Spine最新文献

{"title":"Enhanced Recovery Pathway Mitigates the Impact of Nonmodifiable Factors for Discharge Delay in Thoracolumbar Spine Surgery.","authors":"Hsin-Yi Wang, Yu-Cheng Yao, Po-Hsin Chou, Hsin-Yi Huang, Chien-Kun Ting, Jing-Yang Liou","doi":"10.1097/BRS.0000000000005562","DOIUrl":"10.1097/BRS.0000000000005562","url":null,"abstract":"<p><strong>Study design/setting: </strong>Retrospective observational study using a prospectively collected database from a single tertiary center.</p><p><strong>Objective: </strong>To identify perioperative predictors of discharge time in thoracolumbar spine surgery within a standardized ERP and assess whether ERP mitigates traditionally nonmodifiable risks.</p><p><strong>Summary of background data: </strong>Discharge time is a key outcome in enhanced recovery protocols (ERPs), yet spine surgery-specific risk factors could differ from non-ERP and remain poorly defined. We obtained 465 consecutive patients undergoing thoracolumbar spine surgery under ERP for analysis.</p><p><strong>Methods: </strong>Primary outcome was discharge time. Secondary outcome was correlation between frailty (FRAIL scale) and discharge time. Univariate and multivariate linear regression analyses were performed on perioperative variables. Frailty was evaluated separately due to >10% missing data. Statistical significance was set at P <0.05 for univariate, and P <0.01 for multivariate analysis.</p><p><strong>Results: </strong>Multivariate analysis identified five independent predictors of longer discharge time: ES distance (erector spinae plane block to mid-surgical level), prolonged anesthesia duration, delayed ambulation (POD to walk), chronic kidney disease, and complicated surgery (infection or metastasis). The model had strong performance (adjusted R²=0.82). While the total FRAIL score and its components were statistically associated with discharge time, the correlations were weak (Spearman's ρ<0.2), suggesting limited clinical relevance in the ERP setting.</p><p><strong>Conclusions: </strong>ERP attenuates the impact of traditional nonmodifiable factors, including frailty, on discharge timing after thoracolumbar spine surgery. These findings support broader ERP application and suggest that stringent patient selection may be unnecessary for achieving favorable recovery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1544-1551"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445915","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":"Patient Financial Burden in Surgical Treatment of Adolescent and Adult Spinal Deformity in the United States.","authors":"Wesley M Durand, Alekos A Theologis, Gabriel I Nazario-Ferrer, Elyette Lugo, Miguel A Cartagena-Reyes, Richard L Skolasky, Hamid Hassanzadeh, Khaled Kebaish, Paul D Sponseller, Amit Jain","doi":"10.1097/BRS.0000000000005544","DOIUrl":"10.1097/BRS.0000000000005544","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To quantify out-of-pocket costs (OOPC) for surgical treatment of adolescent idiopathic scoliosis (AIS) and adult spinal deformity (ASD) in commercially insured patients between 2015 and 2020.</p><p><strong>Summary of background data: </strong>OOPC related to spinal deformity surgery can present a significant financial burden on patients. Previous studies have explored surgical costs, but few have examined OOPC specifically for AIS and ASD in commercially insured populations. This study provides an analysis of OOPC and insurance payments.</p><p><strong>Methods: </strong>We utilized a large commercial insurance claims database to identify patients undergoing surgery for AIS (ages 10-25) and ASD (≥40 yr) from 2015 to 2020. The surgical care episode was defined from 180 days preoperative to 30 days postoperative. OOPC and total net payments from insurance were calculated and adjusted to 2020 dollars.</p><p><strong>Results: </strong>A total of 2869 AIS and 1528 ASD patients were included. Median ages were 15.0±2.5 years (AIS) and 58.0±6.2 years (ASD). The median OOPC for AIS surgery was $3231 (SD 2615), representing 2.6% of total net payments, while ASD surgery had a median OOPC of $2559 (SD 2803), representing 1.8%. HDHP patients faced the highest OOPC. The total net payments from commercial insurance were $119,493 (SD 71,480) for AIS and $140,822 (SD 112,060) for ASD. OOPC and total net payments did not significantly increase from 2015 to 2020 ( P >0.1).