Spine最新文献

{"title":"Machine Learning-based Cluster Analysis Identifies Three Unique Phenotypes of Patients With Adult Spinal Deformity With Distinct Clinical Profiles and Long-term Recovery Trajectory: A Development Study.","authors":"Peng Cui, Peng Wang, Shuaikang Wang, Di Han, Qingyang Huang, Wei Wang, Xiaolong Chen, Shibao Lu","doi":"10.1097/BRS.0000000000005267","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005267","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective review of a prospective adult spinal deformity data.</p><p><strong>Objective: </strong>To identify distinct patient clinical profiles and recovery trajectories in patients with adult spinal deformity (ASD).</p><p><strong>Summary of background data: </strong>Patients with ASD exhibit a diverse array of symptoms and significant heterogeneity in clinical presentations, posing challenges to precise clinical decision-making. Accurate patient selection may provide further insight to personalized management strategies.</p><p><strong>Methods: </strong>Latent profile analysis (LPA) was performed to determine possible patient phenotype. Goodness-of-fit indices were used to determine the optimal cluster profiles. Outcome differences were evaluated using Analysis of Variance (ANOVA) and subsequent post hoc Tukey's test, while significant predictors of group membership were identified through multinomial logistic regression.</p><p><strong>Results: </strong>A total of 204 ASD patients (mean age of 60.3 ± 11.8 years, comprising 62.3% females) with complete 1-year and 2-year follow-up outcome were included. LPA identified three phenotypes: 51 patients in phenotype 1, 73 patients in phenotype 2 and 80 patients in phenotype 3, respectively. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. Patients in phenotype 3, although demonstrated the worst Scoliosis Research Society-22 questionnaire (SRS-22r) domains at baseline, patients in this cluster exhibited the most substantial Δchange in SRS-22r domains except for self-image at both 1-year and 2-year follow-up. Remarkably, a relative large proportion of patients (58.8%) who were dissatisfied at 1-year follow-up transited to satisfied at 2-year follow-up. Advanced age, longer symptom duration, severe preoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch, higher preoperative sagittal vertical axis (SVA), fusion extending to sacrum/pelvis and grade ≥ 3 osteotomy predicted membership in the phenotype 3.</p><p><strong>Conclusions: </strong>LPA enabled the delineation of three distinct phenotypes among ASD patients, each characterized by unique clinical profiles and distinct long-term recovery trajectories. By pinpointing the crucial variables that uniquely distinguish and predict membership in different phenotypes, the study provides valuable guidance for patient stratification.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012162","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":"Comparative Efficacy and Safety of Endovascular vs. Surgical Treatment in Spinal Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis.","authors":"Basel Musmar, Joanna M Roy, Atakan Orscelik, Sonu Bhaskar, Saman Sizdahkhani, Elias Atallah, Sravanthi Koduri, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1097/BRS.0000000000005226","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005226","url":null,"abstract":"<p><strong>Study design: </strong>Systematic Review and Meta-analysis.</p><p><strong>Objective: </strong>This study aims to compare the efficacy and safety of surgical and endovascular treatments for SDAVFs.</p><p><strong>Summary of background data: </strong>Spinal dural arteriovenous fistulas (SDAVFs) result from an abnormal connection between the radiculomeningeal artery and the radicular vein, leading to venous hypertension and potential neurological damage. The two primary treatment strategies are surgical closure and endovascular obliteration of the fistula.</p><p><strong>Methods: </strong>PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. We defined the successful treatment as fistula occlusion with sufficient embolic material penetration or obliteration during surgery.</p><p><strong>Results: </strong>A total of 1192 articles were identified, with 40 studies meeting the inclusion criteria, comprising 1818 patients (surgical: 804, endovascular: 1014). The surgical group demonstrated higher rates of complete occlusion at last follow-up (96.8%, 363/375) compared to the endovascular group (72.5%, 470/648) (OR: 0.16; CI: 0.09 to 0.28, P<0.01). Surgical treatment also had higher successful treatment rates (97.5%, 392/402) compared to endovascular treatment (66.7%, 529/793) (OR: 0.11; CI: 0.06 to 0.19, P<0.01). Recurrence rates were lower in the surgical group (OR: 6.04; CI: 3.45 to 10.57, P<0.01) and retreatment rates were also lower (OR: 7.16; CI: 4.11 to 12.48, P<0.01). Initial treatment failure was significantly higher in the endovascular group (32.2%, 329/1023) compared to the surgical group (2.3%, 19/804) (OR: 8.97; CI: 5.56 to 14.45, P<0.01).</p><p><strong>Conclusions: </strong>Surgical treatment for SDAVFs achieves higher rates of complete occlusion and successful treatment compared to endovascular treatment, with lower rates of recurrence, retreatment, and initial treatment failure. Although both treatments show similar improvements in neurological status and periprocedural complications, surgery remains the preferred approach for definitive results. Treatment decisions should be individualized based on patient-specific factors and anatomical characteristics. Further research is needed to confirm these results.