Spine最新文献

{"title":"How Do Functional Comorbidities Affect PROMIS-PF Scores Following Lumbar Fusion Surgery?","authors":"Joshua Mizels, Jake Connelly, Brook Martin, Brian Karamian, W Ryan Spiker, Brandon D Lawrence, Darrel S Brodke, Nicholas T Spina","doi":"10.1097/BRS.0000000000005153","DOIUrl":"10.1097/BRS.0000000000005153","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review.</p><p><strong>Objective: </strong>The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery and to investigate how the presence of functional comorbidities affects PROMIS PF scores. In addition, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and PROMIS Pain Interference (PI) scores.</p><p><strong>Summary of background data: </strong>National Institute of Health's (NIH) Patient-reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain has been validated in spine surgery. However, little is known about how PROMIS-PF scores are affected by functional comorbidities and how these scores change in patients recovering from lumbar fusion surgery over time. In this study, we hypothesize that functional comorbidities negatively affect recovery.</p><p><strong>Materials and methods: </strong>We retrospectively identified 1893 patients who underwent thoracolumbar, lumbar, or lumbosacral fusion for degenerative conditions between January 2, 2014, and January 7, 2022. We summarized PF at three-month intervals for 2 years following surgery between those with and without functional comorbidity, defined as the presence of congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), or paraplegia. Mixed effects multivariable regressions were used to model between group trends in PF through 2 years postoperatively controlling for age, gender, indication, and surgical invasiveness. The minimally clinically important difference (MCID) was defined as 5+ point improvement from baseline in PF.</p><p><strong>Results: </strong>The cohort includes 1224 (65%) patients without functional comorbidity and 669 (35%) with functional comorbidity. The mean age was 65.0, and the Charlson index was 1.0 in the cohort without functional comorbidity compared with 65.4 and 3.8 in the cohort with functional comorbidity ( P =0.552 and <0.001, respectively). The groups were otherwise similar with respect to surgical invasiveness index, vertebral levels, and spine diagnosis (all P >0.05). At 24 months postoperatively, the functional comorbidity group had a 2.5-point lower absolute PF score and a 1.3-point less improvement from baseline ( P =0.012 and 0.190, respectively). 19.3% of patients in the functional comorbidity group achieved the MCID compared with 80.9% in patients without functional comorbidity ( P <0.001).</p><p><strong>Conclusions: </strong>Based on PROMIS PF scores, patients with functional comorbidities do not recover to the same extent and are less likely to achieve an MCID compared with patients without baseline functional comorbidities. PROMIS-PF can help benchmark patients along their recovery, and other metrics may be needed to better understand the recovery of patients with functional comorbidities.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"383-388"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133850","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 Evolution of Curve Patterns in Adolescent Idiopathic Scoliosis During Chêneau Brace Treatment.","authors":"Hao Hou, Dong Guo, Haonan Liu, Yanzhong Luo, Ziming Yao, Lei Feng, Jun Cao, Rongxuan Gao, Xuejun Zhang","doi":"10.1097/BRS.0000000000005059","DOIUrl":"10.1097/BRS.0000000000005059","url":null,"abstract":"<p><strong>Study design/setting: </strong>This retrospective study analyzed bracing outcomes in patients with adolescent idiopathic scoliosis (AIS), focusing on curve pattern changes and brace efficacy.</p><p><strong>Objective: </strong>To analyze the effectiveness of the Chêneau brace across different curve patterns and to evaluate the tendencies in curve evolution during treatment.</p><p><strong>Background: </strong>AIS presents diverse curve patterns, each responding differently to bracing. Understanding these variations is crucial for optimizing treatment strategies.</p><p><strong>Patients and methods: </strong>The study included 177 patients with AIS treated with Chêneau orthoses, categorized based on curve patterns as per the main curve and modified Lenke (mLenke) classifications. We compared patients according to curve patterns and assessed changes in curve magnitude and pattern before and after treatment.