Journal of neurosurgery. Spine最新文献

{"title":"A novel posterior decompression technique (anterior sliding decompression osteotomy) for beak-type ossification of the posterior longitudinal ligament in the thoracic spine.","authors":"Jin-Sung Park, Hyun-Jun Kim, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.3171/2024.10.SPINE24941","DOIUrl":"10.3171/2024.10.SPINE24941","url":null,"abstract":"<p><strong>Objective: </strong>Conventional decompression surgery for beak-type ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine, whether approached anteriorly or posteriorly, poses several challenges, including technical complexity, cerebrospinal fluid leakage, incomplete decompression, and potential neurological deterioration. Therefore, the authors introduce a novel technique, anterior sliding decompression osteotomy (ASDO), for thoracic myelopathy caused by OPLL and evaluate the efficacy and safety of this technique.</p><p><strong>Methods: </strong>Six patients (4 men and 2 women) who underwent ASDO surgery for beak-type OPLL in the thoracic spine with a follow-up period of at least 2 years were included in the cohort. Clinical and surgical outcomes, including modified Japanese Orthopaedic Association (mJOA) score, neurological recovery rate, canal occupying ratio, operation time, and blood loss, were evaluated.</p><p><strong>Results: </strong>The mean ± SD follow-up period was 26.5 ± 2.0 months. The mean mJOA score improved from 6.0 to 9.7, with the mean recovery rate reaching 63.6% at 6 weeks postoperatively to 73.9% at 2 years after surgery. Neural decompression was effective in all patients, reducing the mean canal occupying ratio from 70.8% to 29.1% without complications.</p><p><strong>Conclusions: </strong>ASDO surgery achieves sufficient spinal cord decompression for beak-type OPLL in the thoracic spine. It represents an effective, feasible technique, offering surgeons a familiar view from the conventional posterior approach.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"520-525"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033238","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":"Development of a unified and comprehensive definition of successful spinal fusion: a systematic review.","authors":"Parshva A Sanghvi, Joshua M Wiener, Seth M Meade, Lauren M Boden, Michael D Shost, Michael P Steinmetz","doi":"10.3171/2024.9.SPINE2465","DOIUrl":"10.3171/2024.9.SPINE2465","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Spinal fusion is a commonly performed surgical procedure used to relieve pain, deformity, and instability of various spinal pathologies. Although there have been attempts to standardize spinal fusion assessment radiologically, there is currently no unified definition that also considers clinical symptomology. This review attempts to create a more holistic and standardized definition of spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review of the current literature on cervical, thoracic, and lumbar spinal fusion was conducted using the PubMed, Google Scholar, and EBSCO databases adhering to PRISMA guidelines. Data were collected and analyzed from more than 20 publications that contained pertinent information on the efficacy of different imaging modalities, classification systems, clinical presentations, and the normal course of healing in relation to spinal fusion. The mean methodological index for nonrandomized studies score was 18 ± 2.5. Furthermore, industry experts and board-certified spinal surgeons were consulted in the development of a proposed definition of successful spinal fusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 20 studies evaluating 1324 spinal fusion procedures were included in the final analysis. Based on the available literature, a clinical algorithm that physicians can implement in their practice to determine whether a spinal fusion procedure may be deemed successful was created. The algorithm begins broadly by stratifying patients as either symptomatic or asymptomatic. Asymptomatic patients can be considered as having successful fusions after 12 months. If patients are symptomatic, the imaging modality and healing characteristics are based on the quality of pain experienced. For radicular pain, fusion evaluation includes a flexion/extension (F/E) radiograph to assess for foraminal compression, trabecular bridging, minimal angular rotation, minimal translational movement, and minimal halo sign. For