Journal of neurosurgery. Spine最新文献

{"title":"Letter to the Editor. Cervical instability and cervical myelopathy.","authors":"Atul Goel","doi":"10.3171/2025.5.SPINE25598","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25598","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804325","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":"Does back pain catastrophizing influence 60-month surgical outcomes for patients with degenerative lumbar spondylolisthesis? A Quality Outcomes Database study.","authors":"Eunice Yang, Elan Schonfeld, Deborah Boyett, Praveen V Mummaneni, Dean Chou, Mohamad Bydon, Erica F Bisson, Christopher I Shaffrey, Steven D Glassman, Kevin T Foley, Eric A Potts, Chun-Po Yen, Domagoj Coric, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming Fu, Jonathan R Slotkin, Anthony L Asher, Michael S Virk, Regis W Haid, Andrew K Chan","doi":"10.3171/2025.5.SPINE25310","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25310","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative lumbar spondylolisthesis is a common cause of back and leg pain influenced by factors like instability, disc degeneration, facet arthropathy, and psychosocial phenotype. Patients' experience of high-severity pain is complex, with significant implications for surgical planning. The goal of this study was to assess the impact of back pain catastrophizing on long-term outcomes following lumbar spondylolisthesis surgery.</p><p><strong>Methods: </strong>This study uses the Quality Outcomes Database (QOD) lumbar spondylolisthesis dataset and includes prospectively collected data from the 12 highest-enrolling clinical sites participating in the QOD lumbar module. The authors reviewed patients undergoing single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Severe baseline numeric rating scale for back pain (NRS-BP) scores (≥ 8) were classified as \"catastrophizing,\" and mild to moderate pain scores (< 8) were classified as \"non-catastrophizing.\" Patient-reported outcomes (PROs) were compared for catastrophizing versus non-catastrophizing patients at 60 months. Univariate and multivariate analyses were conducted to assess the impact of catastrophizing on PROs, with multivariate analysis controlling for variables initially reaching a p value < 0.10.</p><p><strong>Results: </strong>Of the 608 patients in this analysis, 260 (42.8%) experienced catastrophizing while 348 (57.2%) did not. Catastrophizing patients were significantly younger (59.9 ± 12.2 years vs 63.9 ± 11.7 years, p < 0.001), less often had ≥ 4 years of college education (31.2% vs 42.5%, p = 0.004), and more often used private insurance (58.8% vs 47.7%, p = 0.01). The catastrophizing cohort also had higher rates of depression (24.6% vs 17.0%, p = 0.02) and back pain predominance (45.4% vs 32.2%, p < 0.001). Surgical and perioperative characteristics did not significantly differ between cohorts. Although catastrophizing patients typically reported worse PRO scores at both baseline and 60 months, they demonstrated significantly greater improvement and minimal clinically important difference (MCID) achievement across almost all PROs at 60 months (p < 0.05). However, North American Spine Society (NASS) satisfaction scores at 60 months did not differ significantly between cohorts. Multivariate analysis found that catastrophizing significantly predicted 60-month NRS-BP change (β -1.45, 95% CI -1.81 to -1.09; p < 0.001) and MCID achievement (OR 1.98, 95% CI 1.52-2.58; p < 0.001) but not mean NRS-BP score or other metrics, including NASS satisfaction.</p><p><strong>Conclusions: </strong>Despite presenting with worse baseline symptoms, patients with pain catastrophizing experienced substantial and clinically meaningful improvement following surgery for degenerative lumbar spondylolisthesis. Patient satisfaction was comparable between cohorts, reflecting a nuanced balance between greater absolute improvement and persistence of residual sympto","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804322","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":"Clinical outcomes of 1-stage posterior hemivertebra resection and monosegment fusion for growing children at the end of spinal growth: a mean 10-year follow-up study.","authors":"Yiwei Zhao, Haoran