Spine最新文献

{"title":"Disc Versus Vertebral Body Contribution to Lumbar Lordosis in Asymptomatic Subjects.","authors":"Marc Khalifé, Renaud Lafage, Emmanuelle Ferrero, Jonathan Elysée, Ayman Assi, Olivier Gille, Mikael Finoco, Wafa Skalli, Pierre Guigui, Claudio Vergari, Virginie Lafage","doi":"10.1097/BRS.0000000000005152","DOIUrl":"10.1097/BRS.0000000000005152","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study of a multicentric prospective database.</p><p><strong>Objective: </strong>This study aimed to describe the relative contribution of vertebral bodies versus discs to lumbar lordosis and its variation with age and pelvic incidence.</p><p><strong>Summary of background data: </strong>While studies sought to determine the physiological magnitude and distribution of lumbar lordosis, data regarding its anatomical composition is lacking.</p><p><strong>Methods: </strong>This study included healthy volunteers with full-body stereoradiographs in free-standing position, without lumbosacral transitional vertebra, or age under 18. The following parameters were analyzed: age, sex, pelvic incidence (PI), and lumbar lordosis (LL). Posterior heights and sagittal Cobb angles between the upper and lower endplate for each lumbar disc and each vertebral body were measured from L1 to S1. Ratios of contribution to LL were calculated for each disc and vertebral body. The cohort was divided into four age groups and four PI groups.</p><p><strong>Results: </strong>Six hundred forty-five subjects were included, mean age was 37.6±16.3, 51% of females. There was a significant decrease in total lumbar disc lordosis with age (-48.9±9.7° to -42.9±10.2°), occurring in lower LL. Vertebral bodies were significantly more kyphotic in Seniors than Youngs (-8.9±8.4° vs. -5.0±9.4°, P=0.03 ), driven by a significant increase in kyphosis of L1 and L2 bodies. Vertebral body contribution to LL significantly increased between groups as PI increased, from a median of 8.0% to 20.5% ( P<0.001 ). This decrease in disc contribution in favor of vertebral bodies mainly took place in lower LL.</p><p><strong>Conclusions: </strong>This study highlights the importance of vertebral contribution to lumbar lordosis, ranging from 8% to 21% among PI groups. Lumbar lordosis decreased with aging through decreased disc lordosis in the lower lumbar spine and increased body kyphosis in the upper lumbar spine. These results may help surgeons in the assessment of sagittal alignment and the selection of operative technique to achieve surgical correction.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1074-1080"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133849","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 Implications of Sacralized Transitional Vertebra on Spinal Alignment.","authors":"Marc Khalifé, Claudio Vergari, Renaud Lafage, Jonathan Elysée, Mikael Finoco, Olivier Gille, Ayman Assi, Wafa Skalli, Virginie Lafage, Emmanuelle Ferrero","doi":"10.1097/BRS.0000000000005187","DOIUrl":"10.1097/BRS.0000000000005187","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study of a multicentric prospective database.</p><p><strong>Objective: </strong>This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbosacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement.</p><p><strong>Summary of background data: </strong>There is little data regarding spinopelvic alignment assessment in LSTV patients.</p><p><strong>Methods: </strong>This study included healthy volunteers with full-body stereoradiographs in free-standing position aged over 18. Castellvi grade, pelvic parameters (measured on S1 and L5), L1-S1 lumbar lordosis (LL), and segmental lordosis for each disc and vertebral body, thoracic kyphosis, cervical lordosis, lower limb, and global alignment parameters were assessed. Castellvi I and II were considered as low-grade and Castellvi III and IV as high-grade LSTV. Alignment parameters between no-LSTV, low-grade, and high-grade LSTV were compared. Propensity score matching was used to match PI in No-LSTV and low-grades. Spinopelvic parameters measured on S1 in the no-LSTV group and on L5 in the high-grades were compared.</p><p><strong>Results: </strong>Seven hundred thirteen subjects were included, of whom 23 low-grades and 27 high-grades. The mean pelvic incidence was 51.0±11.0°, and the mean age was 37.5±16.2 years. LL distribution was different between groups, with an apex and inflexion point significantly higher in high grade ( P<0.001 ). Kyphosis in the LSTV segment was compensated for by a steeper increase of LL above L5 in the high-grades. Low-grades and PI-matched no-LSTV presented similar alignment parameters. There were minor differences in parameters measured on S1 in no-LSTV and no L5 in high-grades.