axial pain, a helical CT scan is recommended, with characteristics of success that include trabecular bridging, lack of radiolucent shadowing, lack of visible bone or hardware fracture, lack of cystic or sclerotic changes, low subsidence level near the graft, and minimal screw-rod construct migration. Spinal fusion is considered \"unsuccessful\" if symptoms persist beyond a year postoperatively, regardless of radiographic findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The authors have constructed a systematic, standardized method for evaluating spinal fusion success that incorporates clinical symptoms, various imaging modalities, and the natural course of bone healing. A potential limitation of this algorithm is its reliance on radiographic imaging and heterogeneous data. However, the authors believe that implementation of this algorithm and a widespread unified fusion definition will lead to better postoperative evaluation, better surgical outcomes, and a standardized metric to assess d","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"403-412"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033251","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. The AO Spine/Praxis Spinal Cord Institute clinical practice guidelines for acute spinal cord injury: interpretation and implications for clinical practice.","authors":"Michael G Fehlings, Nathan Evaniew, Shekar N Kurpad, Andrea C Skelly, Lindsay A Tetreault, Brian K Kwon","doi":"10.3171/2024.9.SPINE241083","DOIUrl":"10.3171/2024.9.SPINE241083","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"526-529"},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pedicle screw accuracy on clinical outcomes after 1- or 2-level minimally invasive transforaminal lumbar interbody fusion.","authors":"Tejas Subramanian, Pratyush Shahi, Junho Song, Takashi Hirase, Maximilian Korsun, Austin C Kaidi, Gregory S Kazarian, Tomoyuki Asada, Eric Mai, Chad Z Simon, Izzet Akosman, Eric Zhao, Kasra Araghi, Troy B Amen, Avani Vaishnav, Cole Kwas, Olivia Tuma, Eric Kim, Nishtha Singh, Joshua Zhang, Myles Allen, Annika Bay, Evan Sheha, Francis Lovecchio, James E Dowdell, Sheeraz A Qureshi, Sravisht Iyer","doi":"10.3171/2024.10.SPINE24692","DOIUrl":"10.3171/2024.10.SPINE24692","url":null,"abstract":"<p><strong>Objective: </strong>When creating minimally invasive spine fusion constructs, accurate pedicle screw fixation is essential for biomechanical strength and avoiding complications arising from delicate surrounding structures. As research continues to analyze how to improve accuracy, long-term patient outcomes based on screw accuracy remain understudied. The objective of this study was to analyze long-term patient outcomes based on screw accuracy.</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion and were queried from a prospectively maintained multisurgeon registry. Pedicle screws were assessed for accuracy and graded as poor, acceptable, or good. Patient demographic characteristics and outcomes including complications, patient-reported outcome measures (PROMs), return to activities, and fusion rates were compared between the cohorts.</p><p><strong>Results: </strong>A total of 665 pedicle screws in 153 patients were evaluated and included in the final analysis. Of these, 20 (13.1%) patients had poor screws, 63 (41.2%) had acceptable screws, and 70 (45.7%) had good screws. All groups showed similar and significant improvements in all PROMs, although the poor screw group experienced delayed improvement in physical function. A majority of patients in all groups returned to working and driving and discontinued narcotics at similar rates. However, the poor screw group displayed significantly slower return to activities. There were no significant differences in intraoperative or postoperative complications, although the poor screw group experienced significantly lower fusion rates.</p><p><strong>Conclusions: </strong>Patients with poorly accurate pedicle screws experienced delayed return to activities and decreased fusion rates with similar long-term PROMs. Surgeons should continue to focus on placing accurate pedicle screws, and research should continue to analyze ways to ensure accurate screw placement.