessing surgical efficacy, especially in patients with spinal metastasis (SM). The updated version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ 2.0) is a disease-specific tool, while the EQ-5D-5L is a general quality-of-life instrument. The aim of this study was to establish the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds for these tools in patients undergoing surgery for SM.</p><p><strong>Methods: </strong>A multicenter prospective observational study of patients with SM who underwent surgical treatment from January 2020 to December 2022 across 4 institutions was performed, and patients were followed for 6 months. Patients completed the SOSGOQ 2.0 and EQ-5D-5L at baseline and 1-, 3-, and 6-month follow-up assessments. Anchor- and distribution-based methods were used to calculate the MCID, SCB, and PASS. Clinical performance was compared between the two tools.</p><p><strong>Results: </strong>A total of 260 patients (138 males, mean age 62.4 years) who underwent surgery for SM were included. Surgery resulted in significant improvements in both PRO measures. The MCID was 19.4 for the SOSGOQ 2.0 total score and 19.6 for the visual analog scale of the EQ-5D-5L. A higher percentage of patients achieved clinically meaningful outcomes per the SOSGOQ 2.0, indicating superior sensitivity and clinical utility over the EQ-5D-5L.</p><p><strong>Conclusions: </strong>Compared with the EQ-5D-5L, the SOSGOQ 2.0 demonstrated higher sensitivity in assessing functional improvements in patients with SM, making it the preferred tool in clinical settings. Further research is recommended for long-term validation.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293927","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 safety and efficacy of posterior vertebral column resection in treating severe thoracolumbar Pott's deformity: a multicenter study with long-term follow-up.","authors":"Junlong Zhong, Jingtao Gao, Lu Chen, Mardan Mamat, Yingsong Wang, Zhaohui Ge, Zhenhai Zhou, Kai Cao","doi":"10.3171/2025.3.SPINE24882","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE24882","url":null,"abstract":"<p><strong>Objective: </strong>In this multicenter study, the authors conducted a comprehensive analysis of the safety and efficacy of posterior vertebral column resection (PVCR) for the treatment of thoracolumbar Pott's kyphosis.</p><p><strong>Methods: </strong>The records of patients with severe thoracolumbar kyphosis (local kyphosis [LK] ≥ 90°) who underwent PVCR across 7 centers from September 2013 to August 2018 were retrospectively analyzed. The operation-related data were collected. Comparisons of spinopelvic parameters as well as American Spinal Injury Association Impairment Scale (AIS) grades were made preoperatively, postoperatively, and at the final follow-up.</p><p><strong>Results: </strong>A total of 145 patients were included in this study, with an average follow-up of 105.7 months. LK decreased from 107.3° before surgery to 32.0° after surgery (p < 0.05) and slightly reverted to 37.1° at the final follow-up (p < 0.05). Thoracic kyphosis and lumbar lordosis significantly improved from 6.0° ± 6.9° and 75.8° ± 12.9° preoperatively to -12.7° ± 7.3° and 44.0° ± 9.5° postoperatively, respectively (both p < 0.05). The preoperative neurological function of 94 patients was AIS grade E, and 114 and 121 patients reached AIS grade E by 3 months postoperatively and the final follow-up, respectively. The Scoliosis Research Society-22 questionnaire score of patients at the final follow-up was significantly improved after surgery, increasing from 2.9 ± 0.3 points before surgery to 3.9 ± 0.2 points at the final follow-up (p < 0.05). Twenty-nine patients experienced early complications. Late complications occurred in 24 patients, including instrument failure in 17 cases, adjacent segment failure in 3 cases, and nonunion in 4 cases.</p><p><strong>Conclusions: </strong>PVCR is an effective surgical intervention for severe thoracolumbar kyphosis, with patients achieving significantly improved spinal alignment, neurological function, and quality of life in the long term. Care should be taken to prevent complications related to surgery and implant failure.