</p><p><strong>Conclusions: </strong>Subjects with low-grade LSTV present similar alignment as PI-matched no-LSTV subjects and S1 should be taken as reference to measure spinopelvic parameters. High-grade LSTV subjects have kyphotic L5-S1 segment with more cranial lumbar apex and thoracolumbar inflexion point. In these subjects, spinopelvic parameters should be measured on L5.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1081-1089"},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508394","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":"Minimally Invasive Unilateral Pedicle Combined With Contralateral Translaminar Facet Joint Screw Fixation for Single-Segment Lumbar Degenerative Disease: A 10-Year Follow-Up Study.","authors":"Bochen An, Bowen Ren, Yihao Liu, Qingzu Liu, Chongyang Liu, Zhenchuan Han, Jianhui Wu, Keya Mao, Jianheng Liu","doi":"10.1097/BRS.0000000000005224","DOIUrl":"10.1097/BRS.0000000000005224","url":null,"abstract":"<p><strong>Study design: </strong>This retrospective study compared unilateral pedicle screw combined with contralateral translaminar facet joint screw (UPS+TFS) fixation with bilateral pedicle screw (BPS) fixation in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar degenerative disease.</p><p><strong>Objective: </strong>To assess the long-term clinical efficacy of UPS+TFS fixation and BPS fixation in MIS-TLIF.</p><p><strong>Summary of background data: </strong>Limited research exists on the long-term clinical outcomes of UPS+TFS fixation in MIS-TLIF. This study addresses this gap by comparing UPS+TFS with the more common BPS fixation technique.</p><p><strong>Materials and methods: </strong>A retrospective analysis of 151 patients with single-segment lumbar degenerative disease treated with MIS-TLIF at Chinese PLA General Hospital (March 2011-December 2012) was conducted. Propensity score matching (1:1) resulted in 32 patients per group (UPS+TFS and BPS). Basic demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared between the groups. Lumbar and leg visual analog scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores up to 10 years postoperatively were also compared. The surgical outcomes of both groups were evaluated using the MacNab criteria at the final follow-up.</p><p><strong>Results: </strong>The UPS+TFS group had significantly lower lumbar VAS scores at three months postoperatively ( P <0.05) with less intraoperative blood loss, shorter surgery time, and reduced hospital stay compared with the BPS group ( P <0.05). No significant differences were found in the JOA or ODI scores between the two groups at three months and 1, 3, 5, and 10 years postsurgery ( P >0.05).</p><p><strong>Conclusion: </strong>UPS+TFS and BPS fixation during MIS-TLIF can achieve favorable clinical outcomes with no difference in long-term clinical efficacy. UPS+TFS demonstrates perioperative advantages such as reduced intraoperative blood loss, shorter operation time, reduced postoperative hospital stay, and less iatrogenic injury. Therefore, MIS-TLIF with UPS+TFS fixation is a reliable treatment for single-segment lumbar degenerative disease.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"990-997"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717064","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":"Magnetic Resonance Imaging-Based Vertebral Bone Quality Score as a Comprehensive Indicator to Evaluate the Trend of Bone Turnover Markers.","authors":"Dachuan Li, Xiao Lu, Zhaoyang Gong, Wei Zhu, Guangyu Xu, Jiongdong Wu, Chenpei Xu, Yuxuan Zhang, Shuo Yang, Hongli Wang, Xinlei Xia, Feizhou Lu, Jianyuan Jiang, Chi Sun, Yunzhi Guan, Fei Zou, Xiaosheng Ma","doi":"10.1097/BRS.0000000000005346","DOIUrl":"10.1097/BRS.0000000000005346","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>This study aimed to analyze the correlation between vertebral bone quality (VBQ) scores and bone turnover markers (BTMs) in lumbar spine disorders.</p><p><strong>Background: </strong>VBQ score is increasingly used in the assessment of bone mineral density (BMD), and bone quality profiles are closely related to bone metabolism. However, the level of bone turnover is often overlooked in clinical practice.