Spine最新文献

{"title":"Response to Letter to the Editor Regarding: Multimodal Deep Learning-Based Radiomics Approach for Predicting Surgical Outcomes in Patients With Cervical Ossification of the Posterior Longitudinal Ligament.","authors":"Satoshi Maki, Takeo Furuya, Keiichi Katsumi, Hideaki Nakajima, Kazuya Honjoh, Shuji Watanabe, Takashi Kaito, Shota Takenaka, Yuya Kanie, Motoki Iwasaki, Masayuki Furuya, Gen Inoue, Masayuki Miyagi, Shinsuke Ikeda, Shiro Imagama, Hiroaki Nakashima, Sadayuki Ito, Hiroshi Takahashi, Yoshiharu Kawaguchi, Hayato Futakawa, Kazuma Murata, Toshitaka Yoshii, Takashi Hirai, Masao Koda, Seiji Ohtori, Masashi Yamazaki","doi":"10.1097/BRS.0000000000005296","DOIUrl":"10.1097/BRS.0000000000005296","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E159-E160"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391770","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":"Postoperative Outcomes Among Dialysis Patients Undergoing Surgery for Cervical Spine Trauma.","authors":"Muhammad Zulfiqar, Ved A Vengsarkar, Elizabeth Driskill, Adam L Shimer, Stephen D Lockey","doi":"10.1097/BRS.0000000000005358","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005358","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study using a large, de-identified database.</p><p><strong>Objective: </strong>To evaluate the impact of dialysis on short-term complications and long-term outcomes in patients with chronic kidney disease (CKD) undergoing surgery for cervical spine trauma.</p><p><strong>Summary of background data: </strong>It is established that patients with advanced CKD are at higher risk of postoperative morbidity and mortality after surgery. The impact of dialysis on postoperative complications among patients with chronic kidney disease (CKD) undergoing surgery specifically for cervical spine trauma is not well understood.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a database to evaluate the impact of dialysis on rates of short-term complications after cervical spine trauma surgery and assess long-term outcomes in dialysis versus non-dialysis patients. Multivariable logistic regression was used to compare these rates.</p><p><strong>Results: </strong>After adjusting for baseline comorbidities, dialysis patients were found to have higher rates of cardiac arrest, surgical site infections, and pressure ulcers compared to non-dialysis patients. Additionally, dialysis patients had higher rates of emergency department visits at one and three months postoperatively, as well as higher two-year mortality.</p><p><strong>Conclusion: </strong>Dialysis is associated with significantly increased risks of postoperative complications, healthcare utilization, and long-term mortality in patients undergoing surgery for cervical spine trauma. Further investigations are needed to determine the impact of dialysis timing in the perioperative setting as well as optimization strategies to mitigate risks in this vulnerable population.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013318","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 Role of the Lumbar Paravertebral Muscles in the Development of Short-term Residual Pain After Lumbar Fusion Surgery.","authors":"Haifu Sun, Wenxiang Tang, Xingyu You, Lei Deng, Liuyu Chen, Zhonglai Qian, Huilin Yang, Jun Zou, Yusen Qiao, Hao Liu","doi":"10.1097/BRS.0000000000005303","DOIUrl":"10.1097/BRS.0000000000005303","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective real-world study.</p><p><strong>Objective: </strong>Using machine learning models to identify risk factors for residual pain after PLIF in patients with degenerative lumbar spine disease.</p><p><strong>Summary of background data: </strong>Residual pain after PLIF is a frequent phenomenon, and the specific risk factors for residual pain are not known.</p><p><strong>Materials and methods: </strong>Between June 2018 and March 2023, 936 patients with lumbar degenerative disease who underwent PLIF surgery were recruited. Group A (n=501) had <7 days of VAS ≥3 pain within 1 month post-PLIF, whereas group B (n=435) had ≥7 days. Imaging outcomes included PMI, MMI, MMD, lumbar lordosis (LL), and LL improvement rate. Functional outcomes were assessed by VAS. Univariate and multivariate logistic regression analyses were used to determine the potential risk of short-term postoperative pain. Risk factors were identified using machine learning models and predicted whether residual pain would occur.</p><p><strong>Results: </strong>A total of 435 (46.5%) patients experienced residual postoperative pain. Independent risk factors included surgical segment, PMI, MMI, and depression level. The Random Forest Model model had an accuracy of 95.7%, a sensitivity of 96.4%, a specificity of 94.1%, and an F1 score of ~95.2% for predicting recurrent pain, indicating high reliability and generalizability.