Spine最新文献

{"title":"Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on Five-Year Prognosis in Lumbar Spine Surgery.","authors":"Hiroshi Taniwaki, Masatoshi Hoshino, Yuki Kinoshita, Akira Matsumura, Takashi Namikawa, Minori Kato, Shinji Takahashi, Hiroaki Nakamura","doi":"10.1097/BRS.0000000000005040","DOIUrl":"10.1097/BRS.0000000000005040","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the five-year clinical outcomes following lumbar spine surgery.</p><p><strong>Summary of background data: </strong>Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking.</p><p><strong>Materials and methods: </strong>A total of 189 patients who underwent lumbar surgery (≤3 disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75-3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and one, two, and five years postoperatively.</p><p><strong>Results: </strong>Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain ( P =0.013), walking ability ( P =0.005), social life function ( P =0.010) of JOABPEQ, and physical component summary of the SF-36 ( P =0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse five-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score.</p><p><strong>Conclusion: </strong>A high preoperative VBQ score is a risk factor for poor five-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and health care costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"259-265"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945547","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":"Genetic Variants Can Predict the Outcome of Brace Treatment in Patients With Adolescent Idiopathic Scoliosis.","authors":"Zhicheng Dai, Kaixing Min, Zhichong Wu, Leilei Xu, Zhenhua Feng, Yong Qiu, Zezhang Zhu","doi":"10.1097/BRS.0000000000005137","DOIUrl":"10.1097/BRS.0000000000005137","url":null,"abstract":"<p><strong>Study design: </strong>A genetic case-control study.</p><p><strong>Objectives: </strong>To investigate the association between AIS progression-associated SNPs reported by GWAS studies and the effectiveness of brace treatment.</p><p><strong>Summary of background data: </strong>Bracing is the most effective conservative method to treat adolescent idiopathic scoliosis (AIS). Several factors have been reported to be associated with bracing failure in AIS patients. Genetic markers associated with AIS have potential prognostic value.</p><p><strong>Methods: </strong>A retrospective cohort of AIS patients undergoing brace treatment was enrolled in this study and divided into success and failure groups based on treatment outcome. Clinical characteristics of AIS patients were documented. Candidate SNPs were selected from previous GWAS studies of AIS, which were known to be associated with curve progression and validated across diverse populations. Genotype and allele frequencies between the success and failure groups were compared using χ 2 analysis.</p><p><strong>Results: </strong>A total of 259 female AIS patients were included in this study, 30.5% of the well-braced patients had curve progression exceeding 5° and 69.5% of the patients undergo an improvement or progression of <5°. Allele C of rs10738445 ( BNC2 ) could significantly add to the risk of bracing failure, with odds ratio of 1.59. No significant association with bracing outcomes was found for rs12946942 ( SOX9/KCNJ2 ), rs1978060 ( TBX1 ), rs1017861 ( CHD7 ), and rs35333564 ( MIR4300HG ).</p><p><strong>Conclusions: </strong>SNP rs10738445 were significantly associated with brace treatment effectiveness. The other four SNPs were not significantly associated with the outcome of bracing. More SNPs and predictors should be included in future study to develop a more accurate predictive model for clinical application.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"238-242"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112303","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":"Active Rheumatoid Arthritis and Scoliosis: A Mid-Term Cohort Study.","authors":"Shintaro Honda, Koichi Murata, Bungo Otsuki, Takayoshi Shimizu, Takashi Sono, Soichiro Masuda, Koichiro Shima, Masaki Sakamoto, Takayuki Fujii, Akira Onishi, Kosaku Murakami, Hideo Onizawa, Masao Tanaka, Akio Morinobu, Shuichi Matsuda","doi":"10.1097/BRS.0000000000005035","DOIUrl":"10.1097/BRS.0000000000005035","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To elucidate the factors related to the progression of scoliosis in patients with rheumatoid arthritis (RA) using longitudinal cohort data.