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012095","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":"Change in Lumbar Lordosis After Decompressive Surgery in Lumbar Spinal Stenosis Patients and Associations With Patient-Related Outcomes Two Years After Surgery: Radiologic and Clinical Results From the NORDSTEN Spinal Stenosis Trial.","authors":"Josefin Åkerstedt, Johan Wänman, Hasan Banitalebi, Tor Åge Myklebust, Clemens Weber, Kjersti Storheim, Christian Hellum, Kari Indrekvam, Erland Hermansen, Helena Brisby","doi":"10.1097/BRS.0000000000005263","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005263","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012052","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":"Using Technique and Technology to Improve Safety and Outcomes in AIS: A Review of 12,795 Screws in Pediatric Spine Deformity.","authors":"Vishal Sarwahi, Katherine Eigo, Effat Rahman, Sayyida Hasan, Keshin Visahan, Yungtai Lo, Jon-Paul DiMauro, Terry Amaral","doi":"10.1097/BRS.0000000000005262","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005262","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>This study aimed to compare outcomes in AIS patients that underwent PSF using either freehand with occasional fluoroscopic assistance (FOFA), computer assisted surgery/navigation (CAS), or technique and technology (T&T).</p><p><strong>Summary of background data: </strong>Pedicle screw insertion in scoliosis is challenging due to abnormal pedicle morphology. Fluoroscopic guidance was frequently utilized, until technological advancements led to the adaptation of computer assisted screw insertion. While improvement in screw accuracy has been documented, an increase in radiation exposure, surgical time, and blood loss can occur. This institution adopted a T&T, or technique and technology, approach that combines freehand technique with CT-based navigation technology for confirmation and navigation for challenging pedicles.</p><p><strong>Methods: </strong>This was a two-part retrospective review of 573 AIS patients that underwent PSF.Part I: 304 were operated in FOFA. 63 patients were operated on with solely CT-based navigation technology (CAS Group). 206 patients were in T&T. Perioperative outcomes were compared.Part II: 206 T&T patients were compared to 326 AIS patients from the NSQIP database that were operated on using computer-assisted navigation (CAN). Operative time and 30-day complications were compared.All data is presented as medians, IQR, frequencies, and percents. Fisher's Exact, Chi-squared, Kruskal-Wallis, and Wilcoxon rank-sum tests were used.</p><p><strong>Results: </strong>FOFA radiation dose was 2.3 mGy and radiation time was 20.4 seconds compared to 22.2 mGy and 21.6 seconds for CAS, and 15.0 mGy and 18.6 seconds for T&T (P<0.001, P<0.001). Operative time was shorter for the T&T patients when compared to FOFA and CAS (P<0.001).Part II: T&T had an operative time of 233.0 minutes compared to 323.0 minutes for CAN (P<0.001).</p><p><strong>Conclusion: </strong>T&T optimizes screw accuracy while reducing the increased radiation burden and operative time associated with CAS. The T&T approach incorporates CT-based navigation technology as confirmation, while maintaining surgeon's skill.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012167","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 Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients With Scoliosis and Cerebral Palsy.","authors":"Kensuke Shinohara, Tracey P Bryan, Carrie E Bartley, Michael P Kelly, Vidyadhar V Upasani, Peter O Newton","doi":"10.1097/BRS.0000000000005098","DOIUrl":"10.1097/BRS.0000000000005098","url":null,"abstract":"<p><strong>Study design: </strong>Cohort study.</p><p><strong>Objective: </strong>Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP).</p><p><strong>Summary of background data: </strong>A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery.</p><p><strong>Methods: </strong>Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0 to 4, SAS 5 to 6, SAS 7 to 8, and SAS 9 to 10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. The area under the curve (AUC) is reported.</p><p><strong>Results: </strong>A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0 to 4; 51.6%, SAS 5 to 6; 30.2%, SAS 7 to 8; 18.5%, SAS 9 to 10; 0/0. When the SAS 7 to 8 group was set as the reference, there was no significant difference compared to SAS 5 to 6 ( P =0.34), while the incidence rate was significantly increased in SAS 0 to 4 ( P =0.02). The AUC was 0.65 (95% CI: 0.54-0.75).</p><p><strong>Conclusions: </strong>Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0 to 4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"96-102"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627798","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":"Temporal Trends of Improvement After Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Pratyush Shahi, Tejas Subramanian, Olivia Tuma, Sumedha Singh, Kasra Araghi, Tomoyuki Asada, Maximilian Korsun, Nishtha Singh, Chad Simon, Avani Vaishnav, Eric Mai, Joshua Zhang, Cole Kwas, Myles Allen, Eric Kim, Annika Heuer, Evan Sheha, James Dowdell, Sheeraz Qureshi, Sravisht Iyer","doi":"10.1097/BRS.0000000000005024","DOIUrl":"10.1097/BRS.0000000000005024","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>To analyze temporal trends in improvement after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).