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed the data from 234 patients who underwent lumbar spine surgery. VBQ scores were evaluated using preoperative lumbar T1-weighted magnetic resonance imaging, with patients classified into high (>3.3), middle (2.7 to 3.3), and low (<2.7) VBQ groups. The data of computed tomography images and dual-energy x-ray absorptiometry were collected to obtain the Hounsfield unit (HU) and T value. Correlation analysis, linear regression, and 1-way ANOVA were used to analyze the relationship between BTMs, including parathyroid hormone (ng/L), 25-hydroxyvitamin D3 (nmol/L), osteocalcin (ng/mL), β-CrossLaps (ng/mL), and procollagen type I N-propeptide (ng/mL) and bone quality. P <0.05 was considered statistically different.</p><p><strong>Results: </strong>Comparative analysis showed BTMs varied markedly across VBQ categories ( P < 0.0001 to P = 0.0158), with osteoblast-related markers [25-hydroxyvitamin D3, OC] decreasing and osteoclast-related markers (β-CrossLaps) increasing with higher VBQ scores. Multivariate analysis confirmed age, sex, BMI, and specific BTMs (except for PINP) as independent predictors of VBQ scores ( P = 0.0075 to 0.0256). VBQ demonstrated superior correlations with BTMs ( r = 0.52 to 0.63) compared with T-scores and HU values, highlighting its enhanced sensitivity to dynamic bone metabolism. Notably, patients with normal BMD/high HU but intermediate VBQ scores showed suppressed osteoblastic activity ( P = 0.0009 to 0.0036), while those with osteopenia-level BMD/HU and elevated VBQ scores exhibited exacerbated bone resorption ( P < 0.001).</p><p><strong>Conclusion: </strong>This is the first study to link VBQ scores with BTMs in lumbar spine patients. Preoperative VBQ assessment through magnetic resonance imaging can initially evaluate bone metabolism without radiation exposure, guiding osteoporosis treatment post-surgery to optimize bone health.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E278-E288"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731674","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 Importance of Redundant Nerve Roots in Patients With Symptomatic Lumbar Spinal Stenosis: A Secondary Analysis of NORDSTEN Spinal Stenosis Trial Data.","authors":"Eric Franssen, Clemens Weber, Tor Åge Myklebust, Ivar Magne Austevoll, Helena Brisby, Christian Hellum, Kjersti Storheim, Jørn Aaen, Hasan Banitalebi, Jens Ivar Brox, Kari Indrekvam, Erland Hermansen","doi":"10.1097/BRS.0000000000005160","DOIUrl":"10.1097/BRS.0000000000005160","url":null,"abstract":"<p><strong>Study design: </strong>Post hoc analysis of data from a randomized clinical trial.</p><p><strong>Objective: </strong>To compare preoperative symptoms of patients with lumbar spinal stenosis with and without redundant nerve roots (RNRs), and to compare the change in clinical outcomes between those two groups 2 years after decompression surgery.</p><p><strong>Background: </strong>RNRs are often seen on magnetic resonance imaging in patients with spinal stenosis. Previous studies have reported that patients with RNR are older and have worse symptoms at baseline. A meta-analysis from 2018 concluded that this radiologic sign could be seen as a negative predictor of outcome. High-quality prospective studies are lacking.</p><p><strong>Patients and methods: </strong>Patient characteristics and reported pain and function scores were compared between lumbar spinal stenosis groups with (RNR+) and without RNR (RNR-) at baseline and after 2 years of follow-up. The primary outcome was the mean change in the Oswestry Disability Score (Oswestry Disability Index). Secondary outcomes included mean change in scores of the Zurich Claudication Questionnaire and the Numerical Rating Scale for leg and back pains.</p><p><strong>Results: </strong>Out of 416 patients included in the present analysis, 163 (39%) had RNR at baseline. Both groups were similar in regard to patient age, smoking habits, Body Mass Index, and duration of symptoms. Both groups also showed similar pain and function scores at baseline. The RNR+ group contained a significantly higher proportion of men, patients with severe stenosis and multiple stenotic levels on magnetic resonance imaging. At a 2-year follow-up, the mean change of the Oswestry Disability Index was -22.1 in the RNR+ group and -17.4 in the RNR- group [mean difference: 4.7 (95% CI: 1.3 to 8.2); P = 0.007]. Statistically significant differences were also found for secondary outcomes Zurich Claudication Questionnaire, and Numerical Rating Scale leg and back pains favoring the RNR+ group.