Journal of neurosurgery. Spine最新文献

{"title":"Intraoperative vancomycin for preventing infection after open spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Yifei Sun, Hariteja Ramapuram, Jovanna Tracz, Sasha Howell, Nicholas M B Laskay, James Mooney, Adeel Ilyas, Jakub Godzik","doi":"10.3171/2025.3.SPINE2547","DOIUrl":"10.3171/2025.3.SPINE2547","url":null,"abstract":"<p><strong>Objective: </strong>The use of prophylactic intrasite vancomycin powder in spine surgery has been described as a possible method for infection prevention. Despite clinical guidelines encouraging the use of intraoperative vancomycin for infection prophylaxis, the evidence in support of such recommendations remains unclear. The primary objective of this meta-analysis was to evaluate the effect of intrawound vancomycin on deep and superficial surgical site infections (SSIs) following open spine surgery.</p><p><strong>Methods: </strong>The PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases were searched from inception to October 2024 for randomized controlled trials that investigated the association between intrawound vancomycin use and infection following open spine surgery. The results were pooled using a restricted maximum-likelihood estimation random-effects model with inverse variance weighting and Hartung-Knapp adjustment to account for variation between studies.</p><p><strong>Results: </strong>Seven randomized controlled trials with 2235 patients met the inclusion criteria. Of these, 1095 (49%) patients were randomized to receive intrawound vancomycin during open spine surgery. The overall rate of superficial and deep SSIs in the treatment group was 3.38%, compared with 4.08% in the control group. The overall rates of deep infection were 2.5% and 1.8% in the treatment and control groups, and the overall superficial infection rates were 0.9% and 1.8% in the treatment and control groups, respectively. In a random-effects model, intraoperative vancomycin was not associated with lower rates of SSI (risk ratio [RR] 0.89, 95% CI 0.47-1.67; p = 0.6; τ2 < 0.0001, I2 = 22%). In a subanalysis of patients who underwent instrumented spine surgery, vancomycin was also not significantly associated with decreased rates of SSI (RR 0.77, 95% CI 0.38-1.57; p = 0.47; τ2 = 0.2041, I2 = 33%), superficial infections (RR 0.59, 95% CI 0.22-1.57; p = 0.45; τ2 = 0, I2 = 0%), or deep infections (RR 1.37, 95% CI 0.78-2.40; τ2 = 0, I2 = 0%), nor was it associated with an increased risk of gram-negative/culture-negative infection (RR 0.99, 95% CI 0.47-2.06; τ2 = 0.107, I2 = 20%).</p><p><strong>Conclusions: </strong>Intraoperative vancomycin may not be associated with significantly decreased rates of superficial or deep SSI in patients undergoing open spine surgery. The role of intraoperative vancomycin in open spine surgery warrants further study in larger randomized controlled trials.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"509-518"},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612137","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":"Perioperative outcomes in adolescent versus young adult patients with idiopathic scoliosis: how different are they?","authors":"Alexandra C Dionne, Lawrence G Lenke, Fthimnir M Hassan, Justin L Reyes, Chidebelum Nnake, Simon Blanchard, Roy Miller, Joseph M Lombardi, Zeeshan M Sardar","doi":"10.3171/2025.3.SPINE241454","DOIUrl":"10.3171/2025.3.SPINE241454","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare intra- and perioperative outcomes, complications, and magnitude of curve correction among patients with adolescent idiopathic scoliosis (AIS; 10-18 years old) and young adult idiopathic scoliosis (YAdIS; 19-40 years old).</p><p><strong>Methods: </strong>A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, and operative data were collected at the pre- and perioperative periods. A 1:1 propensity score-matched analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels, and main coronal Cobb angle.