</p><p><strong>Conclusion: </strong>OOPC for AIS and ASD surgeries remain substantial, particularly for patients with HDHPs. High OOPC may contribute to delays in care or deferral of surgery. Financial counseling, cost transparency, and policy efforts aimed at mitigating OOP burden are important steps to improve timely access to spine surgery and reduce the risk of financial strain for patients.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1533-1537"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303561","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 Impact of Screw Density on Mechanical Complications in Lumbar Spine Deformity Constructs.","authors":"Jaques L Williams, Mohamed Sarraj, Charles A Mechas, Andrew D Pumford, Zoe Postal, Joshua Tucker, Zach Pennington, Melvin D Helgeson, Paul M Huddleston, Ahmad N Nassr, Brett A Freedman, Benjamin D Elder, Arjun S Sebastian","doi":"10.1097/BRS.0000000000005560","DOIUrl":"10.1097/BRS.0000000000005560","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To determine the impact of screw density on outcomes in adult spinal deformity surgery.</p><p><strong>Summary of background data: </strong>Previous studies have suggested that decreased screw density in long lumbar constructs does not compromise mechanical robustness or increase the risk of complications such as PJK, pseudoarthrosis, or reoperation.</p><p><strong>Methods: </strong>We retrospectively identified adults who underwent spinal fusions with an upper instrumented vertebra (UIV) of L2 or above with a minimum 2-year radiographic follow-up. We collected data on UIV, Hounsfield units based on CT scan, and radiographic parameters. Outcomes of interest included rod fracture, pseudarthrosis, proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and overall reoperation. We performed a multivariate logistic regression on each outcome, inclusive of all variables, and dichotomized patients based on mean screw density into high and low screw density cohorts. Multivariable logistic regressions were performed for each outcome of interest to identify predictors of its occurrence. Patients were dichotomized into those with constructs ending at/above T9 (upper thoracic spine) or at/below T10 (lower thoracic spine) to determine whether the impact of screw density was altered by construct length.</p><p><strong>Results: </strong>We included 170 patients (mean age 66.8 yr; mean screw density 1.83/level; mean radiographic follow-up 4.5 yr). Fifty patients underwent reoperation (29%), with refractory pain (N=19) and symptomatic pseudoarthrosis (N=13) being the most common indications. Higher screw density was associated with lower odds of postoperative mechanical complications and reoperation for patients with lower thoracolumbar spine UIVs but not for those with upper thoracolumbar UIVs.</p><p><strong>Conclusions: </strong>Increased screw density may protect against mechanical complications in patients undergoing thoracolumbar fusion with UIV at or below T10. Lower screw density may be a safe and cost-effective option for constructs terminating in the thoracic spine for adult spinal deformity surgery, though further investigation is warranted.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1538-1543"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445947","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":"Concordance and Variability in Thoracolumbar Injury Classification and Severity Score (TLICS)-guided Treatment Decision-making.","authors":"Arash Emami, Siraj Shaikh, Kevin Rezzadeh, Adam Elkholy, Nikhil Sahai, Ki Hwang, Kumar Sinha","doi":"10.1097/BRS.0000000000005772","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005772","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and pooled analysis.</p><p><strong>Objective: </strong>To evaluate the concordance between Thoracolumbar Injury Classification and Severity Score (TLICS) recommendations and actual treatment decisions in thoracolumbar trauma.</p><p><strong>Summary of background data: </strong>TLICS is widely used to guide management of thoracolumbar fractures, recommending nonoperative treatment for scores ≤3 and operative intervention for scores ≥5. However, treatment variability may occur in cases with indeterminate scores, uncertainty in posterior ligamentous complex (PLC) integrity, or clinical modifiers not fully captured within the scoring framework.</p><p><strong>Methods: </strong>A systematic review of PubMed and Embase databases was performed. Studies reporting TLICS scores and corresponding treatment decisions were included. Pooled proportions were calculated for operative treatment in TLICS ≤3, nonoperative treatment in TLICS ≥5, operative treatment in TLICS =4, and delayed surgery following initial nonoperative management. Heterogeneity was assessed using I² statistic.