Spine最新文献

{"title":"Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low-grade Spondylolisthesis.","authors":"Mladen Djurasovic, Leah Y Carreon, Erica F Bisson, Andrew K Chan, Mohamad Bydon, Praveen V Mummaneni, Kevin T Foley, Christopher I Shaffrey, Eric A Potts, Mark E Shaffrey, Domagoj Coric, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming Fu, Jonathan R Slotkin, Anthony L Asher, Michael S Virk, Dean Chou, Regis W Haid, Steven D Glassman","doi":"10.1097/BRS.0000000000005115","DOIUrl":"10.1097/BRS.0000000000005115","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>The aim of this study was to investigate what factors predict delayed improvement after surgical treatment of low-grade spondylolisthesis.</p><p><strong>Summary of background data: </strong>Lumbar surgery leads to clinical improvement in the majority of patients with low-grade spondylolisthesis. Most patients improve rapidly after surgery, but some patients demonstrate a delayed clinical course.</p><p><strong>Methods: </strong>The Quality and Outcomes Database (QOD) was queried for grade 1 spondylolisthesis patients who underwent surgery who had patient-reported outcome measures (PROMs) collected at baseline, 3, 6, and 12 months, including back and leg pain Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). Patients were stratified as \"early responders\" reaching MCID at 3 months and maintaining improvement through 12 months and \"delayed responders\" not reaching MCID at 3 months but ultimately reaching MCID at 12 months. These two groups were compared with respect to factors which predicted delayed improvement.</p><p><strong>Results: </strong>Of 608 patients enrolled, 436 (72%) met inclusion criteria for this study. Overall, 317 patients (72.7%) reached MCID for ODI at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved ODI MCID threshold by the 3-month postoperative follow-up. Sixty-eight patients (21.4%) showed a delayed trajectory, and had not achieved ODI MCID threshold at 3 months, but did ultimately reach MCID at 12-month follow-up. Factors associated with delayed improvement included impaired preoperative ambulatory status, better baseline back and leg pain scores, and worse 3-month leg pain scores ( P <0.01).</p><p><strong>Conclusions: </strong>The majority of patients undergoing surgery for low-grade spondylolisthesis reach ODI MCID threshold rapidly, within the first 3 months after surgery. Factors associated with a delayed clinical course include impaired preoperative ambulation status, relatively better preoperative back and leg pain, and persistent leg pain at 3 months.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E213-E218"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860953","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":"Craniovertebral Junction Anomalies: World Federation of Neurosurgical Societies Spine Committee Recommendations Overview.","authors":"Óscar L Alves, Mehmet Zileli, Salman Sharif, Ricardo Botelho","doi":"10.1097/BRS.0000000000005281","DOIUrl":"10.1097/BRS.0000000000005281","url":null,"abstract":"<p><strong>Objective: </strong>The published literature on craniovertebral junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management, and treatment concepts for different conditions, such as Chiari malformation (CM), basilar invagination (BI), os odontoideum, and syndromic malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability.</p><p><strong>Materials and methods: </strong>A group of expert spine surgeons and World Federation of Neurosurgical Societies Spine Committee members, most of which were extensively published on CVJ anomalies in the past, reviewed the literature issued from 2011 to 2022. Following a common methodology, based on the Delphi method, the authors analyzed the strength of the literature and voted on statements concerning the diagnosis and management of these conditions.</p><p><strong>Results: </strong>A total of 8 papers were produced: (1) CM diagnosis, classifications, natural history, and conservative management, (2) CM: indications for surgery and surgical options, (3) pediatric CM, (4) syndromic atlantoaxial instability, (5) os odontoideum, (6) BI: diagnosis, radiology, and classification, (7) surgical treatment of BI, and (8) BI with associated CM.</p><p><strong>Conclusions: </strong>Despite grey zones on the natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1 to C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occur, surgical decompression is appropriate. If no atlantoaxial instability is present, patients with Down syndrome can participate in competitive sports. In general, contact sports are not recommended.