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293928","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":"Are hospital experience scores correlated with patient-reported outcome measures following elective spine surgery?","authors":"Christopher J Como, Rahul Ramanathan, Jonathan Dalton, Audrey Y Chang, Christopher Gonzalez, Melissa Y Tang, Samuel Adida, Michael Calcaterra, Anthony A Oyekan, Shaan Sadhwani, Feier Chang, Yan Ma, Michael Spitnale, Richard A Wawrose, Joon Y Lee, Jeremy D Shaw, Mitchell S Fourman","doi":"10.3171/2025.2.SPINE241534","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241534","url":null,"abstract":"<p><strong>Objective: </strong>Patient experience scores are hospital-centric metrics, which are becoming increasingly important in healthcare quality assessment; however, the factors that influence these scores are poorly defined. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally administered, publicly reported patient experience survey that exerts a major influence on hospital reimbursement by the Centers for Medicare and Medicaid Services (CMS). The purpose of this study was to investigate the correlation between HCAHPS scores and postoperative patient-reported outcome measures (PROMs) up to 5 years after elective cervical and thoracolumbar spine surgery.</p><p><strong>Methods: </strong>All patients who had undergone elective spine surgery at a single academic tertiary center in 2010-2019 were potentially eligible for study inclusion. PROMs used in the study included the Neck Disability Index (NDI), Oswestry Disability Index (ODI), 10-Item Patient-Reported Outcomes Measurement Information System Global Health survey (PROMIS GH-10) global mental health (GMH) and global physical health (GPH) parameters, and patient acceptable symptom state for neck and back. Patients were excluded for surgical indications such as trauma, infection, or neoplasia or for missing PROM data. HCAHPS scores were collected from the electronic medical record and had been originally obtained via text message. Correlation analysis and longitudinal data analysis were used to assess relationships between PROMs and HCAHPS scores (α = 0.05).</p><p><strong>Results: </strong>Three hundred ninety-seven patients with recorded PROMs were included in the study; 124 had undergone elective cervical surgery and 273 had undergone thoracolumbar surgery. HCAHPS scores showed small but significant correlations with NDI and the PROMIS GMH component 6 months after cervical surgery; however, no significant correlations were seen beyond 6 months. Additionally, there was no significant relationship between HCAHPS and postoperative PROMs following thoracolumbar surgery.</p><p><strong>Conclusions: </strong>Hospital experience scores, as assessed using the HCAHPS, show limited correlation with PROMs after elective spine surgery. While the HCAHPS currently plays a critical role for the CMS in determining hospital reimbursement rates, the study findings suggest that patient perceptions of inpatient care do not necessarily reflect their long-term functional outcomes. This result highlights the need for a multidimensional approach to evaluating healthcare quality, incorporating both short-term patient satisfaction and meaningful, enduring improvements in clinical outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248359","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":"Long-term results of cervical disc arthroplasty: a single-center retrospective study with a minimum 10-year follow-up.","authors":"Junbo He, Yaling Li, Yiwei Shen, Xingjin Wang, Lu Yan, Tingkui Wu, Chen Ding, Hao Liu","doi":"10.3171/2025.2.SPINE241185","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241185","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to retrospectively evaluate the long-term clinical and radiological outcomes following cervical disc arthroplasty (CDA).</p><p><strong>Methods: </strong>This study included 74 patients who underwent single- or two-level CDA between November 2004 and December 2013, with a minimum 10-year follow-up (22 in the Bryan disc group and 52 in the Prestige LP disc group). Patient-reported outcomes and radiological parameters were collected for comparisons. Additionally, the incidences of heterotopic ossification (HO), adjacent segment degeneration (ASD), prosthesis subsidence, and segmental kyphosis at the final follow-up were evaluated and analyzed. A 95% confidence interval (CI) for a mean difference or odds ratio (OR) was used for all general statistical calculations.