</p><p><strong>Results: </strong>Two hundred thirty-six patients (144 with AIS, 92 with YAdIS) were identified. Following propensity score matching, 85 matched pairs were identified. Radiographically, AIS had greater flexible main thoracic (mean -23.7% ± 14.1% vs -18.4% ± 11.0%, p = 0.0155) and thoracolumbar/lumbar curves (mean -32.0% ± 16.6% vs -28.5% ± 20.6%, p = 0.0229) preoperatively. The AIS group had a shorter operating room (OR) duration (mean 4.8 ± 1.3 vs 5.3 ± 1.5 hours, p = 0.0088), estimated blood loss (EBL; mean 654.7 ± 330.7 vs 806.7 ± 446.8 ml, p = 0.0092), and intraoperative transfusion rates (83.5% vs 96.5%, p = 0.0045). Postoperatively, the AIS patients had a lower rate of overall complications (9.4% vs 16.5%, p = 0.0412) and a lower transfusion rate (24.7% vs 40.0%, p = 0.0236). No differences in type of complication and hospital length of stay were observed (p > 0.05). AIS patients had smaller mean T10-12 thoracic kyphosis (TK; 6.3° ± 4.8° vs 9.0° ± 6.5°, p = 0.0242) and T1 pelvic angle (8.7° ± 8.2° vs 11.5° ± 8.7°, p = 0.048) postoperatively.</p><p><strong>Conclusions: </strong>Patients with idiopathic scoliosis who undergo corrective surgery as adolescents had more flexible curves with shorter OR times, less EBL, and lower perioperative complication rates than young adults. Radiographic correction of the major coronal curve and of thoracic sagittal kyphosis was similar for both groups. Overall, AIS and YAdIS patients can expect generally successful operative outcomes and low complication rates.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"443-452"},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612140","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":"Neck-related disability, headache, and pain intensity after anterior or posterior cervical decompression surgery in individuals with cervical radiculopathy and neck-related headache: a national registry-based study with 2-year follow-up.","authors":"Jard Svensson, Anneli Peolsson, Anna Hermansen, Peter Zsigmond, Håkan Löfgren","doi":"10.3171/2025.3.SPINE241511","DOIUrl":"10.3171/2025.3.SPINE241511","url":null,"abstract":"<p><strong>Objective: </strong>Approximately 50% of all individuals with cervical radiculopathy (CR) have headache, but knowledge on neck-related disability, headache, and pain aoof this study was to investigate and compare outcomes of ACDF and PCF regarding neck-related disability, headache, and neck and arm pain in individuals with CR and neck-related headache.</p><p><strong>Methods: </strong>This was a registry-based cohort study with prospectively collected data, including 2-year follow-up, using data from the Swedish Spine Registry (Swespine). All individuals with CR and neck-related headache registered in Swespine who underwent either ACDF (n = 2441) or PCF (n = 448) between January 2014 and March 2021 were included. Outcome measures were neck-related disability as measured by the Neck Disability Index (NDI), headache measured by the headache item of the NDI, and neck and arm pain intensity measured on an 11-point numeric rating scale. Patient-reported data were collected preoperatively and at 1- and 2-year follow-up evaluations. Surgeon-reported data regarding the operation were collected soon after the operation. Between- and within-group differences were analyzed for ACDF and PCF using a linear mixed model.</p><p><strong>Results: </strong>Headache decreased to a greater extent preoperatively by the 2-year follow-up evaluation with PCF than with ACDF (p = 0.021). No other significant between-group differences were found at any follow-up. For all outcome measures, there were significant within-group improvements from preoperatively to both the 1- and 2-year follow-up evaluations after ACDF and PCF (p < 0.001).</p><p><strong>Conclusions: </strong>ACDF and PCF decreased headache in individuals with CR and neck-related headache, but PCF appeared to decrease headache more over time. Both interventions also resulted in similar improvements in neck-related disability and neck and arm pain.