Spine最新文献

{"title":"One Versus Three-Level Fusion in Patients Undergoing Multilevel Lumbar Decompression : Relative Perioperative Risks and Five-Year Revisions.","authors":"Philip P Ratnasamy, Michael J Gouzoulis, Sahir S Jabbouri, Daniel R Rubio, Jonathan N Grauer","doi":"10.1097/BRS.0000000000005130","DOIUrl":"10.1097/BRS.0000000000005130","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess relative odds of perioperative complications, readmissions, and 5-year survival to reoperation for patients undergoing 3-level lumbar decompression who undergo 3-level fusion relative to 1-level fusion.</p><p><strong>Background: </strong>Patients undergoing multilevel lumbar decompression may be indicated for fusion at one or more levels. The question of fusing only one level with indications such as spondylolisthesis or fusing all levels decompressed is of clinical interest in both the short and longer term.</p><p><strong>Patients and methods: </strong>Patients undergoing 3-level lumbar decompression were extracted from the PearlDiver M165Orto database. The subset of these patients undergoing concomitant 3-level and 1-level lumbar fusion were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence and odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis, and a comparative 5-year survival to lumbar spinal reoperation was determined.</p><p><strong>Results: </strong>After matching, 28,276 patients were identified as undergoing 3-level lumbar decompression with 3-level fusion and the same for those undergoing 3-level decompression with 1-level fusion. Controlling for patient age, sex, and Elixhauser Comorbidity Index, patients undergoing 3-level fusion had significantly greater odds ratio (OR) of many 90-day adverse events and aggregated any (OR: 1.42), serious (OR: 1.44), and minor (OR: 1.42) adverse events, as well as readmissions (OR: 1.51; P < 0.0001 for all). Five-year survival to reoperation was significantly lower for those undergoing 3-level decompression with 3-level fusion ( P < 0.0001).</p><p><strong>Conclusions: </strong>Patients undergoing 3-level lumbar decompression who underwent 3-level fusion were found to be at significantly greater odds of 90-day postoperative adverse events, readmissions, and 5-year reoperations relative to those undergoing 1-level fusion. The current data support the concept of limiting fusion to the levels with specific indications in the setting of multilevel lumbar decompressions and not needing to match the decompression and fusion levels.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E242-E247"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073921","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":"Insights Into Chronic Low Back Pain Etiology: Population-Based Genome-Wide Association Study Identifies 18 Risk Loci.","authors":"Amy Elise Martinsen, Sigrid Børte, Mari Spildrejorde, Ben Michael Brumpton, Ingrid Heuch, John-Anker Zwart, Bendik Slagsvold Winsvold","doi":"10.1097/BRS.0000000000005254","DOIUrl":"10.1097/BRS.0000000000005254","url":null,"abstract":"<p><strong>Study design: </strong>Genome-wide association study (GWAS) meta-analysis with downstream analyses.</p><p><strong>Objective: </strong>To explore the genetic architecture of chronic low back pain (cLBP) and identify underlying biological mechanisms that contribute to its development.</p><p><strong>Background: </strong>cLBP is prevalent and debilitating, with many cases having no identifiable biological cause. Current treatment options provide only limited relief, highlighting the need for a deeper understanding of the genetic and molecular factors involved in cLBP pathogenesis. Identifying these factors may lead to more effective, targeted therapies.</p><p><strong>Materials and methods: </strong>We conducted a GWAS meta-analysis involving 325,078 participants from the UK Biobank and the HUNT population studies. This was followed by downstream analyses, including gene prioritization, tissue enrichment analysis, and functional gene set analysis. Genetic loci were examined for their association with cLBP, and gene sets were assessed for functional relevance.</p><p><strong>Results: </strong>Eighteen genetic loci associated with cLBP were identified corresponding to as many prioritized genes, including 8 novel genes not previously linked to the condition. Tissue enrichment analysis highlighted significant involvement of hippocampal brain tissue, suggesting central memory processes may contribute to cLBP. Functional gene set analysis identified 37 gene sets, many related to transcription factors involved in bone and cartilage maintenance. Literature on the prioritized genes suggested a potential role for neurological, cartilaginous, and inflammatory mechanisms, including genes implicated in the innervation of intervertebral discs, inflammatory cell death, and central sensitization. Comparison with previous GWASs indicated potential differences between individuals who seek medical care and those who do not.