Spine最新文献

{"title":"The Effect of Night-time Versus Full-time Bracing on the Sagittal Profile in Adolescent Idiopathic Scoliosis : A Propensity Score-matched Study.","authors":"Martin Heegaard, Lærke Ragborg, Amy L McIntosh, Megan E Johnson, Martin Gehrchen, Daniel J Sucato, Benny Dahl, Søren Ohrt-Nissen","doi":"10.1097/BRS.0000000000005175","DOIUrl":"10.1097/BRS.0000000000005175","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective multicenter cohort study.</p><p><strong>Objective: </strong>To investigate the impact of night-time bracing (NTB) and full-time bracing (FTB) on the sagittal profile in patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Background: </strong>Recent studies have shown that FTB in patients with AIS may induce hypokyphosis. Whether this effect differs between NTB and FTB is unknown.</p><p><strong>Materials and methods: </strong>We included skeletally immature patients with AIS with main curves ranging from 20° to 45° treated with either NTB or FTB. The 2 cohorts were propensity-score matched on Risser stage, age, major curve size, and kyphosis at brace initiation. Coronal and sagittal radiographic parameters were gathered at the initiation and completion of brace treatment.</p><p><strong>Results: </strong>Two hundred fifty-seven patients were eligible for inclusion. The matched cohorts included 62 patients in each group. During bracing, the thoracic kyphosis increased from 31 ± 11° to 35 ± 13° in the NTB group compared with a decrease from 30 ± 12° to 28 ± 13° in the FTB group ( P = 0.011). Of the total, 8% were hypokyphotic (<20°) after bracing in the NTB group compared with 24% in the FTB group ( P = 0.015). Pelvic incidence, sacral slope, and pelvic tilt were not significantly different between the groups. In the coronal plane, curve progression >50° was seen in 50% of the NTB group and 31% in FTB ( P = 0.028).</p><p><strong>Conclusion: </strong>We saw a small increase in thoracic kyphosis in the NTB group versus a small decrease in the FTB group. After bracing, 8% in the NTB group versus 24% in the FTB group showed substantial hypokyphosis. The impact of minor changes in thoracic kyphosis remains uncertain; however, a 3-fold difference in the occurrence of hypokyphosis is notable and merits further attention.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1035-1041"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393529","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 Reoperation Rates After Single-Level Lumbar Discectomy: A Nationwide Cohort Study.","authors":"Suhas K Etigunta, Andy M Liu, Adeesya Gausper, Vivien Chan, Justin Scheer, Tiffany Perry, David L Skaggs, Corey Walker, Alexander Tuchman","doi":"10.1097/BRS.0000000000005328","DOIUrl":"10.1097/BRS.0000000000005328","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aims to evaluate reoperation rates following single-level lumbar discectomy.</p><p><strong>Background: </strong>Reoperation rates following single-level lumbar discectomy are debated, with reports ranging from 5% to 24%. Accurately characterizing these rates is essential for provider and patient education.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted using the PearlDiver database. Patients aged 18 or older with a minimum of 5 years follow-up after a single-level lumbar discectomy were included. The primary outcome was subsequent lumbar surgery rate at 5 years. Secondary analysis evaluated subsequent lumbar surgery following revision discectomy, lumbar fusion rate after primary or revision discectomy, and risk factors for subsequent lumbar surgery. Kaplan-Meier analysis and Cox regression models were employed.</p><p><strong>Results: </strong>There were 308,979 patients included in this study. The 5-year subsequent lumbar surgery rate was 14.4%, and the 5-year subsequent lumbar fusion rate was 6.1%. There were 67,098 patients who received revision discectomy. Of those, 5-year subsequent lumbar surgery rate was 18.2%, and subsequent lumbar fusion rate was 12.4%. Kaplan-Meier curves demonstrated that the probability of avoiding subsequent lumbar surgery decreased more rapidly within the first year following both index and revision discectomy. Cox regression identified obesity (hazard ratio = 1.12, 95% CI = 1.097, 1.141) and higher Elixhauser Comorbidity Index (hazard ratio = 1.06, 95% CI = 1.060, 1.068) as significant predictors of subsequent lumbar surgery following index discectomy.