Neurosurgical focus最新文献

{"title":"Optimizing predictive model performance in adult spinal deformity surgery: a comparative head-to-head analysis of learning models for perioperative complications.","authors":"Shane Shahrestani, Catherine Garcia, Andrew M Miller, Robin Babadjouni, Andre E Boyke, Miguel Quintero-Consuegra, Rohin Singh, Alexander Tuchman, Corey T Walker","doi":"10.3171/2025.3.FOCUS2532","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2532","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and compare 4 predictive algorithms, including logistic regression (LR), random forest (RF), gradient boosting machine (GBM), and neural network (NN), for perioperative outcomes in adult spinal deformity (ASD) surgery. By evaluating these models, the authors sought to explore how linear and nonlinear interactions unique to each outcome influence predictive accuracy, emphasizing the need for outcome-specific model selection.</p><p><strong>Methods: </strong>A retrospective cohort of 7430 patients (mean age of 67 years) who underwent multilevel thoracolumbar deformity correction was identified using the Nationwide Readmissions Database (2016-2019). Predictor variables included demographic data, frailty status, comorbidity indices, nutritional status, and hospital characteristics. Outcomes assessed were prolonged hospital length of stay (LOS), nonroutine discharge, top-quartile all-payer cost, 30-day readmission, and posthemorrhagic anemia. Models were trained on 75% of the dataset and tested on the remaining 25%. LR served as the baseline parametric model, while RF and GBM employed ensemble methods to handle nonlinear interactions, and NN used hidden layers optimized via backpropagation. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values, and DeLong's test was used for statistical comparisons.</p><p><strong>Results: </strong>RF achieved the highest AUC for LOS (0.713), while GBM excelled for posthemorrhagic anemia (AUC = 0.717). LR provided consistent moderate accuracy across all outcomes (AUC range 0.556-0.690). NN underperformed (AUC range 0.540-0.665), likely due to dataset size limitations. Significant differences were observed between models for prediction of LOS and posthemorrhagic anemia (p < 0.05), with RF and GBM performing the best as they capture nonlinear interactions effectively.</p><p><strong>Conclusions: </strong>The results highlight that no single algorithm universally outperforms others across all perioperative outcomes, as each model captures different linear and nonlinear heterogeneities. Careful consideration of the outcome's unique characteristics is essential when selecting a predictive model for ASD surgery. These findings support the integration of tailored machine learning approaches to optimize patient-specific risk stratification and perioperative care.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E12"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199700","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":"Removal of painful pelvic screws following spine fusion surgery: outcomes and complications.","authors":"Anthony L Mikula, Zach Pennington, Nikita Lakomkin, Michael L Martini, Abdelrahman M Hamouda, Ahmad Nassr, Brett Freedman, Arjun S Sebastian, William W Cross, Christopher P Ames, Benjamin D Elder, Jeremy L Fogelson","doi":"10.3171/2025.3.FOCUS2510","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2510","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the risks and benefits of removing painful pelvic/iliac screws in spine fusion surgery patients.</p><p><strong>Methods: </strong>A retrospective review identified patients who had traditional iliac and S2-alar-iliac (S2AI) screws removed for pain. The minimum follow-up was 24 months.</p><p><strong>Results: </strong>Fifty-two patients (75% women) were included with a mean age of 63 years, BMI of 28, and follow-up of 65 months. Most of the removed screws were S2AI (83%) compared with traditional iliac screws (17%). Forty-three patients (83%) had improvement in their pelvic screw related-pain following removal. Eight patients (15%) experienced lumbosacral mechanical complications following pelvic screw removal including sacral fracture (n = 3, 6%) and/or L4-5 or L5-S1 rod fracture (n = 7, 13%). On multivariable analysis, risk factors for mechanical complications following pelvic screw removal included a longer fusion construct (OR 1.34, p = 0.035), greater postoperative L4-S1 lordosis (OR 1.14, p = 0.04, ideal cutoff > 40°), and lack of bone morphogenetic protein (BMP; OR 0.03, p = 0.02). Ten patients (19%) underwent subsequent SI joint fusion following pelvic screw removal, and higher standing pelvic incidence (OR 1.10, p = 0.03) was the only independent predictor of SI fusion.