</p><p><strong>Conclusions: </strong>Our study reveals risk factors for the development of residual pain after PLIF. Compared to the pain group, the non-pain group had better paravertebral muscles, good psychological level, lower surgical segment and LL improvement rate. These factors may represent targets for preoperative and perioperative optimization as a means to minimize the potential for residual pain after PLIF.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"537-547"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450034","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":"No Difference in Short-term Surgical Outcomes From Semaglutide Treatment for Type 2 Diabetes Mellitus After Cervical Decompression and Fusion: A Propensity Score-matched Analysis.","authors":"Xu Tao, Sruthi Ranganathan, Nicholas Van Halm-Lutterodt, Julia Garcia-Vargas, Andrew Wu, Janesh Karnati, Sachin Shankar, Nana Agyeman, Ahmed Ashraf, Parikshit Barve, Kelly Childress, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005099","DOIUrl":"10.1097/BRS.0000000000005099","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the impact of semaglutide treatment for Type 2 Diabetes Mellitus (T2DM) on the risk of short-term (<6 mo) postoperative complications in patients undergoing primary cervical spine decompression and fusion (CSDF).</p><p><strong>Summary of background data: </strong>Semaglutide, a GLP-1 receptor agonist, is gaining popularity as a weekly injectable medication for the treatment of T2DM and obesity. Existing research indicates that higher levels of HbA1c and obesity are linked to fewer positive results after undergoing spine surgery, particularly cervical decompression and fusion. Nevertheless, there is a scarcity of publications evaluating the influence of semaglutide therapy on surgical complications, including surgical site infection, wound complications, and reoperation within 6 months, which were aggregated into a composite measure.</p><p><strong>Methods: </strong>The PearlDiver Database was queried from January 2010 to December 2021 for patients with a primary diagnosis of T2DM who underwent CSDF for degenerative pathology. Patients with semaglutide treatment within 6 months before index surgery were propensity score-matched to patients without the treatment, using age, sex, and Charlson comorbidity index (CCI) as matching covariates. A multivariate regression model was used to investigate the impact of semaglutide treatment on postoperative surgical complications.</p><p><strong>Results: </strong>The propensity score-matched cohort included 596 patients (semaglutide cohort: 298 and control cohort: 298). There were no statistically significant differences between cohorts in the composite measure of postoperative surgical complications following index CSDF (OR 1.26, 95% CI 0.83-1.93, P =0.331). Similarly, both 30-day (OR 0.83, 95% CI 0.49-1.42, P =0.589) and 90-day readmission rate (OR 0.89, 95% CI 0.56-1.42, P =0.724) were similar between both cohorts.</p><p><strong>Conclusions: </strong>This study suggests that in patients with T2DM, semaglutide treatment is not associated with higher rates of short-term adverse events after CSDF. The effect of semaglutide use on long-term outcomes remains unknown.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"515-521"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735045","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":"Changes in Lumbar Lordosis Curvature from 2016 to 2024 in Asymptomatic Chinese Populations.","authors":"Xiang Liu, Wei-Cong Zhang, Yun-Chuan Bai, Xiao-Jun Lu, Zhen-Yan Xu, Li-Xing Zhou, Shi-Yan-Jin Zhang, Pei-Jie Liang, Hai Lu","doi":"10.1097/BRS.0000000000005365","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005365","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cross-sectional study conducted across four centers.</p><p><strong>Objective: </strong>This study seeks to investigate recent trends in lumbar lordosis (LL) curvature over the past eight years and evaluate the influence of contemporary lifestyles on LL.</p><p><strong>Summary of background data: </strong>The significance of lumbar sagittal alignment in clinical practice is gaining increased recognition, owing to its influence on spinal health and its correlation with conditions such as low back pain and facet joint arthritis. Nonetheless, there is a paucity of literature addressing the effects of contemporary lifestyle changes on LL.