Zhang, You Du, Chenkai Li, Guanfeng Lin, Yang Yang, Dihan Sun, Jianguo Zhang, Shengru Wang","doi":"10.3171/2025.4.SPINE24936","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE24936","url":null,"abstract":"<p><strong>Objective: </strong>Congenital early-onset scoliosis (CEOS) resulting from hemivertebra requires early intervention if severe deformity is indicated. For a single hemivertebra, posterior hemivertebra resection and monosegment fusion can correct the deformity with minimal involvement of the spinal segment. Previous studies have shown that this technique is safe and effective, although most of the enrolled patients had not yet reached skeletal maturity. Because CEOS is a developmental condition, the ultimate clinical outcomes can only be determined once spinal growth is complete. Therefore, the authors conducted a long-term follow-up study in which all patients reached skeletal maturity to evaluate the outcomes of hemivertebra resection and monosegment fusion.</p><p><strong>Methods: </strong>A retrospective study of CEOS patients treated with posterior hemivertebra resection and monosegment fusion was conducted between 2007 and 2017. At the latest follow-up, all patients had reached skeletal maturity (Risser sign ≥ 4 and age ≥ 14 years), with a mean ± SD follow-up duration of 10.5 ± 2.5 years. Demographic characteristics, coronal and sagittal deformity correction parameters, spinal and vertebral growth parameters, 22-item Scoliosis Research Society (SRS)-22 scores, and complications were analyzed.</p><p><strong>Results: </strong>A total of 23 patients (15 males and 8 females) were enrolled, and the mean age was 4.8 ± 2.0 years. The preoperative main curve was 32.3° ± 14.4°, which significantly decreased to 7.3° ± 6.5° postoperatively, with a 15.4% loss of correction during follow-up. Sagittal kyphosis significantly improved and was maintained at the latest follow-up. Three patients had coronal imbalance preoperatively, which decreased to 1 patient at the latest follow-up. The T1-12 and T1-S1 heights increased from 15.9 ± 1.6 cm and 27.1 ± 1.7 cm preoperatively to 24.0 ± 2.2 cm and 37.3 ± 3.1 cm at the latest follow-up, respectively. The increase in vertebral body height and interpedicular length was comparable between instrumented vertebrae and noninstrumented vertebrae. The SRS-22 total score was 4.3 ± 0.2 at the latest follow-up. A total of 10 complications occurred in 7 patients.</p><p><strong>Conclusions: </strong>Over long-term follow-up to skeletal maturity, the use of hemivertebra resection and monosegment fusion was a safe and effective surgical approach for single hemivertebra. Deformity correction was well maintained without detrimental effects on spinal growth and achieved acceptable patient-reported clinical outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804321","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":"Editorial. Back pain catastrophizing: evaluating expectations for patients with lumbar degenerative spondylolisthesis.","authors":"Joshua L Golubovsky, John H Shin","doi":"10.3171/2025.5.SPINE25686","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25686","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-3"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of bone quality and paraspinal musculature on proximal junctional kyphosis failure mode among patients undergoing lumbopelvic fusion terminating at the thoracolumbar junction.","authors":"Zach Pennington, Anthony L Mikula, Abdelrahman Hamouda, Aladine A Elsamadicy, Andrew J Grossbach, Gabriella L Paganucci, Brett Freedman, Ahmad Nassr, Arjun Sebastian, Jeremy L Fogelson, Benjamin D Elder","doi":"10.3171/2025.5.SPINE25303","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25303","url":null,"abstract":"<p><strong>Objective: </strong>Proximal junctional kyphosis (PJK) affects 5%-61% of patients following thoracolumbar fusion. Many patients are asymptomatic, but a plurality require surgical revision at a cost of $75,000 per case. This analysis sought to analyze the degree to which bone quality and paraspinal muscle sarcopenia influence PJK failure mode.