Journal of neurosurgery. Spine最新文献

{"title":"Reduction of traumatic unilateral locked facet of the subaxial cervical spine: what predicts successful closed skeletal traction, and is anterior or posterior surgery superior after unsuccessful closed reduction?","authors":"Bradley Wilhelmy, Riccardo Serra, Parantap Patel, Jesse Stokum, Ovais Hasan, Rong Zhao, Chixiang Chen, Kristopher Hooten, Ross Puffer, Steven Ludwig, Kenneth Crandall, Gary Schwartzbauer, Charles Sansur, Bizhan Aarabi, Timothy Chryssikos","doi":"10.3171/2025.3.SPINE241107","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE241107","url":null,"abstract":"<p><strong>Objective: </strong>Closed skeletal traction (CST) to reduce unilateral locked facets in the subaxial cervical spine can expedite spinal realignment prior to definitive surgery but is not always successful. What predicts successful closed reduction is not completely understood. In addition, whether open anterior or posterior surgery is superior for achieving successful reduction after failed closed skeletal traction has not been investigated. The authors sought to assess predictors of successful closed reduction with skeletal traction and to compare the efficacy of anterior versus posterior surgery after failed closed reduction.</p><p><strong>Methods: </strong>The authors performed a retrospective analysis of patients presenting to a single level I trauma center with a de facto unilateral locked facet between 2008 and 2024. Patients with a complex facet fracture without a locked facet, bilateral locked facet, and/or no attempted CST were excluded. Fractures involving discrete, structurally relevant bony elements and other pathological features, and variables of reduction technique were recorded. Successful reduction was determined by restoration of anatomical alignment on fluoroscopy prior to surgery and verified with postoperative CT.</p><p><strong>Results: </strong>Fifty-five patients met the inclusion criteria. The population was 71% male, and the mean age was 47 ± 18 years. Closed reduction was successful in 56% of patients. The mean maximum weight applied was 60 ± 33 lb. Awake CST had a 48% success rate and CST under general anesthesia (GA) had an overall success rate of 61%. Upfront CST under GA (without prior unsuccessful awake CST) had a success rate of 83%, but no cases of failed awake CST were successfully reduced with subsequent CST under GA. On multivariate analysis, a contralateral perched facet increased the odds of successful closed reduction by 32-fold and presence of neurological injury (AIS grades A-D) reduced the odds of successful closed reduction by 21-fold. In patients requiring open surgical reduction after failed CST, posterior surgery was significantly more successful than anterior surgery (100% vs 45%, p = 0.026). Of the 6 patients in whom open reduction failed via an anterior approach, 5 underwent successful reduction during subsequent posterior surgery.</p><p><strong>Conclusions: </strong>A contralateral perched facet predicted successful CST, whereas any neurological deficit (AIS grade A-D) predicted failed CST. GA increased the odds of successful closed reduction but did not salvage failed awake CST attempts. In patients in whom CST failed and open surgical reduction was required, posterior surgery was significantly more successful than anterior surgery for reestablishing anatomical alignment.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132397","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":"A comparative study on the effect of age on Neck Disability Index improvement at 24 months after surgical intervention for cervical spondylotic myelopathy: a Quality Outcomes Database study.","authors":"Ken Porche, Brandon A Sherrod, Spencer Rosero, Andrew K Chan, Christopher I Shaffrey, Oren N Gottfried, Mohamad Bydon, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, John J Knightly, Scott Meyer, Cheerag D Upadhyaya, Mark E Shaffrey, Juan S Uribe, Luis M Tumialán, Jay D Turner, Dean Chou, Regis W Haid, Praveen V Mummaneni, Paul Park, Erica F Bisson","doi":"10.3171/2025.3.SPINE24598","DOIUrl":"https://doi.org/10.3171/2025.3.SPINE24598","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) is often accompanied by neck pain, which, along with more recognized neurological deficits like motor and sensory changes, significantly impacts patients' quality of life. The authors examined whether age influences improvements in neck disability and related quality-of-life measures after surgery for CSM. Using the Neck Disability Index (NDI) as the primary outcome, they compared long-term outcomes at 24 months among patients aged ≥ 65, ≥75, and < 65 years, exploring the effects of surgical intervention on both pain-related disability and functional recovery in older adults.