</p><p><strong>Conclusion: </strong>Five-year subsequent lumbar surgery rate following single-level lumbar discectomy was 14.4%, with a higher rate of 18.2% following revision discectomy. This is the largest cohort to date studying reoperation rates after single-level lumbar discectomy. Patients should be counseled regarding the significant risk of subsequent surgeries, particularly after revision discectomy. Fusion procedures were more frequently performed after revision discectomy, underscoring the need to carefully consider surgical planning and patient selection in recurrent lumbar disc herniation cases.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1052-1057"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630732","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":"Pedicle Screw Placement With Augmented Reality Versus Robotic-Assisted Surgery.","authors":"Franziska C S Altorfer, Michael J Kelly, Fedan Avrumova, Marco D Burkhard, Jiaqi Zhu, Frederik Abel, Frank P Cammisa, Andrew Sama, Mazda Farshad, Darren R Lebl","doi":"10.1097/BRS.0000000000005147","DOIUrl":"10.1097/BRS.0000000000005147","url":null,"abstract":"<p><strong>Study design: </strong>This was a single-center prospective clinical and radiographic analysis of pedicle screw instrumentation with robotic-assisted navigation (RAN) and augmented reality (AR).</p><p><strong>Objective: </strong>This study aimed to compare the accuracy of lumbosacral pedicle screw placement with RAN versus AR.</p><p><strong>Summary of background data: </strong>RAN and AR have demonstrated superior accuracy in lumbar pedicle screw placement compared with conventional free-hand techniques. RAN and AR techniques both tout-specific advantages over their counterparts, but to date, no study has directly compared the two technologies regarding pedicle screw accuracy.</p><p><strong>Patients and methods: </strong>Patients who underwent RAN or head-mounted AR navigated lumbosacral (L1-S1) pedicle screw placement for degenerative conditions were included. Screw accuracy was assessed by two independent reviewers on intraoperative 3D fluoroscopic scans using the Gertzbein and Robbins scale. A generalized linear mixed model was applied to evaluate the relationship between the screw placement technique and accuracy.</p><p><strong>Results: </strong>Two hundred and twelve patients undergoing lumbosacral instrumentation with a total of 1211 pedicle screws placed using RAN (n=108; screws=827) or AR (n=104; screws=384). Overall, grade A was achieved in 92.6% of screws. No significant difference was found between RAN and AR screw placement regarding the incidence of accurate (grade A and B screws; RAN n=824; 99.6% and AR n=379, 98.7%) versus inaccurate screws (grade C and D screws; RAN n=3, 0.4% and AR n=5, 1.3%). When comparing \"optimal\" grade A screws (RAN n= 787, 95.2%, AR n=345, 89.8%) versus all other screws (B, C, and D), significantly higher accuracy was achieved using RAN ( P =0.001).</p><p><strong>Conclusion: </strong>RAN and AR both achieved high accuracy in lumbosacral pedicle screw placement, proving reliable for this procedure. However, RAN resulted in significantly more grade A screw placements than AR.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1058-1064"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133865","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":"Comprehensive Review of Biportal Endoscopic Spine Surgery: History, Techniques, and Implications in Minimally Invasive Spine Surgery.","authors":"Alexander Yu, Samuel Q Li, Laura Ndjonko, Jamie Frost, Daniel Berman, Hyun-Jin Park, Samuel K Cho","doi":"10.1097/BRS.0000000000005335","DOIUrl":"10.1097/BRS.0000000000005335","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objective: </strong>To provide an overview of the evolution of biportal endoscopic spine surgery (BE) and its role in addressing specific challenges in minimally invasive spinal procedures, focusing on its technical features and clinical applications.</p><p><strong>Summary of background data: </strong>Minimally invasive spine surgery has gained momentum due to its ability to reduce tissue damage, postoperative pain, and recovery times compared with traditional open surgery. BE has emerged as an innovative technique, offering unique visualization and maneuverability that allow for addressing complex spinal pathologies with comparable outcomes to other minimally invasive techniques.</p><p><strong>Materials and methods: </strong>This review explores the development of BE, its advantages and disadvantages compared with traditional and full endoscopic spine surgery, and its application in various spinal conditions, based on current literature.