</p><p><strong>Methods: </strong>Patients undergoing thoracolumbar instrumented fusion with an upper instrumented vertebra (UIV) at the thoracolumbar junction (T10-L2) were identified and data were gathered on surgery, bone quality, pre- and postoperative sagittal alignment, and paraspinal muscle cross-sectional area (CSA). PJK was defined as a ≥ 10° increase in proximal junctional angle from the first postoperative radiograph. PJK was classified as discoligamentous failure (type 1), bone failure (type 2), or screw-bone interface failure (type 3) according to the Yagi-Boachie system. Bone quality was assessed by Hounsfield units (HUs) and the vertebral bone quality (VBQ) score at the UIV.</p><p><strong>Results: </strong>One hundred fifty patients were identified (median age 67 years, 53.3% female), 46 of whom experienced PJK (22 type 1, 13 type 2, 11 type 3). The median time to onset was most rapid for type 2 events (2.6 months). There were no differences between patients experiencing PJK versus controls regarding bone quality (HUs or VBQ score) or paraspinal muscle CSA on univariate comparison. However, subdivision by PJK type showed patients experiencing bone failure (type 2) PJK had significantly lower HUs at the UIV and UIV+1 relative to those experiencing type 1 PJK or no PJK (all p < 0.05). The VBQ score trended toward being significant, with a higher VBQ score (worse bone quality) in those suffering type 2 PJK, but did not reach statistical significance (p = 0.07). Patients experiencing discoligamentous failure PJK (type 1) had small multifidus CSA (390 mm2) relative to patients experiencing type 2 (516 mm2) or type 3 (440 mm2) PJK and patients who did not experience PJK (481 mm2), although the difference did not reach statistical significance. On time-to-event analysis, low HUs of the UIV/UIV+1 predicted type 2 (hazard ratio [HR] 0.81, 95% CI 0.70-0.93; p = 0.002) and type 2/3 PJK (HR 0.87, 95% CI 0.78-0.96; p = 0.006) but not type 1 PJK. Low UIV multifidus CSA trended toward being a significant predictor of type 1 PJK (HR 0.85, 95% CI 0.69-1.05; p < 0.10).</p><p><strong>Conclusions: </strong>The combination of underlying bone quality and paraspinal musculature CSA at the UIV appeared to influence failure mode among patients who underwent lumbosacral instrumented fusion terminating at the thoracolumbar junction.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment for complex adult lumbosacral lipomas excluding retethered cases: what are the benefits?","authors":"Jong Seok Lee, Taehoon Kim, Joo Whan Kim, Sung Eun Hyun, Kyung Hyun Kim, Eun Jung Koh, Young Jae Im, Hyung-Ik Shin, Kyu-Chang Wang, Kwanjin Park, Ji Yeoun Lee","doi":"10.3171/2025.4.SPINE241363","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE241363","url":null,"abstract":"<p><strong>Objective: </strong>Although spinal dysraphism is a congenital anomaly, it is also diagnosed and treated in adults. The aim of this study was to analyze the clinical outcomes of adult patients with complex lumbosacral lipomatous malformations (LLMs).</p><p><strong>Methods: </strong>Patients aged 19 years and older who were diagnosed with LLMs from January 2000 to December 2023 at a single institution were retrospectively reviewed. Clinical outcomes of pain and motor, sensory, and urological deficits were evaluated. Based on a uniform workup protocol, MRI, electromyography (EMG), nerve conduction study (NCS), and urodynamic study (UDS) findings were evaluated to assess the clinical correlation. Patients who had deteriorating symptoms with corresponding progressive abnormal findings underwent surgery.</p><p><strong>Results: </strong>Thirty-three patients (median age 33 years) were included in this analysis; 22 patients were surgically treated and 11 patients were conservatively managed. The major surgical indications included intractable pain (n = 3), progressive motor deficits with ongoing activity on the EMG/NCS (n = 9), and urological symptoms with findings of neurogenic bladder on the UDS (n = 16). In the surgery group, 3 patients had intractable pain before surgery, with improvement after surgery in all patients. However, severe permanent neuropathic pain newly occurred in 4 of 22 patients (18%) who underwent surgery. Progression of motor weakness was stabilized by surgery in 7 of 9 patients (78%), and 2 patients showed minor motor deterioration after surgery. In addition, 1 patient without preoperative motor deficit developed new postoperative motor deficit. All patients with urological deficit had the most favorable outcomes, with improvement in 13 patients (81%) and stabilization in 3 patients (19%). For patients in the observation group who had mild and static deficits, the outcomes were favorable with no deterioration.