</p><p><strong>Methods: </strong>Using the Quality Outcomes Database, the authors conducted a detailed propensity score-matched analysis on cohorts aged ≥ 65 and ≥ 75 years compared with a < 65-year-old cohort while controlling for baseline NDI scores, other demographic variables, health status, underlying pathology, number of levels, indication for surgery, surgical approach, and type of surgery. Differences in NDI total and subdomain scores at 24 months postoperatively were the primary measures of improvement. Age-related variability in NDI differential was assessed. EQ-5D and calculated SF-6D were secondary measures.</p><p><strong>Results: </strong>Of the 1141 patients in the cohort (January 2016 to December 2018), 687 patients were < 65 years, 325 were 65 to < 75 years, and 129 were ≥ 75 years of age. After propensity score matching, 197 patients each were well matched in the ≥ 65-year (mean 71.4 years) and < 65-year (mean 55.3 years) cohorts; similarly, 57 patients each were matched in the ≥ 75-year (mean 78.3 years) and < 65-year (mean 55.8 years) cohorts. Improvements in NDI scores and subdomain scores, EQ-5D, and calculated SF-6D were consistent at 3, 12, and 24 months postoperatively across all cohorts. At 24 months, patients ≥ 65 years showed NDI score improvements (-14.7 ± 22.3) similar to those < 65 years (-13.0 ± 21.3, p = 0.454), and patients ≥ 75 years demonstrated NDI improvements (-15.0 ± 19.7) comparable to those < 65 years (-17.6 ± 20.4, p = 0.499). A sensitivity analysis for linear relationship found that NDI improvement was statistically greater in older patients (7.5 points every 30 years, p < 0.0001), but this difference was below the minimal clinically important difference. Other clinical outcomes were similar between cohorts.</p><p><strong>Conclusions: </strong>Surgical intervention for CSM yields substantial and similar improvements in NDI scores and other metrics among various age groups, including those aged at least 65 and 75 years. These results highlight the effectiveness of surgery across a broad patient demographic, underscoring its value in treating CSM irrespective of age.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-16"},"PeriodicalIF":2.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132374","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 suboccipital craniectomy versus suboccipital cranioplasty in foramen magnum decompression for adult Chiari malformation.","authors":"Hangeul Park, Woojin Kim, Jungbo Sim, Hosung Myeong, Jun-Hoe Kim, Chang-Hyun Lee, Chun Kee Chung, Chi Heon Kim","doi":"10.3171/2025.2.SPINE241362","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241362","url":null,"abstract":"<p><strong>Objective: </strong>Foramen magnum decompression (FMD) by suboccipital craniectomy, which aims to restore CSF flow and alleviate symptoms, is the conventional treatment for symptomatic Chiari malformation (CM). However, suboccipital cranioplasty is considered to maintain cervical alignment, prevent headaches, improve cosmetic outcomes, and provide protection against trauma. The aim of this study was to compare two surgical techniques, suboccipital craniectomy and suboccipital cranioplasty, to evaluate clinical outcomes, radiological results, and medical costs.</p><p><strong>Methods: </strong>This retrospective analysis included 64 patients (mean age 37.6 ± 12.7 years) who underwent FMD for CM at a single tertiary referral center from January 2003 to March 2024. Patients were divided into two groups according to whether they underwent suboccipital craniectomy or suboccipital cranioplasty. Clinical data, radiological findings, surgical time, estimated blood loss (EBL), and medical costs were analyzed and compared between the groups.</p><p><strong>Results: </strong>Both surgical techniques significantly improved preoperative symptoms, and no significant differences were observed in surgical time or EBL between the groups. Radiologically, the suboccipital craniectomy group demonstrated a greater increase in subarachnoid space (mean 215.3 ± 113.6 mm2) compared with the suboccipital cranioplasty group (mean 141.4 ± 97.3 mm2, p = 0.008), although the reduction in syrinx size was similar for both groups. The suboccipital cranioplasty group incurred higher daily medical costs (mean $1568.4 ± $455.5) compared with the suboccipital craniectomy group (mean $887.1 ± $340.5, p < 0.001), primarily due to the additional expenses related to bony reconstruction materials such as plates and screws (mean $343.3 ± $81.6).</p><p><strong>Conclusions: </strong>Suboccipital craniectomy and cranioplasty both effectively improve symptoms for patients with CM. However, suboccipital cranioplasty involves additional costs, which should be discussed in the shared decision-making process.