</p><p><strong>Conclusion: </strong>This study enhances our understanding of the genetic basis of cLBP, revealing distinct biological mechanisms and suggesting the existence of patient subgroups with differing treatment needs. These insights may pave the way for more tailored and effective treatment approaches in the future.</p><p><strong>Level of evidence: </strong>Level III-observational study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"881-889"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984437","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":"Long-Term Loss of Alignment Following ASD Surgery in the Absence of Mechanical Complications: Aging Spine?","authors":"Sleiman Haddad, Eva Jacobs, Susana Núñez-Pereira, Aleix Ruiz de Villa, Anika Pupak, Maggie Barcheni, Manuel Ramírez Valencia, Javier Pizones, Frank S Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Ahmet Alanay, Ibrahim Obeid, Ferran Pellisé","doi":"10.1097/BRS.0000000000005142","DOIUrl":"10.1097/BRS.0000000000005142","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a prospective multicenter adult spinal deformity (ASD) registry.</p><p><strong>Objective: </strong>Assess whether spinal alignment deteriorates postsurgery in the absence of mechanical complications and evaluate the long-term outcomes of ASD surgery over a 5-year period.</p><p><strong>Summary of background data: </strong>ASD is prevalent among older adults, leading to significant pain and disability. Surgical intervention, although increasingly popular, is associated with complications, high costs, and uncertain long-term outcomes beyond 2 years. Mechanical failure and alignment loss often necessitate revision surgeries, but the natural progression of spinal alignment postsurgery without complications remains unclear.</p><p><strong>Methods: </strong>Clinical and radiological data were analyzed from surgical patients in a multicenter ASD registry who maintained alignment within the instrumented region and completed a 5-year follow-up. The study evaluated patient demographics, surgical details, radiological parameters, and quality of life (QoL) outcomes. Subanalyses were conducted to compare patients with different initial postoperative alignments and fixation levels.</p><p><strong>Results: </strong>The study included 79 patients (83.5% women, average age 61.9 y) with a mean of 10.7 fused levels. Of these, 29.1% underwent 3-column osteotomies (3CO), and 88.6% had a posterior-only approach. Although 65% showed favorable alignment at 6 weeks postsurgery, there was a progressive deterioration in global sagittal alignment (Global Tilt/RSA) and thoracic kyphosis over 5 years ( P <0.05), along with increased pelvic compensation (PT SS/RPV). These changes did not correlate with worsening health-related quality-of-life outcomes ( P >0.05). Older age was linked to greater progression in T2-T12 kyphosis, and osteoporosis was associated with increased SVA and RPV. Optimal immediate postoperative sagittal alignment did not prevent this \"aging effect.\"</p><p><strong>Conclusions: </strong>ASD surgery and achieving ideal postoperative alignment do not prevent the ongoing \"aging\" of the noninstrumented spine. Both thoracic and global sagittal alignments deteriorate over time. Although no functional decline has been observed, the implications of these changes for surgical planning remain uncertain.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"909-915"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133852","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":"Long-term Clinical Outcomes and Optimal Treatment Approaches of Degenerative Cervical Spondylosis: A 12-Year Multicenter Retrospective Cohort Study.","authors":"Pan Li, Runbo Lei, Lixiang Ding, Youxue Wang, Zhengxu Ye, Dechen Yu, Kangkang Su, Xuerui Yang, Bin Wei, Jinfeng Huang, Xiongfei Cao, Le Chang, Yongfeng Chen, Lu Gan, Junjie Du, Lei Shangguan, Mo Li, Zhuojing Luo","doi":"10.1097/BRS.0000000000005266","DOIUrl":"10.1097/BRS.0000000000005266","url":null,"abstract":"<p><strong>Study design/setting: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis.</p><p><strong>Summary of background data: </strong>ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, whereas SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters.</p><p><strong>Results: </strong>The CDR group exhibited a significantly higher overall success rate compared with CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved the angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristics and calibration curves.</p><p><strong>Conclusion: </strong>This study suggests that CDR provides similar clinical outcomes with fewer complications compared with ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and the potential for selection bias.