</p><p><strong>Conclusions: </strong>Removal of painful pelvic screws resulted in a high rate of postoperative pain relief, albeit with a risk of lumbosacral mechanical complications and subsequent SI joint fusion. Patients at risk for lumbosacral mechanical complications following pelvic screw removal included those with longer fusion constructs, more lordosis from L4 to S1 (> 40°), and lack of BMP. Patients at risk for receiving an instrumented SI joint fusion following pelvic screw removal included those with a higher pelvic incidence.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E15"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199702","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":"Trends in short-term and delayed unplanned readmission in patients with adult spinal deformity undergoing posterior spinal fusion.","authors":"Aladine A Elsamadicy, Sumaiya Sayeed, Sina Sadeghzadeh, Paul Serrato, Shaila D Ghanekar, Sheng-Fu Larry Lo, Daniel M Sciubba","doi":"10.3171/2025.3.FOCUS2513","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2513","url":null,"abstract":"<p><strong>Objective: </strong>Adult spinal deformity (ASD) affects many people in the US, often causing significant back pain and disability and disrupting activities of daily living. As a result, surgical intervention for deformity correction can help improve quality of life. Unplanned readmissions after surgery can significantly impact patients and the value of care. The aim of this study was to assess the trends in short-term and delayed unplanned readmissions following treatment for ASD.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the 2016-2019 Nationwide Readmissions Database. All adult patients undergoing thoracic/thoracolumbar posterior spinal fusion (PSF) for ASD were identified using International Classification of Diseases, 10th Revision coding. Patients were stratified into 7-day readmission (7-R), 30-day readmission (30-R), 90-day readmission (90-R), and no readmission (NonR) cohorts. Patient demographics, comorbidities, adverse events (AEs), and clinical outcomes were assessed.</p><p><strong>Results: </strong>Of the 3628 ASD patients identified, 550 (15.2%) experienced unplanned readmission (7-R: 131 [3.6%], 30-R: 252 [6.9%], 90-R: 167 [4.6%], NonR: 3078 [84.8%]). Patients in the readmission cohorts had higher rates of Medicare coverage, while the NonR cohort had the highest proportion of private insurance (p = 0.004). The 30-R cohort had the highest frailty score, followed by the 90-R, 7-R, and NonR cohorts (p < 0.001), respectively. The 7-R and 30-R cohorts had the highest prevalence of hypertension (p = 0.002), complicated diabetes (p = 0.002), and chronic pulmonary disease (p = 0.011). In addition, the 7-R and 30-R cohorts had a higher frequency of three or more comorbidities (p = 0.002) and two or more AEs (p < 0.001). On initial admission, the 7-R cohort had the longest mean length of stay (LOS) (p < 0.001), while the 30-R cohort had the greatest rate of nonroutine discharge (p < 0.001) and the highest mean cost of index admission (p = 0.039). On readmission, the 7-R cohort experienced the longest mean LOS (p < 0.001) and highest rate of nonroutine discharge (p = 0.025), with no significant differences in costs between cohorts.</p><p><strong>Conclusions: </strong>Our study suggests that increased comorbidities, AEs, LOS, nonroutine discharge, and hospital expenditures are associated with short-term (7 and 30 days) unplanned readmissions following PSF for ASD patients. Future studies should further investigate these observed trends and work to optimize patient care while minimizing unplanned readmissions and healthcare expenditures.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E16"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199703","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":"Validation and clinical application of the ΔC2 pelvic angle - ΔC2 tilt = Δpelvic tilt equation for predicting pelvic tilt in spinal deformity surgery.","authors":"Karan Joseph, Tim Bui, Alexander T Yahanda, Salim Yakdan, Samuel Vogl, Miguel Ruiz Cardozo, Jeffrey T Galla, Zachariah Leatherman, Noah D Poulin, Sundeep Chakladar, Samuel Brehm, Braeden Benedict, Munish Gupta, Nicholas Pallotta, Jeffrey Hills, Michael P Kelly, Jacob K Greenberg, Brian J Neuman, Wilson Z Ray, Camilo A Molina","doi":"10.3171/2025.3.FOCUS2554","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2554","url":null,"abstract":"<p><strong>Objective: </strong>Notably, studies have established a consistent link between global sagittal alignment and pelvic tilt (PT) using C2 tilt (C2T) and C2 pelvic angle (C2PA), described by the following equation: C2PA = PT + C2T. The present study aimed to validate the proposed relationship (predicted ΔPT = ΔC2PA - ΔC2T) based on the assumption that patients aim to maintain a neutral C2T. Additionally, this study sought to evaluate the accuracy of intraoperative C2PA measurements for predicting postoperative PT.