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132375","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":"Responsiveness of the PROMIS Global Health-10 Survey compared with the Oswestry Disability Index in patients undergoing 1- and 2-level lumbar fusions.","authors":"Matthew J Solomito, Heeren Makanji","doi":"10.3171/2025.2.SPINE241315","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241315","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the responsiveness of the mental health T-score (MHT) and physical health T-score (PHT) of the Patient-Reported Outcomes Measure Information System Global Health-10 Survey (PROMIS-10) compared with the Oswestry Disability Index (ODI) and to determine if the patient-reported outcome measures (PROMs) provided a similar assessment of patient outcomes.</p><p><strong>Methods: </strong>A total of 379 patients who underwent 1- or 2-level lumbar fusions between June 2021 and June 2023 were analyzed in this retrospective study. All patients completed their preoperative PROMs as well as their 3-, 6-, and 12-month follow-up PROMs. A responsiveness analysis to assess floor and ceiling effects, the correlation between the PHT and ODI as well as the MHT and ODI, and effect size indices (ESIs) was conducted to determine the responsiveness and construct validation of the MHT and PHT compared with the ODI.</p><p><strong>Results: </strong>Neither the ODI nor the MHT or PHT demonstrated a floor effect; however, up to 16% of the study cohort showed a ceiling effect with the PROMIS, whereas no patients reached the maximum score for the ODI. The PHT was strongly correlated with the ODI score at all time points with the correlation coefficients ranging between -0.71 and -0.82, while the MHT showed weak to moderate correlation (r = 0.48-0.67). The ESI demonstrated that the ODI was the most responsive of the tools assessed followed by the PHT; the MHT was noted to show limited responsiveness.</p><p><strong>Conclusions: </strong>The PROMIS-10 PHT provided similar responsiveness and construct validity as seen with the ODI at detecting functional changes after elective lumbar fusion. The PROMIS-10 MHT provides valuable insight into the patient's current mental health but was not overly responsive to change. The ODI remains the most responsive and accurate tool to assess low back function and postoperative improvement, but the PROMIS-10 can provide additional meaningful data that could be used to augment information gained from the ODI.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086275","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":"Impact of preoperative nutritional status on morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors: a role for the Geriatric Nutritional Risk Index.","authors":"Aladine A Elsamadicy, Paul Serrato, Sina Sadeghzadeh, Shaila Ghanekar, Syed I Khalid, Sheng-Fu Larry Lo, Daniel M Sciubba","doi":"10.3171/2025.2.SPINE241217","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE241217","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The Geriatric Nutritional Risk Index (GNRI) is commonly used to assess malnutrition risk in elderly patients, but its impact on spine surgery for metastatic spinal tumors is not well understood. This study aimed to evaluate the associations between preoperative nutritional status, as measured by the GNRI, and postoperative morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was performed using the 2011-2022 National Surgical Quality Improvement Program database of the American College of Surgeons. Elderly (≥ 65 years of age) patients undergoing laminectomy or corpectomy for extradural spinal tumor metastases were identified using International Classification of Diseases, 9th and 10th Revision and Current Procedural Terminology codes. Patients with missing data on sex, preoperative albumin, height, or weight were excluded. The study population was categorized by GNRI score: normal, malnourished, or severely malnourished. Using receiver operating characteristic (ROC) and multivariable analyses, the authors compared the discriminative thresholds and independent associations of GNRI, the 5-item modified frailty index (mFI-5), and older patient age with any adverse event (AE), extended hospital length of stay (LOS), nonroutine discharge, and 30-day mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 659 patients identified, 277 (42.0%) had normal nutritional status, 163 (24.7%) were malnourished, and 219 (33.2%) were severely malnourished. The severely malnourished cohort had significantly increased proportions of electrolyte abnormalities (p = 0.019) and anemia (p &lt; 0.001), with a significant decrease in BMI and albumin levels across cohorts (p &lt; 0.001). Malnourished and