</p><p><strong>Results: </strong>Fourteen studies encompassing 1,221 patients were included. Among patients with TLICS ≤3, 13.7% (95% CI: 8.7-20.9) underwent operative treatment. In TLICS ≥5 patients, 6.1% (95% CI: 3.2-11.3) were treated nonoperatively. Operative treatment in TLICS=4 occurred in 49.6% (95% CI: 37.6-61.6). Delayed surgery after initial nonoperative management occurred in 7.5% (95% CI: 2.9-18.2). Significant heterogeneity was observed across studies.</p><p><strong>Conclusion: </strong>TLICS-based recommendations were concordant with treatment decisions in most low- and high-score thoracolumbar fractures. Observed treatment variability appeared to arise in predictable settings, including uncertainty in PLC assessment, borderline injury morphology, and patient-specific clinical modifiers. These findings support continued use of TLICS as a decision-support framework integrated with clinical judgment while identifying areas where future refinement of thoracolumbar trauma algorithms may be informed by evolving clinical practice.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"51 21","pages":"E548-E557"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128547","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":"Analysis of Success Versus Poor Realignment in Patients With Cervical Deformity : In-Construct Angles Provide Novel Targets for Correction.","authors":"Themistocles Protopsaltis, Samuel Ezeonu, Fares Ani, Renaud Lafage, Alex Soroceanu, Jeffrey Gum, Munish Gupta, Kojo Hamilton, Justin S Smith, Robert Eastlack, Gregory Mundis, Peter Passias, Han Jo Kim, Richard Hostin, Kal Kebaish, Bassel Diebo, Alan Daniels, Eric Klineberg, Robert Hart, Christopher Shaffrey, Virginie Lafage, Frank Schwab, Shay Bess, Christopher Ames","doi":"10.1097/BRS.0000000000005648","DOIUrl":"10.1097/BRS.0000000000005648","url":null,"abstract":"<p><strong>Study design: </strong>Multicenter prospective study.</p><p><strong>Objective: </strong>The present study investigates in-construct measurements of sagittal angles (SA) within the fusion from C2 to various thoracic vertebrae, which can be used as targets for CD correction.</p><p><strong>Summary of background data: </strong>Correcting cervical deformity (CD) has the potential to significantly improve patient function. However, previously described radiographic parameters cannot be measured intraoperatively.</p><p><strong>Materials and methods: </strong>Patients with CD who had a lower instrumented vertebrae (LIV) at T1 or caudal were included. Patients were categorized into the failed outcome group if they had a cervical sagittal vertical axis (cSVA) of more than 40 mm within three months postoperatively. The in-construct measurements were based on patients' LIV. All patients had a C2-T1 SA. C2-T4 SA were compared between groups with LIV below T4, and C2-T10 SA between groups with LIV below T10. Change in C2-LIV SA described the correction within the fusion for each patient. Linear regression analysis was used to determine the C2-T1, C2-T4, and C2-T10 measures corresponding to a cSVA equaling 40 mm. Health-related quality of life (HRQL) analysis was done in patients with a one-year follow-up.</p><p><strong>Results: </strong>Among 143 patients (mean age 63, 60% female), 51% had radiographic failure. Multivariate regression showed that postoperative C2-T1 SA independently predicted failed alignment (OR: 1.22, 95% CI: 1.10-1.35; P < 0.001). A cSVA of 40 mm correlated with a C2-T1 SA of -9.6° and C2-T10 SA of 14.7° ( r > 0.38, P < 0.05). Change in the distal junctional kypohotic angle (ΔDJKA) was found to be significantly correlated with the C2-T10 SA ( r > 0.57, P = 0.02). Though HRQL outcomes did not differ significantly between groups, greater C2-LIV SA correction was associated with improved neck pain ( r > 0.42, P = 0.036).</p><p><strong>Conclusion: </strong>Failure to restore cSVA and development of DJK was independently associated with undercorrection as evidenced by significantly larger postoperative in-construct angles.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1568-1576"},"PeriodicalIF":3.