</p><p><strong>Results: </strong>BE facilitates enhanced visualization and maneuverability through the use of two independent portals, which allow for precise decompression, discectomy, and fusion procedures with minimal muscle disruption. Studies suggest that BE is well suited for specific cases requiring delicate tissue handling and complex anatomic access. Studies report reduced postoperative pain, shorter hospital stays, and faster recovery compared with traditional methods. While challenges such as longer operation times and learning curves exist, BE offers a valuable alternative to other minimally invasive techniques in procedures like lumbar laminectomy, foraminotomy, and interbody fusion.</p><p><strong>Conclusions: </strong>Biportal endoscopic spine surgery represents an important addition to the arsenal of minimally invasive spine techniques. Its flexibility and adaptability make it a promising option for specific spinal pathologies, particularly in cases where other techniques may pose limitations. Future research should focus on refining surgical protocols, enhancing training frameworks, and expanding the application of BE to other spinal regions and complex conditions.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E289-E298"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658599","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":"Design Factors Affecting the Fixation of Cervical Disc Replacements: A Biomechanical Analysis.","authors":"Jenna M Wahbeh, David A Ballester, Edward Ebramzadeh, Sophia N Sangiorgio","doi":"10.1097/BRS.0000000000005353","DOIUrl":"10.1097/BRS.0000000000005353","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical study.</p><p><strong>Purpose: </strong>The goal of the present study is to explore the connection between various cervical disc replacement designs and the overarching risk of migration.</p><p><strong>Background: </strong>Migration of cervical disc replacements has become an increasingly prevalent complication in clinical use. Despite this, there is a lack of biomechanical studies addressing the relationship between implant design and migration.</p><p><strong>Materials and methods: </strong>Five cervical disc replacement designs were tested in rigid polyurethane models. Before testing, each device had measurements taken of important features: endplate surface roughness, extruding keel/fin heights, device height, ball contact arc, and coverage angle. Each device was subjected to 10,000 cycles of all spinal rotations, and a combined loading pattern of all 3 rotations was applied simultaneously. Sagittal and coronal plane micromotions at the bone-implant interface were continuously measured through all testing. Micromotions were then compared as a function of device design, loading type, and specific fixation features.</p><p><strong>Results: </strong>Overall, one ball-and-socket device, the PCM, had larger cyclic micromotions than all other devices during flexion/extension and lateral bending ( P <0.06). A different ball-and-socket device, the Prestige-ST, had larger overall migrations in the sagittal plane during axial rotation ( P <0.01). When comparing specific device features, trends were identified for three variables: keel/fin height, ball contact arc, and coverage angle. A smaller keel/fin and coverage angle and a larger ball contact arc were associated with an increase in micromotion ( P <0.05, <0.01, <0.01, respectively).</p><p><strong>Conclusions: </strong>This study presents the first quantification of micromotion, representing initial fixation, in cervical disc arthroplasty. Further, findings were generally consistent with clinical literature regarding device migration. This study has identified device-specific trends that may influence micromotion in vivo. These findings or methodology can be utilized to identify successful devices for patients or offer valuable insights into future cervical disc designs.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E299-E307"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804135","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":"Different Risk Factors Between Bony and Ligamentous Proximal Junctional Failure in Patients Undergoing Thoracolumbar Fusion to Pelvis for Adult Spinal Deformity.