Neurosurgical focus最新文献

{"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":"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}

{"title":"Introduction. Scoliosis surgery in adults: navigating complexity and optimizing outcomes.","authors":"Daniel M Sciubba, Camilo Molina, Kristen E Jones, Benjamin D Elder, Stephen J Lewis","doi":"10.3171/2025.3.FOCUS24673","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS24673","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199697","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":"Implications of lumbosacral transitional anatomy on vertebral numbering: evaluation of 3147 adult full-length spine radiographs.","authors":"Shahbaaz A Sabri, Renzo A Laynes, Clayton J Hoffman, Joseph C Chavarria, Parker J Prusick, Rachael E Weesner, Nathanial Stringer, James P Farrell, David Gimarc, Mary K Lowry, Vikas Patel, David Ou-Yang, Evalina Burger-Van Der Walt, Christopher J Kleck","doi":"10.3171/2025.3.FOCUS2555","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2555","url":null,"abstract":"<p><strong>Objective: </strong>When evaluating anomalous vertebral anatomy, limited consensus exists on how to best label vertebrae, leading to numbering discrepancies between radiologists and surgeons. Errors in vertebral numbering can have devastating implications for patients, especially when intraoperative numbering errors occur. Analyzing whole-spine radiographs and identifying patterns of transitional anatomy relative to vertebral numbering could allow for a consistent numbering method.</p><p><strong>Methods: </strong>This single-institution cross-sectional study included patients older than 18 years of age who underwent full-length spine imaging at the University of Colorado Hospital from January 31, 2018, to March 31, 2020. Patients with deformity or congenital fusion were included. A retrospective analysis was performed on full-length spine radiographs obtained in 3147 patients. The number of presacral mobile segments, number of ribs, and presence of hypoplastic or incomplete ribs were identified and recorded. Results were reviewed by a committee of musculoskeletal radiologists, neurosurgeons, and orthopedic spine surgeons, with verification through interobserver analysis.</p><p><strong>Results: </strong>Among 3147 patients (age range 18-89 years), 2868 (91.1%) had the conventional 24 presacral mobile segments (7 cervical, 12 thoracic, 5 lumbar). Transitional anatomy, defined as having fewer or more than 24 presacral segments, was observed in 279 patients (8.8%). Specifically, 174 patients (5.5%) had 25 presacral segments, 104 patients (3.3%) had 23, and 1 patient (0.03%) had 26. Regarding the number of ribbed vertebrae (thoracic), 2976 patients (94.6%) had 12 ribs, including hypoplastic ribs, while 143 (4.5%) had 11 ribs, and 28 (0.88%) had 13 ribs. The co-occurrence of both lumbosacral transitional anatomy and an abnormal number of ribbed vertebrae (thoracic) was least prevalent and observed in 56 patients (1.8%). Considering the first nonribbed vertebra as the first lumbar vertebra aligned with the most prevalent pattern of transitional anatomy.</p><p><strong>Conclusions: </strong>Evaluation of 3147 patients with full-length spine imaging demonstrated a lower prevalence of ribbed vertebral body anatomical variations compared with transitional lumbosacral anatomy. Based on these findings, the authors suggest further investigation of numbering vertebrae in a cranial to caudal progression, designating the first ribbed vertebra as thoracic (T1) and the first nonribbed vertebra in the lumbar spine as lumbar (L1). The clinical impact of a standardized vertebral numbering system is yet to be determined.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E13"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199696","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":"Is the upper arc or lower arc of lordosis more important in avoiding mechanical complications after adult spinal deformity surgery?","authors":"Harsh Jain, Iyan Younus, Lakshmi Suryateja Gangavarapu, Hani Chanbour, Ranbir Ahluwalia, Tyler Zeoli, Adam M Wegner, Julian G Lugo-Pico, Amir M Abtahi, Byron F Stephens, And Scott L Zuckerman","doi":"10.3171/2025.3.FOCUS2576","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2576","url":null,"abstract":"<p><strong>Objective: </strong>Appropriate distribution of the upper and lower arcs of lordosis after adult spinal deformity (ASD) surgery is important in achieving a harmonious spinal shape. In a cohort of patients undergoing ASD surgery, the authors aimed to determine the impact of the preoperative and postoperative upper and lower arcs of lordosis on any mechanical complication, proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), and reoperation for mechanical complications.