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"730-732"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081017","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":"Surgical Treatment of Basilar Invagination: WFNS Spine Committee Recommendations.","authors":"Ricardo V Botelho, Oscar L Alves, Geraldo Sá Carneiro, Zan Chen, Onur Yaman, Jutty Parthiban, Massimiliano Visocchi, Jörg Klekamp, Atul Goel, Mehmet Zileli","doi":"10.1097/BRS.0000000000005282","DOIUrl":"10.1097/BRS.0000000000005282","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aims to outline the therapeutic criteria and clarify the best surgical options for the different types of basilar invagination (BI).</p><p><strong>Summary of background: </strong>BI is a complex developmental malformation for which many surgical remedies have been proposed without clear consensus.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors reviewed the literature on the surgical treatment of BI published from 2011 to 2022 looking at different surgical options. A panel of spine surgeons and members of the WFNS Spine Committee used the Delphi technique to assess the strength of literature, elaborate, and vote on statements regarding the surgical management of BI.</p><p><strong>Results: </strong>Thirteen recommendations were issued covering the most relevant topics related to the surgical treatment of BI. Posterior fossa decompression alone is an option to treat BI without instability. Most cases of BI and AAI can be treated by C1-C2 fixation. In selected cases, distraction of the atlantoaxial joint may be required. Current evidence is lacking which technique is better to correct irreducible BI. OCF can be used in case of atlas assimilation, dysgenesis of C1 lateral mass, in irreducible cases, odontoidectomy and revision of failed C1-C2 fixation. Complications of the OCF may reach up to 50%. The role for anterior fusion for treatment of BI need to be better assessed by further studies. In the setting of irreducible anterior compression caused by BI, the anterior odontoidectomy can be indicated supplemented by C1-C2/occipital-cervical fusion.</p><p><strong>Conclusions: </strong>There are multiple surgical options for basilar invagination depending on the existence of compression, AAD, or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"751-759"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081006","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":"Chiari Malformation: Diagnosis, Classifications, Natural History, and Conservative Management. World Federation of Neurosurgical Societies Spine Committee Recommendations.","authors":"Francesco Costa, Said Ait Benali, Fernando Dantas, Francesco Restelli, Elio Mazzapicchi, Saleh Baeesa, Onur Yaman, Salman Sharif, Oscar L Alves, Mehmet Zileli, Ricardo Botelho","doi":"10.1097/BRS.0000000000005289","DOIUrl":"10.1097/BRS.0000000000005289","url":null,"abstract":"<p><strong>Study design: </strong>A comprehensive search was conducted in PubMed/EMBASE/MEDLINE databases. Inclusion criteria included publications between January 2011 and December 2022 on Chiari malformation (CM) diagnosis classification, natural history, and conservative management.</p><p><strong>Objective: </strong>This study aims to offer an update on diagnosis classifications, natural history, and conservative management in CM.</p><p><strong>Background: </strong>CM type 1 involves cerebellar tonsil herniation leading to neurological symptoms. There is controversy regarding its pathophysiology and optimal management, especially for asymptomatic cases. Previous research has focused on surgical outcomes with limited consensus on conservative strategies. Standardized guidelines are needed to enhance clinical decision-making.</p><p><strong>Materials and methods: </strong>The screening process involved reviewing abstracts, assessing full-text articles, and reviewing references. Eligibility criteria ensured the selection of relevant studies. Data extraction involved recording various variables. Results were discussed and voted on in 2 consensus meetings of the World Federation of Neurosurgical Societies Spine Committee, reaching a consensus using the Delphi method.</p><p><strong>Results: </strong>A total of 164 abstracts were screened. Ninety-nine articles met the inclusion criteria and were included in the study. Headache, brainstem, and/or cerebellar/brainstem symptoms/signs were confirmed as the main typical neurological hallmarks of CM. Still, an accurate clinical assessment appeared to be the most reliable evaluation model available. Considering classification, the most common form in adults is type 1, whereas type 2 is associated with myelomeningocele and hydrocephalus from childhood. Magnetic resonance imaging is the gold standard to show the extent of tonsillar herniation, overcrowded posterior fossa, or the absence of cisterna magna. Focusing on natural history, for asymptomatic or mildly symptomatic radiologically positive patients conservative management is appropriate. Somatosensory, motor, brainstem auditory evoked potentials and polysomnography could be helpful to guide eventual surgical indication.