</p><p><strong>Summary of background data: </strong>Although several studies have shown that patients improve significantly after MIS TLIF, evidence regarding the temporal trends in improvement is still largely lacking.</p><p><strong>Methods: </strong>Patients who underwent primary single-level MIS TLIF for degenerative conditions of the lumbar spine and had a minimum of 2-year follow-up were included. Outcome measures were: 1) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 2) global rating change (GRC); 3) minimal clinically important difference (MCID); and 4) return to activities. Timepoints analyzed were preoperative, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Trends across these timepoints were plotted on graphs.</p><p><strong>Results: </strong>236 patients were included. VAS back and VAS leg were found to have statistically significant improvement compared to the previous timepoint up to 3 months after surgery. ODI and SF-12 PCS were found to have statistically significant improvement compared to the previous timepoint up to 6 months after surgery. Beyond these timepoints, there was no significant improvement in PROMs. 80% of patients reported feeling better compared to preoperative by 3 months. >50% of patients achieved MCID in all PROMs by 3 months. Most patients returned to driving, returned to work, and discontinued narcotics at an average of 21, 20, and 10 days, respectively.</p><p><strong>Conclusions: </strong>Patients are expected to improve up to 6 months after MIS TLIF. Back pain and leg pain improve up to 3 months and disability and physical function improve up to 6 months. Beyond these timepoints, the trends in improvement tend to reach a plateau. 80% of patients feel better compared to preoperative by 3 months after surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"81-87"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857851","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":"Clinical Outcome of Lumbar Hybrid Surgery in a Consecutive Series of Patients With Long-term Follow-up.","authors":"Jessica L Shellock, Jack E Zigler, Scott L Blumenthal, Richard D Guyer, Donna D Ohnmeiss","doi":"10.1097/BRS.0000000000005052","DOIUrl":"10.1097/BRS.0000000000005052","url":null,"abstract":"<p><strong>Study design: </strong>This was a retrospective study combined with attempted prospective patient contact to collect current data.</p><p><strong>Objective: </strong>The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.</p><p><strong>Summary of background data: </strong>Many patients with symptomatic lumbar disk degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disk levels are not amenable to TDR, and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels.</p><p><strong>Methods: </strong>A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified, beginning with the first case experience in 2005. Operative and clinical outcome data, including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and reoperations, were collected. The mean follow-up duration was 67.1 months.</p><p><strong>Results: </strong>There were statistically significant improvements ( P <0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with a minimum 10-year follow-up versus those with a shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of the study group, 38.8% of re-operations). Reoperation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision.</p><p><strong>Conclusion: </strong>This study supports that for many patients with multilevel symptomatic disk degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores, with no diminished improvement in scores among patients with more than 10-year follow-up.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"110-114"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161273","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":"Socioeconomic Status Impacts Length of Stay and Nonhome Discharge Disposition After Posterior Cervical Decompression and Fusion.","authors":"Olivia A Opara, Rajkishen Narayanan, Tariq Issa, Omar H Tarawneh, Yunsoo Lee, Harrison A Patrizio, Abbey Glover, Bergin Brown, Christian McCormick, Mark F Kurd, Ian D Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005125","DOIUrl":"10.1097/BRS.0000000000005125","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.</p><p><strong>Summary of background data: </strong>The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.</p><p><strong>Materials and methods: </strong>Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes, including length of stay, home discharge, complications, and readmissions.</p><p><strong>Results: </strong>Patients living in at-risk/distressed communities were more likely to be Black (53.3%). Patients living in at-risk/distressed communities had the longest hospitalization (6.24 d vs. prosperous: 3.92, P =0.006). Significantly less at-risk/distressed patients were discharged home without additional services (37.3% vs. mid-tier: 52.5% vs. comfortable: 53.4% vs. prosperous: 56.4%, P <0.001). On multivariate analysis, residing in an at-risk/distressed community was independently associated with nonhome discharge [odds ratio (OR): 2.28, P =0.007] and longer length of stay (E:1.54, P =0.017).