</p><p><strong>Conclusions: </strong>Surgical treatment for LLM in adult patients was most beneficial for those with neurogenic bladder. Surgery also had benefits for intractable pain and motor deficits, but caution is needed as unexpected neurological complications can occur.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804326","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 superiority of endplate Hounsfield units relative to cervical vertebral Hounsfield units in predicting subsidence after anterior cervical discectomy and fusion.","authors":"Hannah A Levy, Maria D Astudillo Potes, Caden J Messer, Christopher A Magera, Zachariah W Pinter, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, Bradford L Currier, Ahmad N Nassr, Brett A Freedman, Brian A Karamian, Arjun S Sebastian","doi":"10.3171/2025.4.SPINE241067","DOIUrl":"https://doi.org/10.3171/2025.4.SPINE241067","url":null,"abstract":"<p><strong>Objective: </strong>The present investigation aimed to 1) develop a new CT-based assessment of endplate bone density (endplate Hounsfield unit [EP-HU]) and 2) analyze if EP-HU was a better predictor than vertebral Hounsfield unit (HU) for subsidence after anterior cervical discectomy and fusion (ACDF).</p><p><strong>Methods: </strong>All adult patients who underwent one- to three-level ACDF with a titanium interbody for radiculopathy and/or myelopathy at an academic center between 2018 and 2020 were retrospectively identified. Based on preoperative sagittal CT scans (left, right, and middle cuts), 2-mm superior and inferior endplate regions were circumscribed with the free draw tool to account for endplate surface undulations. The average of the superior and inferior EP-HUs on all CT cuts was used to calculate EP-HU. Cervical vertebral HUs were determined from the average of axial CT cranial, middle, and caudal cuts circumscribing only trabecular bone. The interbody subsidence of the cranial and caudal endplates of each ACDF level was directly measured on the endplate-facing surface of both coronal and sagittal cuts of postoperative CT scans (at 1 year) to determine the maximum subsidence (subsidence defined as ≥ 2 mm). Univariate and stepwise logistic regression analyses were used to compare subsidence based on CT bone metrics. Receiver operating characteristic (ROC) curve analyses were used to determine the probability of subsidence based on EP-HUs and vertebral HUs.</p><p><strong>Results: </strong>A total of 35 patients were included. Subsidence occurred at 32 of 67 unique fusion levels. Subsidence was associated with older age (p = 0.008), diabetes diagnosis (p = 0.015), and decreased interbody length (p = 0.019). EP-HUs exhibited moderate correlation with cervical vertebral HUs (Pearson's ρ = 0.63). Subsidence was significantly associated with decreased total EP-HUs (subsidence: 475 HU, no subsidence: 543 HU; p = 0.019) and decreased lumbar vertebral HUs (subsidence: 296 HU, no subsidence: 341 HU; p = 0.011). ROC curve analysis identified an optimal EP-HU cutoff of 512.30 (area under the curve [AUC] = 0.701) to predict subsidence. The AUC of the vertebral HUs with respect to subsidence was 0.662. EP-HUs < 512.30 predicted subsidence (OR 6.67, p = 0.001) independent of significant demographic and surgical factors.</p><p><strong>Conclusions: </strong>CT cervical EP-HUs rather than vertebral cervical trabecular HUs may be more efficacious in predicting subsidence after ACDF.