</p><p><strong>Methods: </strong>A single-institution retrospective cohort study of patients who underwent ASD surgery from 2009 to 2021 was performed. Inclusion criteria were ≥ 5-level fusion, sagittal/coronal deformity, and 2-year follow-up data. The primary exposure variables were the preoperative and postoperative upper and lower lordosis arc angles, as described by Roussouly. Postoperative outcomes included mechanical complications and reoperations, and a separate analysis was performed for PJK/PJF. A bivariate analysis was performed, as well as a multivariable logistic regression analysis controlling for age, sex, BMI, preoperative type of malalignment, interbody fusion type, and osteoporosis.</p><p><strong>Results: </strong>Among the 184 patients (140 females, mean age ± SD 68.6 ± 11.3 years) undergoing ASD surgery who were included, the mean number of instrumented levels was 10.6 ± 3.1. While the upper lordosis arc increased from before to after surgery (11.4° ± 8.8° to 18.5° ± 13.7°, p < 0.001), the lower lordosis arc did not significantly increase (26.0° ± 14.3° to 28.0° ± 14.5°, p = 0.285). Preoperatively, a smaller upper lordosis arc (8.9° ± 8.6° vs 12.1° ± 8.8°, p = 0.046), lower lordosis arc (22.0° ± 12.2° vs 27.1° ± 14.6°, p = 0.049), and total lordosis angle (30.9° ± 14.9° vs 39.1° ± 17.3°, p = 0.008) were found in patients who had PJK/PJF that required reoperation compared with those who did not undergo reoperation for PJK/PJF. A smaller preoperative lower lordosis arc was found in patients with pseudarthrosis (21.7° ± 12.4° vs 27.9° ± 14.6°, p = 0.006) and reoperation due to mechanical complications (22.7° ± 12.3° vs 27.9° ± 15.0°, p = 0.018) compared to those without. Postoperatively, a smaller postoperative lower lordosis arc was found in patients with mechanical complications requiring reoperation (24.5° ± 16.8° vs 30.0° ± 12.8°, p = 0.014) and pseudarthrosis (23.9° ± 17.4° vs 29.8° ± 12.6°, p = 0.011). In the multivariable logistic regression analysis, a smaller preoperative lower lordosis arc was associated with total mechanical complications (OR 0.97, 95% CI 0.94-0.99; p = 0.006), PJK/PJF requiring reoperation (OR 0.97, 95% CI 0.94-1.00; p = 0.021), and mechanical complication requiring reoperation (OR 0.97, 95% CI 0.95-0.99; p = 0.006). Postoperatively, a smaller lower lordosis arc was associated with mechanical complications requiring reoperations (OR 0.97, 95% CI 0.94-0.99; p = 0.014).</p><p><strong>Conclusions: </strong>A sm","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E7"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199698","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 of a novel artificial intelligence model (SpinePose) to automatically and accurately predict spinopelvic parameters using scoliosis radiographs in an external cohort.","authors":"Rushikesh S Joshi, Edward S Harake, Cheng Jiang, Jason J Haselhuhn, Joseph R Linzey, Jaes C Jones, Mark M Zaki, Kari Odland, Zachary Wilseck, Jacob R Joseph, David W Polly, Todd C Hollon, Paul Park","doi":"10.3171/2025.3.FOCUS2574","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2574","url":null,"abstract":"<p><strong>Objective: </strong>SpinePose was developed in 2024 as a novel artificial intelligence (AI) tool to automatically predict spinopelvic parameters with high accuracy and without the need for manual entry. The authors' published results demonstrated excellent performance comparable to a fellowship-trained spine surgeon with more than 15 years of experience. To date, there have not been any studies that have externally validated the performance of AI-based spinopelvic parameter measurement tools on data acquired from other institutions. To assess the generalizability of SpinePose, the authors report its performance on an external set of heterogeneous whole-spine scoliosis radiographs obtained from an outside institution.