</p><p><strong>Methods: </strong>The medical records of patients > 21 years of age undergoing spinal fusion were retrospectively reviewed. Inclusion criteria were spinal instrumentation and fusion extending to the sacrum with upper instrumented vertebrae at or above L3. Patients without complete preoperative and 6-week postoperative anteroposterior and lateral scoliosis radiographs were excluded. Patients were stratified into short (fusion at or below T10) and long thoracolumbar fusions. Pre- and postoperative measurements included the C2-7 Cobb angle (CA), C6-T4 CA, T5-12 CA, T4 pelvic angle, L1 pelvic angle, pelvic incidence, and lumbar lordosis. A subset of patients with intraoperative radiographs visualizing a visible C2 vertebral body and bilateral femoral heads were analyzed for intraoperative prediction accuracy. ΔC2PA was defined as postoperative C2PA - preoperative C2PA, and predicted ΔC2T was defined as 0 - preoperative C2T. The mean absolute error (MAE) was calculated as the mean absolute difference between the predicted and actual postoperative PT values.</p><p><strong>Results: </strong>In total, 298 patients (mean age 65.4 ± 11.4 years, 71.8% female) met the inclusion criteria; 126 (42.3%) underwent short thoracolumbar fusions, and 172 (57.7%) underwent long thoracolumbar fusions. Preoperatively aligned patients had a mean postoperative C2T of -2.43° ± 2.48°, and preoperatively malaligned patients had a mean postoperative C2T of 0.72° ± 5.32°. The equation demonstrated excellent accuracy in the full cohort, with an MAE of 3.56° and an R2 value of 0.77. Of the total cohort, 69 patients (23.2%) met criteria for intraoperative measurements. Intraoperatively, the equation retained clinical utility (MAE = 5.75°, R2 = 0.576) and maintained high accuracy across stratified analyses by fusion length (MAE in long fusion = 5.89°, R2 = 0.595; MAE in short fusion = 5.31°, R2 = 0.603).</p><p><strong>Conclusions: </strong>This study validates the equation (predicted ΔPT = ΔC2PA - ΔC2T) as a reliable tool for predicting PT in spinal deformity surgery. The equation's dual functionality as a preoperative planning tool and intraoperative predictive guide underscores its clinical utility.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E6"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199704","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. Tilted foundations, leaning towers: the L4 factor in adult spinal deformity.","authors":"Daniel Schneider, Daniel M Sciubba","doi":"10.3171/2025.3.FOCUS25295","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS25295","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E5"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199694","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":"Pain catastrophizing and frailty in adult spinal deformity patients with cognitive impairment.","authors":"Alexa Semonche, Justin K Scheer, Austin Lui, John F Burke, Chloe Jedwood, Albert Wang, Elaina J Wang, Tony Catalan, Diana Chang, Bethany Belfield, Isabelle Thapar, Michael M Safaee, Darryl Lau, Marissa Fury, Thomas Wozny, Anthony L Mikula, David Mazur-Hart, Alekos A Theologis, Aaron J Clark, Christopher P Ames","doi":"10.3171/2025.3.FOCUS2538","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2538","url":null,"abstract":"<p><strong>Objective: </strong>Cognitive impairment and pain catastrophizing are both associated with worse surgical outcomes. The aim of this study was to define the prevalence of cognitive impairment in patients with adult spinal deformity (ASD) and the relationships between cognitive impairment, pain catastrophizing, patient-reported outcome measures (PROMs), and frailty in the preoperative setting.