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"425-434"},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007047","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 and radiographic comparison of robot-assisted single-position versus traditional dual-position lateral lumbar interbody fusion.","authors":"Ting Li, Wenao Liao, Jiang Hu, Wei Zhang, Yang Yu, Fei Wang, Xilin Liu","doi":"10.3171/2024.10.SPINE24808","DOIUrl":"10.3171/2024.10.SPINE24808","url":null,"abstract":"<p><strong>Objective: </strong>The potential of robot-assisted (RA) single-position (SP) lateral lumbar interbody fusion (LLIF) warrants further investigation. This study aimed to assess the efficacy of RA-SP-LLIF in improving both clinical and radiographic outcomes in patients undergoing lumbar spinal fusion surgery.</p><p><strong>Methods: </strong>A total of 59 patients underwent either RA-SP-LLIF (n = 31 cases) or traditional LLIF (n = 28 cases). Surgical parameters including operative duration, estimated blood loss, and fluoroscopy duration were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 36-item Short-Form Health Survey (SF-36). Radiographic parameters were also evaluated.</p><p><strong>Results: </strong>There were no significant differences between the two groups in terms of postoperative and last follow-up times, but both groups demonstrated significant improvements in VAS scores. Similarly, ODI and SF-36 scores showed comparable improvements. Radiographic parameters did not significantly differ between the groups preoperatively, postoperatively, and at last follow-up (p > 0.05). Neither group showed significant improvements in pelvic tilt and sacral slope parameters compared to baseline postoperatively and at last follow-up (p > 0.05). However, the RA-SP-LLIF group exhibited significantly greater improvements in lumbar lordosis (LL; p < 0.01), segmental lordosis (SL; p < 0.01), and pelvic incidence-LL mismatch (PI-LL; p < 0.01) immediately postoperatively compared to baseline, although these differences were not significant at subsequent evaluations. Similarly, the traditional LLIF group improved the LL, SL, and PI-LL parameters postoperatively. Importantly, there was no statistically significant difference in the Bridwell grade and complications between the two groups (p = 0.83 and p = 0.88, respectively). However, the RA-SP-LLIF group had significantly shorter operative and fluoroscopy durations compared to the traditional LLIF group (p = 0.04 and p < 0.01, respectively).</p><p><strong>Conclusions: </strong>Both RA-SP-LLIF and traditional LLIF surgeries achieved satisfactory lordotic correction. However, RA-SP-LLIF surgery demonstrated shorter operative and fluoroscopy times compared to traditional LLIF surgery. Therefore, RA-SP-LLIF is a promising technique for enhancing surgical efficiency, safety, and precision in lumbar spinal fusion procedures.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"443-452"},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007046","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":"Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.","authors":"Daniel Zeitouni, Sarah E Johnson, Sufyan Ibrahim, Erica F Bisson, Praveen V Mummaneni, Regis W Haid, Andrew K Chan, Dean Chou, Michael Y Wang, John J Knightly, Scott Meyer, Oren N Gottfried, Christopher I Shaffrey, Michael S Virk, Kai-Ming G Fu, Mark E Shaffrey, Paul Park, Kevin T Foley, Cheerag D Upadhyaya, Eric A Potts, Jay D Turner, Juan S Uribe, Luis M Tumialán, Domagoj Coric, Mohamad Bydon, Anthony L Asher","doi":"10.3171/2024.9.SPINE24351","DOIUrl":"10.3171/2024.9.SPINE24351","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spondylotic myelopathy (CSM) shows varying levels of improvement after surgical treatment. While some patients improve soon after surgery, others may take months to years to show any signs of improvement. The goal of this study was to evaluate postoperative improvement, patient-reported outcomes, and patient satisfaction up to 2 years after surgical treatment for CSM, which will help optimize the current treatment strategies and effectively manage patient expectations.</p><p><strong>Methods: </strong>This was a retrospective study of prospectively collected data using the Quality Outcomes Database. The primary outcomes of interest were achievement of the minimal clinically important difference (MCID) for the numeric rating scale for neck and arm pain, modified Japanese Orthopaedic Association, Neck Disability Index, and EQ-5D scores and postoperative satisfaction (North American Spine Society scale). Early and sustained improvement was defined as MCID achievement in at least one patient-reported outcome measure (PROM) at the 3-, 12-, and 24-month follow-ups. Transient improvement was defined as MCID achievement only at the 3-month and/or 12-month follow-up but not at the 24-month follow-up. Late improvement was defined as MCID achievement in at least one PROM only at the 24-month follow-up.