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804328","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":"Artificial intelligence and natural language processing for automated coding of cervical and lumbar spine surgery.","authors":"Ashton Huppert Steed, Kenneth Nwosu, Patrick Fillingham, Emma Federico, Sriram Thothathri, Erica Skinner, Tyler Gonzalez, Grant Muller","doi":"10.3171/2025.4.SPINE241099","DOIUrl":"10.3171/2025.4.SPINE241099","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) in healthcare offers substantial opportunities to enhance efficiencies, reduce costs, and improve clinical outcomes. AI is primed to disrupt legacy healthcare processes such as coding and billing, where there is an estimated $11-$54 billion in challenged revenue annually due to billing complexities and claim denials. The purpose of this study was to assess the accuracy of a novel natural language processing algorithm (NNLPA) in coding spine operative reports, according to Current Procedural Terminology (CPT) codes, as compared to the authors' institutional human coders (IHCs).</p><p><strong>Methods: </strong>Operative notes from consecutive adult patients undergoing cervical and lumbar spine surgery at a large academic medical center were analyzed. A 60:20 stratified split was undertaken to create training and testing populations, respectively. After training, NNLPA coding accuracy was tested against the IHCs', using a highly trained third-party super coder as a control group for accuracy. NNLPA performance metrics were assessed via an F1 score, utilizing precision and recall. Contingency tables were used to determine the sensitivity, specificity, positive predictive value, and negative predictive value. Furthermore, chi-square testing was performed to assess the independence of the metrics between the NNLPA and IHC groups.</p><p><strong>Results: </strong>Overall, 200 operative reports were assessed in this study, and 192 CPT codes (88 cervical, 104 lumbar) were identified. NNLPA and IHC weighted mean F1 scores for lumbar spine surgery coding were 0.84 and 0.56, respectively (p < 0.05). Weighted mean sensitivity, specificity, and accuracy of NNLPA coding was 0.79, 0.99, and 0.98, respectively, and 0.59, 0.97, and 0.96 (p < 0.05) for IHCs. The NNLPA and IHC weighted mean F1 scores for cervical spine surgery coding were 0.73 and 0.68, respectively (p < 0.05). Mean specificity and accuracy for NNLPA coding was 0.99 and 0.95, respectively (p < 0.05), and 0.89 and 0.89 for IHCs (p < 0.05).</p><p><strong>Conclusions: </strong>NNLPA performance was noninferior and possibly superior to IHC performance at spine surgery medical coding. This result contributes to the growing body of literature regarding integration of AI in spine surgery and other clinical applications. Further studies are needed to quantify cost savings associated with using a natural language processing platform for coding compared to humans.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"519-524"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764999","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":"Establishing objective markers of physical activity to identify early improvement after lumbar spine surgery.","authors":"Justin K Zhang, Salim Yakdan, Jingwen Zhang, Saad Javeed, Braeden Benedict, Madelyn Frumkin, John Ogunlade, Munish Gupta, Jay F Piccirillo, Shay Bess, Michael P Kelly, Wilson Z Ray, Chenyang Lu, Jacob K Greenberg","doi":"10.3171/2025.5.SPINE25304","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25304","url":null,"abstract":"<p><strong>Objective: </strong>Despite growing interest in using biometric measures as objective tools to monitor recovery after spine surgery, there is sparse guidance on appropriate thresholds to evaluate perioperative changes in these domains. The authors defined thresholds of activity and heart rate (HR) measures that mark improved early recovery and evaluated their association with longer-term surgical outcomes.</p><p><strong>Methods: </strong>A prospective observational cohort study recruited patients undergoing elective surgery for lumbar degenerative spine disease at a single institution from February 2021 to June 2023. Patient-reported outcome measures (PROMs) were collected preoperatively and at 1 month and 6 months after surgery. The authors evaluated 50 metrics of physical fitness available on Fitbit fitness trackers that assessed activity amount, activity intensity, and physiological status based on the responsiveness of each after surgery and correlation with clinical metrics. Anchor-based methods were used to calculate Fitbit metric cutoffs that delineated clinical improvement, with Patient-Reported Outcome Measurement Information System physical function (PF) and pain interference scores used as anchors at 1 month postoperatively. The receiver operating characteristic (ROC) analysis was performed to identify optimal thresholds. Six-month clinical outcomes were compared between patient groups based on the newly defined Fitbit metric cutoffs. Multivariable regression, with 6-month PROMs as the dependent variable, were used to control for clinical confounders.