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005151","DOIUrl":"10.1097/BRS.0000000000005151","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To analyze the risk factors for bony proximal junctional failure (B-PJF) and ligamentous PJF (L-PJF) separately after adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background data: </strong>Despite numerous studies about the risk factors of PJF, it remains unclear whether the same risk factors can be applied to both B-PJF and L-PJF.</p><p><strong>Methods: </strong>Patients who underwent corrective surgery from low thoracic level (T9-T12) to pelvis with a minimum follow-up duration of 2 years were included in this study. Patients with PJF were divided into 2 groups according to the involvement of bony structure: B-PJF and L-PJF. The control group was created using patients who did not develop PJF for ≥2 years postoperatively (no-PJF group). Risk factors were analyzed by comparing various clinical and radiographic parameters between no PJF versus B-PJF group and between no PJF versus L-PJF groups.</p><p><strong>Results: </strong>The final study cohort comprised 240 patients. The mean age was 68.7 years, and there were 205 women (85.4%). On average, 8.1 levels were fused. PJF developed in 103 patients, with 70 (68.0%) in the B-PJF group and 33 (32.0%) in the L-PJF group. Stepwise logistic regression analyses revealed that older age (odds ratio [OR]=1.088), higher body mass index (BMI) (OR=1.161), osteoporosis (OR=3.293), greater postoperative lumbar distribution index (OR=1.032), and overcorrection relative to the age-adjusted pelvic incidence-lumbar lordosis (OR=3.964) were significant risk factors for B-PJF. Meanwhile, no use of a transverse process (TP) hook was the single risk factor for L-PJF (OR=4.724).</p><p><strong>Conclusions: </strong>Understanding the difference in risk factors between B-PJF and L-PJF will facilitate the optimization of surgical outcomes for patients with ASD. Appropriate correction of sagittal malalignment along with the use of a TP hook is advisable to mitigate both B-PJF and L-PJF development.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1065-1073"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133848","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":"Sagittal Femur-Pelvis Balancing Mechanism and Linear Correlation Chain in Patients With Spinal Disorders: A Radiographic Retrospective Analysis.","authors":"Yuxi Liu, Weiguo Zhu, Chao Kong, Xiangyao Sun, Sitao Zhang, Wei Wang, Shibao Lu","doi":"10.1097/BRS.0000000000005344","DOIUrl":"10.1097/BRS.0000000000005344","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To investigate how the femurs and pelvis collaboratively maintain sagittal balance and energy-efficient alignment by investigating sagittal parameters.</p><p><strong>Summary of background data: </strong>Sagittal parameters are increasingly acknowledged as fundamental determinants in sustaining balance and energy-efficient postures. Among numerous parameters, pelvic morphology and retroversion compensation are critical in restoring sagittal imbalance caused by aging and pathologic changes. Despite the significant role of the femurs in the sagittal plane, relevant research remains lacking.</p><p><strong>Methods: </strong>Standing lateral full-length radiographs, including the upper femurs, were obtained from 368 consecutive patients with symptomatic spinal pathologies. Sagittal plane parameters of the thoracic spine, lumbar spine, pelvis, and femurs-such as angulation, tilt, and offset-and pelvic morphology were measured to reflect the sagittal profile. All participants completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires to evaluate health-related quality of life (HRQOL). Relationships between radiographic and clinical parameters were assessed using Pearson correlation coefficients.</p><p><strong>Results: </strong>This cohort (154 males, 214 females) had a mean age of 64.6±11.0 years, height of 163.2±8.5 cm, and BMI of 25.8±3.8 kg/m². The ODI is correlated with the tilt and offset parameters, except those of the pelvic and lumbar regions. Correlations were observed among all tilt and offset parameters regarding offset values, except for TT with PT and LT and TO with PO and LO. These correlations pertain to the symmetry of S1. From the cephalad T1S to the caudal FT, all parameters exhibit the highest correlation with their adjacent parameters.