</p><p><strong>Conclusions: </strong>Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E22-E28"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037049","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":"A New Pilot Hole Preparation System for Percutaneous Pedicle Screw Placement: A Randomized Controlled Study.","authors":"Chaobo Feng, Longfei Wang, Sheng Yang, Xinbo Wu, Yunshan Fan, Huang Yan, Fangjing Chen, Jia Chen, Xiang Wang, Qishuai Guo, Longxiang Yao, Yingchuan Zhao, Shisheng He, Haijian Ni","doi":"10.1097/BRS.0000000000005184","DOIUrl":"10.1097/BRS.0000000000005184","url":null,"abstract":"<p><strong>Study design: </strong>A randomized controlled study.</p><p><strong>Objective: </strong>To introduce a new pilot hole preparation system for percutaneous pedicle screw placement and investigate its efficiency and safety in comparison with the conventional method.</p><p><strong>Summary of background data: </strong>Placing screws accurately, rapidly, and safely with less radiation exposure is critical for minimally invasive lumbar interbody fusion (LIF). Optimizing pilot hole preparation instruments has important clinical implications.</p><p><strong>Materials and methods: </strong>A total of 60 patients (180 screws) were included in this study. All patients were randomized into two groups (new system vs. conventional method) and performed single-level minimally invasive percutaneous fixation, interbody fusion, and unilateral decompression. Basic information, time of pilot hole preparation, time of screw placement, and fluoroscopy time were recorded. Screw placement accuracy was graded based on the Gertzbein-Robbins scale, and the angle between the screw axis and the pedicle axis was collected in postoperative CT.</p><p><strong>Results: </strong>There was no statistical difference in basic information between the 2 groups. The mean time of single pilot hole preparation was 4.08±1.01 minutes in the new system group and 5.34±1.30 minutes in the conventional method group ( P <0.001). The time of single screw placement was significantly shorter in the new system group (0.82±0.20 vs. 1.72±0.33 min), and the fluoroscopy time was also less in the new system group (13.70±3.42 vs. 19.95±5.50 s) ( P <0.001). Screw placement accuracy assessment showed that there were 85 (94.45%) A-grade screws in the new system group while 76 (84.44%) A-grade screws in the conventional method group ( P =0.027).</p><p><strong>Conclusions: </strong>The new pilot hole preparation system has shown significant reductions in the time of pilot hole preparation, time of screw placement, and radiation exposure, and has good clinical application value.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"115-121"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406843","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":"Does Paraspinal Muscle Mass Predict Lumbar Lordosis Before and After Decompression for Degenerative Spinal Stenosis?","authors":"Rajkishen Narayanan, Teeto Ezeonu, Alec Kellish, Sydney Somers, Yunsoo Lee, Akshay Khanna, Anthony Labarbiera, Sebastian Fras, Jose A Canseco, Mark F Kurd, Alan S Hilibrand, Alexander R Vaccaro, Christopher Kepler, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005058","DOIUrl":"10.1097/BRS.0000000000005058","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether muscle mass and quality of the lumbar paraspinal muscles was associated with improvements in lumbar lordosis and other sagittal parameters after isolated posterior lumbar decompression surgery for lumbar spinal stenosis.</p><p><strong>Summary of background data: </strong>Individuals may develop sagittal imbalance over time, either due to degenerative changes or other spinal conditions. In patients with lumbar spinal stenosis, sagittal imbalance can further exacerbate symptoms of pain and radiculopathy. Sarcopenia of paraspinal muscles has been implicated in previous spine research as a variable with influence on surgical outcomes.</p><p><strong>Methods: </strong>Sagittal parameters were measured on preoperative and postoperative lateral lumbar radiographs and included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Preoperative MRI images were evaluated at the base of the L4 vertebral body to assess muscles mass of the psoas muscle and paravertebral muscles (PVM) and the Goutallier grade of the PVM. Patients were divided into three muscle size groups based on PVM normalized for body size (PVM/BMI): Group A (smallest), Group B, and Group C (largest).</p><p><strong>Results: </strong>Patients in group C had greater LL preoperatively (51.5° vs. 47.9° vs. 43.2, P =0.005) and postoperatively (52.2° vs. 48.9° vs. 45.7°, P =0.043). There was no significant difference in the ∆LL values between groups ( P >0.05). Patients in group C had larger SS preoperatively (35.2° vs. 32.1° vs. 30.0°, P =0.010) and postoperatively (36.1° vs. 33.0° vs. 31.7°, P =0.030). Regression analysis showed that PVM/BMI was a significant predictor of LL preoperatively ( P =0.039) and postoperatively ( P =0.031), as well as SS preoperatively ( P =0.001) and postoperatively ( P <0.001).</p><p><strong>Conclusions: </strong>Muscle mass of the paravertebral muscles significantly impacts lumbar lordosis and sacral slope in patients with lumbar spinal stenosis before and after posterior lumbar decompression. These findings highlight the need to address risk factors for poor muscle quality in patients with sagittal imbalance.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E29-E35"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176375","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}