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"472-480"},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612139","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 effect of occipitocervical and subaxial cervical fusion constructs on range of motion: comprehensive guide based on biomechanical cadaveric testing on 1009 motion segments.","authors":"S Harrison Farber, Luke A Mugge, Anna G U Sawa, Joseph D DiDomenico, Temesgen G Assefa, Alexis C Ratliff, Neil R Crawford, Juan S Uribe, Brian P Kelly, Jay D Turner","doi":"10.3171/2025.3.SPINE241380","DOIUrl":"10.3171/2025.3.SPINE241380","url":null,"abstract":"<p><strong>Objective: </strong>Understanding the relative contribution of each cervical motion segment is vital for assessing the effect of fusion constructs on range of motion (ROM). Many spine surgeons are familiar with the work of Panjabi and White, from which these values have historically been cited. However, their data were obtained from a limited number of subjects, and methodological shortcomings have since been identified. In this study, the authors sought to improve understanding of segmental ROM using data from standardized biomechanical tests involving a large number of intact cervical spine specimens.</p><p><strong>Methods: </strong>Flexibility data from 1009 cervical spine motion segments from 286 cadaveric spine specimens spanning the occiput (Occ)-T1 were analyzed. Specimens were subjected to standardized pure moment flexibility tests and loaded to 1.5 Nm in 3 anatomical axes: flexion-extension, axial rotation, and lateral bending. Intervertebral ROM was measured optoelectronically. Hypothetical ROM values of various fusion constructs were calculated, assuming complete loss of segmental ROM across treated segments and lack of compensatory changes in ROM for unfused segments.</p><p><strong>Results: </strong>The overall mean ROM values for the entire cervical spine (Occ-T1) in flexion-extension, axial rotation, and lateral bending were 109.8°, 79.3°, and 37.7°, respectively. The greatest segmental contribution to flexion-extension ROM was the Occ-C1 joint (24% of overall ROM) at a mean (SD) of 26.4° (6.4°), which differed significantly from the values of all other levels (p < 0.001). In axial rotation, C1-2 contributed 53% of overall ROM (41.6° [14.7°]) (all p < 0.001). C3-4 accounted for 16% of lateral bending ROM (5.9° [1.9°]). Cervical ROM after hypothetical Occ-C2 fusion was 59% of the ROM of the unfused spine in flexion-extension, 36% in axial rotation, and 76% in lateral bending. Fusion from C2 to T1 maintained 41% of ROM in flexion-extension, 64% in axial rotation, and 24% in lateral bending. Increasing the length of a subaxial fusion construct leads to a steady decrease in the remaining ROM in all 3 planes of movement.</p><p><strong>Conclusions: </strong>This study demonstrates the segmental ROM values of the intact cervical spine and evaluates the calculated effects of cervical instrumentation on regional ROM based on data from the largest reported number of similarly tested cervical motion segments. These findings can help surgeons to plan surgery and counsel patients regarding the clinical effect of cervical fusion on ROM.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"352-360"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes between 3D-printed porous titanium alloy and polyetheretherketone cages for atlantoaxial intra-articular fusion in craniovertebral malformations.","authors":"Qiang Jian, Zhe Hou, Xingang Zhao, Cong Liang, Yinqian Wang, Dongao Zhang, Kun Wu, Jichao Wang, Tao Fan","doi":"10.3171/2025.3.SPINE241148","DOIUrl":"10.3171/2025.3.SPINE241148","url":null,"abstract":"<p><strong>Objective: </strong>The atlantoaxial intra-articular distraction and fusion technique involves intra-articular release, distraction, and cage implantation and is commonly used to treat craniovertebral bony malformations. Polyetheretherketone (PEEK) cages for C1-2 intra-articular fusion have been in use for over a decade. Three-dimensional printing is an emerging approach in spinal surgery, and several studies have explored 3D-printed porous titanium alloy (3DPT) cages for interbody fusion. However, there is limited research on their application and comparisons for C1-2 intra-articular fusion. In this study, the authors aimed to compare the outcomes of C1-2 intra-articular PEEK cages with those of 3DPT cages.