</p><p><strong>Conclusion: </strong>A linear correlation chain exists in the sagittal plane in patients with spinal disorders. The back tilt of a longer femur increases posterior offset more efficiently, shifting the center of gravity backward in patients with spinal disorders. Anterior pelvic tilt relative to the femur reduces the Pelvic-Femur Angle (PFA) to maintain lumbar lordosis and economic sagittal alignment. These collaborative compensatories are crucial for understanding the sagittal balance and alignment of the spine, pelvis, and lower extremities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1042-1051"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Disaggregated Oswestry Disability Index: What is the Most Predictive Subsection for Patient Satisfaction After Lumbar Surgery?","authors":"Jan Hambrecht, Paul Köhli, Roland Duculan, Erika Chiapparelli, Ranqing Lan, Ali E Guven, Gisberto Evangelisti, Marco D Burkhard, Koki Tsuchiya, Maximilian Muellner, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, Alexander P Hughes","doi":"10.1097/BRS.0000000000005154","DOIUrl":"10.1097/BRS.0000000000005154","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of cohort studies.</p><p><strong>Objective: </strong>To analyze how different ODI subsections and their improvement affect patient satisfaction 2 years after elective lumbar surgery for degenerative lumbar spondylolisthesis (DLS).</p><p><strong>Background: </strong>The Oswestry Disability Index (ODI) is crucial in evaluating outcomes of spinal disorders and provides valuable insights into a patient's preoperative status. There is limited information available on the individual characteristics of its subsections and their relation to postoperative patient satisfaction.</p><p><strong>Methods: </strong>Pre- and 2-year postoperative ODI and patient satisfaction were assessed. The analysis included preoperative scores and improvements in each ODI subsection 2 years postoperatively. Satisfaction was rated on a scale of 1 to 5, with scores ≥4 deemed satisfactory. Univariate linear regression and ROC analysis established cutoffs for subsection improvement and postoperative target values to achieve postoperative satisfaction.</p><p><strong>Results: </strong>Two hundred sisty-five patients (60% female, 67±8 y) were included. ODI improvement was achieved in 91%, and postoperative patient satisfaction in 73%. Patients with lower postoperative subsection scores and greater differences between pre- and postoperative scores were more likely to be satisfied (all P <0.001). A postoperative subsection target score of ≤1 was associated with patient satisfaction. Change in degree of pain was the most predictive subsection for satisfaction, with an AUC of 0.84 (sensitivity 79%, specificity 86%). Walking (AUC 0.83, sensitivity 87%, specificity 65%), pain intensity (AUC 0.82, sensitivity 79%, specificity 79%), personal care (AUC 0.82, sensitivity 83%, specificity 68%), and standing (AUC 0.82, sensitivity 83%, specificity 83%) all had an AUC greater than 0.80. The postoperative subsection with the lowest predictability was sleeping (AUC 0.69).</p><p><strong>Conclusions: </strong>Pain domains, walking, standing, and personal care were the subsections with the highest predictability for patient satisfaction. These findings on the correlation between different ODI subscales and patient satisfaction are valuable for improving preoperative education, addressing disability, and ensuring postoperative satisfaction.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E308-E313"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508393","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 Signal Intensity Change in MRI on the Clinical Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study.","authors":"Narihito Nagoshi, Satoru Egawa, Toshitaka Yoshii, Kenichiro Sakai, Kazuo Kusano, Shunji Tsutsui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Satoshi Maki, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Hiroaki Nakashima, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Hiroshi Moridaira, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Kota Watanabe, Hiroshi Taneichi, Shiro Imagama, Yoshiharu Kawaguchi, Katsushi Takeshita, Masaya Nakamura, Morio Matsumoto, Masashi Yamazaki","doi":"10.1097/BRS.0000000000005355","DOIUrl":"10.1097/BRS.0000000000005355","url":null,"abstract":"<p><strong>Study design: </strong>A multicenter prospective cohort study.</p><p><strong>Objective: </strong>To evaluate the clinical significance of intramedullary signal intensity (SI) changes on T2-weighted magnetic resonance imaging (MRI) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) and assess their impact on surgical outcomes.