</p><p><strong>Results: </strong>There were 630 patients included in the comparative analysis. A total of 463 (73.5%) patients achieved early and sustained improvement, 105 (16.7%) patients experienced transient improvement with subsequent decline, 25 (4.0%) patients reported late improvement, and 37 (5.9%) patients did not report any clinically meaningful improvement after surgery. Patients with an anterior approach were more likely to be in the early and sustained improvement group. African American patients (OR 2.98, 95% CI 1.14-7.76; p = 0.03) were more likely to report late improvement when compared with White patients. The overall satisfaction rate at the 24-month follow-up was 87.8%.</p><p><strong>Conclusions: </strong>These findings indicate that 73.5% of patients achieve early and sustained improvement, and 87.8% of patients are satisfied with surgery 24 months postoperatively.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"500-508"},"PeriodicalIF":2.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962181","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 impact of lower thoracic versus upper lumbar upper instrumented vertebra in minimally invasive correction of adult spinal deformity.","authors":"Robert K Eastlack, Jay I Kumar, Gregory M Mundis, Pierce D Nunley, Juan S Uribe, Paul J Park, Stacie Tran, Michael Y Wang, Khoi D Than, David O Okonkwo, Adam S Kanter, Neel Anand, Richard G Fessler, Kai-Ming G Fu, Dean Chou, Praveen V Mummaneni","doi":"10.3171/2024.8.SPINE231335","DOIUrl":"10.3171/2024.8.SPINE231335","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to compare the impact of using a lower thoracic (LT) versus upper lumbar (UL) level as the upper instrumented vertebra (UIV) on clinical and radiographic outcomes following minimally invasive surgery for adult spinal deformity.</p><p><strong>Methods: </strong>A multicenter retrospective study design was used. Inclusion criteria were age ≥ 18 years, and one of the following: coronal Cobb angle > 20°, sagittal vertical axis > 50 mm, pelvic tilt > 20°, pelvic incidence-lumbar lordosis mismatch > 10°. Patients were treated with circumferential or hybrid minimally invasive techniques at ≥ 3 spinal levels and had a 2-year minimum follow-up. They were then divided into 2 groups depending on whether the UIV was in the UL region, defined as a UIV location of L1-2, or the LT region, defined as T10-12.</p><p><strong>Results: </strong>A total of 114 of 223 patients met the inclusion criteria (68 LT and 46 UL). The UL group was older (67.5 vs 62.3 years; p = 0.015). Preoperative spinopelvic parameters were similar, except for sacral slope, which was higher in the UL group (30.5° vs 26.5°; p < 0.001). The percentage of patients with fixation crossing the lumbosacral junction was also similar (70.6% vs 67.4%; p = 0.717). Postoperative lumbar lordosis (42.5° vs 35.5°; p = 0.01) and change in coronal Cobb angle (-23.2° vs -9.6°; p < 0.001) were greater in the LT group, but other changes in postoperative spinopelvic parameters and changes in health-related quality-of-life scores were similar between groups. Reoperation rates were lower in the UL group (17.4% vs 36.8%; p = 0.025), largely associated with fewer radiographic failures (UL = 10.9% vs LT = 26.5%; p = 0.042); however, overall complication rates were not significantly different (UL = 43.5% vs LT = 60.3%; p = 0.077).</p><p><strong>Conclusions: </strong>Selecting a UL vertebra for UIV in minimally invasive surgical correction of adult spinal deformity results in lower reoperation rates compared to extending fixation to the LT region. This choice also correlates with shorter operating room times and reduced estimated blood loss. Although extending fixation to the LT region is associated with slightly greater lumbar lordosis and a greater change in the coronal Cobb angle, clinical outcomes were similar between the LT and UL groups for UIV.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"462-469"},"PeriodicalIF":2.