</p><p><strong>Conclusion: </strong>Patients with RNR had similar baseline characteristics and similar symptoms as patients without. RNR before surgery was associated with better clinical improvement 2 years after decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"941-947"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354316","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":"Proximal Junction and Transitional Mechanics and Effect of a Novel Tether Pedicle Screw in Long-Segment Spinal Instrumentation.","authors":"Raphael Gmeiner, Heiko Koller, Sara Lener, Christoph Orban, Anto Abramovic, Marko Konschake, Werner Schmoelz, Claudius Thomé, Sebastian Hartmann","doi":"10.1097/BRS.0000000000005329","DOIUrl":"10.1097/BRS.0000000000005329","url":null,"abstract":"<p><strong>Study design: </strong>A biomechanical study of 10 human thoracolumbar (T7-L2) spine specimens was performed.</p><p><strong>Objective: </strong>To analyze the biomechanical characteristics of a Tether pedicle screw (TPS) in long-segment thoracolumbar instrumentation in terms of proximal junction mechanics and transitional motion patterns.</p><p><strong>Background: </strong>Adult spinal deformity correction carries a high junctional failure risk. A soft-landing construct at a rigid construct cranial end might reduce the proximal junctional kyphosis and proximal junctional failure risks. Therefore, a novel TPS was designed to mitigate the proximal junctional kyphosis/proximal junctional failure risk. The pedicle screw is characterized by a tether between the threaded shaft and the screw head, enabling motion among parts.</p><p><strong>Materials and methods: </strong>For initial flexibility tests, 3 instrumentation patterns were tested. Representing conventional instrumentation, standard thoracolumbar pedicle screw-rod instrumentation at T10 to L2 was used [standard (STD) group]. The TPS was tested at T9 (TPS+1 group), 1 level above the upper instrumented vertebra, and at T9 and T8 (TPS+2 group). Flexibility tests (±5 Nm) in all 3 motion directions were performed and repeated after cyclic loading (250 cycles, 1-10 Nm). Finally, specimens in the STD and TPS groups were subjected to screw pull-out testing at the index level to analyze the TPS stress-shielding effects.</p><p><strong>Results: </strong>The TPS+2 group demonstrated the largest range of motion decrease at T9 to T10 in the flexibility tests, with a smaller effect in the second adjacent segment at T8 to T9. No significant change in range of motion was observed in the uppermost segment (T7-T8) among all instrumentation pattern studies. Pull-out testing revealed greater mean forces at the T10 end-level in the TPS+2 group than in the STD group.</p><p><strong>Conclusion: </strong>The TPS effectively distributed the loads across 3 adjacent levels and softened the load transition compared with the rigid construct. The TPS also showed the potential to stress-shield the upper instrumented vertebra (T10) and reduce the end-level screw loosening risk.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1010-1017"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658633","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":"The Application of 3D-Printed Microporous Laminae in Kyphosis Correction Surgery for Ankylosing Spondylitis: Minimum Two-Year Follow-Up.","authors":"Chao Li, Hong Li, Xiangning Meng, Beiyu Xu, Yao Zhao, Longtao Qi, Chunde Li, Yu Wang","doi":"10.1097/BRS.0000000000005331","DOIUrl":"10.1097/BRS.0000000000005331","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>This study designed an innovative 3D-printed microporous lamina and aimed to evaluate the feasibility and effectiveness of kyphosis correction surgery for patients with ankylosing spondylitis (AS).</p><p><strong>Background: </strong>Spinal osteotomy is a widely employed treatment for severe kyphotic deformities in AS. However, mitigating complications associated with osteotomy remains a significant clinical challenge.</p><p><strong>Materials and methods: </strong>A total of 72 consecutive patients with AS who underwent kyphosis correction surgery were analyzed. Customized 3D-printed microporous laminae were designed based on preoperative imaging and three-dimensional modeling of each patient's spinal anatomy. Patients were divided into 2 groups: group A (25 patients), treated with the 3D-printed microporous lamina technique, and group B (47 patients), treated using the traditional technique. Radiologic assessments included bone fusion rate, global kyphosis, thoracolumbar kyphosis, lumbar lordosis, osteotomy angle, pelvic index, pelvic tilt, sacral slope, and sagittal vertical axis. Clinical outcomes assessed were surgery-related complications, reoperation rates, operative time, estimated blood loss, postoperative hospital stay, and Scoliosis Research Society Outcomes Instrument-22. All patients were followed up for at least 2 years postoperatively.