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150839","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":"Tissue Shift and Acoustic Attenuation: Why Pre-Incision Ultrasound Cannot Safely Replace Deep Fluoroscopic Verification.","authors":"Yang Bai","doi":"10.1097/BRS.0000000000005907","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005907","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246454","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":"Anterior Lumbar Plexus Position on Preoperative Supine MRI Is Associated With Postoperative Motor Deficits After Lateral Lumbar Interbody Fusion at L4-5.","authors":"Julia Wimmer, Tom Folkerts, Bryce Demopoulos, Bruno Verna, Pedro Rocha Torres, Steven M Maurer, Jiaqi Zhu, Jennifer Shue, Matthias Pumberger, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes, Marco D Burkhard","doi":"10.1097/BRS.0000000000005908","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005908","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective propensity score-matched case-control study.</p><p><strong>Objective: </strong>To evaluate whether preoperative MRI-based psoas morphology, lumbar plexus position, iliac crest height, and psoas cross-sectional area (CSA) are associated with postoperative motor deficits (PMDs) following standalone lateral lumbar interbody fusion (SA-LLIF) at L4-L5.</p><p><strong>Summary of background data: </strong>PMDs remain a recognized complication of LLIF. Although anatomical characteristics have been implicated in neurological risk, the clinical value of classifying these features on preoperative MRI remains incompletely understood.</p><p><strong>Methods: </strong>Patients who developed PMDs after L4-L5 SA-LLIF were propensity score matched to patients without PMDs. Preoperative supine MRI was used to assess operative-side psoas morphology (Amaral classification), lumbar plexus position (Moro zones), iliac crest height, and absolute and height-adjusted psoas CSA. Conditional logistic regression analyses, including a multivariable model incorporating both psoas morphology and lumbar plexus position, were performed to evaluate their associations with PMDs.</p><p><strong>Results: </strong>A total of 172 matched patients were included. An anterior lumbar plexus position extending beyond the midpoint of the vertebral body on preoperative supine MRI (Moro Zones 1-2) remained independently associated with PMDs after adjustment for psoas morphology (OR 14.37, 95% CI 1.78-115.95; P=0.012). Although Type III psoas morphology according to the Amaral classification was associated with increased odds of PMDs in univariable analysis (OR 4.77, 95% CI 1.65-13.76; P=0.004), this association was no longer statistically significant after adjustment for lumbar plexus position (OR 2.54, 95% CI 0.90-7.18; P=0.078). Iliac crest height, psoas CSA, and height-adjusted psoas CSA were not associated with PMDs.</p><p><strong>Conclusions: </strong>Psoas morphology and lumbar plexus position on preoperative supine MRI were associated with PMDs following L4-L5 SA-LLIF. An anterior lumbar plexus position remained independently associated with PMDs after adjustment for psoas morphology. These findings support preoperative MRI-based anatomical assessment for neurological risk stratification and patient counseling.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246404","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":"Immortal Time Bias and Molecular Heterogeneity: Reassessing Lung Cancer Spinal Metastases Survival.","authors":"Yang Bai","doi":"10.1097/BRS.0000000000005909","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005909","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246444","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":"Neurologic Recovery After Metastatic Spine Tumor Surgery for Spinal Cord Compression: Can Unsupervised Machine Learning Identify Recovery Patterns?","authors":"Clayton R Baker, Harsh Jain, Nick De Oliveira, Sameer Sundrani, Jeremia Williams, Albert Cordoves, Hani Chanbour, Gabrielle Santangelo, Bayard Wilson, Richard Berkman, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1097/BRS.0000000000005906","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005906","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>To use unsupervised machine learning to identify preoperative phenotypes among patients undergoing surgery for metastatic epidural spinal cord compression (MESCC) and evaluate whether these phenotypes stratify postoperative neurologic recovery.</p><p><strong>Summary of background data: </strong>MESCC frequently presents with neurologic deficits, but recovery after separation surgery is variable. Most prior work has evaluated individual predictors in isolation.