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"890-901"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012160","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":"Focused Perioperative Nutritional Supplementation Reduces Wound Complications in Patients Undergoing Spinal Fusion Surgery.","authors":"Christopher J Como, Joshua C Setliff, Jonathan F Dalton, Yunting Melissa Tang, Anthony A Oyekan, Kimberly Hua, Kevin Byrne, Shaan Sadhwani, Michael Spitnale, Kira L Russell, Richard Wawrose, Joon Y Lee, Jeremy D Shaw","doi":"10.1097/BRS.0000000000005136","DOIUrl":"10.1097/BRS.0000000000005136","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To evaluate intensive postoperative nutritional supplementation on wound healing complications and outcomes after spinal fusion surgery.</p><p><strong>Background: </strong>Poor nutritional status leads to inferior postoperative outcomes by increasing mortality and predisposing patients to infection and wound-healing complications. While perioperative nutritional supplementation has shown promise in mitigating these risks, there is a paucity of literature regarding specific nutritional routines in spinal fusion surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on patients who underwent spinal fusion surgery between 2019 and 2022. Demographic and nutritional data, including preoperative prealbumin (PAB) levels and postoperative supplemental diet, were examined. Primary endpoints included wound complications, with secondary outcomes assessing Oswestry Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Health (PH) scores. Statistical analyses included unpaired t tests and χ 2 /Fischer exact tests with significance set at P <0.05.</p><p><strong>Results: </strong>Patients receiving the supplemental diet (n=229) demonstrated fewer wound complications (7% vs . 21%, P =0.004) and reoperations (3% vs . 11%, P =0.016) compared with those without supplementation (n=56). No significant differences were observed in preoperative or postoperative PROMIS PH or ODI scores. Patients with normal preoperative PAB had more wound complications without the supplemental diet (5% vs . 18%, P =0.025). A similar trend was seen in the patients with low preoperative PAB (12% vs . 26%, P =0.12).</p><p><strong>Conclusion: </strong>Postoperative nutritional supplementation significantly reduces wound complications after spinal fusion surgery in a cost-effective manner. This study underscores the modifiability of certain perioperative risk factors and suggests that nutritional strategies can mitigate potential complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E253-E258"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112302","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":"Effect of a Surgeon-Directed Cocktail of Ropivacaine, Methylprednisolone, and Ketoprofen on Postoperative Pain and Ambulation in Adolescent Idiopathic Scoliosis Surgery: A Double-Blind Randomized Controlled Trial.","authors":"Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Koichiro Ide, Kenta Kurosu, Yosuke Shibata, Yukihiro Matsuyama","doi":"10.1097/BRS.0000000000005314","DOIUrl":"10.1097/BRS.0000000000005314","url":null,"abstract":"<p><strong>Study design: </strong>Double-blind randomized controlled trial.</p><p><strong>Objective: </strong>To assess the safety and efficacy of surgeon-directed intraoperative subfascial cocktail analgesics in adolescent scoliosis surgery.</p><p><strong>Summary of background data: </strong>Several studies have demonstrated the efficacy of intraoperative surgeon-directed analgesics in idiopathic scoliosis surgery. However, their retrospective analyses provided limited clinical evidence. Are cocktail analgesics effective in improving postoperative pain in idiopathic scoliosis surgery? Can surgeon-directed intraoperative cocktail analgesics improve postoperative pain scores and help patients ambulate?</p><p><strong>Methods: </strong>Forty-two adolescent patients (mean age 15.8±2.1 yr, 31 females) were randomly assigned to two groups: one receiving cocktail analgesics (21 patients), and the other serving as a control (21 patients). The cocktail consisted of 0.75% ropivacaine, methylprednisone, and ketoprofen. The primary outcome measured was postoperative pain (NRS). Secondary outcomes included ambulation timing, fentanyl and acetaminophen usage. Epidural anesthesia usage was recorded but not analyzed as an independent outcome since perceived pain severity may have influenced its administration.