</p><p><strong>Background: </strong>Of patients, 30% with RA have lumbar scoliosis. However, the effectiveness of current treatment methods in preventing the progression of scoliosis is not well understood due to a lack of longitudinal studies.</p><p><strong>Patients and methods: </strong>We enrolled 180 patients with RA who were followed up for over 2 years, all of whom underwent standing spinal x-rays. These patients were categorized based on their disease activity score-28 with erythrocyte sedimentation rate into 2 groups: (1) those in remission (n = 76) and (2) those in nonremission (n = 104). We evaluated various radiographic measures, including C7 center sacral vertical line, pelvic obliquity, major Cobb angle, and curve location.</p><p><strong>Results: </strong>Fifty-three (29.4%) patients presented progression of scoliosis during a mean follow-up period of 4.8 years. Patients in the nonremission showed larger Cobb angle at baseline and final follow-up, compared with those in remission. The annual progression rate of the curve was also greater in the nonremission group (1.04°/yr) than in the remission group (0.59°/yr, P = 0.001). There was no difference in the incidence of new vertebral fractures. The presence of a baseline Cobb angle of 10° or more [odds ratio (OR): 3.14; 95% CI: 1.38-7.13; P = 0.006], glucocorticoid use (OR: 2.88; 95% CI: 1.18-7.06; P = 0.021), and nonremission at baseline (OR: 2.83; 95% CI: 1.25-6.41; P = 0.012) were significant risk factors for progression of scoliosis.</p><p><strong>Conclusion: </strong>RA disease activity is linked to the progression of scoliosis in patients with RA. Patients with RA who present with initial scoliosis of ≥10°, require glucocorticoids for treatment and are in nonremission at baseline may be at high risk for scoliosis progression.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"252-258"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923239","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":"Infinity: A Prospective Trial for Safety and Accuracy of Navigated Posterior Cervical and Thoracic Instrumentation in Long-segment Fusions.","authors":"Joshua L Wang, Ryan G Eaton, Joravar Dhaliwal, Chi Shing Lam, David S Xu, Stephanus V Viljoen, Andrew J Grossbach","doi":"10.1097/BRS.0000000000005104","DOIUrl":"10.1097/BRS.0000000000005104","url":null,"abstract":"<p><strong>Study design: </strong>Unblinded single-arm prospective clinical trial.</p><p><strong>Objective: </strong>Evaluate safety and accuracy of navigation for placement of posterior cervicothoracic instrumentation.</p><p><strong>Summary of background data: </strong>Computer-assisted stereotactic navigation for placement of spinal instrumentation has been widely studied and implemented in the thoracic and lumbar spine. However less literature exists regarding the use of computer-assisted navigation for posterior cervical instrumentation, particularly with lateral mass fixation. Here we present the first prospective study of navigated cervical lateral mass screw placement for cervicothoracic fusion.</p><p><strong>Methods: </strong>Patients who met indications for posterior cervical fusion were screened, consented, and enrolled preoperatively for instrumentation with medtronic infinity occipital-cervical-thoracic implants, with use of intraoperative O-arm and stereotactic Stealth navigation. Postoperative CTs of the instrumented levels were obtained during the same hospital admission. Primary outcome of the trial was safety. Secondary outcomes were screw accuracy assessed by Gertzbein-Robbins grade, neurologic exams, and patient reported outcomes on the PROMIS 29 questionnaire.</p><p><strong>Results: </strong>A total of 50 patients underwent surgery, and 557 screws were placed. There were no adverse events related to the use of navigation or screw malposition. Gertzbein-Robbins grade A or B placement comprised 95% of navigated screws. There was a decrease in positive Hoffmann sign rate postoperatively, and sensory and motor exams remained stable. There was improvement in patient reported pain and sleep domains.</p><p><strong>Conclusions: </strong>Navigation for cervicothoracic instrumentation is safe overall and leads to high rates of accurately placed screws. Longer term follow-up could provide more insight to whether the use of this technology results in durable improvement in spinal alignment parameters and patient reported outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"224-230"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890133","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":"Pathogenic Detection by Metagenomic Next-generation Sequencing in Spinal Infections.","authors":"Chuqiang Yin, Yanan Cong, Huafeng Wang, Dechun Wang, Xizhong Yang, Xuesong Wang, Ting Wang","doi":"10.1097/BRS.0000000000005148","DOIUrl":"10.1097/BRS.0000000000005148","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective, observational study.