Journal of neurosurgery. Spine最新文献

{"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}

{"title":"Segmental and overall lumbar lordosis after single-level minimally invasive transforaminal lumbar interbody fusion: a systematic review and meta-analysis.","authors":"Justin K Zhang, Salim Yakdan, Saksham Pruthi, Muhammad I Kaleem, Nishtha Chavda, Jiaxi Lu, Kazimir Bagdady, Luke Wegenka, Tom Koch, Matthew ReVeal, Ying Liu, Christopher F Dibble, Jacob K Greenberg, Saad Javeed, Forrest A Hamrick, Spencer Twitchell, Ken Porche, Nicholas T Gamboa, Brandon A Sherrod, Mark A Mahan, Erica F Bisson, Andrew T Dailey, Marcus D Mazur, Wilson Z Ray","doi":"10.3171/2025.1.SPINE231363","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE231363","url":null,"abstract":"<p><strong>Objective: </strong>Because of heterogeneity in previous studies, the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Given this evidence gap, the authors performed a systematic review and meta-analysis of studies reporting lordotic outcomes after single-level MI-TLIF. The authors also performed a meta-regression to identify preoperative factors associated with lordosis after surgery and assessed correlations between lordotic changes and patient-reported outcomes.</p><p><strong>Methods: </strong>In this systematic review, PubMed, Medline, CENTRAL, EMBASE, and Scopus were searched for studies describing single-level MI-TLIF for degenerative lumbar etiologies with at least 10 patients. Random-effects meta-analysis was used for data synthesis and I2 was used to assess heterogeneity. Primary outcomes were changes in SL and/or changes in overall LL.</p><p><strong>Results: </strong>Thirty-five studies comprising 1935 patients were included: 23 (66%) retrospective case series, 9 (26%) retrospective, and 3 (9%) prospective cohort studies. Twenty-five (71%) studies evaluated static interbody devices, 5 (14%) expandable devices, and 5 (14%) both device types. Thirty (86%) studies used bilateral pedicle screw fixation, 2 (6%) used unilateral screw fixation, and 3 (9%) included both techniques. The mean (range) sample size was 55 (13-171) patients, mean ± SD age was 59.5 ± 10.6 years, mean ± SD BMI was 26.9 ± 4.6 kg/m2, and mean ± SD (range) length of follow-up was 21.4 ± 4.3 (6.0-63.7) months. On random-effects modeling, patients experienced a significant increase in SL (standardized mean difference [SMD] +2.2°, 95% CI 1.3°-3.1°, p < 0.001) and overall LL (SMD +2.8°, 95% CI 0.8°-4.8°, p < 0.001) at the latest follow-up. On meta-regression, preoperative SL (β = -0.24°, 95% CI -0.42° to -0.05°, p = 0.01) was predictive of a change in SL, whereas preoperative LL (β = -0.53°, 95% CI -0.81° to -0.25°, p = 0.009) and use of an expandable cage (β = 6.56°, 95% CI 1.0°-12.2°, p = 0.02) were predictive of a change in LL. Univariable meta-regression found that greater increases in SL were associated with larger reductions in postoperative leg pain (β = -1.03, 95% CI -1.6 to -0.45, p = 0.003); however, no significant associations were detected between changes in SL or LL and other clinical outcomes in either univariable or multivariable analyses.</p><p><strong>Conclusions: </strong>Despite the significant heterogeneity among the included studies, these results suggest that single-level MI-TLIF is generally lordosis preserving, with preoperative alignment and interbody device type as possible predictors of postoperative lordosis.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-13"},"PeriodicalIF":2.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012395","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. Minimally invasive versus open surgery for spine metastases.","authors":"Yu Chang, Kuan-Yu Chi, Yen-Ta Huang","doi":"10.3171/2025.2.SPINE25176","DOIUrl":"https://doi.org/10.3171/2025.2.SPINE25176","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970212","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":"Examination of clinical and radiographic outcomes after lumbar interbody fusion: a retrospective analysis of TLIF, MidLIF, and MIS-TLIF procedures.","authors":"Nicholas P Tippins, Anne M Foreit, Nathan J Kussow, Catherine M Milne, Arya M Narayanan, Matthew R Neely, Jack H Poplarski, Jake T Reasoner, Kate Ricks, Vincent J Alentado, Eric A Potts, Jean-Pierre Mobasser","doi":"10.3171/2025.1.SPINE241286","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241286","url":null,"abstract":"<p><strong>Objective: </strong>Despite many available surgical techniques, the optimal method to achieve posterior lumbar interbody fusion (PLIF) is unclear. This study compares the efficacy of open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS-TLIF), and midline lumbar interbody fusion (MidLIF), based on patient-reported outcome measures and radiographic parameters.