severely malnourished patients had significantly longer LOS (9.1 ± 6.2 days and 12.5 ± 8.6 days, respectively, vs 8.6 ± 7.1 days for patients categorized as normal, p &lt; 0.001) and nonroutine discharge (57.9% and 66.7%, respectively, vs 39.7% for normal, p &lt; 0.001). The severely malnourished cohort had significantly increased 30-day mortality (17.4% vs 6.5% for normal and 13.5% for malnourished, p = 0.001). On multivariable analysis, severely malnourished status was independently associated with any AE (adjusted odds ratio [aOR] 1.59, p = 0.036), extended LOS (aOR 2.17, p = 0.001), nonroutine discharge (aOR 1.99, p = 0.001), and 30-day mortality (aOR 2.28, p = 0.013). Malnourished status was independently associated with nonroutine discharge (aOR 1.84, p = 0.005). In ROC analysis, GNRI outperformed the mFI-5 (p = 0.318, p = 0.031, p &lt; 0.009, and p = 0.026, respectively) and patient age (p = 0.018, p &lt; 0.001, p = 0.014, and p = 0.034, respectively) in predicting 30-day AEs, extended LOS, nonroutine discharge, and 30-day mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study suggests that preoperative GNRI-defined malnutrition is associated with a h","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040636","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. Introducing the horizontal lumbar skin incision for open triangular spinopelvic fixation.","authors":"Nathan Beucler, Arnaud Dagain","doi":"10.3171/2025.1.SPINE2525","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE2525","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968273","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":"Traumatic posterior atlantoaxial dislocation based on imaging of the anterior arch-odontoid process-transverse ligament complex: a retrospective cohort study.","authors":"Tingfei Yan, Deshuang Qi, Haoyu Ni, Bingyong Xie, Jianchao Chang, Li Zhang, Peiwen Song, Cailiang Shen, Haisong Yang, Guodong Shi, Haiming Yu, Fulong Dong","doi":"10.3171/2025.2.SPINE24876","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE24876","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic posterior atlantoaxial dislocation (TPAD) is uncommon, and related research is very limited. By analyzing the imaging characteristics of the anterior arch-odontoid process-transverse ligament complex in patients, the authors classify the outcomes of TPAD and elucidate its mechanisms of injury.</p><p><strong>Methods: </strong>This is a retrospective review of CT and MRI data on patients with TPAD treated at two clinical centers from June 2014 to March 2024. Through analysis and statistics on injuries to the anterior arch, odontoid process, and transverse ligament complex, the authors proposed a new classification method based on different injuries to these structures on imaging. Additionally, they discuss the role of hyperflexion and hyperextension injuries in the formation of TPAD.</p><p><strong>Results: </strong>The different injuries to the anterior arch-odontoid process-transverse ligament complex on imaging were classified into four types of TPAD: fracture-free TPAD (type I), odontoid process fracture TPAD (type II), anterior arch fracture TPAD (type III), and compound fracture TPAD (type IV); the latter three types are referred to as \"fracture-associated TPAD.\" Considering the significant role of the transverse ligament in injuries, these four fracture types were further divided into two subtypes based on transverse ligament integrity (i.e., intact or injured). Among the 41 patients included in the study, there were 2 cases of fracture-free TPAD (i.e., 1 type Ia case and 1 type Ib case) and 39 cases of fracture-associated TPAD (i.e., 31 cases of odontoid process fracture TPAD, including 18 type IIa cases and 3 type IIb cases; 5 cases of anterior arch fracture TPAD, including 3 type IIIa cases and 2 type IIIb cases; and 3 cases of compound fracture TPAD, including 2 type IVa cases and 1 type IVb case).</p><p><strong>Conclusions: </strong>Based on the imaging classification method for different injuries to the anterior arch-odontoid process-transverse ligament complex, TPAD injuries demonstrate a higher degree of alignment, facilitating a comprehensive understanding of these injuries. Hyperflexion and hyperextension are the primary mechanisms in TPAD injuries, with the integrity of the transverse ligament playing a crucial role and guiding treatment principles.