</p><p><strong>Methods: </strong>Clinical data from patients with craniovertebral anomalies treated with C1-2 intra-articular cage implantation were retrospectively analyzed. Midsagittal parameters were compared between PEEK and 3DPT and at 3 time points: preoperatively, postoperatively, and follow-up. Other assessments included clinical remission, reduction loss, fusion failure, cage micromotion, and screw-rod failure. Univariate comparisons were conducted.</p><p><strong>Results: </strong>Records of 60 patients were reviewed, with a mean age of 43.75 ± 13.48 years; basilar invagination was the most common deformity. The 3DPT and PEEK cages demonstrated comparable immediate reduction effects. However, during follow-up, the 3DPT cage exhibited superior reduction maintenance, enhanced fusion rates, and reduced cage micromotion. Fusion rates were 100% and 80.6% in the 3DPT and PEEK groups, respectively. Fusion failure was associated with clinical nonremission, PEEK cage, deformity relapse, reduction loss, and cage micromotion, but was not associated with screw-rod construct failure.</p><p><strong>Conclusions: </strong>Fusion failure significantly undermines long-term outcomes. The 3DPT cage is a viable option for improving long-term results by minimizing loss of reduction, preventing fusion failure, and reducing cage micromotion.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"361-374"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564895","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":"Sarcopenia prevalence and relationship to frailty by measurement method in patients with adult spinal deformity.","authors":"Alexa Semonche, Justin K Scheer, Robert C Osorio, Anthony L Mikula, Thomas A Wozny, Winward Choy, Terry H Nguyen, Jaemin Kim, Aaron J Clark, Christopher P Ames","doi":"10.3171/2025.3.SPINE241551","DOIUrl":"10.3171/2025.3.SPINE241551","url":null,"abstract":"<p><strong>Objective: </strong>There is no consensus on how to diagnose sarcopenia in patients with spine disorders, limiting one's understanding of the relationship among sarcopenia, frailty, and surgical outcomes. The authors characterized the baseline prevalence of sarcopenia in patients with adult spinal deformity (ASD) according to previously established methods. They then examined the intersection between sarcopenia and frailty.</p><p><strong>Methods: </strong>This is a retrospective cross-sectional study of preoperative patients with ASD at a single tertiary care center. Muscle function was assessed via hand grip strength, gait speed, and the Timed Up and Go (TUG) test. Bioelectrical impedance analysis was used to determine the skeletal muscle index. Muscle imaging included both CT to determine the psoas muscle index and MRI to assess myosteatosis. Diagnostic thresholds for sarcopenia were taken from the Sarcopenia Definitions and Outcomes Consortium (SDOC) and European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus guidelines. Frailty was assessed using the Edmonton Frail Scale (EFS) and the adult spinal deformity frailty index (ASD-FI). Fisher's exact test, Spearman's rank correlation, and UpSet plot analyses were used to compare sarcopenia rates between measurement methods. Correlations between sarcopenia measures and frailty scores were also tested.</p><p><strong>Results: </strong>Between 2023 and 2024, 101 patients with ASD were evaluated for sarcopenia. The mean age was 66.0 years, and 66 patients (65.3%) were female. The percentage of patients meeting SDOC or EWGSOP2 cutoff criteria for sarcopenia based on grip strength, age-normalized grip strength, grip strength/BMI, gait speed, TUG test, or skeletal muscle index ranged from 0% to 74.2%. The distribution of patients meeting each criterion differed significantly for male and female patients (p < 0.0001 for both). Despite this, all functional and imaging-based measures of sarcopenia, except for gait speed, were significantly correlated with each other. Interestingly, many sarcopenic patients were not frail (69.8% per the EFS, 47.5% per the ASD-FI), but nearly all frail patients were sarcopenic (100% per the EFS, 82.2% per the ASD-FI). Sarcopenia measures were not significantly correlated with frailty scores with a few exceptions.