</p><p><strong>Conclusion: </strong>Further, higher-quality studies are recommended to establish more substantial evidence and recommendations.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"767-778"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383337","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":"Diagnosis, Classifications, and Treatment of Os Odontoideum: WFNS Spine Committee Recommendations.","authors":"Oscar L Alves, June Ho Lee, Djamel Kitumba, Agnaldo Lucas, Saleh Baeesa, Said Ben Ali, Francisco Sampaio, Gustavo Uriza, Ricardo Gepp, Mehmet Zileli, Ricardo Botelho, Jörg Klekamp, Atul Goel","doi":"10.1097/BRS.0000000000005277","DOIUrl":"10.1097/BRS.0000000000005277","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using the Delphi method.</p><p><strong>Objective: </strong>The aim was to formulate consensus recommendations regarding the natural history, diagnosis, classification, and optimal treatment of os odontoideum with global applicability.</p><p><strong>Summary of background: </strong>Os odontoideum (OO) is a rare anomaly of the cranio-vertebral junction (CVJ). Due to the paucity of literature, there is still considerable debate about the clinical management of OO.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors reviewed the literature on OO published from 2011 to 2022. Using the Delphi method, a panel of expert spine surgeons and members of the WFNS Spine Committee analyzed the strength of the published literature and elaborated and voted on statements concerning diagnosis and management.</p><p><strong>Result: </strong>The diagnosis may be established incidentally. Symptoms may manifest as neck discomfort or encompass occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Diagnosis is usually made with plain radiographs and CT scans. Dynamic x-rays identify C1-C2 instability, whereas MRI assesses spinal cord integrity and compression. Asymptomatic cases lacking radiologic instability are generally handled through regular observation and serial imaging until predictors of neurological deterioration necessitate surgical intervention. In the event of atlantoaxial instability or neurological dysfunction, surgical intervention with instrumentation and fusion is required to maintain stability. In irreducible cases, C1-2 joint manipulation and distraction permits realignment and deformity correction avoiding decompression, either from anterior or posterior.</p><p><strong>Conclusions: </strong>The management guidelines for asymptomatic OO are still a gray zone as our understanding of the natural history is still vague. Therefore, we need more large-center studies to investigate this condition further. Whenever symptomatic, unstable, or asymptomatic presenting with risk factors, OO is better managed with atlantoaxial fusion, avoiding occipital inclusion in the construct. In irreducible OO, C1-C2 joint manipulation and distraction are preferred to decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"743-750"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060670","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":"Jiri Dvorak: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg","doi":"10.1097/BRS.0000000000005339","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005339","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 11","pages":"733-736"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049254","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":"Pediatric Chiari Malformation Management: WFNS Spine Committee Recommendations.","authors":"Ricardo Gepp, June Ho Lee, Jutty Parthiban, Francesco Costa, Fernando Dantas, Francisco Sampaio, Zan Chen, Joachim Oertel, Salman Sharif, Jörg Klekamp, Ricardo Botelho, Mehmet Zileli, Óscar L Alves","doi":"10.1097/BRS.0000000000005290","DOIUrl":"10.1097/BRS.0000000000005290","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aims to provide an overview on Chiari malformation in pediatric patients, highlighting the specific clinical manifestations and surgical treatment options.</p><p><strong>Summary of background: </strong>Chiari malformation in children presents a real difficulty to the general neurosurgeon because children are not smaller adults. In the absence of pediatric neurosurgeons, as in many countries of the world, a need for education of general neurosurgeons on the management of Chiari malformation in children was identified.</p><p><strong>Material and methods: </strong>The authors carried out an extensive review of the literature in PubMed database of the last 10 years addressing the topic of Chiari malformation in children. A total of 64 studies were selected for analysis and five statements were drawn to be voted by a panel of expert spine surgeons in two consensus meetings organized by the World Federation of Neurosurgical Societies (WFNS) Spine Committee. A consensus was reached using the Delphi method.