Spine最新文献

{"title":"Outcome After Anterior Cervical Decompression and Fusion-A Nationwide FinSpine Register Study of Independent Predictors of Outcome at 12 Months After Surgery for Degenerative Cervical Spine.","authors":"Nikolai Klimko, Nils Danner, Henri Salo, Anna Kotkansalo, Ville Leinonen, Jukka Huttunen","doi":"10.1097/BRS.0000000000005323","DOIUrl":"10.1097/BRS.0000000000005323","url":null,"abstract":"<p><strong>Study design: </strong>Longitudinal, nationwide register study.</p><p><strong>Objective: </strong>To identify independent predictors of clinical outcomes at 12 months for patients undergoing primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease (DCSD).</p><p><strong>Summary of background data: </strong>ACDF is an established surgical treatment for DCSD. Identifying factors that predict successful surgical outcomes can improve patient selection and inform decision-making.</p><p><strong>Methods: </strong>This study utilized data from the Finnish National Spine Register (FinSpine), covering all Finnish centers that perform ACDF surgery. Patients undergoing primary ACDF surgery for DCSD between June 2016 and February 2024 without prior cervical spine surgery were included (n=5517). Patients were grouped based on the patient symptom status (\"improved\" vs. \"indifferent or worse\") at 12 months postsurgery. Predictive factors were identified using classification tree analysis followed by binary logistic regression.</p><p><strong>Results: </strong>At 12 months, 76.8% (n=1799) of patients reported symptom improvement, while 23.2% (n=542) reported that symptoms were indifferent or worse. Loss to follow-up for the outcome variable was 57.6% at 12 months. The following factors were associated with better outcomes: shorter preoperative pain duration (≤1 yr, OR=1.95, P <0.001), lower preoperative Neck Disability Index (NDI) scores (≤42, OR=1.37, P =0.012), and nonsmoking (OR=1.37, P =0.030). The initial diagnosis also influenced outcomes: patients treated for herniated disks and nerve root stenosis were more likely to report improvement compared to those with central canal stenosis or myelopathy ( P <0.001). Gender, age, BMI, working status, regular use of pain medication, perioperative complications, muscle weakness, levels fused, and use of plate versus stand-alone cage were not independently predictive of outcomes.</p><p><strong>Conclusions: </strong>Shorter preoperative pain duration, lower NDI scores, and nonsmoking status were significant predictors of good outcomes at 12 months after ACDF surgery for DCSD. These findings can help to guide preoperative patient counseling and enhance evidence-based decision-making for treating DCSD.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"664-671"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568132","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":"A Cadaveric Comparison of Discectomy Performance During Transforaminal Lumbar Interbody Fusion Approach Using an Endoscopic Technique Versus a Minimally Invasive Tubular Approach.","authors":"Venakat Boddapati, Frank Yuk, Sohrab Virk","doi":"10.1097/BRS.0000000000005122","DOIUrl":"10.1097/BRS.0000000000005122","url":null,"abstract":"<p><strong>Study design: </strong>Cadaveric study.</p><p><strong>Objective: </strong>Compare discectomy performance between transforaminal lumbar interbody fusion (TLIF) done via an endoscopic versus a tubular technique.</p><p><strong>Summary of background data: </strong>Performance of an adequate discectomy is essential to lumbar fusion when performing a TLIF. Previous cadaveric studies comparing open and minimally invasive techniques have reported 36.6% to 80% discectomy. There is controversy whether an endoscopic TLIF (E-TLIF) can allow for an adequate discectomy.</p><p><strong>Materials/methods: </strong>An E-TLIF was performed on 14 discs (T12-L5) and a minimally invasive tubular TLIF (T-TLIF) was performed on 15 discs (T12-L4, L5-S1). Fellowship trained surgeons performed the TLIFs. Each disc was transected after discectomy, and a digital image was analyzed using an imaging processing software to determine the percent of discectomy. Each quadrant of the discectomy was compared. Quadrant one was defined as the left posterior-ipsilateral quadrant of the disc, with each quadrant numbered 2 to 4 clockwise around the disc. The time to perform the discectomy was compared. Pedicle screws were placed contralaterally to the TLIF, and the change in interpedicular distance was compared between techniques after expandable cage implantation as a marker for indirect decompression. A Student's t -test was used to determine statistical significance.