</p><p><strong>Methods: </strong>Adults undergoing surgery (2010-21) for MESCC with preoperative motor deficits were included. Latent profile analysis clustered patients on preoperative upper and lower motor scores, deficit duration, and sensory deficits. The primary outcome was postoperative motor improvement, reported as any improvement and the proportion achieving ≥25%, ≥50%, ≥75% and 100% recovery and absolute motor change. Groups were compared with ANOVA and chi-square tests, and with multivariable models adjusted for age, sex, and tumor location.</p><p><strong>Results: </strong>Among 101 patients (mean age: 60.7±10.9 years, 61.4% males), 72 (71.3%) patients had any postoperative improvement. Four clinically relevant phenotypes were identified: - Grade-1: acute, mild deficit without sensory loss, n=36. - Grade-2: acute, mild deficit with sensory loss, n=26. - Grade-3: chronic, mild deficit without sensory loss, n=20. Grade-4: chronic, severe deficit with sensory loss, n=19. Rates of any postoperative improvement were similar between Grades (P=0.479), as was percent of motor recovery (P=0.109). Grades differed in absolute motor change (P=0.028) and rates of patients achieving ≥50% (P=0.004), ≥75% (P=0.014), and 100% (P=0.004) recovery. Rates of ≥75% and 100% recovery were lowest in Grade-3 (30.0%, 30.0%) and Grade-4 (21.1%,5.3%), and Grade-4 independently predicted lower recovery after adjustment. Mortality did not differ between Grades.</p><p><strong>Conclusion: </strong>Unsupervised clustering identified four preoperative phenotypes of MESCC patients that stratified clinically meaningful motor recovery and summarized neurologic presentation. This framework supports tailored, multidisciplinary counseling.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246437","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":"What are the Optimal Age Thresholds for qCT-Based Osteoporosis and Osteopenia Screening in Patients Undergoing Lumbar Fusion Surgery?","authors":"Paul Köhli, Jan Hambrecht, Jiaqi Zhu, Erika Chiapparelli, Lukas Schönnagel, Ali E Guven, Gisberto Evangelisti, Krizia Amoroso, Roland Duculan, Jennifer Shue, Koki Tsuchiya, Marco D Burkhard, Matthias Pumberger, Carol A Mancuso, Andrew A Sama, Federico P Girardi, Frank P Cammisa, Alexander P Hughes","doi":"10.1097/BRS.0000000000005401","DOIUrl":"10.1097/BRS.0000000000005401","url":null,"abstract":"<p><strong>Study design: </strong>Secondary analysis of two prospective single-center studies.</p><p><strong>Objective: </strong>To evaluate the effectiveness of guideline-recommended osteoporosis screening age cutoffs in lumbar fusion surgery (LFS) patients and identify optimized thresholds for osteoporosis and osteopenia detection.</p><p><strong>Background: </strong>Poor bone quality impacts lumbar fusion surgery (LFS) outcomes. Current general population screening guidelines recommend starting at 65 years for women and 70 years for men in the absence of other risk factors. This study evaluates their effectiveness and refines age-based screening strategies for LFS patients.</p><p><strong>Materials and methods: </strong>This post hoc analysis included patients aged 50 years or older from two prospective studies enrolling patients undergoing LFS for degenerative conditions. Patients with unsuitable imaging for quantitative CT (qCT) bone mineral density measurements were excluded. Osteoporosis and osteopenia status were determined by medical history and qCT in all patients. Univariable and multivariable logistic regression and ROC analysis to optimize age cutoffs for BMD screening were performed. The number needed to screen (NNS) for age cutoffs to detect one case was calculated.</p><p><strong>Results: </strong>Among 515 patients (56% female, median age: 66 yr), impaired bone quality was present in 70%. Osteoporosis was found in 34%, with 38% of cases previously undiagnosed. Age was the only significant risk factor for low BMD for both sexes. Guideline age cutoffs yielded a sensitivity of 78% in females (NNS 1.8) and 58% in males (NNS 2.4) for osteoporosis, and 68% (NNS 1.2) and 39% (NNS 1.2), respectively, for impaired bone status. Sensitivity-optimized screening for osteoporosis required lowering the age threshold to 58 for men (NNS 4) and 62 for women (NNS 2). Screening all patients for impaired bone status had an NNS of 1.4.</p><p><strong>Conclusions: </strong>General population age cutoffs inadequately detect osteoporosis in LFS patients. We propose individualized osteoporosis screening with sensitivity-optimized age thresholds and osteopenia screening for higher-risk procedures in patients aged 50 years or older.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1486-1494"},"PeriodicalIF":3.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266037","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}