</p><p><strong>Summary of background data: </strong>In OPLL, SI changes on MRI are frequently observed, but their prognostic significance remains unclear. Although some studies associate SI changes with poor neurological function and recovery, others report a weak correlation.</p><p><strong>Methods: </strong>A total of 402 patients with cervical OPLL were analyzed. Patients were classified into SI (+) and SI (-) groups based on preoperative T2-weighted MRI. Clinical outcomes, including the Japanese Orthopaedic Association (JOA) score, the visual analog scale, and the JOA Cervical Myelopathy Evaluation Questionnaire, were evaluated preoperatively and at two years postoperatively. Multiple regression and logistic regression were performed to adjust for confounders.</p><p><strong>Results: </strong>A total of 348 cases (86.6%) were in the SI (+) group. Patients in the SI (+) group were older and had greater cervical range of motion (ROM). They exhibited lower preoperative JOA scores and more severe extremity pain. However, at two-year follow-up, neurological improvement, pain reduction, and patient-reported outcomes did not differ significantly between groups.</p><p><strong>Conclusion: </strong>SI changes on MRI are associated with worse preoperative neurological function and greater pain but do not predict inferior surgical outcomes. Surgical decompression remains effective regardless of SI changes, which can be valuable information for explaining the prognosis to patients in clinical practice.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1019-1024"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804141","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":"Risk Factor Analysis and Risk Prediction Model Construction of Ossification Progression After Postoperative Cervical Ossification of Posterior Longitudinal Ligament.","authors":"Changlin Lv, Jianyi Li, Jianwei Guo, Tianyu Bai, Xiaofan Du, Guodong Zhang, Jiale Shao, Han Zhang, Wenkang Yang, Shiqi Xu, Yukun Du, Jun Dong, Yongming Xi","doi":"10.1097/BRS.0000000000005286","DOIUrl":"10.1097/BRS.0000000000005286","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Objective: </strong>To develop a nomogram to predict the progression of ossification of the posterior longitudinal ligament (OPLL) after surgery, identify potential risk factors, and provide a theoretical basis for preventing postoperative ossification progression.</p><p><strong>Summary of background data: </strong>OPLL is a degenerative condition prevalent in Asian populations, leading to spinal cord and nerve root compression. While surgery is the primary treatment, postoperative ossification progression, particularly after posterior surgeries, remains a challenge, potentially requiring reoperation. Current methods for predicting risk factors rely on clinical experience, highlighting the need for a multidimensional prediction model to identify at-risk patients and improve outcomes.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed 271 patients who underwent posterior cervical spine surgery for OPLL. Univariate and multivariate logistic regression were used to identify independent risk factors for postoperative ossification progression. A nomogram was constructed based on these factors. The model's performance was evaluated using the C-index, ROC curve, calibration curve, and decision curve analysis (DCA), with validation conducted using data from a separate group.</p><p><strong>Results: </strong>Multivariate logistic regression analysis identified four independent risk factors for ossification progression after OPLL. A nomogram was subsequently constructed based on these factors. The C-index values in both the training and validation groups demonstrated high accuracy and stability of the model. The area under the ROC curve (AUC) indicated excellent discriminative ability, while the calibration curves showed high agreement between predicted and observed outcomes in both groups. The decision curve analysis demonstrated that the nomogram provided the highest net clinical benefit within a probability threshold range 0.01 to 1.</p><p><strong>Conclusion: </strong>Younger patients with OPLL, greater initial ossification thickness, more than three affected levels, or continuous/mixed ossification types are at higher risk of postoperative progression. The nomogram provides clinicians with an effective tool to predict and prevent postoperative ossification progression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1025-1034"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120902","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}