</p><p><strong>Results: </strong>Forty-two patients (mean age: 15.8±2.1 yr, 31 females) were included. Both groups had comparable baseline characteristics, including age, sex distribution, and preoperative curve severity. The cocktail group showed significantly lower pain scores one-hour post-surgery (4.1±3.7 vs. 5.6±2.9, P =0.044) and ambulated earlier (2.5±0.5 vs. 3.3±2.5 d, P =0.049). However, there were no significant differences in pain scores after six hours or in fentanyl/acetaminophen consumption. Adverse events attributable to the procedures were comparable between both groups.</p><p><strong>Conclusions: </strong>Surgeon-directed cocktail therapy alone is insufficient to achieve significant improvements in pain control, as evidenced by the minimal impact on NRS scores and early ambulation promotion. Clinically, this underscores the need for more comprehensive, multimodal pain management strategies to optimize postoperative recovery and enhance outcomes for patients with adolescent scoliosis.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"902-908"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731662","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":"Letter to the Editor \"Adjacent Level Canal Area Changes up to Two Years After Lumbar Spinal Stenosis Decompressive Surgery\" by Brisby et al.","authors":"Yingjie Xu, Yongguang Wang","doi":"10.1097/BRS.0000000000005368","DOIUrl":"10.1097/BRS.0000000000005368","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E268"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019779","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":"Sex Differences in Patient-Rated Outcomes After Lumbar Spinal Fusion for Degenerative Disease: A Multicenter Cohort Study.","authors":"Olga Ciobanu-Caraus, Alexandra Grob, Jonas Rohr, Vittorio Stumpo, Luca Ricciardi, Nicolai Maldaner, Hubert A J Eversdijk, Moira Vieli, Antonino Raco, Massimo Miscusi, Andrea Perna, Luca Proietti, Giorgio Lofrese, Michele Dughiero, Francesco Cultrera, Marcello D'Andrea, Seong B An, Yoon Ha, Aymeric Amelot, Jorge B Cadelo, Jose M Viñuela-Prieto, Maria L Gandía-González, Pierre-Pascal Girod, Sara Lener, Nikolaus Kögl, Anto Abramovic, Christoph J Laux, Mazda Farshad, Dave O'Riordan, Markus Loibl, Fabio Galbusera, Anne F Mannion, Alba Scerrati, Pasquale De Bonis, Granit Molliqaj, Enrico Tessitore, Marc L Schröder, Martin N Stienen, Giovanna Brandi, Luca Regli, Carlo Serra, Victor E Staartjes","doi":"10.1097/BRS.0000000000005183","DOIUrl":"10.1097/BRS.0000000000005183","url":null,"abstract":"<p><strong>Study design: </strong>Heterogeneous data collection through a mix of prospective, retrospective, and ambispective methods.</p><p><strong>Objective: </strong>To evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease.</p><p><strong>Summary of background data: </strong>Current literature suggests sex differences regarding clinical outcome after spine surgery may exist. Substantial methodological heterogeneity and limited comparability of studies warrants further investigation of sex-related differences in treatment outcomes.</p><p><strong>Materials and methods: </strong>We analyzed patients who underwent spinal fusion with or without pedicle screw insertion for lumbar degenerative disease included within a multinational study, comprising patients from 11 centers in seven countries. Absolute values and change scores (change from preoperative baseline to postoperative follow-up) for 12-month functional impairment [Oswestry disability index (ODI)] and back and leg pain severity [numeric rating scale (NRS)] were compared between male and female patients. Minimum clinically important difference (MCID) was defined as >30% improvement.</p><p><strong>Results: </strong>Six-hundred sixty (59%) of 1115 included patients were female. Female patients presented with significantly baseline ODI (51.5±17.2 vs. 47.8±17.9, P <0.001), back pain (6.96±2.32 vs. 6.60±2.30, P =0.010) and leg pain (6.49±2.76 vs. 6.01±2.76, P =0.005). At 12 months, female patients still reported significantly higher ODI (22.76±16.97 vs. 20.50±16.10, P =0.025), but not higher back (3.13±2.38 vs. 3.00±2.40, P =0.355) or leg pain (2.62±2.55 vs. 2.34±2.43, P =0.060). Change scores at 12 months did not differ significantly among male and female patients in ODI (∆1.31, 95% CI: -3.88 to 1.25, P =0.315), back (∆0.22, 95% CI: -0.57 to 0.12, P =0.197), and leg pain (∆0.16, 95% CI: -0.56 to 0.24, P =0.439). MCID at 12 months was achieved in 330 (77.5%) male patients and 481 (76.3%) female patients ( P =0.729) for ODI.