</p><p><strong>Results: </strong>There was no difference in discectomy performance between techniques (48.86%±6.98% T-TLIF vs . 50.26%±7.38% E-TLIF, P =0.61). There was no statistical difference between T-TLIF versus E-TLIF at quadrants 1, 3, and 4. There was a difference in discectomy performance at quadrant 2 (39.02%±10.18% T-TLIF vs . 50.13%±14.00% E-TLIF, P =0.02). There was no statistical difference between interpedicular distance created (2.20±1.97 mm T-TLIF vs . 1.36±1.82 mm E-TLIF, P =0.24). E-TLIF took less time than MIS-TLIF (20.00±7.12 min vs. 15.22 min±4.42 min, P =0.048).</p><p><strong>Conclusions: </strong>Our cadaveric study demonstrates that an adequately performed E-TLIF discectomy may be comparable to a T-TLIF discectomy. Further research is required to maximize the efficiency and instrumentation of this technique.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"713-719"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988944","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":"Performance of Artificial Intelligence in Diagnosing Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis.","authors":"Xuanzhe Yang, Yuming Zhang, Yi Li, Zixiang Wu","doi":"10.1097/BRS.0000000000005174","DOIUrl":"10.1097/BRS.0000000000005174","url":null,"abstract":"<p><strong>Study design: </strong>The present study followed the reporting guidelines for systematic reviews and meta-analyses.</p><p><strong>Objective: </strong>We conducted this study to review the diagnostic value of artificial intelligence (AI) for various types of lumbar spinal stenosis (LSS) and the level of stenosis, offering evidence-based support for the development of smart diagnostic tools.</p><p><strong>Background: </strong>AI is currently being utilized for image processing in clinical practice. Some studies have explored AI techniques for identifying the severity of LSS in recent years. Nevertheless, there remains a shortage of structured data proving its effectiveness.</p><p><strong>Materials and methods: </strong>Four databases (PubMed, Cochrane, Embase, and Web of Science) were searched until March 2024, including original studies that utilized deep learning (DL) and machine learning (ML) models to diagnose LSS. The risk of bias of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies is a quality evaluation tool for diagnostic research (diagnostic tests). Computed Tomography. PROSPERO is an international database of prospectively registered systematic reviews. Summary Receiver Operating Characteristic. Magnetic Resonance. Central canal stenosis. three-dimensional magnetic resonance myelography. The accuracy in the validation set was extracted for a meta-analysis. The meta-analysis was completed in R4.4.0.</p><p><strong>Results: </strong>A total of 48 articles were included, with an overall accuracy of 0.885 (95% CI: 0.860-0907) for dichotomous tasks. Among them, the accuracy was 0.892 (95% CI: 0.867-0915) for DL and 0.833 (95% CI: 0.760-0895) for ML. The overall accuracy for LSS was 0.895 (95% CI: 0.858-0927), with an accuracy of 0.912 (95% CI: 0.873-0.944) for DL and 0.843 (95% CI: 0.766-0.907) for ML. The overall accuracy for central canal stenosis was 0.875 (95% CI: 0.821-0920), with an accuracy of 0.881 (95% CI: 0.829-0.925) for DL and 0.733 (95% CI: 0.541-0.877) for ML. The overall accuracy for neural foramen stenosis was 0.893 (95% CI: 0.851-0.928). In polytomous tasks, the accuracy was 0.936 (95% CI: 0.895-0.967) for no LSS, 0.503 (95% CI: 0.391-0.614) for mild LSS, 0.512 (95% CI: 0.336-0.688) for moderate LSS, and 0.860 for severe LSS (95% CI: 0.733-0.954).</p><p><strong>Conclusions: </strong>AI is highly valuable for diagnosing LSS. However, further external validation is necessary to enhance the analysis of different stenosis categories and improve the diagnostic accuracy for mild to moderate stenosis levels.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E179-E196"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508390","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":"Adjunctive Use of Gabapentinoids Increases Opioid Consumption Following One-Level to Three-Level Anterior Lumbar Interbody Fusion With Posterior Fixation: A Propensity Score-Matched Analysis.","authors":"Xu Tao, Aydin Kaghazchi, Geet Shukla, Janesh Karnati, Andrew Wu, Sachin Shankar, Ahmed Ashraf, Sruthi Ranganathan, Julia Garcia-Vargas, Parikshit Barve, Kelly Childress, Owoicho Adogwa","doi":"10.1097/BRS.0000000000005225","DOIUrl":"10.1097/BRS.0000000000005225","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort.</p><p><strong>Objective: </strong>To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following one to three levels anterior lumbar interbody fusion (ALIF) with posterior fixation.</p><p><strong>Summary of background data: </strong>Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and are frequently used as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated.</p><p><strong>Materials and methods: </strong>The PearlDiver database was queried from 2010 to 2021 for patients who underwent primary one to three levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within six months before index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score matched to patients with opioid-only treatment.</p><p><strong>Results: </strong>The propensity score-matching resulted in two equal groups of 2617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average morphine milligram equivalent (MME) per day [standardized mean difference (SMD): -1.33, 95% CI: -2.657 to -0.002, P =0.050]. However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD: 94.97, 95% CI: 56.976-132.967, P <0.001) and a 41.7% increase in total MME consumption per patient (SMD: 4817.23, 95% CI: 1864.410-7770.044, P =0.001). In addition, gabapentinoid use was associated with an increased risk of readmission due to pain [relative risk (RR): 1.10, 95% CI: 1.002-1.212, P =0.050] and the development of drug abuse (RR: 1.37, 95% CI: 1.016-1.833, P =0.046).</p><p><strong>Conclusion: </strong>Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"679-685"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717149","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":"Chronic Gabapentinoid Use and Lumbar Fusion Outcomes: A Comparative Analysis of Gabapentinoids Alone and in Combination With Opioids.","authors":"Riza M Cetik, Steven D Glassman, Colleen Mahoney, Jeffrey L Gum, Charles H Crawford, Roger K Owens, John R Dimar, Benjamin Kostic, Leah Y Carreon","doi":"10.1097/BRS.0000000000005221","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005221","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative cohort study.</p><p><strong>Objectives: </strong>To examine the effects of chronic use of gabapentinoids (GPs) (alone or with opioids) on the outcomes of lumbar fusions.</p><p><strong>Summary of background data: </strong>Opioids have historically been the mainstay medications for pain management, but the ongoing opioid epidemic led physicians to look for alternatives. GPs are used for various indications, and chronic use for any indication may lead to a higher risk of adverse events, especially when combined with opioids.</p><p><strong>Materials and methods: </strong>Patients aged 18 years and older who underwent posterior fusion of the lumbosacral spine and ≥1-year follow-up were included. Patients were grouped according to their preoperative chronic GP and opioid usage as GP and opioid nonuser (-/-), GP user opioid nonuser (+/-), GP nonuser and opioid user (-/+), and GP and opioid user (+/+).</p><p><strong>Results: </strong>A total of 563 patients (M/F%=41/59, mean age 61.1 y) were included. Two hundred eighty (49%) patients were in the group -/-, while 110 (19%) were in +/-, 78 (15%) were in -/+, and 95 (17%) were in +/+. For ODI, back pain and leg pain, +/+ had the worst outcomes at all time points, while -/- had the best. Chronic GP users (+/-) showed back pain improvement similar to the -/- group; however, the improvements in leg pain and ODI were considerably less. GP use resulted in increased postoperative opioid requirements, although not as much as chronic opioid use. Complication rates were similar.</p><p><strong>Conclusions: </strong>Chronic preoperative use of GPs may lead to inferior outcomes when compared with GP-naive patients, and this is significantly accentuated when taken concurrently with opioids. Patients who are using both GPs and opioids had the worst results for almost every outcome measure. Given the significantly worse surgical outcomes documented in this study, concurrent use with opioids should be avoided.