</p><p><strong>Methods: </strong>A retrospective review of a prospectively collected institutional spine quality database was performed to examine the medical records of patients who received a 1- or 2-level PLIF from January 2018 through April 2023. Quality of life (QOL) scores, including the Oswestry Disability Index (ODI), EuroQol 5-Dimension Index (EQ-5D), EuroQol visual analog scale (EQ-VAS), and numeric rating scale for back pain (NRS-BP) and leg pain (NRS-LP), were used to assess patient conditions at baseline, 3 months, and 12 months after surgery. These metrics, along with patient demographics, radiographic measurements, and surgical parameters, were analyzed and compared across the three treatment modalities.</p><p><strong>Results: </strong>Of the 953 patients who met criteria, 81 (8.5%) underwent MidLIF, 108 (11.3%) underwent MIS-TLIF, and 764 (80.2%) underwent open TLIF. MIS-TLIF patients had significantly shorter hospital length of stay and less blood loss compared with MidLIF (both p < 0.001) and open TLIF patients (both p < 0.001). In patients with single-level fusion, open TLIF yielded significantly higher construct lordosis at 12 months postoperatively compared with MidLIF (p = 0.017), although average corrections to construct lordosis were similar across groups. Fusion rates were highest among the open TLIF group and were significantly higher (p < 0.01) than the MIS-TLIF group. Changes in QOL scores at the 3- and 12-month follow-ups were similar between procedure types, with the exception of NRS-LP at 3 months, which improved the most in the open TLIF cohort and was significantly higher than the MIS-TLIF cohort (p = 0.013).</p><p><strong>Conclusions: </strong>This analysis shows that MidLIF, MIS-TLIF, and open TLIF techniques all provide similar durable improvement in change from baseline ODI, EQ-5D, EQ-VAS, NRS-BP, and NRS-LP scores, as well as similar corrections to segmental lordosis. While open TLIF had the highest radiographic fusion rate, fusion rates were high among all groups. These findings provide insight on the variability of each technique, which can inform surgeons in determining the modality of treatment best suited for their patient's condition and needs.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976884","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":"Lumbar Spine Research Society 18th Annual Scientific Meeting.","authors":"","doi":"10.3171/2025.5.LSRS2025abstracts","DOIUrl":"https://doi.org/10.3171/2025.5.LSRS2025abstracts","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":"42 5","pages":"1-97"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970135","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":"Anatomy of the superior hypogastric plexus and its relevance to anterior lumbar interbody fusion.","authors":"Anhelina Khadanovich, Michal Benes, Radek Kaiser, Jeremy Reynolds, Gerard Mawhinney, Jan Stulik, David Kachlik","doi":"10.3171/2025.1.SPINE241365","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241365","url":null,"abstract":"<p><strong>Objective: </strong>Retrograde ejaculation (RE) is a known complication of anterior lumbar interbody fusion (ALIF) and results from injury to the superior hypogastric plexus (SHP) during intervertebral disc exposure. Yet, there has been no recommendation for SHP mobilization. Thus, the aim of this study was to describe the anatomy of the SHP and vessels at the L5-S1 level, and to evaluate the possibility of SHP mobilization and its retraction to the side.</p><p><strong>Methods: </strong>Twelve formaldehyde-embalmed cadavers (6 female and 6 male; mean age 65.5 years [range 60-77 years]) were dissected. Distances from the SHP and middle sacral vessels to the midline were measured at the L5-S1 level. The relationship of the great vessel bifurcations and common iliac vessels to the SHP were noted. The extent of lateral retraction of the SHP following mobilization was measured in relation to the midline. Moreover, the positions of the SHP and middle sacral vessels relative to the midline at the L5-S1 level were determined.</p><p><strong>Results: </strong>The SHP formed below the aortic bifurcation and was present at the L5-S1 level in all cases. The SHP overlaid the midline with a left-sided shift. There were 4 cases (33.3%) in which lateral retraction was not achievable because the plexus divided into hypogastric nerves at the L5-S1 level or was too wide for safe mobilization. In the remaining cases, retraction on the left side was achievable up to 15.3 mm from the midline, while retraction to the right side was limited to 5.3 mm from the midline. The types of SHP morphological arrangement included single cord (41.7%), plexiform (41.7%), and fiber (16.6%).</p><p><strong>Conclusions: </strong>Based on the more extensive left-sided shift of the SHP at the L5-S1 level and frequent presence of the third left splanchnic lumbar nerve, attempting retraction to the left side is recommended. If it is not feasible, the SHP should be split at the midline, with both components mobilized laterally.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012414","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}