</p><p><strong>Methods: </strong>SpinePose was trained/validated on a dataset of 761 sagittal whole-spine scoliosis radiographs from a single institution, with expert-level performance on both whole-spine and lumbosacral radiographs. In this study, the existing SpinePose model was used for inference on a new set of 49 whole-spine radiographs acquired at a tertiary academic hospital located out of state. Externally acquired radiographs represented a diverse set of images, incorporating patients who had undergone instrumentation and those who had not, and a wide variety of fusion constructs including complex deformity patients. Predicted measures included sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and T1-pelvic angle (T1PA). Predicted parameter values relative to ground-truth manual annotations were calculated to determine the model's accuracy.</p><p><strong>Results: </strong>Of the 49 images, 35 (71.4%) had instrumentation compared with 51.0% and 57.5% in the original SpinePose training and testing sets, respectively. All 5 parameters in the external dataset were significantly different at baseline compared with the original test set (p < 0.01). SpinePose accurately predicted all 5 spinopelvic parameters without any statistically significant differences: SVA, 50.7 mm vs 52.3 mm (p = 0.85); PT, 27.6° vs 30.5° (p = 0.24); PI, 58.0° vs 61.8° (p = 0.17); LL, 40.4° vs 42.4° (p = 0.77); and T1PA, 24.8° vs 28.0° (p = 0.21) when comparing ground truth annotations with predicted values.</p><p><strong>Conclusions: </strong>SpinePose was able to accurately predict spinopelvic parameters on an external validation cohort that was generated independently from the images on which the model was trained and validated. This highlights the generalizability of SpinePose to be implemented on novel images from other institutions and geographic settings with high accuracy and minimal preprocessing. The implementation of AI tools more broadly will help standardize our ability to both deliver and provide spine care and assist with surgical treatment and management of spine patients.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199705","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":"Early outcomes with virtual surgical planning software and patient-specific instrumentation in adult spinal deformity.","authors":"Joshua H Weinberg, Nathan Ritchey, Joshua L Wang, Ryan G Eaton, Bryan Ladd, Siri Khalsa, David Xu, Stephanus Viljoen, Andrew Grossbach","doi":"10.3171/2025.3.FOCUS259","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS259","url":null,"abstract":"<p><strong>Objective: </strong>Software engineering innovations have led to the development of virtual surgical planning software (VSPS) for deformity correction. VSPS uses calibrated radiographs and machine learning predictive models to simulate postoperative spinopelvic parameters based on corrective techniques and anticipated compensatory/reciprocal changes. The authors aimed to assess the safety and efficacy of deformity correction in adult spinal deformity using VSPS and patient-specific rods manufactured based on a simulated plan.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database was conducted, and 146 patients who underwent long-segment thoracolumbar fusions with pelvic fixation (October 2015-May 2023) with a minimum of 1 year of follow-up for deformity correction consistent with the Scoliosis Research Society (SRS)-Schwab classification were identified. Patients were dichotomized into a VSPS group (61 patients, mean age 62.1 years) and a historical control group (85 patients, mean age 64.3 years) prior to implementing VSPS. Comparative analyses were performed to assess VSPS accuracy and outcomes. Equivalence analysis was performed via the two one-sided t-test method using Cohen's d = 0.5.