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 10","pages":"672-678"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033182","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":"Comparisons of Interapical Distance and Coronal Balance Measurements Among Standing Positions in Participants With and Without Adolescent Idiopathic Scoliosis Using 3D Ultrasound Imaging.","authors":"Janie Pollard, Brianna Fehr, Aislinn Ganci, Eric C Parent, Edmond Lou","doi":"10.1097/BRS.0000000000005284","DOIUrl":"10.1097/BRS.0000000000005284","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Objective: </strong>The objective of this study was to quantify whether interapical distance and coronal balance measured on 3D ultrasound (3DUS) images differed among 10 standing positions of participants with and without adolescent idiopathic scoliosis (AIS).</p><p><strong>Summary of background data: </strong>Apical vertebral translation (AVT) is an indicator of clinical symptoms and treatment outcomes in AIS. Stereoradiography simultaneously captures a frontal and lateral image, yet patients are required to elevate their arms during the examination and varied positioning may impact coronal plane measurements. Ultrasound can assess these measurements without exposing participants to radiation.</p><p><strong>Materials and methods: </strong>Females with and without AIS were recruited from a scoliosis clinic, and e-mail advertisements, respectively. Participants underwent 3DUS scans in 10 positions: standing; arms anteriorly supported in 60° of shoulder flexion; fingers to clavicles, chin, zygomatic processes, and eyebrows; shoulders abducted at 90° with hands open and thumbs on shoulders; hands on anterior wall with and without blocks; and hands unsupported. AVT and coronal balance measurements were obtained using custom software. Positions and groups were compared using repeated measures ANOVAs with Sidak pairwise comparisons.</p><p><strong>Results: </strong>Fifty-nine females had a mean age, height, and weight of 17.5±4.9 years, 162.8±5.8 cm, and 56.2±10.6 kg, respectively. Seventeen single and 14 double curve participants were included with mean maximum curve angles of 26.4°±3.6° and 25.2°±3.1°, respectively. Overall, there were no statistically significant differences in interapical distance or coronal balance among the 10 positions, as well as in coronal balance between the groups ( P >0.05). The interapical distance of participants without AIS significantly differed from those with single curves in eight positions and from those with double curves in all 10 positions.</p><p><strong>Conclusions: </strong>The positions evaluated may be interchangeable for coronal plane lateral deviation measurements of females with AIS.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"652-663"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256466","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":"Modic Change Edema in Chronic Low Back Pain Treated with Infliximab or Placebo: The BackToBasic Trial.","authors":"Magnhild Hammersland Dagestad, Nils Vetti, Lars Christian Haugli Bråten, Elisabeth Gjefsen, Lars Grøvle, Kristina Gervin, Anne Julsrud Haugen, Gunnstein Bakland, Gunn Hege Marchand, Thomas Kadar, Kjersti Storheim, John-Anker Zwart, Jörg Assmus, Ansgar Espeland","doi":"10.1097/BRS.0000000000005391","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005391","url":null,"abstract":"<p><strong>Study design: </strong>Randomized trial.</p><p><strong>Objective: </strong>To assess whether infliximab is superior to placebo in reducing Modic change (MC) edema, and whether MC edema or apparent diffusion coefficient (ADC) values of MCs modify the effect of infliximab on disability or low back pain (LBP).</p><p><strong>Summary of background data: </strong>In the present BackToBasic trial, infliximab did not reduce disability or LBP at 5-months follow-up in patients with chronic LBP and MC type 1. The effect on MC edema and in edema-defined subgroups is unknown.</p><p><strong>Methods: </strong>Patients with chronic LBP and type 1 MCs were randomized to receive four infliximab infusions or placebo over 98 days. MC edema was assessed using short tau inversion recovery imaging. Primary edema variables were maximum baseline edema volume (Volmax) ≥25% of vertebral body marrow (yes/no) and reduced edema at 6 months (yes/no). Maximum MC-related ADC value (0-100%) was measured at baseline. Outcomes at 5 months were the Oswestry Disability Index (ODI, 0-100, primary outcome) and LBP intensity (0-10). The analyses included logistic regression and linear mixed-effects models.</p><p><strong>Results: </strong>128 patients (mean age 43 years, 84 women) were included, of which78 were treated per protocol (PP). The odds ratio for reduced MC edema at 6 months in the infliximab vs placebo group was 2.2 (95% confidence interval [CI] 0.8, 5.8; P=0.12) in the primary PP analysis and 2.1 (95% CI 1.02, 4.5; P=0.04) in the total sample. Neither MC edema nor ADC values modified the effect of infliximab on ODI or LBP intensity. At 5 months, the effect in the Volmax ≥25% group was -4.2 ODI points (95% CI -11.4, 3.1; primary PP analysis).