</p><p><strong>Conclusion: </strong>Both sexes experienced a similar benefit from surgery in terms of relative improvement in scores for functional impairment and pain. Although female patients reported a higher degree of functional impairment and pain preoperatively, at 12 months only their average scores for functional impairment remained higher than those for their male counterparts, while absolute pain scores were similar for female and male patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"924-931"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Ligamentous Augmentation is Associated With Reduced Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis of 1333 Patients.","authors":"Pavlos Texakalidis, Stavros Matsoukas, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler R Koski, Nader S Dahdaleh","doi":"10.1097/BRS.0000000000005299","DOIUrl":"10.1097/BRS.0000000000005299","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To evaluate the impact of posterior ligamentous augmentation (PLA) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background data: </strong>Adult spinal deformity (ASD) surgery is frequently complicated by PJK and PJF, with reported rates ranging from 17% to 61.7%. Techniques such as PLA, which involves spinous process or sublaminar tethering at the upper instrumented vertebra (UIV) +1 or +2, have been investigated as potential methods to mitigate these complications.</p><p><strong>Materials and methods: </strong>A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Most studies defined PJK as an increase of ≥10° or ≥20° in the sagittal Cobb angle from UIV to UIV+2 compared with preoperative measurements. PJF was defined as PJK necessitating revision surgery.</p><p><strong>Results: </strong>Eight comparative studies comprising 1333 patients (PLA: 579; no PLA: 754) were included. The mean age ranged from 55 to 68.6 years across studies, with a mean follow-up period of 17.6 to 31.2 months. There were no significant differences between the PLA and no PLA groups in terms of age (MD: 2.53; 95% CI: -0.28 to 5.34, I2 : 64.8%), BMI (MD: 1.03; 95% CI: -0.87 to 2.93, I2 : 69%), or sagittal vertical axis (SVA) preoperatively (MD: 3.92; 95% CI: -1.90 to 9.75, I2 : 73.1%) and postoperatively (MD: -1.54; 95% CI: -4.10 to 1.01, I2 : 56.2%). However, the PLA group demonstrated significantly lower odds of developing PJK compared with the no PLA group (PLA: 25.8%; no PLA: 28.8%; OR: 0.54; 95% CI: 0.34-0.85, I2 : 37.4%). Furthermore, PLA was associated with significantly lower odds of PJF (PLA: 3.3%; no PLA: 12.3%; OR: 0.23; 95% CI: 0.12-0.47, I2 : 17.9%).</p><p><strong>Conclusions: </strong>PLA in ASD surgery is associated with reduced odds of developing PJK and PJF over a follow-up period of 17.6 to 31.2 months.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"932-939"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459557","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":"Preoperative Symptom Duration and the Effect on Clinical Outcomes and PROMIS-PF in Patients Undergoing Lumbar Fusion Surgery.","authors":"Andrea H Johnson, Jane C Brennan, Parimal Rana, Sarah Hall, Justin J Turcotte, Chad Patton","doi":"10.1097/BRS.0000000000005134","DOIUrl":"10.1097/BRS.0000000000005134","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>The purpose of this study is to examine the effect of preoperative symptom duration on postoperative clinical outcomes for patients undergoing lumbar fusion surgery.</p><p><strong>Summary of background data: </strong>Lumbar fusion surgery can be significantly beneficial for lumbar spondylolisthesis and spinal stenosis. Surgical treatment is typically preceded by some amount of nonoperative intervention and there is no consensus on the optimal timing between symptom onset and surgical intervention.</p><p><strong>Materials and methods: </strong>A retrospective review of 144 patients undergoing a one-level to three-level lumbar fusion from June 2020 to December 2023 was performed. Demographics, preoperative symptom onset, primary diagnosis, and surgical procedure were compared between patients with less than or greater than two years of symptoms. Postoperative outcomes and PROMIS-PF were compared between groups. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Fifty-two (36.1%) had symptoms for two years or longer while 92 (63.9%) had symptoms for less than two years. There was no difference in demographics, procedure type, primary diagnosis, or preoperative symptoms between those who had symptoms for greater than or less than two years. Those who had symptoms for 2+ years had a significantly lower change in PF (4.7±7.1 vs. 7.7±9.0; P =0.029) and lower rate of MCID achievement (44.2% vs. 65.2%; P =0.023). There was no difference in outcomes by symptom duration. On multivariate analysis those with symptoms of two years or more were 2.4 times less likely to achieve an MCID (OR: 0.42, 95% CI: 0.19-0.92; P =0.031).</p><p><strong>Conclusion: </strong>Patients undergoing lumbar fusion with greater than two years of symptoms before surgery have a smaller increase in PROMIS-PF and are less likely to achieve MCID on PROMIS-PF. Further study is needed to determine the optimal timing for lumbar fusion surgery following symptom onset.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E248-E252"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081602","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}