</p><p><strong>Conclusions: </strong>The baseline prevalence of sarcopenia in patients with ASD varied widely according to the measurement method (0%-74.2%). Despite this, nearly all measures of sarcopenia were significantly correlated with each other. However, many sarcopenic patients were not frail, and sarcopenia measures largely did not correlate with frailty scores. These results highlight the need for a consensus criterion for sarcopenia in patients with spine disorders.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"324-333"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are dorsal column deficits inevitable in intramedullary spine tumor resection?","authors":"Iyan Younus, Alexander T Lyons, Emma Ye, Harsh Jain, Hani Chanbour, Ambika E Paulson, Omar Zakieh, Scott L Zuckerman","doi":"10.3171/2025.3.SPINE241643","DOIUrl":"10.3171/2025.3.SPINE241643","url":null,"abstract":"<p><strong>Objective: </strong>The rate of dorsal column deficit after intramedullary spine tumor resection remains unknown. In a cohort of patients undergoing posterior intramedullary spinal tumor resection, the authors sought to 1) report the rate of dorsal column deficits, 2) report the rate of new motor deficits, and 3) determine risk factors and recovery characteristics for both deficits.</p><p><strong>Methods: </strong>A single-institution, retrospective cohort study of patients undergoing posterior intramedullary spinal cord tumor resection was performed from 2010 to 2020. Primary and metastatic cord tumors were included; cauda equina tumors and patients not undergoing midline myelotomy were excluded. Exposure variables included posterior midline myelotomy, tumor location within the spinal cord, spinal segment, tumor size, presence of cord edema on preoperative imaging, and complete/partial resection. The primary outcome was dorsal column deficit (new numbness/tingling, diminished fine touch, vibration, or 2-point discrimination, or balance/proprioceptive problems). Descriptive statistics were performed.</p><p><strong>Results: </strong>Of 34 patients undergoing intramedullary tumor resection, the mean ± SD age was 44.4 ± 12.1 years and 55.9% were male. Histological analysis showed that 22 (64.7%) patients had ependymoma, 3 (8.8%) astrocytoma, 2 (5.9%) glioblastoma, 2 (5.9%) low-grade glioma, 2 (5.9%) lung adenocarcinoma, and 1 (2.9%) each of hemangioblastoma, lipoma, and necrosis possible neoplasm. Tumor locations were cervical in 17 (50.0%) patients, thoracic in 15 (44.1%), and thoracolumbar/conus in 2 (5.9%). Complete resection was achieved in 19 (55.9%) patients. At presentation, 26 (76.5%) patients had dorsal column deficits and 17 (50%) had motor deficits. Deficits worsened in 17/26 patients with preoperative motor deficits, remained the same in 9, and improved in 0. In 8 patients without preoperative dorsal column deficits, 7 had new dorsal column deficit and 1 had none. A postoperative dorsal column deficit was seen in 33/34 (97%) patients. At the most recent follow-up, 6/33 (18%) patients had improvement in dorsal column deficits and 27/33 (82%) had stable deficits.</p><p><strong>Conclusions: </strong>Postoperative dorsal column deficits occurred in 97% patients who underwent midline myelotomy for intramedullary tumor resection. Dorsal column deficits improved in 18% yet remained stable in the remaining 82%. Motor deficits improved in only 12% and remained stable/worsened in 88%. These results highlight the high rate of dorsal column deficits in patients requiring midline myelotomy for resection of intramedullary tumors.