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000149","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":"Assessing and validating machine learning-enhanced imputation of admission American Spinal Injury Association Impairment Scale grades for spinal cord injury.","authors":"Ritvik R Jillala, Carlos A Aude, Vikas N Vattipally, Kathleen R Ran, Kelly Jiang, Carly Weber-Levine, A Daniel Davidar, Andrew M Hersh, Jacob Jo, Daniel Lubelski, Ali Bydon, Timothy Witham, Nicholas Theodore, Tej D Azad","doi":"10.3171/2025.1.SPINE241135","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241135","url":null,"abstract":"<p><strong>Objective: </strong>The American Spinal Injury Association Impairment Scale (AIS) assigned at patient admission is an important predictor of outcomes following spinal cord injury (SCI). However, nearly 80% of records in the Spinal Cord Injury Model Systems (SCIMS) database-a multicenter prospective database of patients with SCI-lack admission AIS grades. Accurate imputation of this missing data could enable more robust analyses and insights into SCI recovery. This study aims to develop and validate methods for imputing missing admission AIS data in the SCIMS database.</p><p><strong>Methods: </strong>The study included 16,062 patients with SCI from the publicly available SCIMS database (1988-2020). Five machine learning algorithms-random forest (RF), linear discriminant analysis, K-nearest neighbors, naive Bayes, and support vector machine-were compared using performance metrics (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and multiclass area under the receiver operating characteristic curve) using five-fold cross-validation on a training subset of 6054 patients with complete AIS admission grades. The model with the highest performance was trained on all 16,062 patients. The imputed AIS grades were validated by predicting discharge functional independence measure (FIM) scores (range 13-91) with simple and multiple linear regression models on a 1:1 propensity score-matched cohort (n = 5828). Model performance was compared using differences in root mean square error (∆RMSE) with bootstrapped 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The full cohort contained a representative distribution of AIS grades (45% grade A, 13% grade B, 18% grade C, and 24% grade D), and the propensity score-matched cohort characteristics were well balanced. The RF algorithm demonstrated the highest validation accuracy (81.7%). Predictive models showed no significant differences between models using true versus imputed AIS grades, with 95% CIs for ∆RMSE of -0.60 to 0.47 for simple regression and -0.63 to 0.46 for multiple regression models. The coefficients of AIS grades also did not significantly differ between models with true versus imputed values.</p><p><strong>Conclusions: </strong>A data-driven approach to imputation resulted in a robust method for imputing admission AIS grades that demonstrated clinical validity in the SCIMS database. This approach extends the utility of this longitudinal database and may provide a framework for other SCI databases.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022697","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":"A survival analysis for predictors of implant subsidence following 1- or 2-level transforaminal lumbar interbody fusion.","authors":"Zach Pennington, Rahul Kumar, Abdelrahman Hamouda, Michael Martini, Anthony L Mikula, Maria Astudillo Potes, Mohamad Bydon, Michelle J Clarke, William E Krauss, Ahmad N Nassr, Brett A Freedman, Arjun S Sebastian, Jeremy L Fogelson, Benjamin D Elder","doi":"10.3171/2025.1.SPINE24923","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE24923","url":null,"abstract":"<p><strong>Objective: </strong>Transforaminal lumbar interbody fusion (TLIF) offers both indirect decompression and segmental correction through restoration of disc height. However, stresses exerted on the vertebral endplates by the interbody device can result in implant subsidence and loss of correction. The present time-to-event analysis aimed to identify predictors of interbody subsidence.</p><p><strong>Methods: </strong>Patients who underwent 1- or 2-level TLIF were identified. Data on demographics, surgical details, preoperative bone quality using CT-based Hounsfield units (HU), and pre- and postoperative lumbopelvic parameters were collected. Univariable analyses were conducted to identify predictors of subsidence (≥ 2-mm intrusion of interbody into cranial or caudal vertebrae) and significant subsidence (≥ 4-mm intrusion). Multivariable Cox regression was performed to identify independent predictors of subsidence, expressed as hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 198 patients treated at 241 levels were included (median age 66.6 years, IQR 59.5, 73.7 years; 56.6% were women). In 92 levels (38.2%) there was some subsidence and in 25 (10.4%) there was significant subsidence. Implanted levels demonstrating subsidence (≥ 2 mm) were associated with lower HU in cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring; were implanted with taller, more lordotic interbodies; and