</p><p><strong>Objective: </strong>To evaluate the ability and value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from spinal infections.</p><p><strong>Background: </strong>The pathogenic diagnosis of primary spinal infection is challenging. The widespread application of mNGs in clinical practice makes it particularly useful in detecting rare, emerging, and atypical complex infectious diseases.</p><p><strong>Methods: </strong>From January 2019 to December 2023, 120 samples were retrospectively collected from patients suspected of spinal infections and undergoing treatment. Pairwise comparisons between traditional laboratory tests and mNGS were conducted for all cases.</p><p><strong>Results: </strong>Among the 120 cases, 95 were diagnosed as spinal infections, while 25 were classified as noninfectious. Microbiological evidence was found in 59 cases, while 36 cases were clinically diagnosed as spinal infections without definitive microbiological evidence. Rare microorganisms such as Aspergillus fumigatus , Taifanglania major , and Coxiella burnetii were detected by mNGS. The positive rate of mNGS was significantly higher at 88.42% compared with microbiological culture (43.16%), P <0.001. At the genus level, mNGS exhibited a consistency rate of 86.44% (51/59) with confirmed microorganisms. MNGS demonstrated very good agreement with clinically confirmed microorganisms at the genus level (κ=0.833). The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 86.44%, 92.00%, 96.23%, and 74.19%, respectively.</p><p><strong>Conclusions: </strong>The mNGS test exhibits rapidity, efficiency, and accuracy, rendering it of immense diagnostic and therapeutic value in the realm of spinal infection diseases.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E70-E75"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133853","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":"Reply to Concerning the Article: Feasibility of C2 Pedicle Screw Fixation With the \"in-out-in\" Technique for Patients With Basilar Invagination.","authors":"Panjie Xu, Wei Ji","doi":"10.1097/BRS.0000000000005097","DOIUrl":"10.1097/BRS.0000000000005097","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E76-E77"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634579","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":"Surgery With or Without Radiotherapy Versus Radiotherapy Alone for Malignant Spinal Cord Compression : An Updated Meta-analysis.","authors":"Patricio Haro-Perez, Daniela Pinzon-Leal, Prisca Del Pozo-Acosta, Michael Cruz-Bravo, Andrea Ortiz-Ordonez","doi":"10.1097/BRS.0000000000005194","DOIUrl":"10.1097/BRS.0000000000005194","url":null,"abstract":"<p><strong>Study design: </strong>A systematic review and meta-analysis.</p><p><strong>Objective: </strong>To conduct a meta-analysis of studies that compared surgery with or without radiotherapy to radiotherapy alone for patients with malignant spinal cord compression, and a subgroup analysis of patients stratified by hematologic and solid malignancies.</p><p><strong>Summary of background data: </strong>Two previous meta-analyses showed that surgery with or without radiotherapy was better than radiotherapy alone in patients with malignant spinal cord compression. Nevertheless, there was no stratification by tumor type, leading to uncertainty regarding the best approach for patients with hematologic malignancies.</p><p><strong>Materials and methods: </strong>We searched PubMed, Scopus, and Web of Science, for studies comparing surgery with or without radiotherapy to radiotherapy alone in patients with malignant spinal cord compression. The primary outcomes were improvement in ambulatory status and survival at 12 months. For neurological outcomes, we included studies involving both locally advanced primary malignancies of the spine and metastatic tumors. We restricted our analysis to studies on metastases for survival outcomes.