</p><p><strong>Results: </strong>Over an average follow-up of 28.1 ± 10.7 months, the primary curve magnitude decreased from 28.8 ± 6.6° to 25.9 ± 10.5°. Significant reductions were observed in mLenke V and VI patients ( P < 0.05). Patients with main lumbar curves showed better initial in-brace correction and curve control compared with those with main thoracic curves ( P < 0.05). In single-curve patterns, binary logistic regression indicated that mLenke V patients demonstrated higher rates of curve control compared with mLenke I patients ( P < 0.05). No significant differences were found in double-curve patterns between mLenke III and VI ( P > 0.05). At the final follow-up, thoracolumbar/lumbar curves improved significantly in mLenke III and VI patients ( P < 0.05), whereas thoracic curves did not ( P > 0.05). Furthermore, at the last follow-up, the proportions of mLenke I, II, and IV increased, whereas mLenke III, V, and VI decreased.</p><p><strong>Conclusions: </strong>Bracing outcomes were more favorable in patients with main lumbar curves than those with main thoracic curves. However, no significant differences were found in patients with double-curve patterns. Thoracic curves exhibited a higher progression risk compared with thoracolumbar/lumbar curves within the same curve pattern. During bracing, a tendency for primary curves to shift proximally was noted.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"368-374"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248605","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":"Are Surgical Outcomes Different According to Baseline Balance Status in Elderly Patients with Degenerative Sagittal Imbalance?","authors":"Se-Jun Park, Chong-Suh Lee, Jin-Sung Park, Dong-Ho Kang","doi":"10.1097/BRS.0000000000005090","DOIUrl":"10.1097/BRS.0000000000005090","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective study.</p><p><strong>Objective: </strong>We sought to compare surgical outcomes according to baseline balance statuses in elderly patients with degenerative sagittal imbalance (DSI).</p><p><strong>Summary of background: </strong>Although optimal sagittal correction has been emphasized for good surgical outcomes, the effect of the state of preoperative balance on surgical outcomes has been adequately described at present.</p><p><strong>Methods: </strong>Patients aged 60 years and above with DSI who underwent ≥5-level fusion to the sacrum were included. Among them, only those who postoperatively achieved the optimal age-adjusted pelvic incidence (PI) - lumbar lordosis (LL) target were included in this study. Study participants were divided into two groups according to their preoperative sagittal vertical axis (SVA): compensatory balance (SVA <5 cm, group CB) and decompensation (SVA ≥5 cm, group D). Comparisons between the two groups were performed using the χ 2 test or Fisher exact test for categorical variables and the independent t -test or Wilcoxon rank-sum test for continuous variables.</p><p><strong>Results: </strong>A total of 156 patients whose postoperative sagittal alignment matched the age-adjusted PI-LL target constituted the study cohort. There were 59 patients in group CB and 97 patients in group D. Mean follow-up duration was 50.0 months after surgery. Immediate postoperatively, sacral slope and SVA were significantly greater in group D than in group CB. At the last follow-up, the SVA was significantly greater in group D than in group CB (43.6 vs. 22.7 mm), while no significant differences were found in other sagittal parameters. The Oswestry disability index and Scoliosis Research Society -22 scores at the last follow-up were significantly worse in group D than in group CB.</p><p><strong>Conclusion: </strong>The SVA tended to experience less correction postoperatively, with evidence of further deterioration during follow-up in group D than in group CB. This suboptimal correction of SVA may contribute to the inferior clinical outcomes encountered in group D relative to group CB. Therefore, we recommend correction of PI-LL as close as possible to the lower limit of the suggested PI-LL target range in patients with evidence of preoperative decompensation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"395-404"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493479","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":"Analysis of the Biomechanical Effects of Vertebral Body Tethering With Apical Fusion.","authors":"Jil Frank, Per David Trobisch, Miguel Pishnamaz, Frank Hildebrand, Maximilian Praster","doi":"10.1097/BRS.0000000000005261","DOIUrl":"10.1097/BRS.0000000000005261","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical study by using a multibody simulation approach.