</p><p><strong>Results: </strong>In children with CM1, a decompressive surgery with duraplasty before puberty may avoid scoliosis progression. In Chiari type 2, the recommendation is to perform urgently extensive decompression of the craniovertebral junction and cervical canal if there is no decompensation of hydrocephalus. Cranial vault expansion may be recommended in pediatric Chiari malformation associated with craniosynostosis. Children with Chiari type I can play sports because of the low risk of worsening.</p><p><strong>Conclusion: </strong>Pediatric age is a modifier for the management of Chiari malformation (CM). Prompt diagnosis and appropriate decompressive surgery with duraplasty before puberty are essential to mitigate the impact of the condition on the child's well-being. Increased awareness among health care professionals, timely access to specialized expertise in neurosurgical interventions are crucial, especially for type 2 CM patients that require urgent decompression of CVJ and cervical spine.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E208-E212"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383353","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":"Statistics for Spine Care Practitioners and Clinician-scientists: A Practical Guide to Study Design, Analysis, and Interpretation.","authors":"Alexander M Crawford, Brendan M Striano, Grace X Xiong, Jonathan Dalton, Robert J Oris, Andrew J Schoenfeld, Alexander R Vaccaro","doi":"10.1097/BRS.0000000000005332","DOIUrl":"10.1097/BRS.0000000000005332","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"721-729"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658659","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":"Shanmuganathan Rajasekaran: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg, Jill Urban","doi":"10.1097/BRS.0000000000005349","DOIUrl":"10.1097/BRS.0000000000005349","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"737-742"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796565","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":"Indications for Surgery and Surgical Options in Chiari Malformation: WFNS Spine Committee Recommendations.","authors":"Massimiliano Visocchi, Francesco Signorelli, Óscar L Alves, Atul Goel, Jutty Parthiban, Saleh Baeesa, Salman Sharif, Francisco Sampaio, Sait Ben Ali, June Ho Lee, Joachim Oertel, Mehmet Zileli, Ricardo Botelho","doi":"10.1097/BRS.0000000000005288","DOIUrl":"10.1097/BRS.0000000000005288","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objectives: </strong>This review aims to create recommendations on the surgical indications and approaches to treat Chiari malformation (CM) with or without syringomyelia.</p><p><strong>Summary of background data: </strong>Despite the growing body of knowledge on CM, there are diverse and sometimes contradicting perspectives about surgical indications and procedures in both pediatric and adult populations.</p><p><strong>Methods: </strong>The authors reviewed the literature on CM published from 2011 to 2022. Two consensus conferences were organized by WFNS Spine Committee. The first one was held in Sao Paulo, Brazil on August 2022, and the second one was held in Porto, Portugal on December 2022. Using the Delphi method, a panel of expert spine surgeons and members of the WFNS Spine Committee examined the strength of the literature, elaborated and voted statements about the surgical management of CM.</p><p><strong>Results: </strong>We present 11 consensus statements on the surgical management of CM. Surgery is recommended for patients who have symptoms or if an MRI shows progression in asymptomatic patients. In pediatrics, osteoligamentous decompression only is indicated, whereas adults can have foramen magnum decompression with duroplasty, which is usually sufficient to control the associated syringomyelia. Syrinx drainage is the last option. Arachnoid opening can be performed in patients who have previously failed surgery or if arachnoid morphological anomalies are identified during the initial procedure. Tonsillar shrinkage provides somewhat better clinical efficacy than decompression alone, but at a larger risk of complications. Only patients with concurrent basilar invagination and atlanto-axial instability are advised to undergo atlanto-axial fixation alone.</p><p><strong>Conclusions: </strong>The consensus statements created by a collaborative work provide useful information for surgeons treating CM worldwide to achieve better surgical outcomes and avoid complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"760-766"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383350","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}