</p><p><strong>Conclusion: </strong>Infliximab had no clinically relevant edema reducing effect. MC edema did not modify the effect of infliximab on disability or LBP, nor did the MC-related ADC value.</p><p><strong>Level of evidence: </strong>Level 2.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018839","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":"Introducing the Paraspinal Muscle Quality (PMQ) Score: A Novel T2 MRI-Based Intensity Parameter for Lean Muscle Assessment in Spine Patients.","authors":"Ali E Guven, Kyle Finos, Isaac Nathoo, Paul Köhli, Marco D Burkhard, Erika Chiapparelli, Artine Arzani, Jan Hambrecht, Gisberto Evangelisti, Koki Tsuchiya, Bruno Verna, Jennifer Shue, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BRS.0000000000005385","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005385","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cross-sectional study.</p><p><strong>Objective: </strong>To analyze the relationship between the novel paraspinal muscle quality (PMQ) score and muscle atrophy parameters, patient demographics, comorbidities, and functional disability.</p><p><strong>Background: </strong>Paraspinal muscle atrophy is linked to degenerative spine conditions, chronic back pain, and poor postoperative outcomes. Conventional parameters like fatty infiltration (FI) and functional cross-sectional area (fCSA) fail to account for lean muscle quality. Increased T2 MRI intensity reflects muscle aging and reduced function. The PMQ score, normalizing T2 intensity of lean muscle to cerebrospinal fluid (CSF), is introduced as a novel metric.</p><p><strong>Methods: </strong>Patients undergoing primary posterior lumbar surgery for degenerative disease (Dec 2014-July 2023) were analyzed. Demographics, comorbidities, and preoperative Oswestry Disability Index (ODI) were collected. FI and fCSA of erector spinae, and multifidus were quantified at the L4 upper endplate on T2-weighted MRIs. The PMQ score was defined as lean muscle-to-CSF intensity ratio. Interrater reliability for the PMQ score was assessed (n=46) using intraclass correlation coefficients (ICC). Spearman's correlation and proportional odds models adjusted for age, sex, BMI, and FI evaluated associations with the ODI subsection, back pain intensity.</p><p><strong>Results: </strong>Among 463 patients (53.7% female; median age 66 years; BMI 28.7 kg/m²), PMQ score correlated positively with age, female sex, BMI, ASA score, hypertension, and FI but negatively with vertebral bone mineral density and fCSA. Pain intensity was predicted by the erector spinae (OR: 6.07, 95% CI: 1.16 - 31.74, P=0.033) and multifidus PMQ scores (OR: 4.88, 95% CI: 1.31 - 18.20, P=0.019). Interrater reliability was high (ICC: 0.867 [95% CI: 0.720 to 0.932] for erector spinae, 0.874 [95% CI: 0.767 to 0.931] for multifidus).</p><p><strong>Conclusion: </strong>The PMQ score correlates with patient demographics, comorbidities, muscle atrophy, and back pain. While serving as a muscle aging parameter, it may also enhance clinical assessment by detecting early changes, such as edema and denervation, that are not initially identifiable with FI and fCSA, warranting further study.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040310","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":"Physical and Virtual Simulation in Spine Surgery Training.","authors":"Kalin J Fisher, Alexander M Satin, Donna D Ohnmeiss, Richard D Guyer","doi":"10.1097/BRS.0000000000005386","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005386","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review of the literature related to physical and virtual simulation in spine surgery training.</p><p><strong>Objective: </strong>The purpose of this narrative review was to provide an overview of the development of simulated spine surgery, its current role, and future potential use in the training of surgical skills.</p><p><strong>Summary of background data: </strong>Residents and fellows are expected to become proficient in an ever-increasing number of spine surgery techniques. While the standard training for surgery has traditionally involved the use of cadaveric specimens, there are inherent challenges with the specimens including cost, storage, shipping, and anatomical abnormalities or inconsistent quality. Various synthetic and virtual spine models have been produced upon which surgical skills can be practiced.