</p><p><strong>Methods: </strong>This cross-sectional study included patients undergoing evaluation for ASD correction at a single tertiary care center from January 2017 to October 2024. Patients were administered the Montreal Cognitive Assessment (MoCA), Pain Catastrophizing Scale (PCS), Scoliosis Research Society 22-item revised (SRS-22r) questionnaire, the Oswestry Disability Index (ODI), and the Edmonton Frail Scale (EFS). Median survey responses were compared between patients with any cognitive impairment (MoCA score < 26) and no cognitive impairment (MoCA score ≥ 26) using the Mann-Whitney U-test. Associations between survey responses were tested using Spearman's rank correlation analysis. Multivariate logistic regression analysis was performed to identify predictors of severe pain catastrophizing (PCS score ≥ 30).</p><p><strong>Results: </strong>A total of 210 patients (61.4% female, median age 66.5 years) were included in the study. Of these, 123 (58.6%) had normal cognition and 87 (41.4%) had mild or moderate cognitive impairment. Patients with cognitive impairment had greater median PCS scores compared with patients with normal cognition (total PCS score 25.0 vs 19.0, p = 0.01). Lower MoCA scores were significantly correlated with higher PCS (ρ = -0.23, p = 0.0007) and EFS (ρ = -0.21, p = 0.0074) scores, but not ODI and total SRS-22r scores. In the multivariate logistic regression analysis, lower MoCA and SRS-22r scores were associated with greater odds of having severe pain catastrophizing (MoCA: OR 0.82 [95% CI 0.68-0.98], p = 0.03; SRS-22r: OR 0.05 [95% CI 0.01-0.19], p < 0.0001), while ODI score, EFS score, age, and sex were not associated.</p><p><strong>Conclusions: </strong>There was a high prevalence (41.4%) of cognitive impairment in patients with ASD. In both the correlation and multivariate logistic regression analyses, cognitive impairment was associated with pain catastrophizing and thus might contribute to pain perception and frailty in a way that is not consistently captured by traditional PROMs.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199701","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":"Decision regret in adult spinal deformity surgery: a comparison of SRS-22r outcomes and the Decision Regret Scale.","authors":"Daniel R Rubio, John C F Clohisy, Munish C Gupta, Lawrence G Lenke, Michael P Kelly","doi":"10.3171/2025.3.FOCUS2575","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2575","url":null,"abstract":"<p><strong>Objective: </strong>The Decision Regret Scale (DRS) is a valid instrument evaluating the \"correctness\" of a treatment decision from the patient perspective. The minimal clinically important difference (MCID) is proposed as a threshold for patient-reported outcome measure (PROM) improvement success. The relationship between decision regret and failure to achieve clinical success in adult spinal deformity (ASD) surgeries is not known. The authors sought to examine the relationships between the DRS and outcomes, as measured by the Scoliosis Research Society-22r (SRS-22r), in ASD surgery.</p><p><strong>Methods: </strong>ASD patients with a minimum 2-year follow-up completed the DRS and SRS-22r questionnaires. Records were reviewed for complications and revision surgeries. SRS-22r domain scores were dichotomized as successful or not by MCID values. Patients with DRS scores of 0-20 were defined as having no decision regret. Relationships between DRS and SRS-22r domain scores were explored, as were relationships between DRS and complication/revision surgery.</p><p><strong>Results: </strong>A total of 46 patients met inclusion criteria. The average age was 64 years, and the average follow-up was 4.3 years (range 2.0-15.5 years). The mean DRS score was 7.6 with a median score of 0; 15% (7/46) expressed decision regret. Worse SRS-22r pain (p = 0.049), function (p = 0.03), and satisfaction (p = 0.006) were associated with higher DRS scores. Rates of decision regret were not different between those achieving MCID and those who did not (pain, p = 0.1; function, p = 0.1; self-image, p = 0.4; and subscore p = 0.09). There was no difference in the number of patients with decision regret in terms of postoperative complications or patients requiring revision surgery and those who did not.</p><p><strong>Conclusions: </strong>Decision regret after ASD surgeries was uncommon despite complications, reoperations, and failure to achieve MCID changes in SRS-22r domains. Worse SRS-22r pain, function, and satisfaction scores were associated with more decision regret, however.