</p><p><strong>Results: </strong>The bone fusion rate in the 3D-printed microporous lamina group was 96%. There were no statistically significant differences between the two groups in terms of surgery-related complications, reoperation rate, estimated blood loss, postoperative stay, global kyphosis, thoracolumbar kyphosis, lumbar lordosis, osteotomy angle, pelvic index, pelvic tilt, sacral slope, sagittal vertical axis, or Scoliosis Research Society Outcomes Instrument-22. Although the mean operative time was longer in group A than in group B, this difference was not statistically significant.</p><p><strong>Conclusion: </strong>The use of 3D-printed microporous laminae in kyphosis correction surgery for AS provides a promising method for achieving high bone fusion rates through effective laminar reconstruction.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"981-989"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630815","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":"Carbon Fiber Versus Titanium Pedicle Screws : A Systematic Review of Radiologic, Biomechanical, and Clinical Features.","authors":"Joshua M Coan, Alireza Gholipour, Abigail Tianai Zhang, Stefano Conti, Daphne Sorrentino, Daniel G Tobert","doi":"10.1097/BRS.0000000000005356","DOIUrl":"10.1097/BRS.0000000000005356","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>This systematic review aims to compare the radiologic, biomechanical, and clinical features of CF versus Ti pedicle screws to clarify their respective advantages and limitations.</p><p><strong>Background: </strong>Pedicle screw fixation is a cornerstone of spinal stabilization and titanium (Ti) implants are regarded as the standard. However, titanium screws are associated with imaging artifacts and dosimetric inaccuracies that complicate postoperative assessment and radiotherapy planning in spine oncology. Recently, carbon fiber (CF) pedicle screws emerged as a promising alternative, offering radiolucency and improved imaging characteristics.</p><p><strong>Methods: </strong>Adhering to PRISMA guidelines, a comprehensive literature search was performed in PubMed, ScienceDirect, Web of Science, and EMBASE in September 2024 using the keywords \"carbon fiber,\" \"titanium,\" \"screw,\" and \"spine.\" Studies that directly compared CF and Ti pedicle screws across various spinal regions were included. Both in vitro and in vivo observational studies were considered. Data extraction focused on study design, methods, outcome measures, and limitations.</p><p><strong>Results: </strong>Ten studies met the inclusion criteria. Biomechanical evaluation demonstrated CF screws offer comparable stability to Ti screws, with no differences in load cycles until failure or maximal axial force. Clinically, both screw types achieved significant improvements in axial pain and neurological function, although CF procedures were associated with increased operative times and blood loss. Radiologically, CF consistently produced fewer artifacts on CT and MRI, facilitating accurate imaging and radiation dose calculations, which are beneficial in oncological contexts.</p><p><strong>Conclusion: </strong>CF pedicle screws represent a viable alternative to Ti implants, providing equivalent biomechanical performance and outcomes while offering superior radiologic clarity and dosimetric precision. These findings support the adoption of CF screws in spinal stabilization-particularly in cases requiring precise imaging and radiotherapy planning. This review provides a foundation to perform prospective comparative research on the technologies.</p><p><strong>Level of evidence: </strong>Level III-systematic review of retrospective studies.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"998-1009"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804049","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":"Validation of Sagittal Age-adjusted Score in Predicting Proximal Junctional Kyphosis/Failure and Clinical Outcomes Following Adult Spinal Deformity Surgery.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Kyunghun Jung, Minwook Kang, Choong-Won Jung, Hyun-Jun Kim, Chong-Suh Lee","doi":"10.1097/BRS.0000000000005144","DOIUrl":"10.1097/BRS.0000000000005144","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objectives: </strong>To validate the sagittal age-adjusted score (SAAS) in predicting proximal junctional kyphosis/failure (PJK/F) and good clinical outcomes following adult spinal deformity (ASD) surgery.