</p><p><strong>Methods: </strong>A cohort of asymptomatic individuals who had undergone lumbar spine radiography at four hospitals was randomly selected for data comparison between 2016 and 2024. LL curvature was evaluated using four distinct methodologies: the L1-S1 Cobb angle (Cobb A), the L1-L5 Harrison posterior tangent angle (Harrison A), the sacral slope angle (SSA), and the lumbar curve index (LCI). The LL curvature measurements were performed by two authors using a Picture Archiving and Communication System. Participants were categorized into two cohorts: young adults (aged <40 y) and older adults (aged ≥40 y).</p><p><strong>Results: </strong>In both 2016 and 2024 cohorts, age-related differences between genders were insignificant. In 2016, females had higher Harrison A and LCI values than males, while older adults had smaller measurements than younger ones across all assessment methods. By 2024, males and older adults showed increased LL values, except SSA, compared to 2016. There were no significant LL differences for females and younger adults between the two cohorts.</p><p><strong>Conclusions: </strong>Males and older adults show increased LL curvature, which may impact low back pain prevalence. Further research is needed to understand contributing factors.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000192","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 Factors for Early 3-Month Postoperative Mortality in Metastatic Spinal Tumor Surgery: A JASA Multicenter Prospective Study.","authors":"Takaaki Uto, Satoshi Kato, Noriaki Yokogawa, Takaki Shimizu, Satoru Demura, Yuki Shiratani, Akinobu Suzuki, Koji Tamai, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Hideaki Nakajima, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Haruki Funao, Koji Uotani, Shinji Tanishima, Koichi Sairyo, Ko Hashimoto, Chizuo Iwai, Shoji Seki, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya","doi":"10.1097/BRS.0000000000005359","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005359","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter study.</p><p><strong>Objective: </strong>To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators.</p><p><strong>Summary of background data: </strong>Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation.</p><p><strong>Methods: </strong>Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was 3-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores (revised Tokuhashi, Tomita, modified Glasgow Prognostic Score [mGPS], and the New England Spinal Metastasis Score [NESMS]), and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Results: The 3-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P=0.008) and low preoperative performance status (PS) (OR=1.412, P=0.034) were significant independent predictors of early mortality, the Tomita score showed a trend towards significance (OR=1.234, P=0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716.</p><p><strong>Conclusion: </strong>High mGPS and low preoperative PS are significant predictors of 3-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making.</p><p><strong>Level of evidence: </strong>2.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011574","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 Role of Paraspinal Muscle in Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis: A Two-Year Follow-Up Study.","authors":"Xing Chen, Rongkun Xu, Suomao Yuan, Wenyang Fu, Xinzhi Zhang, Yuchen Zhang, Lianlei Wang, Xinyu Liu","doi":"10.1097/BRS.0000000000005132","DOIUrl":"10.1097/BRS.0000000000005132","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether paraspinal muscle could influence postoperative coronal balance and its transition in degenerative lumbar scoliosis (DLS).</p><p><strong>Summary of background data: </strong>Although the importance of the paraspinal muscles (PSM) in sagittal alignment is well recognized, there is no information about its role in coronal balance.</p><p><strong>Methods: </strong>The study included 102 DLS patients. Evaluation of the PSM on magnetic resonance imaging were conducted at baseline. Coronal measurements included coronal balance distance (CBD), major Cobb angle, L4 coronal tilt, and L5 coronal tilt. The cohort was divided based on postoperative parameters into persistent coronal balance (PCB), worsened coronal imbalance (WCIB), recurrent coronal balance (RCB), and persistent coronal imbalance (PCIB) according to immediate postoperative and follow-up coronal balance. Multivariate logistic regression models for postoperative CIB, follow-up WCIB and follow-up RCB were utilized to identify statistically significant associations while accounting for confounders.