</p><p><strong>Results: </strong>After 10 years of follow-up, patients with CDA continued to show significant improvement from baseline in patient-reported outcomes (p < 0.001), with no significant differences between the two groups. However, the Bryan disc group had significantly higher global range of motion (ROM; 95% CI 4.8°-19.2°, p = 0.001) and segmental ROM (95% CI 1.3°-5.9°, p = 0.003) compared to the Prestige LP disc group. At 10 years postoperatively, the incidence of HO was 69.2%, including 29.7% ROM-limiting HO. The incidence of ASD was 55.4%. Segmental kyphosis was observed in 10 patients, with a 20.8% incidence in the Bryan disc group and an 8.1% incidence in the Prestige LP disc group (p = 0.072). In the univariate subgroup analysis, the age of the ASD group was significantly higher (95% CI 0.3-6.8, p = 0.034). However, no statistically significant parameters were identified between the HO and non-HO groups.</p><p><strong>Conclusions: </strong>Through at least 10 years of follow-up, CDA can achieve satisfactory clinical outcomes while effectively preserving segmental mobility.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248361","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":"Erratum. Intentional Enneking-inappropriate surgery and high-energy particle therapy for unresectable osteogenic sarcoma of the spine: a retrospective study.","authors":"Gisberto Evangelisti","doi":"10.3171/2025.2.SPINE231401a","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE231401a","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248360","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 mechanical complications following spondylectomy of thoracolumbar primary spinal column tumors.","authors":"Anthony L Mikula, Zach Pennington, Megan C Everson, Nikita Lakomkin, Paul J Gagnet, Steven J Girdler, Matt H Lindsey, Josh A Spear, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, S Mohammed Karim, William E Krauss, Peter S Rose, Michelle J Clarke","doi":"10.3171/2025.2.SPINE231312","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE231312","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to identify risk factors for mechanical complications following complex spinal reconstruction for spondylectomy of primary spinal column tumors.</p><p><strong>Methods: </strong>A retrospective chart review identified patients treated with spondylectomy for primary spinal column tumors in the thoracic or lumbar spine followed by posterior instrumentation and anterior column reconstruction. Variables collected included basic demographics, smoking status, chronic steroid use, frailty (Charlson Comorbidity Index), extent of resection, Weinstein-Boriani-Biagini classification, tumor volume, Spine Instability Neoplastic Score, anterior column reconstruction and fixation techniques, rod characteristics, Hounsfield units (HUs), and neoadjuvant/adjuvant chemoradiation.</p><p><strong>Results: </strong>Twenty-five patients were included (14 men, 11 women) with an average (± SD) age of 45 ± 18 years, BMI of 28 ± 5.7, and follow-up of 6.0 ± 6.2 years. Primary spinal column tumor pathology included chordoma (40%), chondrosarcoma (16%), giant cell tumor (16%), osteosarcoma (16%), osteoblastoma (8%), and aneurysmal bone cyst (4%). Six patients (24%) experienced mechanical complications, including rod fractures (n = 5) and distal junctional failure (n = 1). Of the 6 patients with mechanical complications, 4 (67%) underwent reoperation. The length of follow-up was the only statistically significant risk factor for patients with mechanical complications (average 11 years) compared to those without complications (average 4.4 years, p = 0.047). Average HUs were 144 for mechanical complication patients versus 180 for those without (p = 0.08). Anterior column reconstruction materials included a titanium cage (13 patients, 3 failures), structural allograft (6 patients, 2 failures), vascularized fibular strut autograft (6 patients, no failures), nonvascularized structural autograft (5 patients, 1 failure), vascularized rib autograft (5 patients, 2 failures), and a polyetheretherketone cage (2 patients, no failures). The vascularized fibular strut autograft had a 0% mechanical failure rate, but this did not reach statistical significance (p = 0.28). Twelve patients (48%) had anterior fixation placed, with a 17% rate of mechanical complications (p = 0.65). Five patients (20%) had > 2-rod constructs, with a 20% mechanical complication rate (p = 0.99).</p><p><strong>Conclusions: </strong>Reconstruction following primary spinal column tumor resection is a significant challenge, as evident by a high rate of mechanical complications and instrumentation failure. Future studies are needed with larger sample sizes to identify techniques that may mitigate the risk of failure.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248362","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}