</p><p><strong>Objective: </strong>Objectification of spinal biomechanics after vertebral body tethering with and without apical fusion.</p><p><strong>Summary of background data: </strong>Vertebral body tethering, a motion-preserving surgical technique for correction of adolescent idiopathic scoliosis, is increasingly being used for thoracolumbar curves. However, tether breakage remains a common problem with breakage rates up to 60% for TL curves. Therefore, surgeons have begun to adapt their surgical technique by fusing the apex. The short-term clinical studies show a significant reduction of the tether breakage rate to 10%, but little is known about the biomechanical reasons. Therefore, this study analyzes the intervertebral compression and tether force in a tethered spine without apical fusion and in a tethered spine with apical fusion between L1/2.</p><p><strong>Methods: </strong>A multibody simulation approach was chosen to analyze the biomechanical effects of two surgical techniques during different physiological movements. The tether and intervertebral compression forces in the different instrumented segments are once analyzed for a T10 to L3 tethered spine and once for a T10 to L3 tethered with additional L1/2 fusion using an intervertebral cage.</p><p><strong>Results: </strong>VBT with apical fusion reduces the prevailing tether forces not only at the fused level by nearly 861 N but also at the adjacent spinal segments by around 100 N. However, a significant increase in intervertebral compression force of ~706 N can be observed, especially at the adjacent spinal segments.</p><p><strong>Conclusion: </strong>L1/2 fusion in a tethered spine reduces tether forces in adjacent segments and thus might decrease the rate of tether breakage. However, fusion results in increased intervertebral compression forces by up to 31% compared with an unfused spine. Long-term clinical studies are needed to further analyze and evaluate the biomechanical consequences.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E110-E117"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012089","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 Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery.","authors":"Anthony Yung, Oluwatobi O Onafowokan, Ankita Das, Max R Fisher, Ethan J Cottrill, Isabel P Prado, Iryna Ivasyk, Caroline M Wu, Peter S Tretiakov, Elizbeth L Lord, Pawel P Jankowski, Douglas G Orndorff, Andrew J Schoenfeld, Christopher I Shaffrey, Peter G Passias","doi":"10.1097/BRS.0000000000005213","DOIUrl":"10.1097/BRS.0000000000005213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective cohort study of prospectively enrolled database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery. The trajectory of recovery may be accelerated by the application of enhanced recovery principles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Inclusion criteria were operative patients with ASD older than 18 years with complete baseline, 90 days perioperative, and 2Y postoperative data. We assessed differences in baseline demographics, surgical details, baseline health-related quality of life (HRQL), and surgical outcomes between ERAS+ and ERAS- patients. Outcomes included adverse events, reoperations, and radiographic parameters such as sacral slope, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, lumbar lordosis, T2 to T12 kyphosis, and maximum Cobb angle. In addition, HRQL measures included the physical component summary, Oswestry Disability Index, Neck Disability Index, EuroQol 5 dimensions, Scoliosis Research Society Questionnaire 22r total and domain scores, Numeric Pain Rating Scale-back, and Numeric Pain Rating Scale-leg. We used multivariable logistic regression and analysis of covariance to adjust for confounding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 471 patients with ASD met the inclusion criteria, with 59 designated ERAS+. Those individuals with ERAS+ were older (64.1 ± 13.0 vs. 58.0 ± 16.0; P = 0.005), had a higher Charlson Comorbidity Index, (2.4 ± 1.8 vs. 1.4 ± 1.6; P &lt; 0.001), and exhibited a higher modified ASD frailty index (8.2 ± 5.4 vs. 6.3 ± 4.9; P = 0.019). The adjusted analysis demonstrated the ERAS+ cohort demonstrated a lower likelihood of