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E3"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199690","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":"Distal junctional failure following pelvic instrumentation in spinal fusion: a novel classification system.","authors":"Benjamin D Elder, Nikita Lakomkin, Scott L Zuckerman, Peter G Passias, Robert K Eastlack, Jay D Turner, Jean-Christophe Leveque, David A Essig, Elizabeth L Lord, Sohaib Z Hashmi, Daniel M Sciubba, David W Polly","doi":"10.3171/2025.3.FOCUS24969","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS24969","url":null,"abstract":"<p><strong>Objective: </strong>While traditional literature in adult spinal deformity (ASD) examining mechanical complications has focused on proximal junctional kyphosis and failure, distal junctional failure (DJF) of constructs ending at the sacrum with or without spinopelvic fixation remains less explored. The current study sought to 1) propose a new DJF classification with a panel of experienced deformity surgeons, and 2) analyze intra- and interreliability of the novel classification.</p><p><strong>Methods: </strong>A prior review study was completed that identified all types of distal complications for lumbosacral fusions. A panel of 25 experienced spinal deformity surgeons used a modified Delphi approach with three rounds of review to create a classification system. Ten deformity surgeons then reviewed a representative series of 14 de-identified cases to assess the interrater reliability of the classification system using the intraclass correlation coefficient (ICC). A second round of review was conducted by each investigator to determine intrarater reliability using Cohen's kappa coefficient.</p><p><strong>Results: </strong>Complications were classified as acute (< 90 days from the date of surgery) or chronic (≥ 3 months from the date of surgery). Acute failures included mechanical failure of the screws or screw-rod interface, such as pelvic set plug dissociation, tulip head dissociation, and fracture of the pelvic screw at any point along its trajectory. Fractures of the rod (proximal vs distal to S1) and distal bony anatomy (sacrum vs pelvis) were included, as was failure of the offset connector. Chronic failures also consisted of pseudarthrosis at distal levels, sacroiliac joint (SIJ) pain, screw halo formation, and painful screw prominence. The intrarater and interrater reliability were both high with Cohen's kappa of 0.91 and an ICC of 0.98, respectively.</p><p><strong>Conclusions: </strong>These data provide a comprehensive and systematic classification scheme of distal complications following long-segment ASD fusion to the sacrum. This new paradigm will allow for more detailed and consistent reporting of distal junctional complications following spinopelvic fusion, with or without supplemental pelvic fixation and/or concomitant SIJ fusion. This classification scheme resulted in high intra- and interrater reliability.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E14"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel classification of coronal malalignment in degenerative lumbar scoliosis for predicting postoperative coronal imbalance: a multicenter cohort study.","authors":"Weipeng Qiu, Zhuoran Sun, Ze Chen, Lianlei Wang, Xinyu Liu, Hongqiang Wang, Yanzheng Gao, Di Zhang, Hui Wang, Xi Yang, Limin Liu, Hui Zhong, Sheng Lu, Chao Chen, Qiang Yang, Zhimin Pan, Haoqun Yao, Weishi Li","doi":"10.3171/2025.3.FOCUS2524","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2524","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the major risk factors of postoperative coronal imbalance (CIB) in patients with degenerative lumbar scoliosis (DLS) and to establish a novel predictive classification system for postoperative CIB.</p><p><strong>Methods: </strong>A multi-institutional, retrospective cohort study was conducted and included 269 patients with DLS who underwent posterior long-segment instrumentation and fusion. Patients were divided into two groups: those with postoperative CIB and those with postoperative coronal balance. Clinical and radiographic data were compared between the two groups. Coronal measurements included the orientation of the C7 plumb line (C7PL), coronal balance distance (CBD), major curve, lumbosacral fractional curve, L4 coronal tilt, L5 coronal tilt, upper instrumented vertebra coronal tilt, and apical vertebral translation. A novel classification was developed based on the factors identified in the multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 104 patients (38.7%) developed postoperative CIB. C7PL orientation and L4 coronal tilt were identified as the most significant predictors of postoperative CIB. Accordingly, patients were classified into 4 types based on their coronal malalignment: type 1a, concave-side C7PL, L4 coronal tilt < 17.5°; n = 84; type 1b, concave-side C7PL, L4 coronal tilt > 17.5°; n = 44; type 2a, convex-side C7PL, L4 coronal tilt < 17.5°; n = 70; and type 2b, convex-side C7PL, L4 coronal tilt > 17.5°; n = 71. Type 2b had the highest incidence of postoperative CIB (73.2%), while type 1a exhibited the lowest risk (8.3%). A distinct distribution of CIB patterns was observed in type 1 and type 2. The receiver operating characteristic curve analysis indicated that the new classification had strong predictive performance for postoperative CIB (area under the curve 0.788, 95% CI 0.733-0.843).