</p><p><strong>Results: </strong>In the VSPS group, the achieved spinopelvic parameters at 3 months were equivalent to the simulated plan for lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, PI-LL mismatch, sagittal vertical axis (SVA), T1 pelvic angle (T1PA), thoracic kyphosis, and L4-S1 lordosis. Compared with controls, VSPS demonstrated an increased L4-S1 lordosis (p = 0.001) and decreased T1PA (p = 0.001); L4-S1 lordosis within 4.26° (p = 0.989) and T1PA within 3.85° (p = 0.969) were not significantly equivalent. VSPS demonstrated a significant increase in achievement of an SVA < 5 cm (p = 0.026), T1PA < 20° (p = 0.001), and age-adjusted T1PA (p < 0.001). The age-adjusted PI-LL mismatch (p = 0.018), PT (p = 0.002), and SVA (p = 0.021) were equivalent. There was no significant difference in the improvement of 1-year patient-reported outcome measures (PROMs), proximal junctional kyphosis (p = 0.270), or proximal junctional failure (p = 0.290) between the two groups. In the multivariate analysis, VSPS use independently predicted achievement of age-adjusted T1PA (OR 6.51, p = 0.001). The upper instrumented vertebra, number of rods and rod material, and VSPS were not predictors of complications or reoperation for hardware failure. The time interval from the first surgery was not a predictor of complications or age-adjusted spinopelvic parameters.</p><p><strong>Conclusions: </strong>VSPS accurately predicted achieved spinal alignment at 3 months. VSPS has the potential to facilitate global spinopelvic parameter correction, particularly reflected by T1PA and L4-S1 lordosis. However, this study did not demonstrate meaningful improvements in PROMs compared with controls. To justify the i","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E11"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199693","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":"Differences across various ideal lumbar lordosis measurement formulas for patient-specific sagittal alignment goals.","authors":"David W Polly, Jason J Haselhuhn, Nathan Keller, Paul Brian O Soriano, Kari Odland, Kristen E Jones, Jonathan N Sembrano","doi":"10.3171/2025.3.FOCUS2568","DOIUrl":"https://doi.org/10.3171/2025.3.FOCUS2568","url":null,"abstract":"<p><strong>Objective: </strong>Multiple studies in the past have developed equations to determine the ideal lumbar lordosis (ILL) in the sagittal plane. These equations differ but all look to accomplish the same goal of providing the surgeon with specific alignment targets during surgery. To date, no study has compared the different equations of ILL against each other. This study compares 5 target alignment formulas in patients with high, normal, and low pelvic incidence (PI).</p><p><strong>Methods: </strong>The authors conducted a retrospective chart review from January 2015 through April 2022 and reviewed available full-spine standing spine radiographs. They classified patients by their PI: high (65°-95°), normal (50°-60°), and low (30°-45°) and included 5 patients for each classification. They calculated ILL based on the measured PI using 5 different formulas (Global Alignment and Proportion [GAP] score [ILL = 0.62 × PI + 29], Le Huec [ILL = 0.5 × PI + 28], Hyun [ILL = 0.62 × PI + 27.6], Hamamatsu University [ILL = 0.45 × PI + 31.8], and Kelly [ILL = 0.6 × PI + 30]). They compared the different ILL equations to determine if there were significant differences and considered any measurement ± 3° as equivalent to account for measurement variability.</p><p><strong>Results: </strong>Fifteen patients were included in the data analysis (5 patients for each PI classification). The mean PI measurements in the patients were as follows: high, 77.8°; normal, 54.6°; and low, 37.8°. The ILL measurements using the GAP formula were high, 77.2°; normal, 62.9°; and low, 52.4°. The ILL measurements using the Le Huec formula were high, 66.9°; normal, 55.3°; and low, 46.9°. The ILL measurements using the Hyun formula were high, 75.8°; normal, 61.5°; and low, 51.0°. The ILL measurements using the Hamamatsu University formula were high, 66.8°; normal, 56.4°; and low, 48.8°. Finally, the ILL measurements using the Kelly formula were high, 76.7°; normal, 62.8°; and low, 52.7°. Two-way ANOVA using Tukey Honestly Significant Difference post hoc multiple comparisons showed that the GAP, Hyun, and Kelly formulas for calculating ILL significantly differed from Le Huec and Hamamatsu University formulas (p < 0.001).</p><p><strong>Conclusions: </strong>Variation exists among the 5 different ILL equations, with 3 of the formulas being statistically different from the others. One must take note of these differences when considering patient-specific sagittal alignment goals. Further discussion is needed to determine which ILL equation should be widely used.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 6","pages":"E9"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199691","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}