</p><p><strong>Results: </strong>Sixty-two patients (mean age 62 [SD 12] years, 33 [53%] female) were included. PROMs at 6 months were significantly improved for all variables. Among 50 candidate Fitbit metrics, 4 were selected: active time (cutoff: 7.6% decrease, area under the ROC curve [AUC] 0.71), daily steps (cutoff: 1.55 steps/min decrease, AUC 0.70), time spent moving at ≥ 40 steps/min (cutoff: 0.7% decrease, AUC 0.67), and HR stability (cutoff: 15% increase, AUC 0.72). When separating patients into groups based on newly defined Fitbit cutoffs, these Fitbit metrics had at least one significant association with 6-month PROMs. These measures improved predictions of 6-month outcomes based on R2 and, except for daily steps, remained statistically significant on multivariable regression.</p><p><strong>Conclusions: </strong>By monitoring the dynamic nature of a patient's PF through wearable trackers, clinicians can gain valuable insights into functional recovery that can complement traditional PROMs. The cutoffs derived from this study can potentially serve as important benchmarks for future studies examining physiological markers of surgical recovery.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765000","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":"What's the harm? Evaluating complications associated with salvaged red blood cell transfusion in spinal deformity surgery: a nonrandomized controlled trial.","authors":"David B Kurland, Anthony Frempong-Boadu, Darryl Lau","doi":"10.3171/2025.5.SPINE25348","DOIUrl":"https://doi.org/10.3171/2025.5.SPINE25348","url":null,"abstract":"<p><strong>Objective: </strong>Salvaged red blood cells (sRBCs) are frequently used in spine surgery, despite concerns about their quality and efficacy as a blood substitute. This study aimed to evaluate the association of sRBC transfusion with postoperative complications in spinal deformity surgery.</p><p><strong>Methods: </strong>This single-center, prospective, nonrandomized controlled trial included patients undergoing posterior-based multilevel thoracolumbar instrumented fusion for spinal deformity from June 2022 to July 2023. Participants were grouped based on whether they received an sRBC transfusion. Postoperative complications were analyzed using frequentist methods, with and without propensity score matching (PSM), and a series of five Bayesian models of varying complexity that included hierarchical structures and covariates. Model comparison followed by weighted model averaging based on predictive performance was performed to integrate the results from the different models into a composite model.</p><p><strong>Results: </strong>After PSM (specifically matching surgical invasiveness and blood loss), sRBC transfusion was associated with increased odds of infection (OR 3.77, 95% CI 0.99-14.33; p = 0.046), acute kidney injury (OR 3.36, 95% CI 1.37-8.22; p = 0.007), liver injury (OR 3.52, 95% CI 1.64-7.54; p < 0.001), pulmonary complications (OR 2.26, 95% CI 1.13-4.53; p = 0.025), and thrombocytopenia (OR 9.02, 95% CI 2.54-32.0; p < 0.001). The composite Bayesian model yielded consistent results, with additional associations noted for cardiac events (OR 2.18, 95% highest density interval [HDI] 1.36-3.03) and coagulopathy (OR 3.13, 95% HDI 1.85-4.50). In contrast, allogeneic RBC transfusion was only associated with infection (OR 1.65, 95% HDI 1.04-2.59) and pulmonary complications (OR 1.73, 95% HDI 1.08-2.89).</p><p><strong>Conclusions: </strong>Salvaged RBC transfusion in complex spine surgery was found to be independently associated with increased risks of various complications. These findings reinforce concerns about the safety of sRBC transfusion, suggesting a need for caution in their use in this setting.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765002","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}