</p><p><strong>Results: </strong>The cohort was divided into 57 with PCB, 13 with WCIB, 10 with RCB, and 22 with PCIB. The follow-up groups with CIB exhibited more severe fatty infiltration in the extensor muscle compared with the balanced groups. Specifically, the WCIB group demonstrated the most severe extensor muscle degeneration, particularly on the concave sides, and the most prominent asymmetric degeneration of the PSM among the four groups. Furthermore, patients with CIB had worse sagittal malalignment compared with those with CB at the last follow-up.</p><p><strong>Conclusions: </strong>Patients exhibiting stronger extensor muscle mass were prone to immediate postoperative CB and more likely to experience spontaneous improvement or recurrence of coronal balance during follow-up. Severe extensor muscle degeneration and prominent asymmetric bilateral PSM degeneration represent potential risk factors for persistent CIB and recurrent CIB. It is crucial to assess the dynamic change during the follow-up period as long-term prognosis may be impacted if CB deteriorates, or otherwise develops during follow-up.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"528-536"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073923","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":"Cost-Effectiveness of Instrumented Versus Uninstrumented Posterolateral Fusion for Single-Level Degenerative Spondylolisthesis.","authors":"Andreas K Andresen, Mikkel Ø Andersen, Leah Y Carreon, Jan Sørensen","doi":"10.1097/BRS.0000000000005310","DOIUrl":"10.1097/BRS.0000000000005310","url":null,"abstract":"<p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Objective: </strong>The aim of this study was to investigate whether instrumented posterolateral fusion is cost-effective compared with uninstrumented posterolateral fusion in elderly patients who undergo fusion surgery for one-level degenerative spondylolisthesis with spinal stenosis.</p><p><strong>Summary of background data: </strong>For patients with persistent symptoms due to degenerative spondylolisthesis, surgical intervention may be recommended, typically decompression and fusion. Evidence on cost-effectiveness of choice of fusion method, related complications, and outcome is sparse.</p><p><strong>Methods: </strong>This cost-effectiveness analysis is based on a single-center, open-label, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either instrumented or un-instrumented posterolateral fusion. Quality-Adjusted Life Years were obtained from EQ-5D. Use of health services was obtained from patient charts and accumulated until 2 years after index surgery.</p><p><strong>Results: </strong>Of the 108 patients included in the study, 107 patients received the allocated intervention. There were no differences in preoperative demographics. Although the base price for the index instrumented surgery was significantly higher than the index uninstrumented surgery, average cost of surgery was only €146 higher in the instrumented group based on two-year cost data. The instrumented fusion group had a significantly lower reoperation rate [1/54 (1.9%)] than the uninstrumented fusion group 7/53 (13.2%), significantly less visits to the outpatient clinic, less magnetic resonance imaging performed and fewer days of hospitalization. The base case incremental cost-effectiveness ratio was estimated at €1536 per QALY gained over a two-year time horizon. Instrumented fusion was favored over uninstrumented fusion in sensitivity analyses including all reoperations or using hospital reimbursement rate.</p><p><strong>Conclusion: </strong>Instrumented fusion is cost-effective compared uninstrumented fusion, with an incremental cost-effectiveness ration well below the standard range of cost-effectivenes, the difference in cost was driven by lower reoperation rates and less health care resource utilization over a two-year time horizon.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"501-507"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459434","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":"Inpatient and Outpatient Palliative Care Utilization Rates of Patients with Spine Metastases.","authors":"Meghan Price, Edwin Owolo, Dana Rowe, Isabel Prado, Tara Dalton, Jacob Sperber, Harrison Hockenberry, James Herndon, Kerri-Anne Crowell, Elizabeth P Howell, Eli Johnson, Margaret Johnson, Elizabeth Fricklas, Christopher Jones, Arif Kamal, C Rory Goodwin","doi":"10.1097/BRS.0000000000005127","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005127","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review.