underwent greater disc height restoration. Those showing significant subsidence (≥ 4 mm) were similarly associated with lower HU in the cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring of the caudal vertebrae; and underwent greater disc height restoration. Multivariable Cox regression showed that time to subsidence was predicted by greater implant height (HR 1.20/mm, 95% CI 1.05-1.38; p = 0.009), greater postoperative disc height (HR 1.21/mm, 95% CI 1.09-1.34; p < 0.001), and greater disc height restoration (HR 1.11/mm, 95% CI 1.04-1.19; p = 0.002). The time-to-subsidence analysis for significant (≥ 4 mm) subsidence showed that it was predicted by lower HU in the cranial vertebrae (HR 0.98/unit, 95% CI 0.97-0.99; p = 0.001); increasing number of levels instrumented (HR 1.26, 95% CI 1.04-1.52; p = 0.016); and greater disc height restoration (HR 1.33/mm, 95% CI 1.18-1.51; p < 0.001).</p><p><strong>Conclusions: </strong>This time-to-event analysis suggests that interbody subsidence following TLIF is best predicted by implantation of a taller interbody and aggressive disc height restoration. Significant subsidence is similarly predicted by aggressive disc height restoration along with poor baseline bone quality. The results suggest the need to balance aggressive correction at the time of surgery against the increased risk of subsequent interbody subsidence.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968179","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":"Use of pelvic incidence on preoperative prone and supine radiography to predict postoperative pelvic incidence following thoracolumbar fusion for adult spinal deformity.","authors":"Zach Pennington, Michael L Martini, Anthony L Mikula, Maria Astudillo Potes, Abdelrahman M Hamouda, Nikita Lakomkin, Arjun Sebastian, Brett A Freedman, Ahmad N Nassr, Jeremy L Fogelson, Benjamin D Elder","doi":"10.3171/2025.2.SPINE24706","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE24706","url":null,"abstract":"<p><strong>Objective: </strong>Pelvic incidence (PI) is a key parameter of sagittal alignment. While conventionally held to be fixed, increasing evidence suggests PI may be variable. This study aimed to identify predictors of change in PI with patient position and to assess the association of preoperative radiographic characteristics and intraoperative maneuvers with postoperative PI.</p><p><strong>Methods: </strong>Patients who underwent thoracolumbosacral fusion were identified, and data were gathered on preoperative spinopelvic parameters, patient demographic characteristics, and operative details. Preoperative spinopelvic parameters were measured on upright, supine, and prone radiographs. Univariable comparisons of PI between the different patient positions were performed. Multivariable analysis was performed to identify variables independently correlated with PI on 6-week postoperative radiographs. Change in PI was defined as ≥ 5° change between positions.</p><p><strong>Results: </strong>In total, 138 patients were identified (mean ± SD age 66.0 ± 8.7 years; 38.4% male). Statistically significant differences in PI were noted between preoperative standing and supine (mean -3.2° ± 4.2°, p < 0.001), preoperative supine and prone (3.5° ± 4.7°, p < 0.001), preoperative and 6-week postoperative standing (1.5° ± 6.2°, p = 0.01), and immediate and 6-week upright (1.1° ± 3.9°, p = 0.007) radiographs. Univariable comparisons showed PI decrease from standing to supine was predicted only by weight (87.0 ± 15.0 vs 81.1 ± 19.3 kg, p = 0.04); there were no significant predictors of increase in PI from standing to prone. Increase in PI from preoperative to 6-week standing radiographs was predicted by lower preoperative PI class (p < 0.001), L5/S1 interbody placement (74.4% vs 52.0%, p = 0.02), and change in PI from preoperative standing to supine (12.8% vs 39.8%, p = 0.002) and from standing to prone (51.3% vs 13.3%, p < 0.001). Multivariable analysis showed that 6-week postoperative PI was associated with only preoperative supine PI (B = 0.293, 95% CI 0.10-0.48, p = 0.003) and prone PI (B = 0.647, 95% CI 0.44-0.85, p < 0.001).</p><p><strong>Conclusions: </strong>There are position-dependent changes in PI among patients without prior pelvic fixation. Statistically significant changes in PI are seen even after pelvic fixation with a single S2-alar-iliac screw bilaterally. Postoperative PI was best predicted by preoperative PI on supine and prone radiographs rather than upright radiographs, suggesting that preoperative prone and supine radiographs may provide surgeons with the best information for achieving PI-lumbar lordosis mismatch < 10°.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026016","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}