</p><p><strong>Results: </strong>We included 2536 patients from 18 studies. Surgery was performed in 890 (35%) patients. The pooled analysis of all studies revealed that improvement in ambulatory status [odds ratio (OR): 2.65; 95% CI: 1.60-4.39] and survival at 12 months (OR: 1.66; 95% CI: 1.10-2.52) were significantly higher in patients who underwent surgery with or without radiotherapy. Improvement in ambulatory status (OR: 1.92; 95% CI: 1.19-3.09) and survival at 12 months (OR: 4.24; 95% CI: 2.35-7.66) were significantly higher in patients with hematologic malignancies in the surgical arm. The primary outcomes were not significantly different between patients with solid malignancies.</p><p><strong>Conclusion: </strong>Surgical intervention demonstrates superior neurological outcomes and increased survival compared with radiotherapy alone. Subgroup analysis revealed that patients with hematologic malignancies in the surgery group experienced superior primary outcomes; however, the high risk of bias of the included studies precludes definitive changes in standard care based on this data. These findings underscore the need for further research regarding the efficacy of surgical versus radiotherapeutic approaches for specific tumor types.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"277-284"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547613","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 on Quality of Life of Full-time and Night-time Braces in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial.","authors":"Alejandro Peiro-Garcia, Rocio G Garcia, Victor Martin-Gorgojo, Inmaculada Vilalta-Vidal, Luis Gonzalez-Gonzalez, Jose M Martin-Moreno, Antonio Silvestre-Muñoz","doi":"10.1097/BRS.0000000000005228","DOIUrl":"10.1097/BRS.0000000000005228","url":null,"abstract":"<p><strong>Study design: </strong>Randomized clinical trial.</p><p><strong>Objective: </strong>To compare the effect on quality of life of night-time (NT) and full-time (FT) brace treatment for adolescent idiopathic scoliosis (AIS).</p><p><strong>Summary of background data: </strong>Conservative treatment of AIS with FT braces has proven to prevent the risk of progression and the need for surgery, with an inversely proportional relationship to the number of hours worn. However, therapeutic adherence and its effect on quality of life continue to pose a clinical challenge.</p><p><strong>Materials and methods: </strong>Open-label clinical trial including AIS patients with curves between 25 and 45° randomized to either NT or FT brace group. Follow-up occurred over 2 years, assessing treatment efficacy through radiographs and quality of life using SRS-22 and visual analog scale (VAS) questionnaire scores at baseline, 6 months, and 12 months. Compliance was monitored with thermal sensors every 3 months. Statistical analyses were conducted, with significance set at P < 0.05.</p><p><strong>Results: </strong>Seventy-eight AIS patients, predominantly females (85.9%), were recruited, including 35 (44.87%) in the FT group and 43 (55.13%) in the NT. Initial Cobb angles were comparable between groups. Nine patients were excluded, and eight required surgery (NT 12.82%, FT 10%). After 2 years, both braces showed similar effectiveness in preventing curve progression. No differences in SRS-22 nor VAS scores were found before treatment. At 6-month follow-up, the NT group reported significantly better outcomes in \"self-image\" compared with FT ( P =0.047). After 1 year, NT patients reported less pain compared with baseline ( P =0.048).</p><p><strong>Conclusions: </strong>According to our results, both braces are equally effective in avoiding the progression of the deformity and need for surgery. However, FT brace has a higher impact on self-image and pain compared with NT brace.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"231-237"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781037","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":"Return to Work After Surgery for Lumbar Disk Herniation: A Nationwide Registry-based Study.","authors":"Sozaburo Hara, Lene Aasdahl, Øyvind Salvesen, Tore Solberg, Sasha Gulati, Karen W Hara","doi":"10.1097/BRS.0000000000005082","DOIUrl":"10.1097/BRS.0000000000005082","url":null,"abstract":"<p><strong>Study design: </strong>An observational registry-based study.</p><p><strong>Objective: </strong>We investigated the long-term patterns of sick leave among patients undergoing surgery for lumbar disk herniation using two nationwide databases to study the achievement of postsurgery return to work (RTW).</p><p><strong>Summary of background data: </strong>The ability to RTW is increasingly recognized as an essential outcome measure for spine surgery.