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"257-264"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564893","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 the amount of spontaneous thoracic curve correction after selective lumbar fusion for Lenke type 5C adolescent idiopathic scoliosis affect outcomes of posterior deformity correction?","authors":"Chang Ju Hwang, Nam-Yeop Kim, Choon Sung Lee, Dong-Ho Lee, Jae Hwan Cho, Sehan Park","doi":"10.3171/2025.3.SPINE241606","DOIUrl":"10.3171/2025.3.SPINE241606","url":null,"abstract":"<p><strong>Objective: </strong>Selective lumbar fusion (SLF) is commonly performed for Lenke type 5C adolescent idiopathic scoliosis (AIS). However, whether a greater amount of spontaneous thoracic curve correction (STCC) could lead to better surgical outcome remains unclear. This retrospective cohort study was conducted to identify whether the amount of STCC after SLF for Lenke 5C AIS is associated with outcomes of posterior deformity correction and to clarify factors that could predict greater STCC.</p><p><strong>Methods: </strong>A total of 62 patients who underwent posterior-only SLF and were followed up for > 2 years were reviewed. Radiographic measurements and Scoliosis Research Society (SRS)-22 scores were analyzed. Patients with an STCC rate of > 50% at postoperative 2 years were classified as the middle thoracic (MT)-corrected group, while those with an STCC rate of ≤ 50% were included in the MT-uncorrected group.</p><p><strong>Results: </strong>In total, 62.9% (39/62) of patients reached an STCC rate of > 50%, while the remaining 37.1% (23/62) failed to achieve an STCC rate of > 50%. The Cobb angle of MT significantly increased during the postoperative 2-year follow-up in the MT-uncorrected group (mean difference [MD] 2.279, 95% CI 0.681-3.877, p = 0.002), while it did not increase in the MT-corrected group (p = 0.820). Patients with an STCC rate of > 50% demonstrated significantly higher self-image (MD 1.513, 95% CI 0.943-2.854, p = 0.001), satisfaction (MD 1.322, 95% CI 0.529-2.231, p = 0.001), and overall (MD 0.611, 95% CI 0.321-1.219, p = 0.004) SRS-22 scores at the postoperative 2-year follow-up. Furthermore, greater MT curve flexibility (p = 0.042, cutoff value 55%) and less apical vertebral translation (AVT) of MT (p = 0.003, cutoff value 7 mm) demonstrated significant results for predicting an STCC rate of > 50% at the 2-year postoperative follow-up.</p><p><strong>Conclusions: </strong>Patients with an STCC rate of ≤ 50% demonstrated worse outcomes compared to those with an STCC rate of > 50%. Patients with greater preoperative MT curve flexibility and less AVT of MT were more likely to achieve an STCC rate of > 50% with SLF. Inclusion of thoracic curve within the fusion construct could be considered for those who do not meet these criteria.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"334-343"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564896","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":"Vertebral fracture following primary stereotactic body radiation therapy for spinal bone metastases: a decade of experience.","authors":"Kuan-Nien Chou, David J Park, Vivek Sanker, Xianghua Ye, Yusuke S Hori, Amit R Persad, Cynthia Chuang, Sara C Emrich, Louisa P Ustrzynski, Armine Tayag, Kiran A Kumar, Melissa Usoz, Maria Mendoza, Elham Rahimy, Erqi L Pollom, Scott G Soltys, Atman Desai, Cheng-Hsiang Lo, Steven D Chang","doi":"10.3171/2025.3.SPINE231234","DOIUrl":"10.3171/2025.3.SPINE231234","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this retrospective study was to comprehensively evaluate the factors that contribute to and protect against the occurrence of vertebral fracture (VF) following stereotactic body radiation therapy (SBRT) for the treatment of spinal bone metastasis (SBM).</p><p><strong>Methods: </strong>This study focused on adult patients who underwent primary SBRT for management of solid tumor SBMs from March 2012 to January 2023 with detailed follow-up medical records for at least 6 months. Target volume delineation for sacral and spinal SBRT was conducted in accordance with International Spine Radiosurgery Consortium guidelines and international consensus recommendations. Patients with SBM showing local progression during the follow-up period were excluded. The Spine Instability Neoplastic Score (SINS) was used to assess the relationship between various factors and the occurrence of post-SBRT VF.