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962192","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":"Awake, endoscopic lumbar interbody spinal fusion: 10 years of experience with the first 400 cases.","authors":"Michael Y Wang, Jay Grossman","doi":"10.3171/2024.9.SPINE2431","DOIUrl":"10.3171/2024.9.SPINE2431","url":null,"abstract":"<p><strong>Objective: </strong>Awake, endoscopic spinal fusion has been utilized as an ultra-minimally invasive surgery technique to accomplish the goals of spinal fixation, fusion, and disc height restoration. While many techniques exist for this approach, this series represents a single institution's experience with a large cohort and the evolution of this method.</p><p><strong>Methods: </strong>The medical records of a consecutive series of 400 patients treated over a 10-year period were retrospectively reviewed. Endoscopic decompression, expandable intervertebral spacer deployment, and percutaneous screws were combined with liposomal bupivacaine to allow for the surgery to be performed without general endotracheal anesthesia (GETA) in the vast majority of cases. Clinical and radiographic postoperative results were reviewed with special attention to surgical complications, in particular dorsal root ganglion (DRG) irritation.</p><p><strong>Results: </strong>All patients underwent surgery successfully without conversion to an open operation. Their mean age was 69.1 ± 10.4 years, and 42% of the patients were male. A total of 509 levels were fused, with the most common indication being spondylolisthesis (67.5%). The mean operative time was 84.6 ± 31.4 minutes, the mean intraoperative blood loss was 98 ± 63 ml, and the mean hospital length of stay was 1.93 ± 1.1 nights. Overall, 4.3% of the patients underwent planned GETA due to comorbidities, and 2% were converted to GETA intraoperatively. Eighty percent of the patients experienced > 75% improvement in leg pain, and 52% experienced > 75% improvement in axial back pain. Complications included transient DRG irritation (23%), adjacent-level disease requiring reoperation (3.5%), inadequate decompression (2.3%), and nonunion (1.8%).</p><p><strong>Conclusions: </strong>This large case series demonstrates that awake, endoscopic spinal fusion is a viable option with acceptable clinical and radiographic results in a select patient population. Meticulous attention to detail is required to limit the rate of DRG irritation, achieve interbody height restoration, and mitigate nonunions.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"435-442"},"PeriodicalIF":2.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962179","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 recovery trajectory of patient-reported outcomes in elderly patients with frailty undergoing lumbar spine fusion: a propensity score-matching analysis.","authors":"Peng Cui, Qingyang Huang, Peng Wang, Chao Kong, Shibao Lu","doi":"10.3171/2024.9.SPINE24858","DOIUrl":"10.3171/2024.9.SPINE24858","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the complicated relationship between frailty, perioperative complications, and patient-reported outcomes (PROs) in elderly patients (≥ 75 years old) undergoing lumbar spine fusion (LSF).</p><p><strong>Methods: </strong>Consecutive patients who underwent LSF between March 2019 and December 2021 were recruited in this study. Frail patients (modified frailty index [mFI] score ≥ 2) were propensity score matched to nonfrail patients (mFI score 0-1) on the basis of age, sex, and the number of fused levels. Perioperative complications were collected and assessed according to the comprehensive complication index. Subgroups were further subdivided on the basis of the presence of major complications. The data from SF-36, Oswestry Disability Index (ODI), and North American Spine Society Satisfaction Questionnaire (NASS) at baseline and 1- and 2-year follow-up evaluations were compared between groups. Furthermore, the minimal clinically important difference (MCID) achievement rate was also compared.</p><p><strong>Results: </strong>The final analysis included 631 patients: 344 in the frail group and 287 in the nonfrail group. Frail patients were older (79.7 ± 5.1 years vs 76.4 ± 4.8 years, p < 0.001), with a higher proportion of females (68.9% vs 57.8%, p = 0.004) and those with malnutrition (17.7% vs 11.1%, p = 0.020). After propensity score matching for age, sex, and number of fused levels, 402 patients (201 in each group) were analyzed. Frail patients were more prone to have delirium (7.5% vs 3.0%, p = 0.044), blood transfusion (43.3% vs 30.3%, p = 0.007), and surgical site infection (6.0% vs 2.0%, p = 0.041). In addition, frail patients had a higher proportion of major complications (29.4% vs 16.9%, p = 0.003). Although they had worse PROs at baseline, frail patients obtained higher mean improvements and higher rates of MCID achievement by the 1- and 2-year follow-up evaluations than their nonfrail counterparts. Major complications did not seem to affect PROs in frail and nonfrail patients.