</p><p><strong>Conclusions: </strong>The authors propose a novel coronal classification system that improves preoperative risk stratification for postoperative CIB, which may assist in surgical decision-making regarding coronal realignment in DLS surgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199679","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 thoracolumbar inflection point on outcomes and complications in adult spinal deformity.","authors":"Jamshaid M Mir, Justin S Smith, Anthony Yung, Oluwatobi O Onafowokan, Renaud Lafage, Jeffrey Gum, Breton G Line, Bassel Diebo, Alan H Daniels, D Kojo Hamilton, Nitin Agarwal, Thomas J Buell, Justin K Scheer, Robert K Eastlack, Jeffrey P Mullin, Gregory M Mundis, Naobumi Hosogane, Mitsuru Yagi, Neel Anand, Praveen V Mummaneni, Dean Chou, Eric O Klineberg, Khaled M Kebaish, Munish C Gupta, Han Jo Kim, Lawrence G Lenke, Christopher P Ames, Frank J Schwab, Virginie Lafage, Richard A Hostin, Shay Bess, Douglas C Burton, Christopher I Shaffrey, Peter G Passias","doi":"10.3171/2025.3.FOCUS24651","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS24651","url":null,"abstract":"<p><strong>Objective: </strong>Existing literature on the impact of alignment parameters relative to the thoracolumbar inflection point remains sparse. The authors aimed to investigate the influence of the inflection point, lumbar lordosis apex (LLA), and other alignment parameters on complications, reoperations, and clinical outcomes.</p><p><strong>Methods: </strong>Patients with adult spinal deformity who underwent fusion of the lower thoracic spine (T7-12) to pelvis, for whom 2-year data were available, were included. Parameters relative to the inflection point, the inflection point from the upper instrumented vertebra (UIV), the LLA, and the theoretical inflection point based on pelvic incidence in the normative populations from Roussouly morphology were assessed. Patients were evaluated based on inflection point changes of at least 1 level from baseline and stratified into caudal, same, and cranial groups. The analysis controlled for invasiveness, baseline deformity, frailty, and PJK prophylaxis.</p><p><strong>Results: </strong>A total of 435 patients (mean age ± SD 65 ± 8 years) were included in the study. The mean baseline inflection point was at the L1-2 interbody space, which was corrected more cranial to the L1 body after surgery. Development of proximal junctional failure (PJF) or proximal junctional kyphosis (PJK) with reoperation was associated with a more caudal baseline inflection point (L2 inferior endplate vs L1 body, p < 0.001). In the adjusted analysis, patients with a more caudal baseline inflection point had 25% higher odds of developing PJF by 2 years (OR 1.26 [95% CI 1.08-1.46], p = 0.003). Postoperative normalization to the theoretical Roussouly inflection point had decreased rates of rod breakage (4.5% vs 9.3%, p = 0.049) but higher rates of PJF (13.1% vs 7.7%, p = 0.044). Stratifying patients based on inflection point change from baseline, rates of PJK and PJF 2 years after surgery were higher in the cranial group (both p < 0.003), with no difference in meeting the Roussouly target inflection point. Compared with the cranial group, there was 4.4 times lower odds of developing PJF in the caudal group and 2.0 times lower odds in the group with the same inflection point (p < 0.05). Increased distance from the UIV to the inflection point was associated with mechanical complications (MCs) (p < 0.05). Decreased distance between the LLA and inflection point at baseline was associated with MC (p = 0.04).</p><p><strong>Conclusions: </strong>Although correction of the inflection point to normative values decreased rates of MC, PJK rates remain high suggesting other factors being at play. These correlations between the inflection point and the UIV and LLA underscore the pivotal role of the inflection point in achieving adequate realignment.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E8"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199695","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}