</p><p><strong>Results: </strong>A total of 304 patients (178 male, median age 65 years) with 450 SBMs involving 557 vertebrae were analyzed. The overall occurrence rate of VF, including post-SBRT VFs on SBRT-treated vertebrae and adjacent VFs (AVFs), was 16.6%. Post-SBRT VFs accounted for 15.6% of cases, while AVFs constituted 3.3%. Post-SBRT VFs predominantly exhibited a biconcave shape. Key factors associated with the development of post-SBRT VF included SBMs in the lumbar segment, spinal instability (SINS ≥ 7), the presence of pre-SBRT VF, and a higher radiation dose (biologically effective doses [BED3] ≥ 153.3 Gy). The use of antiresorptive agents, including bisphosphonates and denosumab, significantly reduced the occurrence rate of post-SBRT VF, with denosumab showing a particularly enhanced protective effect. Pain relief and recalcification of SBMs following SBRT were also observed.</p><p><strong>Conclusions: </strong>This study offers valuable insights into the occurrence of post-SBRT VF in SBM. While post-SBRT VF remains a significant concern in SBRT treatment, the potential for remineralization in SBM provides a promising avenue for enhancing spinal stability over time.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"294-304"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512059","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":"Association between concomitant traumatic brain injury and unfavorable 1-year outcomes in patients with traumatic spinal cord injury.","authors":"Vikas N Vattipally, Carlos A Aude, Kathleen R Ran, Kelly Jiang, Sruthi Ranganathan, Carly Weber-Levine, Jawad Khalifeh, Liam P Hughes, Jacob Jo, Saad Javeed, James P Byrne, Timothy Chryssikos, Gary Schwartzbauer, Daniel Lubelski, Ali Bydon, Timothy Witham, Nicholas Theodore, Tej D Azad","doi":"10.3171/2025.3.SPINE241470","DOIUrl":"10.3171/2025.3.SPINE241470","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic spinal cord injury (tSCI) can cause lasting functional impairment. Concomitant traumatic brain injury (cTBI) is a common injury constellation, but the impact of tandem traumatic brain injury (TBI) and tSCI on long-term patient outcomes requires further study. The objective of this study was to compare outcomes among tSCI patients with and without TBI.</p><p><strong>Methods: </strong>Patients with tSCI were identified from the Spinal Cord Injury Model System (SCIMS) database. Patients with cTBI and tSCI were 1:1 propensity score matched to those with tSCI only on demographic and injury characteristics. TBI severity was stratified in the SCIMS as mild (loss of consciousness [LOC] < 30 minutes), moderate (LOC 31 minutes to 24 hours), or severe (LOC > 24 hours). Multivariable linear and logistic regression models were specified to assess relationships between cTBI severity and 1-year follow-up outcome metrics including rehospitalization, functional recovery, and quality of life (QOL).</p><p><strong>Results: </strong>Among the 1442 patients included (median age 36 [IQR 24-52] years), 44% (n = 636) presented with cTBI. After propensity score matching, 601 patients with cTBI were compared to 601 with tSCI only. Patients with cTBI had increased rehospitalization rates, reduced functional Craig Handicap Assessment and Reporting Technique mobility and occupational scores, and increased pain severity at 1-year follow-up (all p < 0.05). Additionally, patients with severe cTBI specifically exhibited significantly lower functional independence measure (FIM) scores, Satisfaction with Life Scale scores, and a higher incidence of new-onset depression (all p < 0.05) compared to those without cTBI. Multivariable analyses confirmed that moderate and severe cTBI were independently associated with worse outcomes across 8 of 10 assessed metrics, including increased rehospitalization, new-onset depression, lower FIM scores, and greater pain severity (all p < 0.05).</p><p><strong>Conclusions: </strong>Patients with tSCI and cTBI experience worse functional outcomes and have reduced QOL 1 year after injury. Targeted rehabilitation programs could benefit patients with cTBI in the setting of tSCI.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"375-383"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512058","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}