overall reoperations (Odds ratio (OR): 0.3; 95% CI: 0.13-0.89), and a lower likelihood of overall adverse events (OR: 0.4; 95% CI: 0.19-0.93). ERAS+ was more likely to achieve the minimal clinically important difference in the Scoliosis Research Society Questionnaire 22r total scores at 6 months (6M; OR: 3.1; 95% CI: 1.2-8.4), self-image domain at 6M (OR: 9.0; 95% CI: 1.6-50.0), in the pain domain at 6M (OR: 3.5; 95% CI: 1.01-11.9) and 1 year postoperatively (OR: 2.6; 95% CI: 1.03-6.7), and in the SF-36's physical component summary (PCS) scores at 1 year (OR: 2.1; 95% CI: 1.05-4.2). No other statistically significant differences in HRQL were observed at the remaining time points (P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our work is the first to evaluate HRQL metrics and complications over 2Y following ASD correction with ERAS. Despite presenting with more severe baseline frailty ","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 6","pages":"357-367"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484047","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 Fate of The Broken Tether: How Do Curves Treated With Vertebral Body Tethering Behave After Tether Breakage?","authors":"Tyler A Tetreault, Tiffany N Phan, Tishya A L Wren, Michael J Heffernan, Michelle C Welborn, John T Smith, Ron El-Hawary, Kenneth Cheung, Kenneth D Illingworth, David L Skaggs, Lindsay M Andras","doi":"10.1097/BRS.0000000000005072","DOIUrl":"10.1097/BRS.0000000000005072","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, multicenter.</p><p><strong>Objective: </strong>The aim of this study was to assess curve progression and occurrence of revision surgery following tether breakage after vertebral body tethering (VBT).</p><p><strong>Summary of background data: </strong>Tether breakage after VBT is common with rates up to 50% reported. In these cases, it remains unknown whether the curve will progress or remain stable.</p><p><strong>Materials and methods: </strong>Adolescent and juvenile idiopathic scoliosis patients in a multicenter registry with ≥2-year-follow-up after VBT were reviewed. Broken tethers were listed as postoperative complications and identified by increased screw divergence of >5 degrees on serial radiographs. Revision procedures and curve magnitude at subsequent visits were recorded.</p><p><strong>Results: </strong>Of 186 patients who qualified for inclusion, 84 (45.2%) patients with tether breakage were identified with a mean age at VBT of 12.4±1.4 years and mean curve magnitude at index procedure of 51.8±8.1 degrees. Tether breakage occurred at a mean of 30.3±11.8 months and mean curve of 33.9±13.2 degrees. Twelve patients (12/84, 14.5%) underwent 13 revision procedures after tether breakage, including six tether revisions and seven conversions to fusion. All tether revisions occurred within 5 months of breakage identification. No patients with curves <35 degrees after breakage underwent revision. Revision rate was greatest in skeletally immature (Risser 0-3) patients with curves ≥35 degrees at time of breakage (Risser 0-3: 9/17, 53% vs. Risser 4-5: 3/23, 13%, P =0.01). Curves increased by 3.1 and 3.7 degrees in the first and second year, respectively. By 2 years, 15/30 (50%) progressed >5 degrees and 8/30 (26.7%) progressed >10 degrees. Overall, 66.7% (40/60) reached a curve magnitude >35 degrees at their latest follow-up, and 14/60 (23.3%) reached a curve magnitude >45 degrees. Skeletal maturity did not affect curve progression after tether breakage ( P >0.26), but time to rupture did ( P =0.048).</p><p><strong>Conclusions: </strong>While skeletal immaturity and curve magnitude were not independently associated with curve progression, skeletally immature patients with curves ≥35 degrees at time of rupture are most likely to undergo additional surgery. Most patients can expect progression at least 5 degrees in the first 2 years after tether breakage, though longer term behavior remains unknown.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"405-411"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306929","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":"Identifying Factors for Predicting Postoperative Segmental Motor Paralysis in Patients Undergoing Anterior Cervical Spine Surgery: A Multicenter Study.","authors":"Hiroaki Onuma, Takashi Hirai, Kenichiro Sakai, Motonori Hashimoto, Hiroyuki Inose, Kentaro Yamada, Yu Matsukura, Shingo Morishita, Satoru Egawa, Jun Hashimoto, Kentaro Sakaeda, Satoshi Tamura, Ichiro Torigoe, Masaki Tomori, Kyohei Sakaki, Yutaka Kobayashi, Kazuyuki Otani, Kazuo Kusano, Norihiko Miyake, Tsuyoshi Yamada, Shuta Ushio, Shigeo Shindo, Yoshiyasu Arai, Atsushi Okawa, Toshitaka Yoshii","doi":"10.1097/BRS.0000000000005193","DOIUrl":"10.1097/BRS.0000000000005193","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery.</p><p><strong>Summary of background data: </strong>Segmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors.</p><p><strong>Results: </strong>Ninety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels at a final follow-up.</p><p><strong>Conclusion: </strong>This study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"375-382"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508387","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: Single-Position Prone Lateral Interbody Fusion is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.","authors":"Hao-Ju Lo, Tsan-Wen Huang","doi":"10.1097/BRS.0000000000005264","DOIUrl":"10.1097/BRS.0000000000005264","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E120-E121"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012064","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":"Untreated Osteoporosis in Lumbar Fusion Surgery Patients: Prevalence, Risk-factors, and Effect on Bone Metabolism.","authors":"Paul Köhli, Jan Hambrecht, Shu-Han Wang, Jiaqi Zhu, Erika Chiapparelli, Lukas Schönnagel, Ali E Guven, Gisberto Evangelisti, Arne Kienzle, Jennifer Shue, Koki Tsuchiya, Marco D Burkhard, Matthias Pumberger, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BRS.0000000000005231","DOIUrl":"10.1097/BRS.0000000000005231","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of a prospective single-center study.</p><p><strong>Objective: </strong>To analyze the prevalence and risk factors for untreated osteoporosis in patients undergoing lumbar spinal fusion surgery (LFS) and its impact on bone mineral density (BMD) and bone turnover markers.</p><p><strong>Background: </strong>Osteoporosis is a risk factor for mechanical complications in LFS, which can be mitigated by antiosteoporotic treatment. However, there is limited research on factors leading to untreated osteoporosis before LFS and its impact on preoperative bone status.</p><p><strong>Materials and methods: </strong>A secondary analysis of a prospective study enrolling adults undergoing LFS for degenerative conditions (2014-2024) with preoperative quantitative CT osteoporosis screening was performed. Demographic data and medical history were analyzed for prevalence and risk factors of untreated osteoporosis, while BMD, vitamin D, PTH levels, and bone turnover markers were assessed for the effects of lacking treatment.</p><p><strong>Results: </strong>A total of 445 patients (48% female, median age 64) were included, of which 137 patients (31%) had osteoporosis. Of these, 66 (48%) were untreated and 71 (52%) were treated, with 40 (56%) receiving pharmacological and 31 (44%) nonpharmacologic treatment, including vitamin D supplementation and lifestyle modifications. Of the untreated patients, 55 (80%) were identified by preoperative screening. Seventy-one percent of osteoporotic men versus 35% of osteoporotic women were untreated ( P <0.001). Multivariable logistic regression confirmed male sex as a significant contributing factor (OR: 4.3, 95% CI: 1.9-10.1, P <0.001) for untreated osteoporosis. Treated osteoporotic patients had higher BMD ( P <0.001), higher vitamin D levels ( P =0.023), and lower levels of bone resorption parameters ( P =0.004) than untreated patients.</p><p><strong>Conclusion: </strong>Untreated osteoporosis is common before LFS, especially in men, with untreated having lower BMD and higher bone resorption marker levels than treated patients. Identification of osteoporotic cases and subsequent osteological optimization could potentially reduce the risks of adjacent fractures or screw loosening.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"420-428"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772408","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 Regarding Same-Day Versus Staged Spinal Fusion : A Meta-Analysis of Clinical Outcomes.","authors":"Yixi Wang, Xinkai Luo, Jian Cui, Paerhati Rexiti","doi":"10.1097/BRS.0000000000005251","DOIUrl":"10.1097/BRS.0000000000005251","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E118"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898297","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}