</p><p><strong>Methods: </strong>For this narrative review, a comprehensive literature search was performed to identify relevant articles reporting on the use of physical and/or virtual surgery simulators in the training of spine surgeons.</p><p><strong>Results: </strong>To date, a variety of study formats and simulated models have been described. Study participants most commonly include neurosurgical and/or orthopaedic surgery residents. Despite the heterogeneity of the studies, almost all have found benefit from the simulated training on a range of variables including pedicle screw placement, procedure time, and trainee confidence.</p><p><strong>Conclusion: </strong>Modern advancements in material engineering and computer science have led to high-fidelity virtual and physical spine surgery simulation models. These models provide a safe environment for practice while addressing some of the limitations inherent to the modern surgical training model. While the literature consistently demonstrates a benefit of simulation compared to traditional teaching, more information is needed to determine if simulation training translates to improved real-world surgical outcomes. Future work should focus on establishing objective benchmarks for competency and expert status.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015878","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":"Three-level Anterior Cervical Discectomy and Fusion with or without an Investigational Posterior Stabilization System Assessed through 24 Months: A Multi-Center Randomized Controlled Trial.","authors":"K Brandon Strenge, Joshua E Heller, Daniel M Williams, Alexander C Lemons, Rahul V Shah, Pierce D Nunley, Gabriel C Tender, Marcus B Stone, Bruce M McCormack, Jon E Block, Matthew B Jenkins, April E Slee, Erik M Summerside","doi":"10.1097/BRS.0000000000005387","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005387","url":null,"abstract":"<p><strong>Study design: </strong>Prospective Randomized Controlled Trial.</p><p><strong>Objective: </strong>This trial was designed to understand safety and effectiveness outcomes in subjects with three-level cervical degenerative disc disease treated with anterior cervical discectomy and fusion (ACDF) alone or supplemented with a posterior cervical fusion (PCF) performed using an investigational posterior cervical stabilization system (PCSS).</p><p><strong>Background: </strong>ACDF remains the most common surgical treatment for cervical disc disease. Long-segment (3+ disc levels) procedures are associated with increased risk of complications including symptomatic non-union. Supplementing ACDF with PCF to form a circumferential cervical fusion (CCF) improves biomechanical stability but increases the surgical burden for the patient.</p><p><strong>Methods: </strong>This multi-center study compared outcomes in participants with 3-level symptomatic cervical disc degeneration treated with either ACDF or CCF. The CCF procedure incorporated PCF with PCSS. The primary endpoint was 12-month fusion success, defined by bridging bone across the interbody and range of motion <2° across all treated disc levels. The 24-month secondary endpoint was a composite of fusion success, neck disability index (NDI) improvement, neurological status success, and freedom from surgical revision.</p><p><strong>Results: </strong>This protocol-defined interim analysis included 202 participants with 12-month outcomes and 116 participants with 24-month outcomes. Twelve-month fusion success was higher for CCF (61/100, 61%) compared to ACDF (17/102, 17%) (P<0.001). The 24-month secondary endpoint was also improved with CCF compared to ACDF (51% [30/59] vs 23% [13/57]; P=0.002). Revision rates were lower for CCF (1/59, 2%) compared to ACDF (13/57, 23%) (P<0.001), with 11 of 13 ACDF revisions addressing symptomatic non-union. Adding supplemental PCF with PCSS did not increase the rates of adverse events (ACDF=65%, CCF=46%, P=0.005).</p><p><strong>Conclusions: </strong>This study represents the first randomized controlled trial assessing treatment of 3-level cervical disc disease. Long-segment ACDF demonstrated low fusion rates and high rates of revision. Adding supplemental PCF with PCSS improved fusion without increasing the risk of surgical complications.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049251","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}