</p><p><strong>Objective: </strong>Specialty Palliative Care (PC) can be instrumental in improving patient quality of life for patients with spine metastasis. It is important to identify disparities in access to PC to ensure that equitable care is provided to all patients. No prior study has assessed the impact of sociodemographic and treatment factors on the utilization of in-patient PC (IPPC) and outpatient PC (OPPC) in patients with spine metastases.</p><p><strong>Methods: </strong>We examined IPPC and OPPC utilization in a cohort of 265 patients seen by our institution's Brain and Spine Metastases Tumor Board (BSMTB) between February 1, 2018, and February 31, 2020. Statistical analyses were performed comparing characteristics and outcomes between patients who did or did not utilize IPPC and/or OPPC.</p><p><strong>Results: </strong>We observed no difference in rates of IPPC and OPPC consultation between patients across gender or race. Outpatient PC consultations varied across insurance and primary tumor type (P=0.056 and P=0.025, respectively). Patients who received surgical intervention or radiation therapy within 30 days of being presented at BSMTB had higher rates of OPPC utilization than those who did not (P=0.0032 and P=0.040, respectively). Patients who received an IPPC consult had worse overall survival than patients who did not consult IPPC (6.5 mo vs. 24.2 mo median survival) while those seen by OPPC had less of a survival disadvantage; median survival for OPPC was 11.2 months versus 19.2 months for those who were not seen by OPPC.</p><p><strong>Conclusion: </strong>We identified differences in PC utilization across insurance and primary tumor type. Additionally, we present the unique finding that patients who receive surgery or RT for their spine metastases had higher rates of OPPC consultations than those who did not. Further work is needed to better appreciate PC utilization trends and identify interventions that improve the accessibility of PC.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014389","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":"Waistline Asymmetry Patterns and Clinical Impact in Patients with Adolescent Idiopathic Scoliosis.","authors":"Tomohiro Banno, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Hideyuki Arima, Shin Oe, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Yusuke Murakami, Yukihiro Matsuyama","doi":"10.1097/BRS.0000000000005351","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005351","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective design.</p><p><strong>Objective: </strong>This study aimed to 1) classify waistline asymmetry by scoliosis type, 2) evaluate postoperative changes, and 3) assess clinical outcomes in patients with adolescent idiopathic scoliosis (AIS) using digital photography.</p><p><strong>Summary of background data: </strong>AIS often affects physical appearance, with waistline asymmetry being particularly affected. Despite its importance, studies on waistline asymmetry, especially its variation among individuals with AIS and related postoperative outcomes, are limited.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of patients with AIS who underwent posterior fusion surgery and had a minimum of two years of follow-up. Waistline asymmetry was assessed using digital photography. The waist angle (WA), waist-height angle (WHA), and waistline depth (WLD) were measured pre- and postoperatively. Radiographic parameters and the revised 22-item Scoliosis Research Society Questionnaire (SRS-22r) were also evaluated. We categorized waistline patterns into two types based on the WLD ratio: Type R (WLD ratio < 0.5) and type L (WLD ratio > 0.5). The frequency of each waistline type was determined using the Lenke classification system. We defined severe waistline asymmetry (SWA) as WLD on one side at least twice that on the opposite side and compared its clinical outcomes with those of patients without SWA.</p><p><strong>Results: </strong>In total, 192 patients were included in this study. Photographic and radiographic parameters significantly improved postoperatively. Pre- and postoperative waistline parameters were significantly correlated with radiographic parameters, particularly the TL/L curves. Type R was more common in lumbar modifiers A and B, whereas type L was more common in lumbar modifier C. Preoperative SWA, which was observed in 55% of patients, reduced to 11% postoperatively. Patients with postoperative SWA showed significantly higher TL/L curves and AVT-TL/L, lower L4 tilt, and lower self-image scores.</p><p><strong>Conclusion: </strong>Postoperative residual waistline asymmetry negatively affected self-image. These data suggest that correcting the lumbar curve is crucial to improving asymmetry.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812463","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}