</p><p><strong>Materials and methods: </strong>The study included 13,698 patients aged 18 to 60 on sick leave undergoing surgery for lumbar disk herniation from January 2007 through January 2019. Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration (NAV) were linked. Certified sick leave around the time of surgery was assessed. The patients were further categorized according to the length of presurgery sick leave, and the rate of sustainable RTW for the different groups was compared using survival analysis. The association between successful surgical outcomes, defined by a 30% improvement in Oswestry Disability Index score, and achievement of sustainable RTW was analyzed using a logistic regression model.</p><p><strong>Results: </strong>Two years after surgery, 76% of the patients had returned to work. Shorter presurgery sick leave was associated with a higher proportion and rate of achieved sustainable RTW: Among patients with sick leave of <30 days, a total of 99% achieved sustainable RTW (median: 46 days); only 40% of patients with longer lasting work assessment allowance achieved the same goal within 2 years. Successful surgical outcomes were associated with sustainable RTW for all patient groups, but the impact of surgical success on RTW declined as sick leave extended beyond 180 days.</p><p><strong>Conclusions: </strong>Most patients had returned to work 2 years after lumbar disk herniation surgery. Shorter presurgery sick leave was associated with achieving faster and more sustainable RTW. Successful surgical outcomes had less impact on patients with extended sick leave.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"217-223"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470821","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":"One-Level Versus Two-Level Anterior Lumbar Interbody Fusion (ALIF) From L4 to S1 : Comparison of Complications, Alignment, and Patient Outcomes.","authors":"Manjot Singh, Ashley Knebel, Michael J Kuharski, Joseph E Nassar, Tucker Callanan, Bryce A Basques, Eren O Kuris, Bassel G Diebo, Alan H Daniels","doi":"10.1097/BRS.0000000000005133","DOIUrl":"10.1097/BRS.0000000000005133","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Compare outcomes in patients undergoing one-level or two-level anterior lumbar interbody fusion (ALIF) at L4-S1.</p><p><strong>Background: </strong>Although ALIF may deliver restoration of lumbar lordosis and improvement in clinical outcomes, it also carries risk of complications including major vascular injury. Whether one-level and two-level ALIF offers similar outcomes is not known.</p><p><strong>Materials and methods: </strong>Adults who underwent one-level L4-L5 or L5-S1 ALIF and two-level L4-S1 ALIF at a single academic institution were identified. Patient demographics, procedural characteristics, improvement in spinopelvic alignment, and one-year postoperative patient-reported outcome measures (PROMs) and complications were compared. Multivariate regression analyses, accounting for age, sex, and Charlson comorbidity index (CCI), were also performed.</p><p><strong>Results: </strong>In total, 158 ALIF patients (111 one-level and 47 two-level) were included, with mean age of 51.4 years, 57.0% female, mean CCI of 1.2, and mean follow-up of 27.0 months. Surgical time (147.3 vs. 124.6 min, P =0.002) and hospital length of stay (3.5​​​ vs. 2.9 d, P =0.036) were higher for two-level ALIF. One-year postoperatively, two-level ALIF patients had more caudal apex of lordosis ( P =0.016) and 4.1 mm ( P =0.002) and 2.0 mm ( P =0.019) higher L4-L5 anterior and posterior disc heights, respectively. PROMs were not statistically different across groups ( P >0.05). Finally, two-level ALIF patients were 10.9 times more likely to have in-hospital complications ( P =0.040), such as intraoperative vascular injury (11.1% vs. 1.5%, P =0.040) or postoperative ileus (7.4% vs. 0.0%, P =0.027), than one-level ALIF patients.</p><p><strong>Conclusion: </strong>In this investigation with greater than one-year follow-up, two-level ALIF in the L4-S1 spine had higher procedural time, length of stay, and approach-related complications than one-level ALIF. Although there were minor improvements in alignment with two-level ALIF, PROMs were comparable with improvements from baseline to last follow-up. These findings may help surgeons carefully weigh the risks and benefits of one-level versus two-level ALIF when determining surgical plans for patients.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"271-276"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081601","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}