</p><p><strong>Conclusions: </strong>Despite being associated with worse baseline PROs, frail patients gained greater mean improvement in PROs and higher rates of MCID achievement by the 1- and 2-year follow-up evaluations than nonfrail patients. In addition, the presence of major complications did not affect PROs at the 1- and 2-year follow-ups. Although associated with major complications, elderly patients with frailty could benefit from LSF.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"348-355"},"PeriodicalIF":2.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926770","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 gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery.","authors":"Justin S Smith, David Ben-Israel, Michael P Kelly, Virginie Lafage, Renaud Lafage, Eric O Klineberg, Han Jo Kim, Breton Line, Themistocles S Protopsaltis, Peter Passias, Robert K Eastlack, Gregory M Mundis, K Daniel Riew, Khaled Kebaish, Paul Park, Munish C Gupta, Jeffrey L Gum, Alan H Daniels, Bassel G Diebo, Richard Hostin, Justin K Scheer, Alex Soroceanu, D Kojo Hamilton, Thomas J Buell, Stephen J Lewis, Lawrence G Lenke, Jeffrey P Mullin, Frank J Schwab, Douglas Burton, Christopher I Shaffrey, Christopher P Ames, Shay Bess","doi":"10.3171/2024.8.SPINE24703","DOIUrl":"10.3171/2024.8.SPINE24703","url":null,"abstract":"<p><strong>Objective: </strong>Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery.</p><p><strong>Methods: </strong>Adult patients with CSD were prospectively enrolled into a multicenter registry. Surgeons documented alignment goals prior to surgery, including C2-7 sagittal vertical axis (SVA), C2-7 sagittal Cobb angle, T1 slope minus cervical lordosis (TS-CL), and C7-S1 SVA. Goals were compared with achieved alignment, and the offsets (achieved goal) were calculated. General linear models were created for offset magnitude for each alignment parameter, controlling for baseline deformity and surgical factors.</p><p><strong>Results: </strong>The 88 enrolled patients had a mean age of 63.6 ± 13.0 years. The mean number of anterior and posterior instrumented levels was 3.5 ± 1.0 and 10.6 ± 4.5, respectively. Surgeons failed to achieve their preoperative alignment goals by an average of 17.2 (range 0.1-75.4) mm for C2-7 SVA, 10.3° (range 0.1°-45.5°) for C2-7 sagittal Cobb angle, 15.6° (range 0.0°-42.9°) for TS-CL, and 34.2 (range 0.3-113.7) mm for C7-S1 SVA. The sagittal alignment parameters with the highest rate of extreme outliers were TS-CL and C7-S1 SVA, with 32.2% exceeding 20° and 60.8% exceeding 20 mm from goal alignment, respectively. After controlling for baseline deformity and operative parameters, the only factor associated with achieving targeted alignment for C2-7 sagittal Cobb angle was greater baseline thoracic kyphosis (TK; B = -0.148, 95% CI -0.288 to -0.007, p = 0.040), and for TS-CL, the only associated factor was lower baseline TS-CL (B = 0.187, 95% CI 0.027-0.347, p = 0.022). Both lower TK and greater TS-CL may reflect increased baseline deformity through greater thoracic compensation and increased TS-CL mismatch, respectively. No significant associations were identified for C2-7 SVA and C7-S1 SVA.</p><p><strong>Conclusions: </strong>Surgeons failed to achieve their preoperative alignment goals by an average of 17.2 mm for C2-7 SVA, 10.3° for C2-7 sagittal Cobb angle, 15.6° for TS-CL, and 34.2 mm for C7-S1 SVA. The few factors identified that were associated with offset between goal and achieved alignment suggest that achievement of goal alignment was most challenging for more severe deformities. Further advancements are needed to enable more consistent translation of preoperative alignment goals into the operating room for adult CSD correction. Clinical trial registration no.: NCT01588054 (ClinicalTrials.gov).</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"309-319"},"PeriodicalIF":2.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927447","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}