</p><p><strong>Summary of background data: </strong>SAAS is a relatively new assessment system that incorporates age-adjusted sagittal parameters of pelvic incidence (PI)-lumbar lordosis (LL), pelvic tilt (PT), and T1 pelvic angle (TPA) to predict the PJK/F. External validation is required to verify its clinical usefulness.</p><p><strong>Materials and methods: </strong>We included patients with ASD undergoing ≥5-level fusion including the sacrum or pelvis. SAAS was calculated based on the scores of the three components: PI-LL, PT, and TPA. PJK/F rates and clinical outcomes were compared among the correction categories (undercorrection, matched correction, and overcorrection) for the SAAS as well as for each of the three components. PJK/F rates were compared according to the correction groups of the sagittal components and total SAAS using the χ 2 test. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive ability of overcorrection to develop PJK/F for the three sagittal parameters and SAAS. PROMs at final follow-up were compared among correction groups using ANOVA with Bonferroni post hoc corrections.</p><p><strong>Results: </strong>A total of 411 patients were included in the study (mean age: 69.3 y, mean body mass index: 25.9 kg/m 2 , total levels fused: 7.7 levels, and follow-up duration: 43.3 mo). Postoperative SAAS categories were as follow: undercorrection (13.4%), matched correction (30.2%), and overcorrection (56.4%). The PJK/F rates were significantly higher in the overcorrection group relative to PI-LL component ( P =0.001) as well as SAAS ( P =0.038) compared with undercorrection or matched correction groups. The clinical outcomes were best in patients who achieved matched correction relative to PI-LL component as well as SAAS compared with the other correction groups. However, the differentiating power of clinical outcomes across the correction categories was greater in the PI-LL component than in the SAAS.</p><p><strong>Conclusion: </strong>This study validated the efficacy of SAAS system to differentiate PJK/F development and good clinical outcomes. However, its differentiating power seems to be largely attributable to the function of the PI-LL component, as the PI-LL correction status better predicted PJK/F risk and clinical outcomes than SAAS.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"948-955"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133867","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":"Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System.","authors":"Rajkishen Narayanan, Jonathan Dalton, Richard Bransford, Marcel R Dvorak, Harvinder Singh Chhabra, Andrei F Joaquim, Mohammad El-Sharkawi, Lorin M Benneker, Klaus Schnake, Cumhur Oner, Charlotte Dandurand, Jose A Canseco, Christopher K Kepler, Alexander R Vaccaro, Gregory D Schroeder","doi":"10.1097/BRS.0000000000005297","DOIUrl":"10.1097/BRS.0000000000005297","url":null,"abstract":"<p><strong>Study design: </strong>Global cross-sectional survey.</p><p><strong>Objective: </strong>To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience.</p><p><strong>Summary of background data: </strong>To create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I-occipital condyle and craniocervical junction; II-C1 ring and C1-2 joint; III-C2 and C2-3 joint), and (subtype: A-isolated bony injury; B-bony/ligamentous injury; C-displaced/translational injury), neurological status [N0-intact; N1-transient deficit; N2-radiculopathy; N3-incomplete spinal cord injury (SCI); N4-complete SCI, and NX-unable to examine], and case-specific modifiers (M1-injuries at risk of nonunion; M2-injuries at risk of instability; M3-patient specific factors; M4-vascular injury).</p><p><strong>Materials and methods: </strong>Totally, 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero-low severity to 100-high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty.</p><p><strong>Results: </strong>One hundred forty-eight responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurological status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS among levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC ( P =0.003), IIB ( P =0.003), and IIIB ( P =0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB ( P =0.002) and IIIB ( P =0.026) as more severe than orthopaedic spine surgeons.</p><p><strong>Conclusions: </strong>The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"956-964"},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441644","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}